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.


The Medicine of Place

I recently stumbled upon The Medicine of Place in a coffee shop in St. Cloud, Minn. The authors, Jerry Hansen and Chuck Norwood, are local guys. In fact, Chuck works a few doors down at the Paramount Center for the Arts, where I connected with him a few days later. (I see patients at the Stearns County Jail, which is right around the corner.)

The book contains perennial wisdom and beautiful photographs, and is a reminder that there are still mystics among us. Consider the following page (click to enlarge):

Easy Essay CXCIV

The title is published by North Star Press, also in St. Cloud.

Many thanks to Curtis Weinrich, with North Star Press, and Chuck Norwood for permission to post the page above.

Predicting Death

I’ve been teaching evidence-based medicine at the University of Minnesota since 2004. I have a particular interest in evidence-based physical diagnosis; that is, the relative value of history and physical exam data for establishing and excluding disease. This is the realm of pretest probability, likelihood ratios and Bayes’ Theorem.

I reviewed the National Early Warning Score (NEWS) in my December 2017 column in Today’s Hospitalist (where I contribute a numbers-oriented piece every other months). NEWS is a deceptively simple mash-up of vital signs that accurately predicts 24-hour mortality. Low scores—which is where my interest lies—have exceedingly high negative predictive value (translation: very few people with low scores die).

Nerdy footnote: Please check out JAMA’s Rational Clinical Examination and Stephen McGee’s Evidence-Based Physical Diagnosis for more numbers for doctors.

Bend, But Don’t Break

I’m pleased to be presenting at the HealthEast Spine Symposium on November 30th. My topic is resilience, which is the flip-side of burnout.

Although I don’t plan to spend a lot of time on it, healthcare leaders should consider Slides 41 and 42, the underlying study and my commentary in Today’s Hospitalist. In short, bad bosses contribute to burnout.

The relationship between personality structure and burnout and is also worth a look (Slides 43–46 and the related study).

You can find my PowerPoint here or by clicking on the image below.

Bend, But Don’t Break

Life isn’t easy—especially in healthcare. Burnout is a huge problem that has rightfully received a lot of attention. But what’s the solution?

Resilience is an antidote to burnout. It’s the approach the U.S. military takes when deploying troops to stressful, unpredictable and often dangerous circumstances.

Today, I’ll be discussing resilience at the Upper Midwest Oncology Education Network’s annual meeting. In a novel twist, we assessed attendees’s resilience in the weeks preceding the conference and will be challenging them to improve their resilience in the months that follow.

You can find my associated PowerPoint here.

Late-breaking news: Burnout in oncology pharmacists has been studied. Pharmacists had the highest rate of burnout—53%—in a large cohort that also included physicians, advanced practice providers and nurses.


Predicting Opioid Overdose

I’m a long-time contributing editor to Today’s Hospitalist. My “beat” involves numbers—dollars, RVUs, burnout—basically anything that can be measured.

I considered a simple bedside calculator that predicts opioid overdose in my October 2017 commentary. Overdose risk is generally much higher than providers think because of ubiquitous risk factors like concomitant antidepressant use.

Readers who want to go deeper can find primary literature here, here and here.