As rheumatologists, we pride ourselves on spending time with our patients, listening to their problems and their family’s problems, and answering all of their questions. Whenever my husband and I run into a patient of mine on the street, they always tell him that I am the best doctor ever. In spite of these accolades, I realized recently I was guilty of doing something with a handful of my patients ...

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Upon starting medical school, I remember feeling amazed to learn just how many of my classmates had physician parents. I felt like I was in the minority, not having any family members of my own who were doctors. This made me realize: Physician parents tend to breed physician children. But why? I soon discovered that the answer may lie in the genetics of personality. The academic study of personality has grown extensively over ...

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On my last day of internal medicine residency, as I finished my senior grand rounds presentation, I “came out” to my colleagues and confessed the deep dark secret I had been hiding since medical school: I have fibromyalgia. A few jaws literally dropped, and there was an awkward silence, then polite applause. Afterwards several of my colleagues came up to talk with me privately and were offended and/or curious as to ...

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The term “big data” is a favorite mantra of health care today. Big data sets are starting to drive much of what is done in medicine including directing research, drug development, clinical pathways, insurance coverage and public opinion. The official definition of “big data” in health care is subject to interpretation by different sources. One dictionary defines big data as “data of a very large size, typically to the extent ...

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Early on a random Tuesday morning, I walked into the burn unit and found my 87-year-old patient, Mr. Gray, in septic shock. While Mr. Gray’s burn injury was small by our standards, it appeared that the sequelae of the injury might prove fatal. I called Mr. Gray’s wife to obtain consent for a vascular catheter through which I planned to begin continuous dialysis and was surprised when she declared, “No ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty ...

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It was several years ago. I was a first-year internal medicine resident. Keen, tired, overworked, and still idealistic. Mr. Smith was a 45-year-old lawyer who rolled into St. Paul’s Hospital Emergency room, while our medicine team was on intake. He was a healthy appearing lawyer who noted that for the past month he had become more short of breath performing his regular exercise. Things were especially bad for him during ...

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Jim Morrison of the Doors once sang, "Petition the Lord with prayer ... You cannot petition the Lord with prayer." But we did that. We petitioned. On one side of the ICU, we had an 18-year-old girl, upper middle-class family, had everything. Beauty, brains, money, supportive parents, and she was off into this new bright world, choosing her college of choice. A simple surgery led to sepsis, severe sepsis that raged through ...

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Many of us harbor an archaic view of what health care is, so let me offer a little history. During the past century, it's changed from Healthcare 1.0 to 2.0, and now it's Healthcare 3.0. In the early twentieth century, Healthcare 1.0 was a service, though it amounted more to personal contact than effective medicine. At best, medications and procedures were hit-and-miss, so doctors relied heavily on their relationship with their ...

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You start out by working in a busy emergency department. You see patients with all sorts of complaints: abdominal pain, headaches, and chest pain. Vomiting, diarrhea, and dysuria. Ankle sprains, bug bites, and allergic reactions. Domestic violence, rape, and child abuse. You don’t ever let the stress of the job take away your humanity. You treat your patients with empathy and respect. You listen to their stories, treat their symptoms, contact the police, ...

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