Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus (MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and ...

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Let's face it, residency is no picnic. A combination of on the job training and trial by fire, no physician who has gone through it and survived will ever forget the experience.  The emotions run from jubilation to sheer terror. It is inevitable that some of the people you interact with will leave a lasting impression. In the case of the resident, it is the attending physicians that fulfill  the ...

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“55-year-old man with history of laryngeal carcinoma, status-post radiation therapy, laryngectomy, bilateral neck dissection, with metastases to the lung, status post thoracotomy, currently undergoing chemotherapy who is being admitted for a for first-time seizure. Patient is a transfer from Riker’s Island.”
Prisoners are a common occurrence in Bellevue Hospital. This, however, was my first prisoner-patient. The hyphenation both as I write this now and as it formed as a concept in ...

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About a year ago, there was a great commercial that depicted the slowing of time as a free-falling, but worry-free, James Franco uses his smartphone to chart a safe landing on the billowy awning of a restaurant dozens of stories below.  There probably isn’t a single person who hasn’t, at one point or another, wished she or he could control time in order to navigate a better outcome.  And doctors ...

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It is well accepted among health economics wonks that the lion’s share of pharmaceutical company profits come when these companies hold exclusive rights to their products. Once their blockbuster pills go “generic,” competitors enter the marketplace and profits plummet. Consider captopril, a groundbreaking heart failure medication introduced in the early 80s by Bristol-Myers Squibb under the trade name Capoten. After making a fortune for the company, captopril went generic in 1996. ...

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In India, when the first heavy droplets of rain meet dry earth it releases a particular kind of smell: a dampness arising from sizzling soil that in Bengal we call shnoda gondho. It is raining on the second day we go to visit my grandfather in the hospital. He has been readmitted to the hospital, after spending a week recovering at home from a hospitalization for rib fractures and bleeding into his ...

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I drank the Kool-Aid early.  We installed our first EHR in 1996 with me doing the lion’s share of pushing and pulling.  While I’d ultimately turn my back on this passion, I had a number of notable accomplishments before walking down my road to Damascus.

  • Within a year of implementation, our practice became one of the top installations for our vendor.
  • Within two years, I was elected to the board of our user ...

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My first experience administering injections involved sitting in an ICU room, ten years old, drinking bitter diet Shasta colas and watching thrillers from the 90s starring Sandra Bullock. The nurses started me on oranges. Easy as pie -- I could stab away, practicing insulin injections with saline and fruit. The oranges practically squealed with delight upon puncture, rewarding me with the scent of citrus and a plume of juice -- ...

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It was the boy who was unable to speak who ended up teaching me the most. I was seeing patients in the epilepsy clinic during my neurology rotation. The attending physician with whom I was working, an internationally renowned pediatric epilepsy specialist with a penchant for attracting exceedingly complex cases, wanted me to observe the end of a patient session with one of the child neurology fellows. I entered the patient’s room ...

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When I was a resident, I saw a middle-aged man, “Charles,” who came into the hospital after playing a round and a half of golf. When I looked at his right foot, he had an ulcer in the shape of a golf tee. He had played the entire day with a golf tee in his shoe and only noticed when he found drainage on his sock. The story sticks in ...

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Delivering bad news is part of my job, an important part. It is fashionable nowadays to speak of the doctor-patient relationship as a partnership. In the sense that both doctor and patient have important roles to play for the patient to get good care, that’s very true. But even in the best of times, it’s a very asymmetric partnership. Even in a run-of-the-mill visit for a sinus infection the patient and ...

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The recent Germanwings tragedy has called commercial aviation's concept of fitness for flight into question.  Although the official mishap investigation has not yet concluded, available information at the time of this writing points to an intentional crashing of the plane by the 27-year-old co-pilot, Andreas Lubitz. Reports from the co-pilot’s medical records allege he had previously experienced episodes of depression and carried diagnoses for other psychosomatic disorders.  Antidepressants and torn medical memorandums stating that ...

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Yeah, it happened. The SGR is finally dead. Hooray! Sort of. I mean, it's great and all that -- we'll no longer have the annual threat of a massive payment cut from a poorly crafted piece of legislation from the 1990s; we'll no longer have to endure the annual ritual of last-minute legislative theatrics to avert the yearly cuts, we'll no longer have to waste our lobbying time and effort ...

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The 92-8 vote in the United States Senate to join the House in passing the Medicare Access and CHIP Reauthorization Act (MACRA), H.R. 2, represents a remarkable milestone for the Medicare program, and for ACP advocacy on behalf of internists and patients. It is remarkable not only because it eliminates the failed Medicare SGR -- how often does Congress admit it made a mistake, and then correct it? -- but because it ...

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Dear patients, First of all, thank you for calling for an appointment. Seriously. Ever since I’ve gone open access, if the phone doesn’t ring I’m toast. And thank you for your interest in preventive care. The fact that it’s now free (well, no cost to you at time of service: trust me, it’s not “free”) has probably motivated more of you to call. That’s OK. But sometimes it seems that your ...

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medpagetodayFrom MedPage Today:

  1. Delayed Autism Diagnosis Common in Primary Care. Parents with autistic children were more likely to receive a passive, rather than a proactive response from a provider when raising concerns about their children's development compared with parents whose children exhibited signs of developmental delay.
  2. MOC Watch: ABMS President Rebuts Critics. ...

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How many times do we start out our day with the best of intentions? It’s probably most days, if you’re at all like me. Even when we’re going through a spell of negativity, we all try to pull it together for the sake of our patients, our staff, our families. A couple weeks ago, I was tempted to throw in the towel. It was one of those days when the last straw was ...

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In medical school, class is scheduled for approximately 30 hours a week. This includes lectures on basic life sciences, histology, anatomy, and clinical examination skills. In addition, my first semester included approximately three hours of classroom time a month devoted to a supplemental curriculum called Health Systems and Policy, which covers the legal aspects of health care, public policy, and, briefly, health disparities. Now, in my second semester, these efforts ...

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The tenets engendered by cancer have been slowly elucidated throughout the years. The hallmarks of cancer have been well documented by Douglas Hanahan and Robert Weinberg in Hallmarks of Cancer: The Next Generation. Some of these features are well known and are inclusive of sustained proliferative signaling, evading growth suppressions, and others clearly outlined in their review. These cellular processes have been discovered by basic science researchers and subsequently, modern ...

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Forty is the new thirty. Orange is the new black. And failure is the new success. It seems these days that no success story is complete without a failure (or two) along the way: the bankruptcy that gave birth to a successful company; the entrepreneur who lost it all just before hitting the Fortune 500. Entire issues of the Harvard Business Review and the New York Times Magazine have been devoted ...

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