shutterstock_182066816 Imagine an institution where the occupants are routinely left immobile, deprived of sleep and fed a diet that is tasteless and nutritionally marginal. Imagine further that they experience the indignity of losing any semblance of privacy and get stuck multiple times a day with needles. Sounds like a brutal prison, right? Yet the same description could apply to a typical U.S. hospital. As ...

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The scope of the problem Chronic pain is a health epidemic. Estimates suggest that up to a third of adults or a hundred million Americans live with chronic pain conditions that interfere with their work and life. From back pain to headaches to diabetic neuropathy, chronic pain is widespread and debilitating. These patients suffer tremendously, and societal consequences are significant; back pain is one of the most common causes of missing ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 29-year-old woman is evaluated during a routine examination. She seeks advice in reducing her personal risk of developing rheumatoid arthritis, because her mother was recently diagnosed with the disorder. The patient is asymptomatic. She has a 10-pack-year history of smoking and consumes six alcoholic beverages per week, usually on weekends. She ...

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Over the years, applicants whom I've interviewed for positions in the first-year medical student class at Georgetown have often asked how our school's mission statement influences the educational experiences and clinical services we provide:

Guided by the Jesuit tradition of Cura Personalis, care of the whole person, Georgetown University School of Medicine will educate a diverse student body, in an integrated way, to become knowledgeable, ethical, skillful, and compassionate physicians and ...

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shutterstock_143614549 It's been a very slow week in my office.  Today we almost pitched a no-hitter, having only one patient come in toward the end of the day.  Overall, we've been quiet in nearly every way: few phone calls, few patients stopping by, few appointments, few secure messages. What's wrong? That was a trick question.  This is exactly what should be happening when things are going ...

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shutterstock_280855511 After the last elective case of the day, the neurosurgeon I was shadowing told me that he was on overnight call that evening, and that I could stick around to observe more surgeries if I wanted to. “Yes,” I responded. “Absolutely yes.” My fascination with surgery stems from its ability to provide immediate results to a patient by cutting out, repairing, reshaping, or ...

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The transition between the basic science years and the clinical years in medical school are jarring, mystifying, exhilarating and thought-provoking. Recently, I did an hour conference with approximately 30 medical students. About half started their clinical year five weeks ago, while the remainder have only three weeks left before they finish the year. They gave me permission to share our discussion. We focused on their (and my) observations about the ...

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shutterstock_112594832 Dr. James Lyons graduated from the University of Michigan's Medical School in 1942, just a few months after the Japanese bombed Pearl Harbor on December 7, 1941. As our country swung into a state of all-out war against the Axis powers, many newly minted MDs were assigned specialties by the government instead of being able to choose themselves, and Dr. Lyons ...

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When I was in training, the rule was: See one, do one, teach one. That was the rule for everything. It could be starting an arterial line, suturing a wound, dictating an operative report. No doubt, that rule is still in play. But now, the playing field has changed. Could you be sending out the wrong message? Demonstrating a poor way to proceed? Before you say “No way!” -- Think about this: Have you ever ...

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shutterstock_116541763 You could hear a pin drop. The awkward silence at a dinner table after my pager went off. Eyes locked on me. For a split second, the laughter ceased, forks held in mid-air, chewed food, half-swallowed. The nervous system of every doctor adapts to the sound of his or her pager during residency. Early in training, widening pupils and hair-raising palpitations fade ...

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shutterstock_216645019 asco-logo We all have our fair share of so-called “difficult” patients. And, I would suggest that how we define “difficult” is as diverse as we are as health care providers and as individuals. Some patients come to us with that reputation -- perhaps, a vague descriptor in a referral letter or ...

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shutterstock_117645061 Imagine the United States of America when a simple skin infection from a scrape causes a 10 percent chance of dying.  Out of every 1,000 women who give birth, nine will die, and out of the 1,000 infants born,  up to 30 percent will die.   It is difficult to imagine, but these are the alarming statistics prior to antibiotics in the early ...

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shutterstock_122391511 Leave early. Two words. Simple concept. But, one worth thinking about. James Altucher explains it well, but this is the same guy who also thought he could save his business by becoming more like a Jedi Knight. Admittedly, the Jedi thing seemed to work for him, and his businesses, as well as the uncountable number of people he’s helped since then. ...

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On July 7th, 2015, I cross-posted an article from "Hope Amantine," a pseudoanonymous surgeon who previously blogged at Simple Country Surgeon: "A lesson in the OR that prepared this doctor to be a surgeon." On July 8th, 2015, 11 a.m. Eastern, I was notified by an editor at MedPage Today about the controversy questioning the truthfulness of the story. I then reached out to "Hope," asking whether her story was fictional or not. I ...

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shutterstock_266789546 Last night, one of my close and friends told me the story of her recent trip for her annual gynecology appointment. Her longtime gynecologist had retired, and she was meeting her new physician. After taking a history, the first new physician explained to her that since she always had normal Pap smears, including recent ones from the past several years, she ...

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shutterstock_223663249 Chronic insomnia affects 5 percent to 15 percent of Americans. It is far from only a nighttime problem. As all of us know from occasional sleepless nights, the following day is unproductive and sometimes dangerous. Sleep deprived people are more prone to accidents, and are more likely to have depression, anxiety, diabetes and high blood pressure. It is no surprise then that ...

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shutterstock_207548383 Manny Alvarez is a 23-year-old college student with the misfortune of having not just a devastating cancer -- but the wrong devastating cancer. The chemotherapeutic agents shown to be highly active against his specific tumor cells are FDA approved for the treatment of leukemia, but not for the stunningly rare kind of sarcoma with which Manny has been diagnosed. Nothing is ...

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shutterstock_148383902 I am in my twenties. I am a student in dental school. My seven classmates and I have gathered, notebooks and pens in hand, for the first day of our ten-day rotation at the Veteran's Hospital oncology department. Dr. Steele, a published expert in oral cancer, instructs us to follow him to the outpatient clinic. Some of those he'll examine are initial consultations; ...

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New_Image “What’s up with the ABIM?” “I just got a note about an alternative board. Should I join it?” “Aren’t you glad to be off the Board?” These days, I get these questions from friends and colleagues regularly. When I first joined the board of directors of the American Board of Internal Medicine (ABIM) in 2004, the organization was a well-respected pillar ...

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shutterstock_233804005 The outcry over antipsychotics has ranged far and wide.  Everyone from governmental agencies to senior advocacy organizations have pointed to the abysmal data.  Antipsychotics have a negative impact on morbidity and mortality.  They say we are chemically restraining those who are too fragile to stick up for themselves.  They say we are sedating instead of treating. And I disagree wholeheartedly. I manage a ...

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