A female patient came to see me with some difficulty swallowing, a very routine issue for a gastroenterologist.  I performed an scope examination of her esophagus and confronted a huge cancer occupying the lower portion of her esophagus. I expected a benign explanation for her swallowing issue.   She was relatively young and not particularly ill.  She had seen my partner years in the past for a similar complaint, which he ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated during a follow-up visit. She has a history of well-controlled hypertension and type 1 diabetes mellitus. She is at 16 weeks' gestation with her first pregnancy. Prior to conception she was taking lisinopril, which was discontinued in anticipation of the pregnancy, and labetalol was initiated. Other medications ...

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I’ve been invited to speak to a group of attorneys who work at the interface of psychiatry and the law. The topic of my talk? “Psychiatry 101.” A psychiatrist who gave this talk to a similar group a few years ago advised me: “You should assume that lawyers are laymen. It’s surprising how little they know, given the work that they do.” This teaching opportunity to teach has given me pause: What is mental ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old woman is evaluated during a routine examination. She is concerned about her gradual weight gain over the years and requests counseling on how she can most effectively lose weight. Over 8 years, she has gained approximately 18 kg (40 lb). With several commercial diets, she has lost weight but always gains ...

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As someone involved in both the medical and acting world, I was tremendously saddened to read about Dr. Fredric Brandt’s recent suicide, which is presumed to be in response to an impersonation of him on the Netflix’s series, The Unbreakable Kimmy Schmidt.  Project Casting, a website offering free casting calls and auditions, posted a link on their website asking, “Did Netflix go too far” and I was shocked by people’s ...

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A pilot deliberately flying a plane full of passengers into a mountain is horrific, unbelievably sad, and, thankfully, very rare. But suicide is far from rare. Tragically, those usually lonely acts of despair are rising.    But can they be prevented? Someone in this country dies by suicide every 12.8 minutes. The national suicide rate has increased to 12.6 suicide deaths per 100,000 and for ages 18 to 35 -- the prime of one’s life ...

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$28 million was awarded to a patient for a late diagnosis of a pelvic tumor, an osteosarcoma. This rare cancer presented as a case of low back pain and sciatica. The patient claimed that if the osteosarcoma had been caught earlier that the subsequent surgery would have been avoided. Could doctors have done better in diagnosing more quickly? These cases strike fear into all primary care doctors. Which patient has a ...

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Many people know what it feels like to be depressed. It’s hard to go through life without at some point experiencing that helpless/hopeless feeling. Some people, however, stay stuck in this painful state. In my family therapy practice, I frequently get calls from people seeking help for depression. Sometimes their depression is self-diagnosed, reflecting their experience of ongoing distress.  Other times they’ve been referred by their family doctor.  It’s common ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 46-year-old woman is evaluated before undergoing a dental cleaning procedure involving deep scaling. She has a history of mitral valve prolapse without regurgitation and also had methicillin-resistant Staphylococcus aureus (MRSA) aortic valve endocarditis 10 years ago treated successfully with antibiotics. The patient notes an allergy to penicillin characterized by hypotension, hives, and ...

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When I was a resident, I saw a middle-aged man, “Charles,” who came into the hospital after playing a round and a half of golf. When I looked at his right foot, he had an ulcer in the shape of a golf tee. He had played the entire day with a golf tee in his shoe and only noticed when he found drainage on his sock. The story sticks in ...

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