Health Care Through the Back Door: The Dangers of Nurse Visits
By HANS DUVEFELT In some practices, patients with seemingly simple problems are scheduled to be seen by a nurse or medical assistant. Sometimes they can […]
Hans Duvefelt
How to Talk to Clinicians: Forget Workflows, Just Tell Us How Things Work
BY HANS DUVEFELT Workflows are all the rage with EMR people. But doctors, NPs and PAs are smart. Nothing burns us out as fast or […]
The Healing Power of Even Virtual Human Connection
By HANS DUVEFELT Almost two years into this new age of varying degrees of self quarantine, I am registering that my own social interactions through […]
Behind the Mask: A Country Doctor Writes
By HANS DUVEFELT Today I saw a patient I have known for years. He suddenly pulled his mask down and said, “I’d like to know […]
We Use Too Many Medications: Be Very Afraid of Interactions
By HANS DUVEFELT I happened to read about the pharmacodynamics of parenteral versus oral furosemide when I came across a unique interaction between this commonest of diuretics […]
Medicine is a Moving Missile, Aiming for a Dangerous, Elusive Target
By HANS DUVEFELT (Desperate times called for desperate measures.) In the tech world, we have come to expect our devices to become outdated and obsolete […]
We Shouldn’t Tolerate Sloppy Allergy Lists
By HANS DUVEFELT The medication and allergy lists seem like they would be the most important parts of a health record to keep current and […]
American Primary Care is a Big Waste of Time (When…)
By HANS DUVEFELT Before Johannes Gutenberg invented the printing press in 1450, books in Europe were copied by hand, mostly by monks and clergy. Ironically, […]
I Am a Decision Maker, Not a Bookkeeper
By HANS DUVEFELT Perhaps it is because I love doctoring so much that I find some of the tools and tasks of my trade so […]
A Man With Sudden Onset of Gastroparesis
By HANS DUVEFELT Leo Dufour is not a diabetic. He is in his mid 50s, a light smoker with hypertension and a known hiatal hernia. […]
Anxiety, Worry or Fear? Disappointment, Grief or Depression?
By HANS DUVEFELT Especially in these strange and uncertain times, many people feel uneasy. Some of them come to us with concerns over their state […]
Burnout? Not Even Close!
By HANS DUVEFELT I am a 68 year old family physician in rural Maine. This morning I read yet another article about physician burnout, this […]
Health Insurance is a Stumbling Block in Many Patients’ Thinking
By HANS DUVEFELT I have a patient with no health insurance but a brand new Mercedes. He says he can’t afford health insurance. He cringes […]
EHRs Are Workarounds, Rerouting the Way Physicians Work
By HANS DUVEFELT IT GUY: Hey, Doc, don’t make up workarounds, use the EHR the way it was designed. DOCTOR: Listen, your whole EHR is […]
“This Doesn’t Usually Hurt that Much”: Patients With Fibromyalgia Spectrum Disorder
By HANS DUVEFELT Specialists in orthopedics and general surgery often want us, the primary care doctors, to manage postoperative pain. I don’t like that. First, […]
The Call to Be a Primary Care Doctor
By HANS DUVEFELT I suspect the notion of calling in narrower specialties is quite different from mine. Surgeons operate, neurologists treat diseases of the nervous […]
The Call to Be a Primary Care Doctor
By HANS DUVEFELT I suspect the notion of calling in narrower specialties is quite different from mine. Surgeons operate, neurologists treat diseases of the nervous […]
Can the Practice of Primary Care Medicine ever be Practical Again?
By HANS DUVEFELT When I first lost power and then saw my generator fail during a storm last winter, two other failures struck. As I […]
The Art and Soul of Medicine Exist in the Ordinary
By HANS DUVEFELT The Art of Medicine is Doing the Ordinary Well Primary care doctors don’t usually operate any sophisticated medical instruments or perform any […]
The Science of Clinical Intuition
By HANS DUVEFELT In 2002, Dr. Trisha Greenhalgh published a piece in the British Journal of General Practice titled Intuition and Evidence – Uneasy Bedfellows? In it […]
Why I Seldom Recommend Vitamins or Supplements
By HANS DUVEFELT People here in northern Maine, as in my native Sweden, don’t get a whole lot of natural sunlight a good part of […]
Did Covid and Telemedicine Finally Make the Physical Exam Obsolete?
