Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A ...

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As I sat next to her bed in the intensive care unit, I wondered if she knew that today was her last day when she woke up this morning. I didn’t think she knew that it was her last day now. I was sure that she knew that something was wrong but did she know that she’d be dead in a few hours? One of the most profound things about being a ...

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I make my way down the aisle of the plane, squeezing past my fellow passengers and plop down in my assigned seat.  Sitting next to me is a middle-aged woman with a kind smile. As the plane takes off, she begins making small talk: ”What do you do?” I silently debate, do I adopt my travel persona or answer truthfully?  Answering honestly will result in one of two things; either we ...

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When I had my first baby, I was a busy resident trying to complete my residency on time.  I didn’t want to extend my residency even if it meant sacrificing time with my newborn.  In order to get my 8-week leave, I banked days whenever I could.  There was one period I worked 45 days straight (well, not straight, I did get the mandatory 24 hours off between once a week) so ...

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Our patient was a 15-year-old girl who came to the emergency room of our hospital saying she wanted to commit suicide after being raped several weeks ago at a classmate's party. In the emergency room, a urine pregnancy test was positive. On admission to the hospital, she was very clear that her thoughts of killing herself came from her rape and current pregnancy. She was clear that she wished to ...

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Dustin Ouellete grew up a bit the other day. I had known Dustin as an infant, and his mother before that. Several years ago, the Ouellete family moved away to the big city, but last summer they came back. Dustin came in a few times with his father, and his main concern was migraines. Dustin’s father, a quiet man who seldom smiles, was concerned that the headaches were keeping his son from ...

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You’ve all heard it. Those ads about that wonderful product that will change your life. The new kind of mattress that will finally give you a good night’s sleep every night. The new electric car. The superfood. They go on about them for thirty seconds or a minute, you are enthralled, and you dream of going right out and purchasing. Ah, marketing, how powerful you are. How much we want ...

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The art of eliciting the medical history requires medical knowledge, cultural knowledge, and many “people skills.”  History taking is not science, but rather, art, because it requires interpretation and clarification.  Patients with the same symptoms express them differently.  A major feature of the art of medicine involves learning how to interpret different descriptions of the same phenomenon. A few examples might clarify these concepts. The patient tells you that they have chest ...

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Recently, the CDC announced that its Advisory Committee on Immunization Practices (ACIP) voted to stop recommending the nasal spray flu vaccine, FluMist, for anyone. Bottom line: it doesn’t work. Though their recommendation against the use of FluMist still has to be approved by the CDC director to make it “official,” it’s pretty much a done deal. The AAP’s president has already endorsed the announcement, too. Bye, Flumist. We’ll ...

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asco-logo The phone rang in my office one morning last week. Woman: “I received a notice of an appointment with you, and it says to bring my partner or spouse with me. This problem has nothing to do with him.” (The opening statement could just as easily be from a man, and often is.) I quickly looked up her notes in the electronic medical record ...

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I find it amusing to be accused of being an unsuccessful practitioner of naturopathic medicine. I graduated with high grades from Bastyr University. I landed a highly competitive naturopathic residency. Had I remained in practice, I would currently be eligible to take the naturopathic pediatrics “board-certification” exam offered by the Pediatric Association of Naturopathic Physicians. I was making decent money at my practices in Seattle and Tucson. By all accounts, I was ...

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Recently, ACP offered practical solutions to physicians’ concerns about Medicare’s proposal to implement the new payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA). The College’s detailed recommendations, summarized here in a press statement that is linked to the comment letter itself, would replace CMS’s proposed and unnecessarily complex quality scoring system with a much simpler and understandable approach as developed by the College. We challenge CMS to completely ...

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Small, independent private practices are closing, increasing numbers of physicians are retiring, and fewer medical school graduates are choosing primary care.  The old-fashioned practice my father and I have built is a dying entity.  Parents say coming to see us for an appointment feels more like a visit with a friend than a medical encounter.  I am fighting for the survival of primary care practices.  MACRA proposed reimbursement will decimate ...

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It's a typical chaotic day on the hospital's hematology and oncology floor. I'm sitting in a side room with one of my fellow medical students, doing paperwork and making follow-up calls for our medical team. That's when the music starts. The sounds of two guitars, a tambourine, and a few maracas drift down the hallway. I can't make out how many people are singing, but the happy voices and the song's ...

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Autonomous dissection by the internet. We all do it, but is taking an online medical selfie really a good thing? Disease, prognosis, and treatment explained in exquisite, exhaustive, confused, nonspecific and erroneous detail, which often yields the wrong diagnosis, recommendations for irrelevant therapy and wildly inaccurate conclusions, resulting in confusion and fear. Given this common reality, should patients avoid computer self-investigation entirely and leave e-research to the “professionals?” The bad Patients, left ...

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Watch how pathologists help the early detection of women's cancers.  Created by the College of American Pathologists.

Hi there, Allow me to introduce myself. I’m you. I’m you 20 years ago, or 45 years ago if you were in the Class of ’72. I’m you one month ago if you were in the Class of 2016. I spilled coffee down my shirt, my hair is kind of a mess, and there are dark circles under my eyes from long hours spent studying. Sound familiar? Great. Then you’re in the right place. The ...

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It turns out that when Shakespeare asked, "What's in a name?" he didn't have medical providers in mind. In the last decade, the nondescript and confusing term "provider" has crept into the American medical lexicon thanks to the Centers for Medicare & Medicaid Services (CMS) which defined a provider as a Medicare participant that is contractually obligated to provide health care to Medicare beneficiaries. This was beginning of clubbing all ...

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This is the question that every premed student must answer. It is the automatic query that follows after you have informed someone of your future goal to become a doctor. It is also the question many med school interviewers will ask in an attempt to gain their first impression of you. “Why do you want to be a doctor?” Everyone who poses this question has their own intention behind it. Your follow-up ...

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The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there's free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma or a particularly nasty infection. We're prepared to handle them. "Where is the patient?" I inquired. "On the way down from ICU. The surgeon's on his way in," I was told. Hmm … ...

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