shutterstock_141411661 I didn’t really notice him standing in line. But how could I? Hundreds of kids came through the high school gym yesterday. His turn for the heart and lung portion of the high school sports physical had come. He said he was going to play baseball and basketball. How could he with that arm he carried so carefully? I am not ...

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Draping a shroud of 30's Depression on any dust bowl child can thicken the skin, so my 88-year-old patient learned to be fiercely independent with a “talk to the hand” attitude, and “don’t get in my way” personality.  Even after her husband passed away, she remained autonomous traveling and golfing in her social circuit. Living life as a smoker was always a threat to her health, and this year became a ...

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shutterstock_164925521 I keep getting served a Facebook ad from the American Association of Medical Colleges imploring me to ask politicians to fund residency training for medical school graduates.  The link leads to a webpage with neat graphics and a series of well-designed cartoons dramatizing an ominous shortage of 90,000 doctors expected to occur by 2025. Now, the notion of “doctor shortage” by itself is meaningless. ...

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shutterstock_205431067 What is it like for physicians to fail their ABMS Maintenance of Certification® (MOC) program examination? How does the largest member board of the ABMS, the American Board of Internal Medicine (ABIM), respond to doctors who fail their secure examination? As I continue to confidentially collect information from physicians who have failed their MOC examination, I thought it would be important to publish ...

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shutterstock_150037820 Lately I've had the opportunity to work in an outpatient clinic where the regular doctor is out sick for a prolonged period of time. It is a breathtakingly beautiful little community, with green hills and a crystal clear river. It is also troubled by methamphetamine and prescription drug abuse. The little clinic in town is unwittingly a partner in this crime. Like ...

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If you were a cancer center trying to get patients to come to receive care at your facility, what message would you send them? In other words, what would you as a cancer center director think people would value in choosing a place to receive cancer care? One way to answer this would be to survey cancer center directors. You could conduct face-to-face interviews or written surveys. You could hold focus ...

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shutterstock_195635468 I was driving to work the other day, and there was a story on the radio about the Congressional reaction to the latest recommendations for breast cancer screening from the United States Preventive Services Task Force (USPSTF). Here’s the background. USPSTF published recommendations in late 2009 for the use of screening mammography in different age groups. For women between 40 and ...

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A new clinical report from the American Academy of Pediatrics is a rare beacon of coherent thought about lice and children. Rather than humiliating children and driving them away like lepers, the AAP recommends common-sense steps to identify and treat lice. Some facts really shouldn’t be in dispute:

  • Lice is not a serious illness or a significant hazard to health. They don’t make anyone sick, and they do not spread any ...

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shutterstock_59443372 The other day, a teen patient of mine told me she is pansexual. We were having the usual talk I have with teen patients, the one where I we talk about sex and sexuality and birth control and sexually transmitted infections. But over the past few years, that conversation often takes interesting turns when I ask about sexuality, like it did the ...

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medpagetodayFrom MedPage Today:

  1. Time to Retire Lithotripsy for Kidney Stones? More than 30 years ago, extracorporeal shock wave lithotripsy (ESWL) had a highly anticipated, much-ballyhooed introduction as a nonsurgical therapy for kidney stones. Obviating the need to cut the skin or insert a device into the body, ESWL would use acoustic shock waves to ...

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shutterstock_246706588 Imagine a surgeon removing a gallbladder miles away from where he or she actually is. Imagine when you are ill, a physician has the ability to diagnose you from your living room. Telemedicine. Telemedicine itself is not a concept that is all that new. In the 1930’s, Italy used telemedicine to communicate with ships at sea, while in the United States, NASA ...

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Thankfully, many medical conditions that once were never discussed in public, such as cancer, AIDS, and even infertility, have largely shed their stigma and sense of secrecy. Miscarriage holds an unusual place in medicine in being both common and something that many in society thinks is rare. One in four pregnancies ends in miscarriage, and there are 1,000,000 miscarriages each year in the U.S. -- yet miscarriage remains shrouded in privacy ...

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shutterstock_141622243 Some years ago when my father underwent bypass surgery, he was anxious, depressed and in pain as he lay in the hospital bed tied to IV catheters and tubes. Each day, his surgeon, his hospitalist, and other consultant doctors whisked in and out, asking how he was feeling and then ordering a treatment plan. A few years after his full recovery, ...

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Recently, I was back in the United Kingdom for a short trip home. It happened to be the week of the general election, and after a long campaign the country finally went to the polls on Thursday. For those of you unfamiliar with U.K. politics, for the last five years there’s been a coalition government between David Cameron’s Conservatives and the Liberal Democrats (the first coalition government for 70 years). The ...

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shutterstock_260680658 I wasn't the first simple country surgeon, you know. When I was a resident, our training program broke us into two teams -- one that served general surgery, pediatric surgery, and trauma; the other, general surgery, transplant, and oncology.  Every day was an intricate dance to see all the patients (generally between 20 and 40) for the assigned team, operate all day, ...

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An excerpt form Baby City: An Inside Look into Labor & Delivery. I am going to make this medical student cry. I don’t know how I know it, but somehow I can sense it. I know it the second she walks into the resident room on labor and delivery at Cadence ...

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I was volunteering at one of the free clinics associated with my medical school last weekend, and while teaching a medical student how to sew a cut, he queried, "That is an interesting technique, who taught you how to suture? Are you a surgeon?" "I am actually a radiologist," I replied. "To answer your first question, I was actually taught this by an obstetrician during my third year of medical school." Puzzled, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old woman is evaluated for redness that developed over her right leg at the site of a mosquito bite. She is otherwise healthy and takes no medications. On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 120/70 mm Hg, pulse rate is 70/min, and respiration rate is 14/min. There ...

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Hepatitis C is one of the most common chronic infectious illnesses in the U.S. today and affects nearly 3.2 million Americans. Complications of hepatitis C infection include liver cancer as well as cirrhosis.  Many patients with chronic hepatitis ultimately develop liver failure and will die without liver transplantation.  In the last year,  a new drug class has entered the market and can produce cure rates in excess of 90 percent. These ...

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Practicing physicians like me rely on up scientific medical journals to keep us current on medical developments. We learn about new treatments for old diseases. New diagnostic tests are presented as alternatives to existing methods. Established treatments, which are regarded as dogma, may be shown to be less effective or less safe than originally believed. It’s a confusing intellectual morass to sort among complex and conflicting studies some of which ...

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