Only in America can we find a way to scare the bejesus out of a woman with normal breasts and a normal mammogram. Because that’s exactly what happened when New York Times reporter Roni Caryn Rabin read her entirely normal mammogram results letter: "A sentence in the fourth paragraph grabbed me by the throat. 'Your breast tissue is dense.'" I can’t really blame Rabin for being afraid. The information about breast density in ...

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Recently, in front of my family, friends, colleagues, and teachers, I accepted my diploma during the graduation ceremony for the UCLA psychiatry residency program. While it wasn’t my real diploma -- it’s been months since I’ve been able to work, so when I’m better I need to go back and finish some requirements -- my residency program coordinator put together an awesome fake diploma so I would have something to pick ...

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With advanced cancer, there are no guarantees"I just want to know that she'll be able to travel," my patient's husband said. Stan and Jane Jackson (names changed) sat side-by-side on the mauve loveseat in the exam room. A binder filled with sheaths of paper -- copies of Jane's lab reports, CT scan reports, discharge papers, and chemotherapy information handouts -- sat open on his lap. On top ...

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I wrote recently about getting started with an evaluation for a child who’s not doing well in school. Don’t rush to just do ADHD testing: There are many reasons for attention problems, and it’s best to not just zero in on ADHD at the start. Still, there’s a time when confirmation and testing for an ADHD diagnosis is appropriate. What kinds of tests are available? A clinical history is, well, talking ...

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It is so nice to be right. To summarize what I wrote almost 4 years ago, based on my experience, patients and families will accept the theoretical risk of a future cancer if it means they'll get an accurate diagnosis. A recent study validates that opinion. MedPage Today reports that before receiving any recommendation for CT scanning, 742 parents of children who presented with head injuries ...

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Recently, a family physician colleague asked me to explain why the Affordable Care Act requires private health insurers to provide first-dollar coverage for preventive services that the U.S. Preventive Services Task Force assigns an "A" or "B" (recommended) rating, but allows public insurers (Medicare and Medicaid) to determine if and how they will cover these services. Until recently, the question hadn't come up, since Medicare has agreed to cover pretty ...

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Our nation has recently witnessed another tragedy involving a young adult, with young adult victims. Facts often emerge slowly and it is important not to speculate about diagnoses through the news media; however, it seems clear in this case that mental illness is a factor -- even though few people living with mental illness are violent. To avoid tragedies, solutions are needed.  One area of real promise is early ...

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A total knee replacement is a very common operation and more than 700,000 of them are performed each year in the United States. With a mean cost of about $16,000 each, in 2011 we spent over eleven billion dollars paying for knee replacements. Projections are that, by 2030, we’ll be doing 3.5 million per year. The operation has great results and patients generally do well during and after their surgery. Anesthetic care has improved dramatically ...

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Toilet training can sometimes be a stressful process. This is particularly the case for children who achieve daytime dryness but continue to wet themselves, and the bed, overnight. It may leave you wondering what’s normal and what you can do to help your child. Nighttime wetting is one of the most common urologic conditions in childhood. The vast majority of cases are not related to a physical cause. Most commonly, nighttime ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old man is evaluated for a 1-year history of cough with mucoid sputum and a 6-month history of mildly progressive dyspnea. He has a 12-pack-year history of smoking. He has no history of asthma, allergies, skin disease, or liver disease. On physical examination, vital signs are normal. Pulmonary examination discloses decreased breath ...

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