Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated at a well-patient visit. Both her parents have a history of nonmelanoma skin cancer within the past year, and she is seeking counseling regarding skin cancer prevention. She has a history of remote sunburns and had previously tanned as a teenager. She requests advice on how ...

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The medical assistant swabbed my nose and my throat multiple times. Pricked my finger too. Then, the phlebotomist (or vampire?) drew bottles and bottles of my blood. Along with the physical discomfort, there was emotional discomfort too. What would the test results show? If they were all negative, would I be satisfied without having an answer? Being a patient can be extremely vulnerable. Not only do you often divulge to a ...

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I spent the evening of the 2016 presidential election and the morning after on an emotional rollercoaster. It began high and then descended into shock, disbelief and grave concern about the future of our country. Now that we have selected a candidate who intends to take the country in a radically different direction, and I worry about the consequences of reversing the Affordable Care Act, reversing economic assistance programs, and ...

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When you hear people say, “I don’t want to vaccinate my kid. Why would I give them autism?” It’s hard not to get upset and meet your patients with some judgment. John and Carly were middle-class Americans that had a lot of misconceptions about vaccines — mostly from the media. They loved their two-year-old daughter Leslie and wanted the best for her. They didn’t understand that we wanted the same thing. ...

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Quick, name the most watched, financially successful and competitive sports league in the United States? The NFL. Right? Now, name the most tightly regulated, transparent sports league, one that has a multilayered system of wealth redistribution and the one of the strongest unions of any profession in the United States? The NFL. Surprised? This is not a coincidence Major problems with concussions and Roger Goodell’s persona and salary aside, the NFL offers a tremendous lesson ...

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As an internist and geriatrician, I deal with elderly patients all the time. We always end up talking about end-of-life issues: “Should I be resuscitated if my heart stops and I stop breathing?" “Do I want a feeding tube or gastrostomy tube if I stop eating and require nutrition?” “Should I be kept alive on machines and for how long if there is no reasonable hope of recovery?” “When should we refuse tests for ...

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Tests and exams are the most challenging part of campus life, especially when it is in medical school where students will frequently encounter different types of examinations. One of the things which makes it special is that in medical school, exams are not only given as a written examination but also as oral and practical examinations in which students must face their instructors. Most of the time these are external ...

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Recently, President-elect Trump selected Rep. Tom Price, MD to lead the Department of Health and Human Services.  Suffice it to say, this signals Mr. Trumps’ resolve and commitment to definitively repealing and replacing.  Dr. Price has already sunk his teeth into health care reform, having proposed alternative health care solutions in every Congressional session since 2009. As a physician myself, I am delighted at the prospect of having another doctor at ...

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On Tuesday, November 29, President-elect Donald Trump named Dr. Tom Price, a former orthopedic surgeon, current Republican congressman, and chair of the House Budget Committee, as his pick for Secretary of Health and Human Services. The same day, the American Medical Association issued a press release enthusiastically endorsing Price for the position. The next day, Dr. Andrew Gurman, the president of the AMA, came to my hospital to ...

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Madame Laurent came to my office one day last year with bloodshot eyes and a two-day headache. She’s well known in our clinic – kind to all the staff and always smiling even when she’s in pain. Despite a stroke a few years ago, she is mentally sharp, often able to read what I want to say before I can say it – an impressive feat considering that she only ...

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For a century, the white coat has been the symbol of the medical doctor. Today, the vast majority of medical schools in the U.S. begin with a white coat ceremony. There, the fledgling, future doctors stand together and recite a modified version of the Hippocratic Oath before being called up one-by-one to receive the white coats that they will wear throughout the upcoming trials and adventures of medical school. The ...

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You will probably never meet me in person. Your name will be on the bill my insurance receives from the hospital. Your signature will be on the line after the end of the report as you mumble report after report into the system. You will never know my story. I am my organs to you; organs will anomalies that you have to squint and sometimes lean back to look for.  You ...

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Physician burnout has received a lot of well-deserved attention lately. Characterized by emotional exhaustion and professional frustration, it's tied to an array of adverse consequences, from physician suicide to poor patient outcomes. Organizations are waking up to the need to measure its prevalence and ameliorate its impact. There seems to be two broad schools of thought about the causes — and by extension, the fixes — of physician burnout. The first focuses ...

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I hugged them longer than any 10- or 11-year-old wants to be hugged by their mom, and tried not to cry tears of gratitude that they were in my arms. The last kid their age I saw was the one I had resuscitated and admitted to the PICU just hours before, and it took my breath away to think about that happening to my sons. I had to make one ...

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On November 1973, I had an epiphany.  My first week on my internal medicine clerkship, I realized that I had found my specialty: internal medicine. Prior to medical school, I had worked with emotionally disturbed children in an inpatient hospital.  I really enjoyed the experience, and learned a great deal.  During my first two miserable years in medical school (I disliked how they taught the basic sciences and even more how ...

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One of the terrible things about being a physician who has spent his adult life working in emergency rooms is that you have a certain terrible clarity about the dangers of this life. It’s why we’re forever pestering our loved ones with phone calls and texts: "Are you there yet!" Or telling the children, "Be careful! After midnight there are too many drunks on the road!" Met, of course, with ...

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asco-logo Ten years ago, I first met this patient, newly diagnosed with intermediate-risk prostate cancer. As I walked into the examination room, I was struck by the juxtaposition of his wife, crumpled in a chair and weeping silently, with the patient himself, pacing the 12'-by-4' room with a look of either anger or frustration. This difference in response between the man and ...

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If we, as a country, focused on and invested in prevention as the basis for health care, the system in the United States would be transformed. However, the physicians who provide primary care services tend to have the least status and are paid lower than other specialties. They are often mandated to do tasks and paperwork that are burdensome, time-consuming, and unrelated to their skills as a physician or their ...

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It’s widely acknowledged that the American health care system achieves relatively poor ­quality outcomes compared to most industrialized nations and at much higher cost. A new survey, conducted by Nielsen Strategic Health Perspectives and commissioned by the Council of Accountable Physician Practices (CAPP), provided important insights into why this could be the case — and more ominously, why the future may be no better. CAPP is made up of ...

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Man collapses at 30,000 feet. Quick, who’s in charge? Hint: It’s not the doctor. Last month, Dr. Tamika Cross was told to sit down when she tried to help an unresponsive man. Why? Apparently, the flight attendant was looking for an “actual” medical doctor, not a black woman. Turns out she’s not the only doc making headlines for being turned down in a medical crisis. What ...

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