By HANS DUVEFELT Left to my own devices, I would be selective about when and how much of a physical exam I do: either not […]
The Art of Medicine is Not an Algorithm
By HANS DUVEFELT The Art of Medicine is such a common phrase because, for many centuries, medicine has not been a cookie cutter activity. It […]
Voicemail, Repeat Requests and Multitasking: Inefficiencies in Today’s Healthcare
By HANS DUVEFELT My nurse regularly gets at least 50 voicemails every day, many saying “please call me back”. I have one patient who frequently […]
What Does Your Patient Need to Hear You Say Right Now?
By HANS DUVEFELT Today a patient told me a cancer doctor had told her husband that he only had a year to live. She was […]
“Tell Me More”
By HANS DUVEFELT Words can be misleading. Medical terms work really well when shared between clinicians. But we can’t assume our patients speak the same […]
Five Weight Loss Myths I am Constantly Fighting
By HANS DUVEFELT 1) EXERCISE MORE I talk to people almost every day who think they can lose weight by exercising. I tell them that […]
Screening for Depression: Then What?
By HANS DUVEFELT Primary Care is now mandated to screen for depression, among a growing host of other conditions. That makes intuitive sense to a […]
Some People Don’t Think Like Doctors (!)
By HANS DUVEFELT This may come as a surprise for people with business degrees: Doctors don’t really care when a test was ordered. We care […]
Please Sign Below: Fraudsters Phishing for Physician Signatures
By HANS DUVEFELT Almost every day I catch a suspicious fax needing my signature. Often it is an out of state vendor who wants my […]
The Parallel Realities of Health Care: Ratio and Intellectus
By HANS DUVEFELT Every patient is unique, with some common basic and measurable features and parameters. For a couple of decades now, healthcare has professed […]
The Pain Is In Your Brain: Your Knees Know Next to Nothing
By HANS DUVEFELT A “frozen shoulder” can be manipulated to move freely again under general anesthesia. The medications we use to put patients to sleep […]
Doxepin, a Little Known Super Drug in My Personal Black Bag of Tricks
By HANS DUVEFELT A while back I was able to completely stop my mastocytosis patient’s chronic hives, which the allergist had been unable to control. I […]
The Art of the Chart: Documenting the Timeline
By HANS DUVEFELT The timeline of a patient’s symptoms is often crucial in making a correct diagnosis. Similarly, the timeline of our own clinical decisions […]
Playing Poker With the Devil: “Prior Authorizations” are Paralyzing Patients and Burning out Providers
By HANS DUVEFELT The faxes keep coming in, sometimes several at a time. “Your (Medicare) patient has received a temporary supply, but the drug you prescribed […]
“I Don’t Do Windows” Says the Maid. “I Don’t Do Machines” Says this Doctor – “But I Do Nudge Therapy”
By HANS DUVEFELT The hackneyed windows phrase, about what a domestic employee will and will not do for an employer, represents a concept that applies […]
The Art of Clinical Decision Making: Friday Afternoon Dilemmas
By HANS DUVEFELT The woman had a bleeding ulcer and required a blood transfusion. The hospital discharge summary said to see me in three days […]
The Art of Asking: What Else is Going on?
By HANS DUVEFELT Walter Brown’s blood sugars were out of control. Ellen Meek had put on 15 lbs. Diane Meserve’s blood pressure was suddenly 30 […]
The Art of Listening: When the Inner Voice Whispers
By HANS DUVEFELT “I worry, so you don’t have to”, is how I explain to patients when something about their story or physical exam makes […]
Driverless Cars or Keyboardless EMRs? Which Do We Need Most?
By HANS DUVEFELT I love cars and dislike computers. My car takes me where I need to go, but it also gives me pleasure along […]
The Year When Everything Changed: Covid, Self Care and High Tech Innovation In Medicine
By HANS DUVEFELT Life as we knew it and medicine as we had viewed it shapeshifted so dramatically in the past year that it is […]
Stewardship: We Worry More About the Environment than Our Own Bodies
By HANS DUVEFELT Sooner, rather than later, we will be driving electric cars because of the environment. We use energy efficient light bulbs and recyclable […]
The Art of Listening: Beyond the Chief Complaint
By HANS DUVEFELT A doctor’s schedule as typical EMR templates see it only has “Visit Types”: New Patient, 15 minute, 30 minute. But as clinicians […]
Physicians’ Communication Skills are Overlooked and Undervalued
By HANS DUVEFELT Interviewing celebrities can make you a celebrity yourself, and it can make you very rich. So there’s got to be something to […]
Meaningful U’s
By HANS DUVEFELT Meaningful Use was a vision for EMRs that in many ways turned out to be a joke. Consider my list of Meaningful […]
I Cured My Patient, But What Was His Diagnosis?
By HANS DUVEFELT He cancelled his followup appointment because he was feeling fine. He didn’t see the point in wasting a Saturday to come to […]
