A few years ago, a patient of mine was diagnosed with lung cancer.  A metastatic work up revealed a small mass in his liver that had the radiographic appearance of a benign liver cyst.  But in the setting of a newly diagnosed lung cancer, we couldn’t be sure it wasn’t a metastatic lesion, so we decided to biopsy it.  Due to scheduling issues, we couldn’t get it done for seven ...

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by Brad Stuart, MD Atul Gawande’s brilliant essay in the New Yorker sums up the dilemma we face, whether we’re patients, families, and/or clinicians, as we near the end of life. His point is that we have to face it together: “People die only once. They have no experience to draw upon. They need doctors and nurses who are willing to have the hard discussions and say ...

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As an e-Doctor, one with some IT literacy, I welcome the e-Patient movement. I think patients should be equipped, enabled, empowered, engaged, equals, and emancipated, as Wikipedia explains.  The link also adds “and experts” and here I have a problem, not because I don’t think patients should have access to knowledge or know a lot about their own disease, but because knowing one pattern of pathology, i.e. your own, does not make you an expert. No more ...

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by Edward Stevenson One of the things that drew me towards medicine was the fact that I personally value health and the sense of well being. I would expect that if I inquired of my colleagues that a similar statements of values would echo this fact. Yet despite this near universal affirmation of value for health and well-being, a considerable amount of hypocrisy exists in the ...

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When I ran into Paul S. not knowing he had cancer, I barely recognized him and struggled with what to say. “What happened?” didn’t seem appropriate, although it was my initial reaction. I believe I said, “I barely recognized you,” which was true. I’ve been in many situations where I wasn’t sure what to say to someone who was ill or in distress; I wanted to be supportive ...

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by Devin Gross Here’s a question. It’s not a 5¢ or $5 question that anybody can solve on their own without much thought or effort. It’s a $100 ask-an-expert or think-about-it-for-a-second question. What’s the point of patient empowerment? Much of the current discussion of empowerment deals with patients who for one reason or another have had to fight for their care. CNN’s Elizabeth Cohen opens her book, ...

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Grandmother Pat LaColla, 82, was lured by the hype—"get in shape without setting foot in a gym"—when she bought a pair of Skechers last year, wincing at the $100 price tag. Toning shoes like those she bought are the newest craze in athletic footwear, projected to grow 500 percent to become a $1.5 billion market this year. Although the designs vary, toners typically have strongly curved, thickened soles. From the moment ...

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An excerpt from Treat Me, Not My Age: A Doctor's Guide to Getting the Best Care as You or a Loved One Gets Older. by Mark Lachs, MD Over my twenty-five-year medical career, the route by which people are admitted to the hospital for an overnight stay has subtly evolved in ways that most patients (and even many doctors) may not realize. Specifically, the proportion of ...

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Here is an unfortunate, but almost daily not-so-secret occurrence in my practice: I am in the midst of an intricate follow-up visit with a rather complicated patient with diabetes, high cholesterol, and high blood pressure. I am feeling as though I am a CIA agent in a rather mission impossible assignment: she is here for lab results, is complaining of low back pain, and presents with an elevated blood pressure of ...

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I need help.  In dealing with obesity as a medical problem, that is. I am pretty solid at arrhythmia management, but as an obesity doctor, not so much.  If I was the teacher, and my obese patients were the students, I would surely be fired for poor student test performance. At least, if the core measure was the patient's BMI. If a student does poorly on an achievement test, is it the student's ...

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