When I was in medical residency, more than thirty years ago, I ran with a pack of fellow residents, all guys who were fit to varying degrees. Once, on an outing, we discussed the -- hopefully -- hypothetical question: "If the need arose, which one of us would we eat first?" "Randy!" my friends gleefully concluded. "His meat would be the most marbled," one added. I've never been fat. More accurately, my body ...

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Internal medicine requires knowledge, deduction, and many skills: history taking, physical examination, analyzing diagnosis tests. When confronting a new patient problem, we use our brains to work on finding a diagnosis. Much like police detectives, we would like to have brilliant diagnostic epiphanies, but often we make our diagnoses by painstakingly collecting all the clues and doing the necessary boots on the ground work. We had a woman admitted to our ...

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In case you haven't noticed, a hot new topic in education is "grit." In order to reduce the long-standing 20% attrition rate of surgical residents, some say we should select applicants who have more grit or conscientiousness. A recent paper in Surgery reported residents who dropped out of programs had decreased levels of grit as measured by a short-form survey. But due to unexpectedly low attrition rates in the surgical programs ...

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Top stories in health and medicine, August 19, 2014From MedPage Today:

  1. Hospitals Question Charity for Some Patients. As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn't.
  2. Antibiotics Early in Life May Boost Obesity Risk. Exposure to antibiotics ...

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It was with much fanfare that two American aid workers were airlifted from across the world and brought to Emory University Medical Center where they began experimental treatment for Ebola. We hope for a full and speedy recovery for them and others like them who do God’s work. But it appears to me that lost in this conversation are myriad others who need help but never get it. Right now, humanitarian work ...

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Vaginal video games: What to make of mobile Kegel apps There are two new high-tech ways that aim to help you with Kegel exercises, both with Kickstarter campaigns. There is the Skea (Smart Kegel Exercise Aid), basically a video game that proposes controlling the avatar with a vaginal probe that uses the pelvic floor muscles and kGoal, a vaginal insert that is meant to connect wirelessly with your smart phone and measures your squeeze ...

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Marcus Welby wont survive todayMarcus Welby wont survive today An excerpt from So Long, Marcus Welby, M.D.: How Today's Health Care Is Suffocating Independent Physicians - and How Some Changed to Thrive. A 30-ish public-relations executive representing a large, modern physician practice was shaking her head in puzzlement. Her physician client liked to talk about how his practice was not "a ...

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“Then you should say what you mean,” the March Hare went on. “I do,” Alice hastily replied; “at least–at least I mean what I say–that’s the same thing, you know.” “Not the same thing a bit!” said the Hatter. “You might just as well say that “I see what I eat” is the same thing as “I eat what I see!” The brilliant Lewis Carroll had a field day with logical fallacies in ...

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The blonde minority: Sexism is alive in medicine While demographic data may suggest otherwise, I still consider myself a minority, albeit a less common one. I am a young woman in medicine, and I am a natural blonde. I barely qualify for a prescription for eyeglasses, but I have found they give credence to my words and patients seem to take me more seriously. Perhaps three years of residency training ...

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Part of a series. In earlier posts, I have described direct primary care (DPC) in its various forms called membership, retainer and concierge. There are some concerns with DPC. Does more doctor-patient time really mean better quality care? Does it really mean lower total costs? It seems logical that closer care means better care, fewer referrals to specialists and fewer hospitalizations. Most DPC physicians will tell you this is the case ...

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Top stories in health and medicine, August 18, 2014From MedPage Today:

  1. Feds to Withhold One-Third of Sunshine Act Data. Next month, when the federal government releases data about payments to physicians from pharmaceutical and medical device makers, one-third of the records will be withheld because of data inconsistencies.
  2. Derms Want NP/PA Practice Limits. NPs and PAs who bill Medicaid as ...

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I don't like to brag, but if there is one area of my skills as a doctor about which I am proud, it would be my skill as a diagnostician.  I like to play Sherlock Holmes and figure out what's going on with people, and I think I'm pretty good at it. So I lied.  I do like to brag ... a little. In most people's mind's eye, the role of diagnostician ...

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There is growing healthy skepticism about the past promises of mobile technologies.  Issues concerning safety after the release of the FDA guidance of mobile medical appsprivacy and security, and efficacy. Followers of the sector are poised for the rubber finally meeting the road in health care. While most mobile health tools used today are reference apps for health care providers and patients, there  are ways in which ...

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As a fourth-year medical student, it was fairly easy to maintain a healthy lifestyle. When you have much leisure time and are relatively stress free, you can eat healthy, stay physically active and maintain quality mental health. However, as I begin the journey called residency, it is clear that the task of maintaining my own health will be much more difficult. But the importance of this task should not be overlooked. ...

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It is clear that patient compliance with prescribed medications is critical to success in the treatment of any chronic disease process.  In addition, patient engagement and co-management of their disease has been proven to improve outcomes.  A new study from the Annals of Internal Medicine suggests that any changes in the appearance of a medication may result in a decrease in compliance; when a pill looks differently patients often simply ...

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In a recent post, I wrote about the value of a yearly checkup with your child’s doctor -- it can be a whole lot more helpful than a quick sports physical at the local quickie-clinic. You can be sure to get the most out of your child’s checkups with these tips. First, and most important at all, go to the visit. You’d be surprised how often children are brought by ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 19-year-old man is evaluated for a sore throat, daily fever, frontal headache, myalgia, and arthralgia of 5 days' duration. He also has severe discomfort in the lower spine and a rash on his trunk and extremities. He returned from a 7-day trip to the Caribbean 8 days ago. The remainder of ...

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California is contemplating requiring physicians to submit to alcohol and drug testing.   Citizens there will be voting on this proposal this November. I do think that the public is entitled to be treated by physicians who are unimpaired.  Physicians, as members of the human species, have the same vices and frailties as the rest of us. I have no objection to this new requirement, if it passes. This will not be ...

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"Dad, you have the nicest patients!" She was right, of course. Daughters that you bring to work with you to shadow for a day can bring you back to what's important in medicine.  In fact, seeing medicine through fresh eyes is helpful, especially when we forget to look up from our work-a-day lives. It had been over ten years since I had my first "bring your daughter to work" experience.  Her first time ...

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We must bear in mind the difference between thoroughness and efficiency. Thoroughness gathers all the facts, but efficiency distinguishes the two-cent pieces of non-essential data from the twenty-dollar gold pieces of fundamental fact. - Dr. William Mayo The practice of medicine involves a lot of details, but details without the big picture are meaningless at best and distracting at worst. The expression, “the devil is in the details” implies that the details can ...

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