A Country Doctor Writes

APRIL 6, 2025

The thought of writing about my experience as a doctor had been percolating for a couple of years before I started my blog and published my first post on April 28, 2008. I remember having a black notebook during our traditional New Year’s visit to Château Frontenac in Quebec. I was all dressed up in my tuxedo, waiting for the New Year’s dinner to begin and I finally hatched the title, A Country Doctor Writes.

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A Country Doctor Writes

APRIL 16, 2025

When I read a case report in a journal or whenever a patient comes in to see me about a new symptom, all my senses are tuned in and I know there is a diagnosis to be made. But on regular clinic days with “routine” follow ups, I find myself not being as tuned in as I would like to be. I know my patients well; we are all growing older together.

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A Country Doctor Writes

APRIL 17, 2025

I recently reposted a 2017 WordPress reflection on my Substack about how sometimes a disease evolves so slowly that you, as a continuity provider, barely notice it but another, covering, provider notices the subtle abnormalities and recognizes the pattern as a new disease. When taking a medical history, it is often very difficult to pin down the duration of a patient’s symptoms or the speed of change.

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A Country Doctor Writes

APRIL 23, 2025

Melanie’s breathing troubles started almost three weeks ago. Her pediatrician suspected cough variant asthma, but she didn’t respond that much to her medications. “Give them more time to start working”, was her recommendation. A Country Doctor Writes: is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

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Illness Asthma Family Families 130

A Country Doctor Writes

APRIL 26, 2025

As doctors, we are like actors or musicians. We play roles, we play compositions that can reach deeply into the consciousness of other human beings. We can evoke feelings and sometimes bring about change if we are skilled and genuine in our delivery of the message our patients need to hear in the moment we meet them. This is a topic I keep coming back to, with words like ACT, CHAMELEON and ROLE PLAY.

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A Country Doctor Writes

MAY 9, 2025

Medicine is a love that finds us wherever we happen to be. It snatched me, a quiet four year old boy, almost sixty [ eight(!) ] years ago. I don’t know how it happened. I remember being in the hospital and having stomach X-rays and I have also been told we had a family doctor who made house calls. I couldn’t have seen doctors on TV, because television was only introduced in Sweden when I was three and I saw my first program at age 5, a show about an infantile doll named “Andy P

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Family Doctor IT Family Families 130

A Country Doctor Writes

MAY 11, 2025

Jimmy has a bad back. He’s fused at every level, some of them done twice. After many prescriptions of oral pain medication, he landed on Butrans, the buprenorphine patch that stays on for a week, hits the mu receptor for pain just like the regular opiates but not the depression inducing kappa receptor. It has fewer side effects in general and is less likely to cause respiratory depression if somebody were to double up on their dose.

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A Country Doctor Writes

MAY 18, 2025

16 years ago I was a newcomer, at age 56, in the northernmost part of Maine. In one way I was starting over, but in another way, I was continuing what I had done in my previous job near Bangor. There, as medical director, I had a friend and ally in the behavioral health director, and both our departments underwent years of rapid growth. This was in part because we shared patients and patient experiences between our departments and had a bidirectional way of making warm handoffs.

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Primary Care Patient-Centered Nurse Practitioner Primary Care Doctor 130

A Country Doctor Writes

MAY 29, 2025

Glenda Cyr has been my patient for many years. She also follows with an endocrinologist in the city because of hypoparathyroid disease. She’s on varying doses of calcitrol and vitamin D and he follows her bloodwork regularly, even though he last saw her about two years ago. He works at the Catholic hospital across the city from the rival, bigger, Cityside hospital.

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A Country Doctor Writes

MAY 31, 2025

I had this idea to write a post about quality, linking to the characterization of quality in the classic book Zen and the art of motorcycle maintenance. On a whim, I gave ChatGPT the task, formulated like this: Write a 500 word essay with the title Zen and the art of doctoring, borrowing the major concept of the book Zen and the art of motorcycle maintenance, applying the principles to the practice of medicine A Country Doctor Writes: is a reader-supported publication.

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A Country Doctor Writes

MAY 31, 2025

I was impressed by the clever and quick response I got to my ChatGPT request this afternoon, but I’m not worried that AI will make those writers obsolete who reveal their personality and create and nurture relationships with their readers. Hans’s Substack How to Beat ChatGPT An idea had been percolating in my mind for the last week or two: I should write a blog post about quality in medicine borrowing from the concept in the book Zen and the art of motorcycle maintenance.

Relationship 130

Relationship 130

A Country Doctor Writes

JUNE 1, 2025

I wrote this in 2017, when I was working with a simple EMR and when my practice had 15 minute visits. Years later, after adopting Epic, we never got over what was supposed to be a temporary slowing down to 30 minute visits while learning the new system. I have heard of practices where providers tell their patients that they’ll get 10 minutes face-to-face, so the doctor has enough time to work the computer, documenting the 10 minute encounter.

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A Country Doctor Writes

JUNE 3, 2025

I wrote this in 2016, when my visits were shorter because that EMR was simpler. But the math is the same, no matter how long your normal appointments are. I have always tried to “squeeze” urgent visits in when I know the patient and the issue they’re having. I never liked when somebody else decided which patient and what kind of problem could be handled in half the time of another person’s appointment that could be something that, if anything, could have been expected to

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Patients Appointment Patient-Centered Screening 130

A Country Doctor Writes

JUNE 5, 2025

So often, I note that my middle aged patients slowly gain weight between visits. It is a recurring topic during routine physicals. I call it the middle age creep and I make a big deal of it. I warn my thirtysomething male patients with budding potbellies that this doesn’t get any easier to get rid of later in life. A Country Doctor Writes: is a reader-supported publication.

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A Country Doctor Writes

JUNE 7, 2025

I was covering for Dr. Kim the other day. A 60-something diabetic who had started taking insulin a few months ago had left a message that she wanted to change from Novolog (insulin aspart) to Humalog (insulin lispro) because she had just had her second UTI (urinary tract infection). And she had just read that UTI is listed as a side effect of Novolog but not of Humalog.

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A Country Doctor Writes

JUNE 8, 2025

It’s been six years since I posted this on my WordPress blog and the reaction has been an almost deafening silence. Personally, I think this would be a huge improvement for clinicians who are constantly trying to find the clinical essence among all the verbiage in modern day office notes. A Country Doctor Writes: is a reader-supported publication.

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A Country Doctor Writes

JUNE 9, 2025

In my first 30 days on Substack, I published a post that got eight new subscribers and broke my record of how many views it had, 195, more than twice what my budding Substack had accomplished before. It was a call to reimagine, reinvent and reinvigorate primary care. I re-blogged this post on my original, much older WordPress blog and it got 14 comments, many more than usual.

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Primary Care Insurance Diagnose Screening 130

A Country Doctor Writes

JUNE 11, 2025

I used to teach photography and dark room techniques. Now that I only use my iPhone for picture taking, I have forfeited many of the tools that used to help me tell a good story within a photograph. We may only have 15 minutes with each patient. At least in my opinion, that means you always have to make the choice very early in the visit between going narrow and deep or wide and shallow.

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