The urologist broke the news: "Out of 12 cores, three were positive for cancer, so you have a small amount of cancer." He would soon explain the treatment choices -- surgery, radiation, or active surveillance (watching the cancer closely with blood tests and biopsies). He described each option in elaborate detail, because he knew that the "right choice" would depend on what his 70-year-old patient thought about the pros and cons ...

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We all try to do our very best for our patients.  Often the decisions we make have profound impacts on outcomes.  Medicine is not always cut and dry, and many times gut instinct and judgement calls must play a role in choosing therapies for patients (especially when made in the setting of best available data).  As it is in most professions, Monday morning quarterbacking frequently occurs in medicine as well.  It is ...

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Recently, I awoke to a picture of myself in the Wall Street Journal. I was asked to comment on the effects of the coming Sunshine Act. Respected health care journalist Peter Loftus found me through social media channels. What follows are some thoughts about how the Sunshine Act might play out. Every Thursday during my cardiac fellowship training, at noontime, the entire department gathered for an hour-long conference on echocardiography. Unknown ...

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My patient Maria sits before me, looking vaguely distressed. She's returned for a follow-up visit, six weeks after our first. The morning is half over, and I'm clipping along, staying on time, using the new electronic medical record system (EMR) without a glitch and with a sense of satisfaction. Three months back, when I joined this small-town practice as part of my new position as a health-system medical director, I found ...

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When I was young, one of my favorite stories was O. Henry’s “The Gift of the Magi.”  Originally published in 1905, the short story became standard fare in public school reading classes and I doubt that there are any of you out there who have not read it.  But just in case -- the story is about a young couple, poor and deeply in love.  At Christmas, they have no ...

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One would never guess that a frequent activity in the OR is painting. I’m not referring to the application of paint to the walls of a room or house. The painting I’ve seen is limited to the patient and his or her body parts. I suppose the first application of “paint” would be the initial scribble placed by the surgeon, marking the surgical site. This is a relatively new requirement and ...

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acp-logoA guest column by the American College of Physicians, exclusive to KevinMD.com. ACP recently launched a campaign to celebrate and increase awareness of internal medicine, the "I.M. Proud to Be an Internist" campaign. If you visit the website, you will find a summary of the campaign’s goals,  information for patients and families, links to downloadable posters for the office, and merchandise ...

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I thought I'd share what I saw on my Twitter feed as soon as I got up recently. I immediately felt a blog post coming on, particularly after reading the Twitter comments as they rolled in. I felt a bit sick, knowing what some of my colleagues in Ohio must be going through right now. This post is for you. When it comes to patient suicide, correctional psychiatry is probably one ...

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1101_Dookhan The attorney appointed by Massachusetts Governor Deval Patrick to investigate the case of Annie Dookhan, the Massachusetts state drug lab chemist who allegedly faked test results, tampered with evidence and neglected protocols over a several year period, now states more than 40,000 cases may have been affected. So far the state has released 330 inmates and dismissed or declined to prosecute more than 1,100 other ...

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1984 was a great year -- not just for George Orwell lovers, or for me as I embarked on my medical education. Daley Thompson won his second Olympic gold medal in the decathlon event, and in securing his place in athletics history also broke the world record. Picture the scene afterwards if you can, as journalists jostled to talk to the great man draped in Union flags and his gold ...

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