A patient I see for psychotherapy, without medications except for an occasional lorazepam (tranquilizer of the benzodiazepine class), told me his prior psychiatrist declared him grossly undermedicated in one of their early sessions, and had quickly prescribed two or three daily drugs for depression and anxiety.  He shared this story with a smile, as we’ve never discussed adding medication to his productive weekly sessions that focus on anxiety and interpersonal conflicts.  Indeed, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old woman is evaluated during a routine follow-up visit. She was recently diagnosed with type 2 diabetes mellitus and hyperlipidemia. She feels well. Medications are metformin, atorvastatin, and aspirin. Physical examination findings and vital signs are normal. BMI is 27. Laboratory studies reveal a serum creatinine level of 0.9 mg/dL (79.6 µmol/L), an ...

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I have a patient with very unusual visual symptoms and sense of imbalance that has persisted for more than a year.  She describes very unusual and concerning symptoms including true diplopia, a sense of major visual disturbances like the floor buckling in her visual fields, vertigo, severe sense of imbalance and swaying, headache, memory fog and concentration difficulty. Of note is that her symptoms seemed to start after a cruise.  I ...

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While it is unusual for gastroenterologists to see colorectal tumors in patients under the age of 50, and even more uncommon before the age of 40, it does happen, so patients need to be aware of their risks. Colorectal tumors in young people are often detected either through symptom evaluation or because of a colonoscopy performed for an underlying risk factor, most commonly a family history of colorectal cancer (CRC). During ...

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The page comes from the psychiatry intern on call. “There’s a situation with patient RB on the unit. Please advise.” We gather in the hall outside the patient’s room. There are already three -- no, four -- security guards standing several feet away with their arms folded. Backup. Ready. Ready for what? We whisper in hushed tones as the intern explains what happened. He was “acting out.” He was running through the ...

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I recently fulfilled my civic responsibility by completing a stint on jury duty. Somehow I had never previously been summoned. Being the Law & Order junkie that I am, I was kind of awestruck by my first up-close exposure to the court system. I sat erect and at attention in the courtroom, listening to the judge charge us prospective jurors. I even became slightly teary when he spoke of the important role we ...

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Among the more contentious issues regarding health and weight control -- perhaps surprisingly, contentious among professionals and the general public alike -- is the role of personal responsibility. Unfortunately, this readily devolves into discord, because the cultural tendency of our time is denigrate those with whom we disagree, and hunker down in our distal, opposing corner. Just take a look at Congress to see how well this is ...

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Schuur and colleagues in JAMA Internal Medicine listed five low value services in the emergency department (ED). Although compilation was not solicited by the American College of Emergency Physicians as part of the Choosing Wisely program, it has its ethos. The list was developed by a technical expert panel after multiple iterations. The list is not only wise but derived from sound methodology. Most importantly, the recommendations are ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old man is evaluated for a 2-week history of nonproductive cough and fever. He has a 20-year history of asthma. Three weeks ago, he visited friends in Indiana. He has no dyspnea, hemoptysis, or worsening of his baseline asthma symptoms. His only medication is an albuterol inhaler as needed. On physical examination, ...

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In the first recent piece of good news about the child obesity epidemic, the latest statistics on preschoolers -- those 2- to 5-year-old bundles of joy whom we worry about so much -- suggest that they’re less obese than they used to be. Between 2003/2004 and 2011/2012, according to the Centers for Disease Control (CDC), there was a huge drop in the ...

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