I didn’t know Dr. Margaret Keenan but wished that I had. One of her eulogies said this of her:

I think that what her patients craved was not to be healed but to be understood

I pray that my own demise is far off—our kids are still young and I’m just beginning to master my craft. But when I’m gone, I hope that my patients will generally recall that I understood them. §

Lights, Camera

Treatment Basics, an excellent educational DVD, is now available from Hazelden Publishing. I was fortunate to be included in the project.

Treatment Basics, an excellent educational DVD, is now available from Hazelden Publishing. It complements Addiction Basics, which appeared in 2017.

I was fortunate to be included in both projects. Many thanks to Wes Thomsen and his team for the ongoing collaboration. What’s in the hopper for 2019? §


Think Like a Doctor

My longtime collaborator, Jim Beattie, and I will be taking our roadshow to Cleveland, Ohio, for the Midwest Chapter of the Medical Library Association’s Annual Conference. Our four-hour workshop (sounds long, goes fast) provides a practical introduction to evidence-based medicine (EBM). The material is adapted from courses that we teach at University of Minnesota and prior MLA conference presentations. This blog post serves as our “course website.”

PowerPoint Presentations
Think Like a Doctor: Course Introduction
Think Like a Doctor: Diagnosis
Think Like a Doctor: Therapy

Other Course Materials
Competency-Based Medical Education (resource)
Abstract Attack (resource)
PubMed Citations for Small Groups

Family Medicine Clerkship Assets
Unanswered Clinical Questions (article)
Should We Google It? (article)
Evidence Uptake by Synthesized Resources (article)
12 Step EBM Project
CAT Template
PLS Template
Clinical Bottom Line tip sheet
Strengths & Weaknesses of Evidence tip sheet

EBM Resources
Centre for Evidence-Based Medicine (organization)
Levels of Evidence (LOE) Taxonomy (2011) (resource)
Strength of Recommendation Taxonomy (SORT) (resource)
POO, DOO and You (article)
A POEM a week for the BMJ (article)
The Rational Clinical Examination (article series)
The Rational Clinical Examination (book)
Users’ Guides to the Medical Literature (book)
Evidence-Based Physical Diagnosis, 4th ed. (book)
Evidence-Based Medicine, 5th ed. (book)
Diagnostic Calculator (resource)
Biostatistics Calculator (resource)

Predicting Suicide & Violence

I recently delivered a webinar on suicide and violence for the Minnesota Center for Chemical and Mental Health. You can view the presentation here.

I’m a huge fan of using validated scales and measures to guide clinical decisions. I described the use of the following tools in the webinar:

I also referenced an important meta-analysis by Joseph C. Franklin, Ph.D., et al., and an associated press release by the American Psychological Association.

Finally, here’s a shameless plug for some translational pieces on suicide and violence that I wrote for Today’s Hospitalist (where I’m a long-time contributing editor).

Received Wisdom — 1



Mental suffering takes place when we don’t get what we want, or when we’re forced to live with and endure what we don’t want.

—Steve Hagen


Steve Hagen. Buddhism Plain and Simple. Boston: Charles E. Tuttle Co., 1997, p. 30

Received Wisdom is the big ideas that I use with patients. This post is the first in a series of many.

Drinking Less = Longer Life

How much alcohol is too much? For years, we’ve been using numbers from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). It defines low-risk drinking as:

  • Women
    No more than 3 drinks per day; and
    No more than 7 drinks per week
  • Men
    No more than 4 drinks per day; and
    No more than 14 drinks per week

where 1 drink = 14 grams of absolute or “pure” alcohol. This corresponds to 12 ounces of beer, 5 ounces of table wine or 1.5 ounces of distilled spirits (e.g., vodka).

National Institute on Alcohol Abuse and Alcoholism

All that is about to change. A new study involving about 600,000 people found that drinking targets should be a lot lower—probably no more than 100 grams of alcohol per week. This corresponds to just 7 standard drinks.

The study found that people who consume more than 100 grams of alcohol per week had a higher risk of dying. They also had more heart attacks, strokes and other cardiovascular diseases.

Here’s the flip side: drinking less appears to add years to your life. For example, 40-year-olds increase their life expectancy by at least 1 year when they reduce alcohol intake from NIAAA’s current upper limits to no more than 100 grams per week.

I’ve loaded these data into my longest running PowerPoint slide deck (Slides 14–16) and am encouraging my students to change the advice they give to patients. Please pitch in and start spreading the word!

The Accidental Psychiatrist

I’m honored to be the keynote speaker at the Minnesota Academy of Family Physicians’ Spring Refresher. Here’s a fairly final version of my PowerPoint.


The bulk of my presentation will be devoted to the systematic management of major depressive disorder. The STAR*D Study, which has only become more relevant over time, will provide the overall framework.

I’ll also be discussing suicide assessment and how to monitor various psychotropic medications.