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).

2018 Top Doctors

I was recently recognized by Minnesota Monthly as a “Top Doctor” in the specialty of addiction medicine. I’ve appeared in its annual listing every year since 2014. The directory can be found in the October print issue and online.

Received Wisdom — 3

Thinking

“Learning how to think” really means learning how to exercise some control over how and what you think.

—David Foster Wallace

David Foster Wallace. This Is Water. New York: Little, Brown and Company, 2009, p. 53

Received Wisdom is the big ideas that I use with patients.

Received Wisdom — 2

Pain

Pain? Yes, I have more than enough pain. But, you know, the pain is not such a bad thing, it’s brought me back to reason.

—Hermann Hesse

Hermann Hesse. Narcissus and Goldmund. Translated by Leila Vennewitz. London: Peter Owen Publishers, 1993, p. 247

Received Wisdom is the big ideas that I use with patients.

Received Wisdom — 1

Suffering

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).

us.standard_drinks — 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.

SBIRT

I attended Hazelden Betty Ford’s Professionals in Residence (PIR) program in 2002. I started the week thinking I was going to be a family physician—I was a resident at the time—but was hooked on addiction (bad pun intended) by the end of the experience. And so began my odyssey to an eventual career in addiction medicine.

I returned to PIR as faculty in 2009 and have been teaching for the program ever since. I lecture on Screening, Brief Intervention & Referral to Treatment (SBIRT—not to be confused with Ernie and Bert!).

My slide set has evolved considerably over the years. This blog post contains the latest and arguably greatest.

Demystifying Suboxone

I’ve been treating opioid addiction with buprenorphine (Suboxone, Zubsolv, Bunavail) since 2005. Here’s a conference presentation that covers some perennial questions that I receive from primary care providers. I’m happy to bring the slide deck to you for a live training.