There is an interesting article from ProPublica called “When Evidence Says No, but Doctors say Yes" making the rounds. It's about the number of doctors who disbelieve, don’t know or don’t care about medical evidence to the detriment of patients. I do not find any fault with the article. I rail against this daily. I have my whole professional life. It is actually a big reason ...

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4.9 million — yes, million — people are diagnosed with skin cancer every year in the United States. It costs an estimated $8.1 billion —with a “B — to treat those skin cancers, according to the Centers for Disease Control (CDC). Do I have your attention? I hope so. The problem is we don’t have enough attention. There is no other way to ...

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Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their personal role in the genesis of this problem. Our words matter. They can reverse the good we do with our medications and procedures. If you are a heart ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated for new-onset ascites with lower-extremity edema. Symptoms have increased gradually over the past 4 weeks. He has consumed three alcoholic beverages per day for many years. His medical history is notable for coronary artery bypass graft surgery 8 months ago and dyslipidemia. His medications are low-dose ...

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In the not-to-distant past, American health care was the gold standard. It offered job satisfaction and autonomy, was financially rewarding and was considered by many to be the most honorable profession. But as we all know, over the last two decades, increasing health care costs and demands and increasing competition for insurance contracts have changed the face of medicine. Metrics ranging from quality and safety (which are needed and were ...

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When the political process is not working, one option is to examine the shared values of most Americans. Values are learned, clarified and even negotiated. They are the algebraic axioms from which the formulas of public policy are derived. Examples include: Society should care for the sick, written into the EMTALA law that prohibits turning patients away from emergency rooms. Free enterprise is the engine of material prosperity. The government must correct the dangers ...

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From a young age, I knew I wanted to be a physician. There were no physicians in my family, but I had interacted frequently with doctors as a child and felt a strong desire to similarly help others as I grew older. To this end, I focused on academics. In choosing a university, I chose the one I felt was academically best, despite being a private school in an expensive city ...

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Welcome to planet medicine, where four rides around the sun earns you a golden ticket to study more, to train more, and to enjoy splicing two sacred letters onto the end of your title. The days are long, the weeks go fast, and sleep is optional. In this world, all-star draftees leave their immaculate collegiate careers as masters of memorization and intellectual puzzle solvers only to still be no more ...

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I am a bioethics researcher who studies physician misconduct. I am also a former gymnast. I haven’t really kept up with gymnastics since I quit when I was 17. With the exception of the most recent Olympic Games, I avoid watching it on TV. The taciturn criticism from the commentators is too much for me to bear. I think, of course, she didn’t stick the landing. She just flew through the ...

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“Daddy, time to wake up! It is morning time!” I open my eyes to our four-year-old daughter at the foot of the bed smiling, her hair meticulously braided. I get up and wake her younger brother from his crib and carry him downstairs. The baby is still sleeping. Soon come shouts of “coffee!” as we enter the kitchen -- they know my routine well. After breakfast, we all get dressed, I ...

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Part of a series. The percentage of the population that will be “elderly” is rising fairly dramatically. In 1900 only four percent of the population was over 65 and only one percent over 75. By 1950 it was eight and three percent, respectively. By 2000 it was thirteen and five percent, and now it’s about fourteen and six percent. By 2030 it will be substantially more again. There are many ...

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A few weeks ago, I had the opportunity to interview a faculty physician at a large academic medical center. We spoke about burnout in students and faculty in general terms. He was aware of the problem yet did not seem affected himself. I asked him how he managed to avoid burnout. He talked about remembering his purpose in entering medicine -- that the profession is a calling, not just the daily ...

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Am I the only emergency physician who sometimes wonders who left me in charge of an ED? I should be confident in managing whatever comes through those ED doors after more than ten years of single-coverage night shifts, but each night I hear a little voice in my amygdala questioning whether tonight will be the night I won't be able to handle something. Sometimes I feel afraid of the unknown ...

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And if they can, should they? In recently post, I wrote about some unresolved issues with driverless cars and ended by saying “So are you ready to have an autonomous robot perform your gallbladder surgery? I’m not.” But the robots are coming. A recent paper in Science Robotics proposed six different levels of autonomy for surgical robots. The authors say some devices ...

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Most of you know me -- if you know me at all -- as a pediatrician. But I’m a parent, too, just like you. I have three fantastic girls that I love dearly. Let’s talk. My first daughter was born before I knew anything about medicine. She has taught me more than I could have imagined. I’ve watched as she has grown from a tiny and helpless infant ...

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Being a radiologist, I rarely speak to patients, but I was asked to counsel Mrs. Patel (not her real name), who was worried about the risks of radiation from cardiac calcium CT scan. Because of her risk factors for atherosclerosis, her cardiologist wanted her to take statins for primary prevention, but she was reluctant to start statins. They eventually reached a truce. If she had even a speck of calcium ...

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Pacing refers to spacing out your activities during the day so that you’re able to stay within the limits of what your body can handle without exacerbating your symptoms. Another way to think of it is that pacing is a way to keep you inside your “energy envelope” -- the envelope that contains your energy stores for any given day. First, an admission: Even though pacing may be the single best ...

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Election Day 2016 should have been Christmas morning for Republicans. Long awaited control of the White House and both houses of Congress. A chance to deliver on an every two-year election cycle promise to repeal and replace Obamacare. In 2010 Republicans needed the House. They got it. In 2014, it was the Senate. Delivered. But we still need the White House they said. Asked and answered with President Donald Trump. So, ...

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The return from a vacation weighed on me physically.  This had been a true vacation -- an entire week away from clinic and spent with my family.  I even managed to unplug to the point of only checking email on my phone twice per day -- really! The tension that years ago took up permanent residence in my shoulders had faded away without my noticing, so that when I awoke to ...

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The emergency room is packed. I interject another question to further clarify when exactly Mrs. Smith’s chest pain started, cutting off a story about her daughter -- a tactic I would have found unthinkably rude only years before but has now become a necessary technique. After leaving the room, I try to put in orders, but the electronic medical record resets itself, I’m informed an X-ray won’t upload unless I ...

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