The things I would tell you if the visit were an hour longer.
I write occasionally — about pain and why medicine handles it so poorly, about growing old without being reduced to a chart, and about the questions patients ask me quietly, near the end of an appointment, once the formal business is done. These are not medical advice. They are how I think.
What we get wrong about opioid tapering
Most tapers fail for the same reason: they remove something before putting anything in its place. A patient who has been on the same dose for nine years is not simply dependent — they have built a life around a fragile equilibrium. Here is how I approach it, slowly, and why the calendar matters less than what we build alongside.
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Earlier pieces
Ten medications, four doctors, and nobody holding the whole picture
Polypharmacy is rarely anyone's fault. Each prescription was reasonable on the day it was written. The harm lives in the arithmetic between them — and in the fact that no one has been asked to do that arithmetic.
Read this piece 7 minutesPalliative care is not the moment you give up
The referral is often delivered as bad news, which tells you how badly we have explained it. Comfort and dignity are not what we offer when treatment fails. They are treatment, and they work best when they start early.
Read this piece 5 minutesWhy ketamine, and why so carefully
For complex regional pain syndrome I have watched it accomplish what nothing else could. That is not the same as recommending it widely. What separates an infusion from a drip bar is the evaluation before it and the follow-up after.
Read this piece 9 minutesTaking healing traditions seriously enough to test them
Respect for a tradition and rigour about its claims are not in tension. My fellowship taught me to hold both at once — and to say no to a treatment as readily as I offer one.
Read this piece 6 minutesThe question families ask me on the way out of the room
It is almost never the question they came with. It arrives at the door, half-apologised for, and it is usually the one that has kept them awake. I have learned to leave time for it.
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These pages are not medical advice.
What I write here is general — a way of thinking, not a plan for anyone in particular. Your case is yours alone, and it deserves to be examined rather than matched to an article. If something here sounds like your situation, the useful next step is a conversation, not a conclusion.