Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated for a 1-year history of loose stools. She reports approximately four episodes per day without abdominal pain. She has not had nausea, vomiting, weight loss, bright red blood per rectum, or melena. On physical examination, temperature is 36.7 °C (98.1 °F), blood pressure is 115/85 mm Hg, pulse ...

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shutterstock_284306441 How do we measure a doctor? Hospital length of stay? Infection rate? Flu shot compliance? Waiting time? These reality surrogates do not tell us how a patient feels or the quality of life. They are complex to measure, require major data crunching and may not focus on an individual physician. This week, two patients reminded me of a basic screening tool for ...

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Fecal microbiota transplantation (FMT) is the process of administering a preparation of healthy donor stool to a patient with a certain disease, usually Clostridium difficile colitis, in an attempt to treat the disease.  I covered some of the basics about the microbiome and FMT in a previous article, so this will just be a cookbook-style post on how we do FMT with colonoscopy. First, a healthy donor must be identified.  The donor ...

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shutterstock_159719039 This past March, thousands descended on Austin, TX, home to the famous and much celebrated South by Southwest (SXSW®) conferences and festivals. This year, I decided to attend the education-focused festival, SXSWedu®, a relatively new addition to the SXSW® family of events.  A four-day conference chocked with interactive workshops, panel sessions, and even play summits, SXSWedu® is designed to showcase the creativity ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 52-year-old man is evaluated during a routine examination. He is asymptomatic but is concerned about his weight. Medical history is significant for prediabetes and elevated cholesterol levels. He smokes one or two cigars a week. He drinks one or two alcoholic beverages a few nights each week. He does not get ...

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shutterstock_146497481 Genomics and its impact on clinical medicine appear to be the topics du jour. The science is rapidly advancing, but our ability to understand and apply that science may not be keeping pace. The question is whether expectations will meet the promise, and are we wise enough to navigate the maelstrom and bring true benefit to our patients and consumers in general? Three ...

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While sitting in the study lounge of my med school, I had on my computer screen one of our three slides on anencephaly. I was trying to memorize the two key phrases framing the graphic photograph of a stillborn baby with bulging eyes and a cratered head -- “anterior neural tube defect,” and “elevated alpha-fetoprotein.” A third year walked past me and sneaked a glance at my screen. Without faltering ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 78-year-old woman is evaluated for a rapidly enlarging neck mass that has been present for 4 weeks and is associated with neck discomfort, dysphagia, and hoarseness. The patient has had Hashimoto thyroiditis and hypothyroidism since age 24 years and has been taking levothyroxine since that time. Physical examination reveals an older woman ...

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shutterstock_166859618 Every few news cycles placenta-eating seems to make the rounds. I’ve already seen it a couple of times this year, so I figured the Internet is trying to tell me something. Some women, but mostly those who recommend and/or prepare placenta for them, think that ingesting placenta can cure/help postpartum depression and possibly a host of other postpartum ills and issues. Some ...

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Kevin-Dietl-crop-2 Medical school graduation: Time to celebrate our brand new doctors! Except for the families who can’t celebrate their child’s graduation. Or their child’s marriage. Or their child’s birthday -- ever again. Like Michele and John Dietl. They lost their son, Kevin (pictured above), just weeks before graduation. Now they cling to online condolences and family photos. And to the never-ending question: Why? I’ve become a sideline specialist ...

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