A popular meme is that the U.S. spends more on health care than other developed nations but has nothing to show for that spending. This is different from saying that the U.S. spends more, but achieves something, but the something it achieves is so little that it isn’t worth the public purse. The latter is difficult to assert because the asserter must then say how little is too little in ...

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I’m just coming out of two years of sleep deprivation. Due to some sleep apnea issues (hopefully finally resolved), my now two-year-old daughter slept like a newborn until this summer. Which means, like the mom of a newborn, I was up every three hours at night for the last two years. This has given me more experience in living with sleep deprivation than I ever wanted and plenty of time to think ...

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We fought. And we fought hard. We were smarter and quicker and we could multi-task, and critically think beyond any MD or NP or PA or beyond any cardiovascular ICU (CVICU) nurse. We always thought we had the higher acuities. We had the critical patients. The multi-system failure patients. The hemodynamically unstable patients. We had to figure out the lungs, the heart, the kidneys, the brain, the pancreas, the gallbladder, the liver. And ...

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A study published in JAMA Dermatology regarding women’s pubic hair grooming practices has people abuzz. This cosmetic act needs a formal medical name because “clamscaping” just doesn’t work on grant applications. Although why the authors couldn’t go with hair removal, I don’t know. The study wasn’t about styling, it was about removal. The study even made it into the New York Times. And yes, my first ...

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A 21-year-old woman is evaluated for management of type 1 diabetes. She was diagnosed 3 months ago after presenting to the emergency department with diabetic ketoacidosis. Her HbA1c level at the time of diagnosis was 15.2%. She was discharged from the hospital on a basal and prandial insulin regimen with minor adjustments required as an outpatient. Her blood glucose log demonstrates a recent change manifesting as frequent symptomatic episodes of ...

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Psychosomatic. I learned not to use that word forty years ago, after I'd told a patient her malady might be psychosomatic in origin. She turned red, jumped up, and on her way out said, “I hope you fall into an open manhole and die!” Well, maybe I should've been more circumspect. I hadn't realized until then that people can understand “psychosomatic” in a different way than I do. I'd meant what ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 34-year-old man is evaluated for progressive left knee pain. The pain causes difficulty with his work as a mail carrier, particularly when walking. His occupation does not require repetitive bending. He played football in college and experienced left knee trauma during sports participation; he underwent left meniscectomy and stopped playing ...

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It was an interesting fortnight for the debate about the treatment of appendicitis. On November 1, David Agus, a medical oncologist, and director of the University Of Southern California's Center for Applied Molecular Medicine, had some thoughts about how appendicitis should be treated. He cited the Finnish randomized trial of antibiotics vs. surgery and said a 70 percent cure rate was good enough. In a brief article on the Fortune magazine website, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is evaluated in follow-up for a right-sided pleural effusion. He initially presented with increasing dyspnea and a constant dull ache on his right side. He also has lost 9.1 kg (20.0 lb) over the last 6 months. Medical history is otherwise unremarkable, and he takes no medications. He ...

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This is a story of a very special patient. A story that may change your outlook on life. When I first met her, there was an interesting aura that surrounded her. An aura of positivity and contentment. She was listening to her favorite band on her iPhone and humming along. Her carefree countenance was perfectly paired with the jovial tunes. I had admitted her to the hospital for an infected bedsore. She ...

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