Family physician, author, blogger, speaker, physician leader.

Recent Articles

How to Treat Hay Fever / Seasonal Allergies – Your Cheat Sheet

Hay fever or seasonal allergies are a problem for many patients I see. The good news is many of the prescription medications are now over the counter and available to you. This is good news for patients! No longer do you need to worry if you forgot it at home. No more phone calls to the pharmacy or doctor to get a refill. However, what do you do now with all of the choices available to you? Not to worry, here is a suggested plan. As anything else on this blog, this information is meant to be informative and not a substitute for a medical evaluation. Hope you find these suggestions and tips useful. Nasal steroid sprays. The active ingredient, a steroid, can help decrease the inflammatory process causing the allergy response. These nasal sprays are typically well tolerated. Benefit – do not cause sedation. Typically well tolerated. Medication applied […] Read More »

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The Red Flags for Low Back Pain – Can It Find Cancer Cases?

$28 million was awarded to a patient for a late diagnosis of a pelvic tumor, an osteosarcoma. This rare cancer presented as a case of low back pain and sciatica. The patient claimed that if the osteosacroma had been caught earlier that the subsequent surgery would have been avoided. Could doctors have done better in diagnosing more quickly? These cases strike fear into all primary care doctors. Which patient has a sinister pathology when the majority of patients with similar symptoms of back pain are due to benign non-life threatening causes? Is the answer simply ordering more imaging like CT scans and MRIs? Though ordering more tests on more patients would be technically feasible, the truth is that CT scans or MRIs often find abnormalities which are not medically important. Once found, however, these abnormal findings require more work-up.  This can cause unnecessary worry both psychologically and financially for patients. […] Read More »

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February 2015 – Best articles for Physician Leaders

The best thing about Youtube and the internet is one can spend hundreds of hours learning from Malcolm Gladwell and set up a blog with his most interesting talks. I hope to meet Gladwell in person one day! In a talk in Connecticut, Gladwell spoke about how health insurance should be catastrophic care and health insurance should not cover the costs for having a baby (these costs are definable and predictable for 90 percent of deliveries and should be paid for out of pocket like we do other goods and services) but be available for unpredictable outcomes (i.e. emergency c-section, complication). Agree?   Health Care Vaccines and viruses! It’s not about the data! -> Doctors Learn to Talk Vaccines. AND Judgment calls – intuition, hard-work, a little luck, and courage when there the challenge in unprecedented and unknown. You don’t know what you don’t know. Trial by Ebola – How […] Read More »

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Deflategate, Antennagate, Human Nature, and Leadership Lessons

Leadership lessons are often a trial by fire. An unexpected discovery and problem and sometimes even a disaster occurs. Media pounces on the story. Someone caused the problem. How did others not see? Were they complicit? As the story unfolds, theories abound as the cause of the problem is not initially obvious or clear. Many premature conclusions. When there is no reasonable answer offered quickly, particularly in today’s 24/7 news cycle, it is human nature to assume something negative. Someone did something with malicious intent. Someone should have known. The problem should have been anticipated and prevented. The fact that it was not means someone was up to no good, was covering up, or acted deliberately towards this outcome. Even when an alternative explanation grounded in facts or science is offered, will it be enough to dispel this perception? Many of us want to believe that leaders are omniscient even […] Read More »

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Millennial Doctors More Tech-Savvy, But Not Better Doctors. Different Education. Different Challenges.

Are Millennial Doctors well trained for the 21st century? That was the question posed in NPR’s Millennial Doctors May Be More Tech-Savvy, But Is That Better? I believe how Millennials Doctors are educated may make them less adequately prepared than previous generations. This isn’t a reflection of medical education, but of education in general. Do the technological tools available prevent the engagement needed to develop deep learning and expertise of our future doctors? Do residency hour work restrictions prevent this learning as well? Dr. Amy Ho noted that “with modern technology, med school really wasn’t too hard… If you want to do the whole thing by video stream, you can,” she says. “I would wake up at 10 a.m., work out for an hour or so, get some lunch and then video stream for 6 hours and then go to happy hour. It actually was not that bad.” Is learning […] Read More »

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