Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 57-year-old man is evaluated for a diagnosis of acute kidney injury. He was diagnosed with gastroesophageal reflux disease 3 weeks ago and was prescribed omeprazole. Several days ago he noticed lower extremity swelling and decreased frequency of urination. Laboratory evaluation showed a serum creatinine level of 2.2 mg/dL (194.5 µmol/L). ...

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Recently, the widow of Robin Williams made a plea to neurologists. Susan Schneider Williams' plea, in the form of an editorial in the journal Neurology, aimed to help neurologists "understand your patients along with their spouses and caregivers a little more" and "add a few more faces behind the why you do what you do." Her article tells the story of her husband’s tragic physical and psychological battle culminating in his death ...

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I’m a psychiatrist. I’ve been practicing for 30 plus years. I’ve worked in inpatient and outpatient settings seeing the typical mix of general psychiatric patients.  About five years ago, I was asked to take the training for a buprenorphine license to serve as a backup for our addiction psychiatrist in her suboxone clinic.  I did the training, doubting that I would every really use it on a consistent basis. But ...

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One of the latest trends in health care is “patient choice,” meaning the patient is in charge of their own care. Our job as a physician is to educate patients about the diagnosis, discuss the various treatment options, go over risks and benefits, then allow the patients to choose the best course of action. Of course, this assumes that patients always make the right choices and are solely motivated to ...

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As we drown in the overwhelm of modern day health care duties, most physicians I know, including myself, fail to follow their own advice. Far too many of us have become overly tired, irritable and resentful about our workload.  It is difficult to look forward to the dawn of the next work day. Medical journals and blogs label this as “physician burnout” but the reality is very few of us are ...

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Behind every doctor is a child who once watched helplessly. Maybe it was her father or grandfather who suffered under the weight of a disease that was deemed all but incurable. Perhaps her own skin was battered and bruised by the repeated trauma of an unrelenting tourniquet. She swore that when (if) she got older she would protect the innocent from such things. Her vow was the light that guided ...

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Recently I've seen a number of reports of women who are denied the ability to help in a plane emergency because they are not believed to be doctors. While most of the denied women are of color, since this became public a large number of women of all races have come forward because of similar racial and gender discrimination. I am an emergency physician, and I was once called to duty ...

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Patients forming an opinion of your practice are doing so in a matter of seconds. And some of the latest research on first impressions, suggest that it may even be within the blink of an eye. Regardless of the length of time, first impressions are powerful and very difficult to reverse. So, if a patient has formed a bad opinion of you and your staff, during the first point of ...

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I have a mentor who is quite gifted at getting me to break a sweat in the OR. No matter how well an operation is going, she’ll have me set my instruments down. “If this doesn’t work, what’s your plan B?” We discuss how variations in anatomy, damage to critical structures, or unanticipated pathology could change our operative plan. She challenges me to not only consider plan B, but plans ...

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I recently spoke at the Washington State Medical Association's annual meeting. Here's an interview shortly before the keynote. Enjoy.

Several years ago, I was sitting at the gate in a Washington, DC, airport when I got a call on my cell. A close friend of one of my patients wanted to let me know that Lara (not her real name) had died after a long and difficult course of throat cancer. Lara was relatively young, a kind, brilliant and incredibly thoughtful woman, and I'd had a deep patient-physician relationship with her, given all that she'd been through ...

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When it comes to our health and our health care, we love the numbers. Sometimes, we even fall in love with the numbers, assuming that the numbers tell us the whole story when, in fact, that may not be the case. Cholesterol numbers, blood pressure numbers, body mass index, whatever. As patients and consumers, we are frequently defined by our numbers. But what happens when those numbers and other medical tests, ...

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Nearly a month before our national presidential election, a video surfaced online capturing a conversation between Presidential candidate Donald Trump and reporter Billy Bush. During this 2005 “private” conversation between the two, Trump lewdly brags to Bush about kissing and groping women without their consent. He is even heard boasting he can “get away” with this behavior because of his celebrity status. Trump has been heavily criticized for his words ...

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Some dear friends of mine, at Busy Community Hospital, are having a momentous day.  Today is the "go-live" for their brand new, shiny EMR. For those of you outside the hallowed, creaky halls of medicine, this EMR is one of the most widely used electronic medical records systems in America.  It’s big, it’s expensive, it captures lots of data, integrates ERs, hospitals, clinics, labs and everything else.  (Probably your cat’s shot records too.) The problem ...

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Even though I don’t have an outpatient practice, I like to keep in touch with some of my patients after they’ve been discharged from the rehab hospital. Jack is one of my very favorite success stories. I met Jack in a small regional hospital in rural America. He had been admitted with sudden-onset weakness, and during the intake process, he mentioned enjoying occasional evening cocktails when out for dinner. Unfortunately, this ...

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asco-logo She had come to see me in consultation. A professor at a local university, she was well until four years earlier when she developed abdominal bloating and pain — telltale signs of ovarian cancer. Surgery followed, then adjuvant chemotherapy with intraperitoneal treatments. (“Terrible regimen,” she said.) She was fine for two years, until the bloating recurred heralding ...

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In medical training, each morning begins with pre-rounds, a sort of prologue to the work day that gives us a preview of our patients’ conditions. Like a daily ritual, we arrive in the hospital as the sun begins to peek over the horizon and proceed to visit each of their rooms. Some of them are still sleeping, but we wake them up anyway to needle them with questions. Any pain? ...

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“Then it’s me and my machine For the rest of the morning, For the rest of the afternoon And the rest of my life.” - James Taylor, “Millworker” It’s Friday afternoon, 4:30. I am sitting in front of my computer. My last patient is gone, my prescriptions are done, my messages answered, my office charges submitted and my office notes completed. Now, it’s time to tackle the incoming laboratory results. Opening up the list of completed ...

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Vaginal yeast infections are common, up to 75 percent of women will have at least one and 5 percent of women suffer from chronic yeast infections (meaning four or more a year). Many women out of frustration with allopathic medicine (preventing recurrent yeast infections can be challenging) or because of their beliefs turn to alternative medicine options. More and more I am hearing about vaginal garlic. The problem with many alternative ...

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Four years ago, I was having a conversation with a friend of mine. We had graduated residency the same year and our careers had taken us to different parts of the country. It was ACEP 2012. We’d been mingling with old friends and current colleagues, and the conversation turned to kids. I told him my wife and I were getting ready to start having children. He said he and his wife ...

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