Knee replacements are booming. Between 2005 and 2015, the number of knee replacement procedures in the United States doubled, to more than one million. Experts think the figure might rise sixfold more in the next couple decades, because of our aging population. Since many people receiving knee replacements are elderly, Medicare picks up most of the cost of such procedures. In response to this huge rise in expenditures, ...

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The ER doc sounded genuinely concerned, which is never a good sign. “Sixty-year-old guy, no real medical history, dude is seriously hallucinating. Head imaging is negative. Can you come take a look at him?” I flitted through the chart. A car accident a few years ago that left him with chronic, poorly controlled migraines. Depression, on Prozac and well controlled. That was pretty much it. I grabbed my stethoscope and ...

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Pediatricians face a difficult task determining when to refer a child for a suspected bone marrow failure syndrome. We now realize that only a subset of children with bone marrow failure syndromes present with the findings described in textbooks.  These children often appear well and lack classical physical stigmata. By the time they look sick, their marrow’s ability to produce blood cells can be so weakened that it could be ...

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FODMAP what? Have you heard? It’s the new dietary approach for the bloating and belly cramps seen with irritable bowel syndrome (IBS). IBS affects one in seven Americans. It’s a gut condition which affects the flora in the bowels and causes abdominal pain, cramping, diarrhea or constipation, bloating, gas and overall discomfort and misery. It can be life changing and debilitating; jeans and Spanx don’t stand a chance! IBS has been ...

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On January 31, 2017, the Psychology Today editorial staff published a well-balanced summary of the debate over whether to declare President Trump mentally ill. While the debate focuses on mental health professionals such as psychiatrists and psychologists who are credentialed to make such diagnoses, the question clearly goes further. Public commentary following this and other articles expresses outrage -- not only at the behaviors and policies of Trump himself, but also at any suggestion ...

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Most health care professionals went into the field because of a calling. For many of us, it is not just a career but a sense of mission. While the system drives hoards to the brink and over the edge of burn-out, a sense of purpose remains. The goals are not the same for all, but it is a good time to re-examine our life goals. Being a doctor, or any professional ...

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Early in our careers, few of us imagined a vaccine could one day prevent cancer. Now there is a vaccine that keeps the risk of developing six Human Papillomavirus (HPV)-related cancers at bay, but adoption of it has been slow and surprising low. Although it’s been available for more than a decade, as of 2014 only 40 percent of girls had received the full three doses of the vaccine, ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. When the American College of Physicians (ACP) and the other primary care societies introduced the Patient-Centered Medical Home (PCMH) over 10 years ago, the model was untested.  Here’s a look at how the PCMH recognition process has evolved and how my ...

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I am a new mom to a beautiful 8-month-old girl, and I am breastfeeding. I am also a doctor at a large, well-known academic institution. The hospital where I work delivers several thousand babies a year, and highly encourages their new moms to breastfeed. They offer a postpartum consultation with a lactation consultant, keep the baby in the mom's room 24/7 while in the hospital, and provide several other pro-breastfeeding ...

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An article from the Wall Street Journal caught my attention, and for all the wrong reasons. It was a review of two recent studies showing that medical trainees have difficulty diagnosing patients with complicated histories or confounding psychosocial features. At least, that’s the way I would describe those studies. The WSJ, however, used much more pejorative language, referring to them as “difficult patients,” “a nuisance,” and “an annoyance.” The ...

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I’m a member of the 25,000-strong medical school graduating class of Obamacare. We were pre-med college students during the debate over the Affordable Care Act (ACA) and began medical school during its implementation. We put ourselves into deep debt and studied late into the night with the promise that we would practice medicine in a system that promoted insurance coverage, reduced medical bankruptcy, and incentivized high-quality care. Increasingly, we see that promise ...

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During residency, one of my patients brought a tape recorder to his appointment.  It was a big bulky old tape recorder, that was antique technology ten years ago.  He was older and wanted to record his appointment so he could remember every detail.  His children often called him and wanted an in-depth report of all of his medical visits.  He decided he would audio-record his appointments and send the tape ...

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It was around 2 p.m. when a 380-pound woman came into the ED. She was in her late 30s. The physician went to see her and then ordered IV fluids, some basic blood tests, and a urine sample. At a hospital, everyone’s job is made harder when a patient is obese. Getting the patient on the bed requires more personnel. Inserting an IV -- an intravenous catheter to infuse fluids or ...

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One of the most memorable times from my family medicine training days was the annual residency my intern year. It was the year of the World Cup, and a bonding experience that would later save my life.  Being able to be with not only my residency class, but also the faculty in a relaxed and empowering environment brought a sense of safety that allowed me to reach out to one ...

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The amount of prescribed medications and the number of individuals taking them are increasing rapidly. The share of Americans taking one or more prescription drugs has risen among all age groups. According to the IMS Health Study, the total spending on prescription drugs in the U.S.  reached $310 billion in 2015. This is almost three times more than total drug expenditures in the year 2000. It is forecasted that the ...

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“Bask in the glory, toots. You deserve it!” I received this text message from my very dear friend a few days ago after an extraordinary occurrence. I’m a retired internist, and recently my clinical acumen and intervention saved another friend’s life. That is a statement of fact, not a boast.  And that’s why I’m writing about it. The patient, a retired surgeon, hosted our circle of friends’ New Year’s Eve party a little ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including ...

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Sure, it’s nice to think about cutting back on the work hours and spending more time at home with the kids. Or out on the running trails getting fit and enjoying nature. Or singing in a chorus. But how do you really make that decision? And if you do decide to work part-time, how do you make the most of it? After struggling to juggle two full-time health care careers with ...

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A computer algorithm learning how to play StarCraft like a champ may raise some eyebrows, but when algorithms start to give the skills of a trained physician a run, job security becomes a futile construct. An algorithm now diagnoses melanoma as well as a dermatologist: A consolation for the dermatologists, though: Folks across the hallway -- the radiologists and the pathologists -- are feeling the heat as well. ...

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The Mylan EpiPen debacle may have inadvertently weakened the grip of big pharma on U.S. lawmakers.  Recently, a bill proposed by Senator Bernie Sanders was narrowly rejected by a vote of 52 to 46.  Unexpectedly, 12 Republicans and 1 Independent voted with Senator Sanders in favor of allowing pharmacists and distributors to import cheaper prescription drugs from foreign countries.  The winds of change may finally blow in a bipartisan direction.  ...

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