Chronic Lymphocytic Leukemia is a rotten thing to find.  Last night's phone call from the lab with an alert value of 50.2 WBC's with smudge cells was unexpected .. as are most diagnoses of CLL.

Today's meeting with my otherwise healthy patient was challenging too. 

Here's a good patient information handout on CLL.

Next step is flow cytometry.  Here's a nice little  review of flow cytometry methods,  rationale and interpretation.

I'm so sad about this.  Most of this job is fun.  Delivering babies this weekend was exhausting but exciting .. and the "routine" work of seeing patients – primary care issues – hypertension, Diabetes, depression etc – is all fairly straightforward and fulfilling. 

But bearing the news of a chronic and likely deadly illness – even if it's very slowly progressing –  is just plain sad.   No – not an "interesting case" as the medical students seem to think.  Just Sad.

Newborn Neurologic Exam

  Figure. Summary of the neurologic examination with respect to gestational age. ATNR = asymmetric tonic neck reflex. From:   Yang: Neurology, Volume 62(7).April 13, 2004.E15-E17

This is a useful table that I often look for when teaching students and residents.  Now I'll never need to look very far.  😉


Health Data Management reports that NAPCI now exists.  After years of work, this organization, the brainchild of Moon Mullins and John Zapp, has finally hatched from the egg.

NAPCI is a good idea, and has support from nearly all of the primary care specialties.  "Nearly all" means that AAFP is missing, and this is an ambarrasment for AAFP, IMHO. 

As a member of the Board of NAPCI (I represent STFM) .. I am clearly biased.  But as an AAFP member, I am also compelled to help "my" organization understand the needs of its members.  I've therefore been part of a recent effort to help educate the AAFP on the reasons for NAPCI membership .. and to understand why they have chosen not to join.  Ideed, the boards of STFM and NAPCRG have communicated formally with the leadership of AAFP – imploring AAFP to reconsider this decision.

Alas … I fear that AAFP's vision for how primary care informatics needs should be expressed lies largely in the hands of David Kibbe – a bright and assertive man who has a clear vision that AAFP should:

… serve as the "physician voice" about the information revolution in office-based medical practice — to make widely known the views of physicians, and their patients, as they relate to empowerment through HIT.

But if AAFP is the physician voice .. where does that leave all of the other specialties?  Long downtrodden as the Rodney Dangerfields of medicine, we family physicians should have well learned not to be so excluse as this sort of language suggests.  We need to work with the other specialities.  NAPCI therefore needs to become the primary care provider's voice — with AAFP an active particpant in framing the statements.

At our Board meeting in early March, several representatives of other specialties reported that the leadership of the EHR collaborative had concerns about involving the AAFP because they perceived AAFP to be "going its own way."

This is troubling.  David K denies that he's been uncooperative – and insists that collaboration is a core component of his work.  Yet somehow this is not coming across, and the failure of AAFP to join NAPCI is a rather clear message that AAFP does NOT want to collaborate .. isn't it?