It was January 1, 2000, and I was an intern in emergency medicine at the University of Arkansas for Medical Sciences. I had gone to sleep the night before listening to celebratory fireworks and congratulating myself for surviving Y2K.  Now I was walking into the emergency department of our large, level 1 trauma center where I was furthering my medical training.  Like most urban ERs, this one was a busy place ...

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Does owning cancer equipment change treatment patterns? Today’s article follows the money trail to expose a different form of bias: the kind that takes place when doctors own their own diagnostic and therapeutic equipment. For people living with cancer, this kind of bias can have a particularly painful impact. Radiation therapy brings out medical bias In the United States, cancer is the second most common cause of death, killing nearly 600,000 ...

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Sometimes my day is like a book.  The first chapter may begin in the darkness of a self imposed corner as a phone call is made.  A voice, full with the thickness of slumber, answers unexpectedly. "I think today is the day." No matter how many years I have been discussing death I still find myself using poor euphemisms.  The bane of medical school teaching, I often struggle with the directness.  "Your mother ...

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We are, I trust, all but universally familiar with the knee jerk, or patellar, reflex. A doctor taps the patellar tendon with a rubber mallet, and our leg kicks forward in response. The reaction is famously unthinking. In fact, it is literally so. What makes a reflex a reflex is that the brain is substantially uninvolved. The stretch of a tendon by the mallet is transmitted to the spinal cord, and the ...

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I see nearly 100 patients a week.  Of these, easily 35% are overweight and 15-20% are obese with a BMI greater than 30.  I live in New Orleans, Louisiana, which along with Mississippi has the highest rate of hypertension, diabetes mellitus, arthritis, and other diseases commonly associated with obesity.  There are many explanations for the obesity academic in America but certainly poor nutrition and lack of exercise are at the ...

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I got the following email a few weeks ago (details changed for confidentiality reasons):

Dear Sir, I read about your unique practice online.   I have an 91-year-old ambulatory father who will not go to a doctor.  He definitely is not well and this is the only way I can get him the attention he needs.   He is adamant about not wanting medical interventions, however he still needs to be seen ...

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Is much of the annual physical a waste of time? So much in medicine and in life is done out of habit.   We do stuff simply because that’s the way we always did it.  Repetition leads to the belief that we are doing the right thing. In this country, we traditionally eat three meals each day.  Why not four or two? We prefer soft drinks to be served iced cold.  I’ve never tried ...

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Dont be stupid, and other wise words to new college students Welcome to college, young people! It’s an amazing time in your lives. These years will impact your life dramatically if you use them well. So, to help you along the way, allow me to give you some wisdom. First and foremost, get some wisdom. You are bright and capable, otherwise you probably wouldn’t be in college in the first place. But for all ...

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I have a new favorite doctor show, “The Knick” on Cinemax, airing on Friday nights.   The show stars Clive Owen as the charismatic cocaine-addicted chief of surgery Dr. John Thackery at a fictitious New York City hospital called The Kickerbocker at a time when surgery was one foot out of the barbershop.  The tagline is, as they say, priceless: “Modern medicine had to start somewhere.” On the third episode, last Friday ...

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What do eggs, roofing nails, men’s haircuts and plastic cups have in common? A bizarre fraternity ritual or my Saturday morning honey-do list?  Gasoline, copying paper and paperclips?  Shopping for a mobile accounting office?  Nope.  What these items share is that who ever makes them, wherever you buy them, they are essentially the same.  They are commodities. They do not vary significantly in construction or quality.  The only way to ...

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