Introduction

Growing up as a doctor’s son in a smaller community, I was quite starry-eyed about medicine. The doctors I observed were curing the masses, loved, respected, placed upon a pedestal, wealthy, and intelligent. During medical training and after passing medical board examinations, I could diagnose and treat problems A-to-Z. The problem lies in that primary care providers may see the majority of conditions once or twice in a lifetime. I have provided the most common conditions that physicians will treat on a daily basis, and they must be familiar with the atypical presentations of the common conditions. For older physicians that are stuck in their old ways, it is hoped they will see that life-changing medications and treatments are at their disposal.

Today I am a grizzled veteran of twenty-seven years in primary care medicine. I have two target audiences: the general public who are invested in their health, and other primary care physicians. In the pages that follow I will bridge old and new school medicine and preserve the past traditions while embracing new technologies. I address the changing doctor-patient and doctor-doctor relationships that are quite different in this day and age.

I began practicing medicine in an autonomous situation where I could prescribe any medicine or order any study I desired. Medicine is no longer autonomous as insurance companies dictate what the physicians may do. Patients are information hungry and desire instant gratification. Patients no longer discuss their symptoms with me; they just tell me their diagnosis. Google search has taken over their medical care. When I Google certain diseases, differential diagnoses, and medications, it is often difficult for even me to understand them; it is very time-consuming, and nothing is concise. I have written this book in layman’s terms and hope the general public will understand it clearly.

During patients’ office visits, doctors speak in medical terms and discuss diagnostic testing and disease states as if patients actually understand what they are telling them. What I’ve done here is provide patients a CliffsNotes version of common disease, laboratory review, simplified testing, and medications that should be prescribed for common problems. Patients deserve to know what doctors are thinking and why we are prescribing certain medications and not prescribing others that are potentially harmful for them. Multiple, different, equally effective cancer screenings, tests, and treatment plans exist for every disease. My recommendations reflect the standard of care and are cross-referenced with the American College of Physicians publication, Medical Knowledge Self-Assessment, Number 17.

I have grown bitter with the change in medicine throughout the years. Big business and technology have ruined the physician-to-physician relationships. Communication between physicians is awful as information is passed on by a fax or redundant chart notes from the electronic medical record (EMR). A phone call is almost extinct between the specialist and primary care physician. Also, EMR has changed the whole dynamic of routine office visits with patients. No longer can doctors practice medicine like the empathetic and caring Marcus Welby, MD! Since I was trained in old-school medicine and have adapted to the new technology, hospital-owned practices, hospitalists, and EMR, I believe my advice will be beneficial to medical students, residents, and young doctors, and I hope it will rattle the chain of large hospital institutions.

Sincerely,

Robert E. Barkett Jr., MD