At a party they come up to me

For a finger, a shoulder, or knee

What I don’t have to prove

Is that you just have to move

Not a consult, that advice is just free.


Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, short jobs in western Iowa and Alaska, I’m traveling right now but not for business. Any identifiable patient information has been included with permission.

More subspecialists than FPs show up to my social gatherings.  Today, in Texas, I found myself at a brunch.  Parents socialized and 21 children behaved like children.

I got called just as I finished my omelet.  By name and kinship status, they said, Someone needs you.  No surprise.

I stood, I followed.  One EMT in particular seemed to know where she was going.  Around two corners and…No, no injury here.  The staff said, go downstairs.  Which we did, all 8 of us in search of someone to be rescued.

We spread out around the pool.

Nope, no injuries here, either.

Back up to the lobby, where the clerk chided us:  With all those children running loose, someone is going to get hurt.

Well, better a false alarm than a real injury.  Really.

Later in the day, in a much smaller group, I talked with someone about a finger problem, and demonstrated “muscle energy” as a technique to improve range of motion.  Emphasizing the need for slow progress over sudden change, I cautioned gentle exercise 3 times a day for 3 weeks.  And we talked about the problem of disuse.

Right after that someone with a shoulder problem asked about a supplement consisting of curcumin, the active ingredient in tumeric.  I said, “Is it working?”

I asked the same question of the man with knee pain earlier in the day; he wanted to know about glucosamine/chondroitin.

Both told me that, yes, it helped, but they wanted to know if they benefited from the placebo effect.

Don’t knock the placebo effect, I said.  Though I didn’t get the chance to add that 60% of the patient’s improvement comes from the patient’s expectation for improvement.

Then I told both the story of a friend of ours with an allergy to overeating.  If he eats too much he gets hives, and, as a consequence, he doesn’t overeat, and over the decades we’ve known him he has slowly lost weight.  In a case like that, with a disorder so rare, we’ll never be able to generate really good data on treatment.

In an informal situation, with no record being made, I didn’t get into the depth of the problem.  I didn’t seek the answers to the 2 key questions: what does the patient’s illness mean to the patient?  Why did the patient get sick?

But the person with the shoulder problem had the real answer to 90% of musculoskeletal ailments: continued activity.






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