My grandmother's room is silent, save for the plucks of sitar strings and Pixar movie soundtracks I try to stimulate her with. Instead of books, we fill the shelves around her bed with mouth swabs, drab hospital gowns and vials of baby powder. My grandmother — who walked an hour every day, who thrashed me in gin rummy, who rose before sunrise every morning to read — now lies bedridden ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 56-year-old woman presents to the office to discuss management of her type 2 diabetes mellitus. She is unhappy with her recent HbA1c value. She adheres to the maximum dose metformin monotherapy, which she has been taking for 1 year. Additionally, she has been working toward weight ...

Read more...

Ask babies with fever how they feel, and they’ll say … well, they probably won’t say anything, because they’re babies. But ask older kids, and they’ll look at you funny, and maybe say “Why are you asking me?” Kids these days, am I right? Fevers make kids feel bad. Achy and miserable and bleh. So for comfort, I think it’s a good idea to treat fever in a child who’s uncomfortable. ...

Read more...

That’s the question sticking in my mind after reading a recent report about a local radiology practice opening a large mammography center in an upscale shopping mall in Long Island, New York. Let’s face it: Medical care is changing. And with changes come new ideas. Some will work, some won’t. The thought of getting a mammogram while on a shopping trip may just be what the doctor ordered ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 37-year-old man is evaluated for a 2-year history of low libido, loss of morning erections, fatigue, and decreasing muscle mass. His medical history is otherwise unremarkable. He takes no medications. On physical examination, vital signs are normal. BMI is 35. The remainder of the examination, including genital ...

Read more...

My nurse practitioner was pleased to see me at my annual physical this year. “So how does it feel to be 20 pounds lighter?” “It feels terrible,” I replied. Allow me to explain. Weight has been an issue my entire life. Raised on a standard Midwest diet of complex carbohydrates and the best processed delicacies that government assistance could buy, I spent most of my childhood socially segregated by my peer group due ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated for a 2-year history of cough and a 1-year history of increasing dyspnea. He describes the cough as nonproductive, and his shortness of breath is worse with exertion. He does not have chest pain, orthopnea, paroxysmal nocturnal dyspnea, or any other symptoms. ...

Read more...

A few thousand years ago, a talking snake convinced a child to pick a piece of fruit, squeeze it really hard, and drink whatever came out. The kid liked it, obviously, because what’s not to like about juice? So the next day at preschool, he told all his friends to ask their parents for juice, too. Some of them said the magic word; others just whined until their parents gave ...

Read more...

I carried it around with me the entire shift. I showed it to my E.R. colleagues, the internists, and even a couple of surgeons. I’d tell them the story. “Never,” one of them said. “Not in twenty-eight years. Never seen that before.” One of them held the small urine jar up to a light and began unscrewing the lid. “Don’t!” I said. “Why not?” “It stinks. You wouldn’t believe how much it stinks. We ...

Read more...

Recently after pulling a couple 20-hour shifts, people kept encouraging me to sleep on my break. They were obviously concerned for my well-being but it got me thinking more about the role sleep plays in our lives. If the average life expectancy is 78 then we spend 30 percent of our lives asleep which is also the same amount we spend in our cars commuting, and a meager 0.16 percent ...

Read more...

Most Popular