When I think back about what I learned about drug addiction in medical school in the 1980s, I can’t think of much. Sure, I talked to plenty of patients who had been snorting coke and injecting heroine. One man with AIDS promised to teach me how to draw blood, if I’d sit by his side and keep him company. He didn’t have any other visitors. Maximum security prison where he was ...

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This post is purposely controversial.  I write it because I believe that mounting evidence suggests that we should encourage “out of the box” thinking about this issue.  This post is hypothesis challenging.  I may be right, or I may be wrong.  I hope we get some debate on my speculations. The latest blow to the cholesterol hypothesis: "Dashing Hopes, Study Shows a Cholesterol Drug Had No Effect on Heart ...

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Over the past few months, the federal government has mobilized against what is being called "the opioid crisis": a national epidemic of fatal overdoses that in 2014 claimed more than 14,000 lives, the most ever recorded. Since most of these opioids were originally prescribed by physicians to treat pain, the Centers for Disease Control and Prevention recently finalized a guideline containing recommendations for appropriate opioid ...

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“One can dream.” That’s often a quote we hear when we talk about winning the lottery or landing a job that lets us do something great like being a taster of new ice cream flavors for a living (I wish). However, what’s sad is that many American moms utter those same words when they think about life after baby. A year of paid maternity leave. Access to a good lactation consultant. Family members who ...

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Today’s restless society has taken its toll on modern medicine. Among all the strategies for protocol optimization and health insurance improvements, doctors get to spend less and less time actually talking to their patients. Each check-up needs to be performed in a certain amount of time, and every procedure needs to be completed as quickly as possible so that hospitals are efficient and profitable. While this makes perfect financial sense, it ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 77-year-old woman is evaluated 4 months following a left middle cerebral artery ischemic stroke. The severity of her stroke required prolonged initial hospitalization and a 3-month stay in a rehabilitation center before returning home. Residual deficits include dense right-sided hemiparesis and dysphagia requiring oral feeding with thickened liquids. Medical history is ...

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We are born with arms wide open, and we die in much the same way.  It is that which we carry, in the time between, that defines us. The newborn, caught in the primordial stew of beginnings, is unable to recognize the difference between self and other.  She grasps and roots at inanimate objects with the same voracity she reaches for her mother.  It is a time of differentiation, a time ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 30-year-old woman is evaluated for a 2-day history of increasing pain in the right antecubital fossa and biceps. She reports daily injection drug use. Medical history is otherwise unremarkable, and she takes no prescription medications. On physical examination, temperature is 39.7 °C (103.5 °F), blood pressure is 90/56 mm Hg, pulse rate ...

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Back in my first year of blogging, I wrote a post, titled "A Day Without a Diagnosis," about the way we now spend most of our time “managing” chronic diseases, some of which weren’t even considered diseases when I went to medical school. That’s not how all my days go nowadays: A week ago I had a day of some very real doctoring. My first patient of the day was ...

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"I hereby authorize xxx, my patient, to donate plasma up to two times per week." I moved to Cleveland over the summer to start work as a full-time primary care internist. Within a few weeks, I started receiving a form in my mailbox that I had never seen during my training in San Francisco: an authorization request for my patients to donate their plasma. By the time the fourth form came, I realized ...

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