The worst thing anyone ever said to me was, “You think you know everything, but let me tell you:  You don’t know jack!” I was six weeks into my social work internship at a hospice and it was my student supervisor who decided I needed an attitude adjustment. Needless to say, I didn’t stay there. I was angry and hurt for a long time but now I’ve come to realize ...

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Earlier this year a child died following a surgical procedure in California for a condition called obstructive sleep apnea. The case generated a great deal of concern among parents about both this condition and the surgery often done to treat it. I wrote a post myself about it at the time. I still get questions about it because I care for quite a few children immediately after they have had ...

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When I hear debate over the association between SSRIs (selective serotonin re-uptake inhibitors, a class of antidepressant medication) and suicidal behavior in children and adolescents, I am immediately brought back to a night in the early 2000s.  As the covering pediatrician I was called to the emergency room to see a young man, a patient of a pediatrician in a neighboring town, who had attempted suicide by taking a nearly ...

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If you’ve ever worked in an emergency room, you’ve likely treated a victim of human trafficking. We all have, often without knowing it. With nearly thirty million people in modern-day slavery around the world, there are more slaves today than at any point in history. Human trafficking is defined as “the recruitment, harboring, transportation, provision, or obtaining a person for labor or services, through the use of force, fraud, or coercion” for the ...

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Most hospitals are strapped with a massive amount of debt.  Not monetary debt, but sleep debt.   Amongst both the staff and patients, sleep is severely lacking.  In our busy society, we associate sleep with leisure and relaxation; a reward at the end of a long day.  But sleep isn’t a luxury.  Rather, it’s a medical necessity. Sleep deprivation has widespread consequences, causing cognitive dysfunction, weakened immune system, impaired healing, increased blood ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started ...

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We live in a digital age. Technology has become an integral part of how we see, learn about, and interact with the world. From computers at the office, to televisions at home, to smartphones on the bus or in the grocery line, many of us spend over half of our waking lives in front of a screen. Naturally, some of us have begun to worry about the effects this may have ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 21-year-old man is evaluated during a medical examination for health insurance. The patient is a weight lifter. He has no medical problems and takes no medications or illicit drugs. On physical examination, blood pressure is 128/73 mm Hg, pulse rate is 56/min, and respiration rate is 16/min; BMI is 30. Increased skeletal ...

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From time immemorial until about 75 years ago or so most babies were born at home. Now it’s around 1% in the USA, although it’s much higher than that in many Western European countries. The shift to hospital births paralleled the growth of hospitals, pediatrics, and obstetrics. With that shift there has been a perceived decrease in women’s autonomy over their healthcare decisions. There has also been an unsurprising jump in ...

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Last week a patient said to me, "You live your whole life thinking you're going to have time to enjoy life later on, and then this happens." Then he started to cry because we had just reviewed his recent CT scans and some of his lab results and he had a new diagnosis of a type and stage of cancer that meant he likely had about eight months to live. ...

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