Psoriatic arthritis can be a debilitating condition. It can lead to painful complications such as neuropathy. Its treatments can lead to complications such as shingles, which can leave a patient with continuing pain. Ehlers-Danlos Syndrome is for most patients a painful condition that leads to spontaneous dislocations, early arthritis, and frequent migraines. My husband and I have decades of experience between us in living with these conditions. My husband and I ...

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Comments have again morphed into an essay. And, once again, they’re in response to a blog post by Dr. Suneel Dhand: When it comes to positive change, physicians are their own worst enemy. I thought it was excellent and spot-on. My first comment read in part:

When reading this post -- before I read the comments -- I found myself silently nodding ... maybe because I agree with much ...

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I am an ENT surgeon, a friend of the author, the patient, and their daughter, whose intervention saved his life. This is a smart, loving family caught in a terrible vortex of terrible medical care until they pulled themselves out, and a story that physicians must read, as we struggle to reinstate humanity and humility into our noble profession. Here is Paul's tale, as told by his wife. *** On a mid-December ...

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As a child and adolescent psychiatrist, I have the privilege of working with many children who are victims of severe abuse, neglect, and trauma.  Some, in turn, become perpetrators of violence. One adolescent, let's call him Steven, told me that he wants to be an electrician, but he is struggling to earn his high school diploma, which he needs in order to enroll in technical school. When I inquired about ...

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It’s still flu season, although the flu gods have shown a bit more mercy than in years past.  So many variables determine whether each winter brings a relatively mild flu season, a “flunami,” or something in between.  I’m a country boy doing primary care in the city, and I have only a modest understanding of which influenza strain is circulating, the concepts of antigenic drift and shift, and how the ...

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I’ve written a lot lately about caring for our patients, and about caring for our spouses, and those things make me very happy. But now and then, things rub me the wrong way. I was recently working at TMH, or Tiny Memorial Hospital, my vague name for small facilities since I work at several and wish to preserve their anonymity.  While there a patient checked into the ED for a fairly unremarkable ...

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Though I am two years into my residency, I still experience flashbacks to my time as a medical student on the wards. The adrenaline of arriving at the hospital 2 hours before rounds, scrambling to see my patients, constructing a note that no one would ever look at, and preparing a hastily-constructed presentation to deliver in a half-performance, half-examination outside of our patient’s room. I remember being the object of a ...

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1. You either over or under-react to everything related to your child’s health. Your kid chokes?  You perform the Heimlich and are back to dinner conversation 2 minutes later.  Your infant spits up a little more than usual after their introduction to rice cereal?  You decide they may have FPIES and stay up all night worried they may require tube feeds.  True story. 2. You can’t go to any ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old woman is evaluated for a slowly enlarging, telangiectatic, pearly, ulcerated 1-cm plaque on the left temple. It bleeds periodically when traumatized. Medical history is significant for atrial fibrillation. She takes warfarin daily. She is otherwise in good health. On physical examination, vital signs are normal. Cardiac examination shows an irregular heart ...

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38 states currently have an apology act. This means that if doctors feel they owe a patient an apology, they may provide one without any ramifications, if future legal actions are taken by the patient/patient’s family. In 2006, I spent 218 days in the hospital after the healthy birth of my daughter. My chronic autoimmune disease, scleroderma, masked certain signs of preeclampsia, which went undiagnosed. This led to a massive infection ...

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My name is Dr. Neha Sharma, and I have a confession. Recently, a patient was transferred to me from New Mexico. He was found in his house, unresponsive. By the time I admitted him, he was connected to a breathing machine, and had a serious lung infection. Over a course of a few days, his condition improved. We were able to remove his breathing tube and successfully treat his infection. However, ...

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Mental illness has long been associated with shame and stigma. Although progress has been made through the efforts of global celebrities like Stephen Fry and many others to de-stigmatize mental illness -- many are still ashamed to admit to it, and the stigma is far from being annihilated. Nowhere is this stigma more entrenched than within the medical profession itself. A fact that should shock us out of our judgmental slumbers ...

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“We are witnessing a paradigm change, an unchecked slide into an era in which the scale of global forced displacement as well as the response required is now clearly dwarfing anything seen before.” - Antonio Guterres, United Nations High Commissioner for Refugees The global political upheaval caused by the Syrian refugee crisis could potentially mask a critical issue that has all the signs of a catastrophic public health disaster -- the health of ...

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"'Normal' is one of the most powerful words a radiologist can use." - Curtis P. Langlotz, professor of radiology, Stanford University After I used “clinically correlate” thrice in a row in my report, the attending radiologist asked, “How would you feel if the referring clinician said on the requisition for the study 'correlate with images'? When you ask them to clinically correlate, you’re reminding them to do their job.” I had been a ...

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It is February of our last few months of clinical rotations. I am a rising fourth-year medical student at a well-known East Coast institution with a not-so-bad track record, I guess you could say. I scored in the top percentile for the USMLE Step 1, honored my third-year rotations, and have comments from attendings about how I am destined to succeed in this career. One might think that at this point ...

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I walk up to the ICU. Ecstatic. I just placed a subclavian line, a chest tube, and performed a bronchoscopy on my patient. Intern year is going well, and today is a great day. For me. I have been learning so much, been trusted to do even more, and been a part of gratifying experiences. Successes. Life-changing procedures. Things that still make me sit in awe that we can transform the human body, ...

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I was spending time with friends and family over the holiday when I started to experience various vague symptoms without an obvious etiology. Having been treated for high blood pressure about ten years prior before successfully overcoming the issue with exercise, I immediately recognized the return of the condition. (As an aside, it should be stated that elevated blood pressure typically produces no symptoms at all.) Stopping by my local pharmacy, ...

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There's a code among physicians, both in the private and academic setting. It is that, as a physician -- unless you are dying, or very close to it -- you show up to work. Taking unscheduled time off, for either physical illness or grieving, is not easy as a physician. Doctors experience a huge amount of guilt and pressure, and rather than experience that, most of us will drag ourselves ...

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The affection families express for their dying loved ones can take many forms.  Recently, I saw a spry 91-year-old Spanish-speaking gentleman with lung cancer which had consumed the better part of his right lung.  He had a large family with many doting daughters.  In his neighborhood, he was popular and well respected.   He, according his family, had "many girlfriends."  His lung cancer was no doubt a result of a ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. I have a “like-hate” relationship with clinical metrics, performance measurements, and other such things. By now, almost all physicians live with them in the form of insurer “report cards,” PQRS, and “meaningful” use. Some of us have even more exposure to them by participating in ...

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