Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is seen for follow-up evaluation after results of a carotid ultrasound obtained to investigate a left neck bruit show a mixed density plaque at the origin of the left internal carotid artery. Stenosis is estimated to be 60% to 80%. He has had no ...

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In a world of diverse mental health treatments and treatment settings, psychoanalysis and psychodynamic psychotherapy have lost their former prominence.  Only a small fraction of patients have the time, money, and interest to engage in long-term, open-ended mental exploration -- even if doing so would get to the root of their problems and lead to lasting improvement. More commonly, emotional distress is dealt with in emergency departments, in crisis clinics, on the medical and surgical floors of hospitals, in ...

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As a consultant in gynecologic pathology, I receive requests for second opinions from patients who have been diagnosed with endometrial hyperplasia. My opinion is based upon correlating the relevant clinical history with a review of the patient’s pathology slides and report. In my experience, there is a difference of opinion that leads to a change in treatment in about half of the cases. 75 percent of cases with changed diagnoses ...

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No matter how well the one you love ornaments your life, they should never be an ornament. Meaning — you should never have to find them hanging in the closet like it's some tree where each broken branch represents sadness, sickness and issues that only make sense in hindsight. That metaphorical tree was as astonishing as Christmas morning yet as terrible as a Halloween horror. And although surreal — like Dali ...

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After years of declining rates of colorectal cancer (CRC), a study from the American Cancer Society raises the specter that not all is going as well as we would have hoped, especially among younger folks born since 1990. And that raises the question of what the future holds for this frequently preventable form of cancer, ...

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Two years ago, former President Barack Obama announced the Precision Medicine initiative in his State of the Union Address. The initiative aspired to a “new era of medicine” where disease treatments could be specifically tailored to each patient’s genetic code. This resonated soundly in cancer medicine. Patients can already manage their cancer with therapies that target the specific genes that are altered in their particular tumor. For ...

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After Michael Uvanni’s older brother, James, was diagnosed with a deadly form of skin cancer, it seemed as if everyone told the family what they wanted to hear: Have hope. You can beat this, and we are here to help. The brothers met with doctors at a half-dozen of the country’s best hospitals, all with impressive credentials that inspired confidence. Michael Uvanni was in awe when he visited the University of Texas ...

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As New Jersey Governor Chris Christie takes the lead in crafting the Trump administration’s response to the opioid crisis, he and his colleagues need to understand that we can’t fix the problem until we kick our long-term addiction to the war on drugs and accept overdoses for what they are: a health ...

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I met “Samantha” during my first rotation as an intern. She was a strong-willed and optimistic lady who weighed about 100 pounds. She was dependent on a tube in her stomach for nutrition, and she appeared 10 or 15 years older than her age of 44 years. Pictures of her children were next to her bed. I asked her how we could help her. She cried. Her husband of 20 years ...

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Why does the universe have conscious beings? The physical and biological laws of nature do not seem to explain the existence of conscious creatures such as humans. Neuroscience has done well to explain many of our behaviors, illnesses and medical therapies based on purely physical and observable rules. But no one has ever measured consciousness. And yet it appears fundamental to whether my patient will recover from their disease. After 15 ...

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