Posted by: notdeaddinosaur | March 21, 2015

Quote of the Day

Family physicians are the pluripotential stem cells of American health care.
 -Dr. Wanda Filer

Well said.

Dr. Filer (I get to call her Wanda because I’m special; also, she’s really nice) did hands-down one of the best talks I’ve ever heard on the long term effects of childhood trauma, which probably affects more than a third of my patients, and I don’t even know it. (Look for upcoming post on asking established patients — some of them decades-long — new patient questions.) She is also the President-elect of the American Academy of Family Physicians, which means that even though I just went to it last year, and even though I already have more than twice as many CME hours as I need by the end of this year, I just made the decision to attend again this year just to see her installed. She’s that awesome. Also, it’s in Denver, so I get to see DenverDaughter.

I’m spending the weekend at an educational conference sponsored by my state Academy. (Hi, PAFP!) The sessions are fabulous, though it’s like trying to drink from a fire hose as the incredibly useful day-to-day pearls come fast and furiously. It’s also nice to catch up with friends and colleagues I don’t get to see otherwise, professional solitude being part and parcel of solo practice. It’s also inspiring (really the only word) to get a glimpse of the world of organized medicine, which briefly produces a yearning to participate. I call it the “I could do that” phenomenon. But just thinking about the pile of work needing to be caught up on after just one day away from the office quiets that urge rather effectively. 

Things I am going to start doing right away:

  • Stop prescribing low dose aspirin for primary prevention in low risk patients (really no good evidence for it)
  • Add two questions to my domestic violence screen (currently asking, “Are you or have you ever been in a relationship where you’ve been beaten, threatened, or abused?”): “Do you feel safe at home?” and “Have you ever been sexually asaulted?” (as defined by the patient)
  • Feel more comfortable starting insulin sooner
  • Learn more about the newer diabetes medication classes
  • Back off even more on medicating pediatric fever
  • Feel more confident advising just 1-2 days of rest after mild concussions instead of longer periods
  • Look harder for afib after cryptogenic stroke

And that’s just the first day.



  1. I recently heard a talk by Dr. Gabor Mate on the effects of childhood trauma, which I thought were excellent. If you aren’t familiar with his work, he’s written a few excellent books (“In The Realm of Hungry Ghosts”, “When The Body Says No”) that you might find interesting.

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