“Good morning baby,” she said to me each morning I when I came into her room. Ms. K was an educated woman in her early 50s with three children. She loved drinking tea in the morning. She also had a very advanced case of lobular carcinoma of the breast that had extended into her abdomen. A cluster of cancer cells was obstructing her small intestine, causing her to have nausea, vomiting, ...

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A couple of months ago I finally joined the swelling ranks of Uber customers. Several friends had been trying to persuade me for some time to start using the service, but me being generally skeptical of new technology (what they call a “late adopter”), it took an extreme situation to get me to finally download the app. It was a freezing February evening, and I was just getting home from work. ...

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Every year roughly 400 physicians take their lives: a group of physicians greater than the size of two graduating classes at my medical school. Let's be clear, physician suicide and medical professional mental health awareness is a neglected issue in medicine. We are twice as likely to commit suicide than our non-physician counterparts. Women physicians are up to three times as likely to take their lives than their non-physicians ...

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Count no man happy till his end is known.  - Herodotus This was true in ancient Greece 2,500 years ago. It is even more true today -- aggressive end-of-life hospital care, the lack of sufficient palliative care, and unduly restrictive assisted suicide laws make it impossible for most people to die with dignity. There is no worse death than a hospital death. Dying well means dying at home. This requires preparation and preparation ...

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Everything eventually expires. I looked down at the bottle of natural spring water in astonishment.  It had an expiration date.  Scanning the empty hospital cafeteria on an early Sunday morning, I wondered what on earth about spring water could go bad?  It had no living parts,  Nothing that serves as nourishment for wayward bacteria or fungus.  The container was sealed.  Pristine. I figured it was another fiscal hoax, perpetrated on unsuspecting consumers.  ...

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Time magazine published this article about why Hillary Clinton is the perfect age to run for president. The author, Dr. Holland who is a psychiatrist, chose not to focus on Ms. Clinton’s vast political experience or her education but rather on Ms. Clinton’s menopausal status. Yes, you read that right, when it comes to qualifications for president of the United States menopause trumps a Yale law degree, eight years as a senator from ...

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medpagetodayFrom MedPage Today:

  1. Delaying HCV Tx Reduces Likelihood of Eradication. Delaying treatment of hepatitis C virus infection markedly increased the risk of not being able to clear the virus in these patients.
  2. Paying Residents to Keep Stroke Patients Safe. A team of resident watchdogs and a simple checklist helps one hospital system ...

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A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist.  I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus. I expected a benign explanation for her swallowing issue.   She was relatively young and not particularly ill.  She had seen my partner years in the past for a similar complaint, which he ...

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Who is a PCP? (And does that second “P” stand for “physician” or “provider”?) Who gets to say? Does it matter? Perhaps we should start with some basic qualifications: The degree of MD or DO, the satisfactory completion of an accredited residency in family medicine, and successfully passing the written examination of the American Board of Family Medicine (ABFP, an organization distinct and independent of the AAFP). Hard to argue with those. How ...

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shutterstock_77642626 Earnest Tipp was very overdue for his blood pressure follow-up. Almost a year and a half overdue, as a matter of fact. The last few times I had refilled his medications, I had added “needs follow-up” to the signum on his scripts. The other day I finally saw him in my schedule. I thought about him all morning. A tall, muscular 90-year ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated during a follow-up visit. She has a history of well-controlled hypertension and type 1 diabetes mellitus. She is at 16 weeks' gestation with her first pregnancy. Prior to conception she was taking lisinopril, which was discontinued in anticipation of the pregnancy, and labetalol was initiated. Other medications ...

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I’ve been invited to speak to a group of attorneys who work at the interface of psychiatry and the law. The topic of my talk? “Psychiatry 101.” A psychiatrist who gave this talk to a similar group a few years ago advised me: “You should assume that lawyers are laymen. It’s surprising how little they know, given the work that they do.” This teaching opportunity to teach has given me pause: What is mental ...

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I am not an economist. This is how I start my high-value care session during the internal medicine clerkship orientation day at the Medical College of Wisconsin (MCW), and it is absolutely true.  It doesn’t take an economist, though, to realize that health care is too expensive.  Health care spending as a percentage of GDP has increased from around 7 percent in 1970 to almost 18 percent in 2010.   An ...

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Anyone considering attending a Caribbean or any foreign medical school should do due diligence. An Internet search is step one. If the school does not list residency match statistics, that could be a red flag. It would not be easy to accomplish, but try to speak with some current students or recent graduates of any schools you are thinking about. If the school won't give you any names, use caution, and ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old woman is evaluated during a routine examination. She is concerned about her gradual weight gain over the years and requests counseling on how she can most effectively lose weight. Over 8 years, she has gained approximately 18 kg (40 lb). With several commercial diets, she has lost weight but always gains ...

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“Nobody does this …” Dr. D said as a greeting as he walked in holding the 700-word letter I had sent him some weeks before my periodic physical examination. Half the letter addressed six issues that had arisen during the year and a half since my last physical. I thought, nearing age 62, that it’d be both efficient and prudent to provide my GP an update on my health experiences. Half ...

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shutterstock_216555211 I am lucky enough, from time to time, to be invited to speak to young women who want to be surgeons when they "grow up." I always have a hard time striking a balance between what I should share that is positive and inspirational and what I should share that is a little harsh and uncomfortable. Once, I turned to my ...

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As a patient, I would like a primary care visit that is pleasant, comprehensive, convenient, and efficient. As a future practitioner, I hope for a visit that is unhurried, educational, efficient, and holistic. We may have through all these years grown accustomed to the status quo -- on both ends -- that is, we have come to expect the 45-minute wait in the atrium prior to our beckoning by the ...

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I argue that pharmacist should fill prescriptions even if their own morals do not agree. Pharmacists should not be limiting someone from getting something they may need because they do not agree with it. Pharmacists have no right putting their business (ideology) where it doesn’t belong. Women struggle enough when going to the pharmacy to fill a prescription for birth control or emergency contraceptive, now with the added possibility of not ...

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Elizabeth Sedway, a 51-year-old undergoing treatment for multiple myeloma, was outraged to be removed from a Hawaii-San Jose flight due to concerns about her health.  Wearing a mask to prevent infection as her immune system was compromised from chemotherapy, she requested handicapped seating and told an airline employee she felt “weak.”  The employee consulted with an airline doctor who was concerned about taking a passenger with this profile on a ...

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