A Country Doctor Writes:

I was left wondering exactly what was what, not an unusual situation in primary care. Was there cellulitis? Did he have shingles with mild encephalitis? Does he have a disc problem in his neck that might flare up again when he is off the prednisone? And did his blood sugar play any part in his altered mentation? I’ll probably never really know.

I keep coming back to the famous quote by Sir Willam Osler, “Medicine is a science of uncertainty and an art of probability.”
— Read on www.kevinmd.com/blog/2020/09/i-cured-my-patient-but-what-was-his-diagnosis.html

The second book in my A Country Doctor Writes series is now available.

This book is more specifically written for a medical audience than CONDITIONS, which has many general interest essays. IN PRACTICE contains lessons and reflections from colleagues’ and my own practice and also essays about how to be the kind of doctor each patient needs. Several chapters on professional burnout make IN PRACTICE relevant to both seasoned and aspiring medical providers.

Medication errors are serious business. Transitions of Care are dangerous, in large part because of the many pitfalls in medication reconciliation.

One of my clinics is collecting the extra money Medicare offers for having care coordinators track hospital discharges, reaching out to patients to make sure they have what they need, and poring over discharge summaries to reconcile the hospital and the outpatient medication lists. They also keep track of pending test results, all in an effort to make the transition from inpatient to outpatient care safer.

My other clinic doesn’t do this. The medication reconciliation is done by the primary provider-nurse team during the sometimes hectic office visits.

I see too often that a patient admitted through the emergency room has the wrong medication information entered in his admission history and orders. Then the hospitalist changes what was incorrect in the first place and the patient ultimately gets discharged with new orders to double up on something they already took in exactly the new dose, or to continue a medication that they already may have stopped.

The technology to avoid such errors already exists.

In both my EMRs, I can click on a virtual button that lets me see in full detail what medications have been prescribed electronically, as long as we record the patient’s consent to do this. I can then manually import this information into my own EMR’s medication list.

I don’t believe our local hospitals can access this information in the middle of the night from the emergency room. And I can’t access it if there is a delay at the front desk in documenting this and other consents lumped in with it, which all require annual updating.

If we really must tolerate the non-interoperability quagmire of Epic, Cerner and all the small EMR companies, I think in the name of patient safety, we should at least do this:

Make all these for profit companies use one universal medication module that automatically updates through the already existing technology. This would save lives and prevent countless medication errors. It would also save a lot of time, effort and frustration in our already stretched-too-thin primary care clinics.

And let every hospital EMR in on this, too.

Doctor publishes book based on his experiences as health care provider

What began as an online blog has turned into a published book based on a Maine doctor’s experiences in the world of medicine.
— Read on www.wagmtv.com/2020/09/02/doctor-publishes-book-based-on-his-experiences-as-health-care-provider/

My second book in the series based on my blog had a working title of Progress Notes. I pictured the bulk of its chapters/essays would be equal parts my personal and other doctors’ observations, circumstances and reflections. But as I went through my archives, I saw many essays with a magazine article flavor (indeed republished quite widely) that seemed logical to include. They have themes like how to be both a more effective and a more healing doctor and how not to get burned out in your pursuit of that ideal.

I have decided the new title will be A Country Doctor Writes: IN PRACTICE – Starting, Growing and Staying in the Medical Profession. It will be about twenty pages longer than CONDITIONS and priced the same. For that book, too, I will offer bulk purchasing of multiples of 10 paperback books for the typical wholesale price of $10 each.

My hope is that both CONDITIONS and IN PRACTICE will be of interest to students from pre-med through medical school, to residents and also practicing physicians. Most of us, from time to time, end up looking for reading material to help us keep the focus and faith in our chosen professions, where so many distractions now cloud our vision of why we are doing what we set out to do.

Hence, IN PRACTICE… Available on or shortly after Labor Day.