Mark Letterman’s rheumatoid arthritis had been progressing unrelentingly despite popping dozens of pills each week -- eight methotrexate pills on Mondays alone. Letterman felt like he was 63 going on 93. If rheumatoid arthritis progresses unchecked, it is as debilitating of a disease as can be imagined. Don’t think garden variety arthritis that only interferes with activities like, um, gardening. Think: finger and wrist joints so inflamed it feels like your ...

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I recently went hiking in a beautiful national park outside of Columbia, SC. This park was in a swampy area and contained all sorts of wildlife (called “critters” down here) and plant life (called “trees and those other things” down here). When I was young, my dad would take us kids on hikes through the Adirondack Park in New York, and so being on hikes in nature hits my soul ...

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I want to talk about the word everyone seems to use: drama.  This word is used in many facets, to describe conflict, negative interactions with others, disagreements, or obstruction to a new idea. No one likes drama. Yet some people seem to instigate it, and others seem to have to deal with it on a rotating basis. We all wish we could ignore it, avoid it, and leave it for people who ...

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Gastroenterologists, as specialists, are called upon by other doctors to address digestive issues in their patients. For example, our daily office schedule is filled with patients sent by primary care physicians who want our advice or our technical testing skills to evaluate individuals with abdominal pain, bowel issues, heartburn, rectal bleeding and various other symptoms. The same process occurs when we are called to see hospital patients. If a hospital ...

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I have spent three days at the Society to Improve Diagnosis in Medicine. Whenever I come to this meeting, I have insights from listening to talks and many conversations with leaders in the field. When one considers diagnostic errors, one must consider two important factors: physician factors and system factors. We have a major system factor that can cause problems. Most hospitals in the U.S. require a diagnosis for admission. I ...

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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to “usual care” in highly controlled environments, outcomes such as a 0.4 per day decrease in length of stay with ...

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“It is not for me to judge another man's life. I must judge, I must choose, I must spurn, purely for myself. For myself, alone.” -Hermann Hesse, "Siddhartha" What does it mean to die with dignity? As a neurosurgeon who faces life and death decisions routinely, I ponder this question often. When a terminally ill person decides to choose death over suffering, we perhaps recognize the ensuing act as a dignified death. But ...

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Long ago, I represented a doctor who was … difficult. He was a phenomenal surgeon, world famous in his field, but he was not warm and fuzzy — not even close. Cold and hard were more his speed. We spent two weeks together, on trial in city hall. It takes about two years from the time a case is filed to the time the case goes to court. During that ...

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Every morning around 5 a.m., the overnight intern updates me on what happened to the patients on my service. In a hospital where disease knows no hour, the nights can often be just as busy as the days. “Just letting you know, his wound seemed a little wet to me. Maybe it’s starting to get infected.” “Good to know. We may have to change the dressing more frequently.” “And this patient had constant ...

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“Jag ska bli doktor,” a four-year-old boy announced to his family sixty years ago. Somehow, everything he did after that moment seemed to move him in that direction, even when, on the surface, his path through life seemed to be meandering. As a student, he was just as interested in literature and philosophy as he was in scientific subjects. He even failed his first quiz in organic chemistry just after receiving the ...

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Do you want your surgeon to work back-to-back overnight 12-hour shifts and then perform brain surgery on you the next morning? There’s currently no regulation prohibiting this kind of dangerous scheduling in medicine. Physicians are human. Like truck drivers or airline pilots, their fatigue can lead to dangerous consequences for those around them. A recent study showed that even mild sleep deprivation causes the same levels of impairment ...

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“Doc, you mind switching that to an oral preparation?” our clinical pharmacist inquired during multi-disciplinary rounds as intravenous infusion devices beeped annoyingly in the background.  Taking care of ICU patients can be extraordinarily complicated, so doing it as part of a team helps make sure that all bases are covered. Like many hospitals, ours uses a multidisciplinary model which makes rounds on all patients in the ICU.  An ICU nurse, clinical ...

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An excerpt from Cancer What You Need to Know. Treating cancer means taking care of the whole patient -- the physical, the emotional, and the spiritual. This starts at diagnosis and carries through treatment and beyond. Unfortunately, for some patients, cancer does find ways to spread that can cause physical pain, ...

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Congratulations! At this point, you are almost halfway done with your first year of medical school. Either you have finally figured out what's going on, or if you're like me, you are still trying to figure it out. Relax, take a few deep breaths. Medical school is unlike anything you have ever done. The volume of information, constant testing, and overwhelming need to keep up with your peers is an ...

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An excerpt from A Parent's Guide to Teen Addiction: Professional Advice on Signs, Symptoms, What to Say, and How to Help (Skyhorse Publishing; October 2017). Marijuana, the illegal drug most commonly used by teenagers, is widely accepted as harmless, but is it? Its effects range from the trivial—silliness, bloodshot ...

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“I lift things up and put them down.” This quote is from a commercial for Planet Fitness I have seen in the past. It portrays a bulky body builder on a tour of the gym premises. There is no real communication with the tour guide since he keeps saying that he lifts things up and puts them down, irrespective of what the tour ...

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I was talking to a physician in my hospital several years ago, and he expressed his frustration that the annual well-child exams for his four kids were expensive. Puzzled, I stated that I found it odd that a doctor’s own health insurance plan had poor coverage for routine care, and he replied that his group jointly decided on a plan with considerable upfront out-of-pocket costs. Why would doctors buy bad ...

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I have been doing health care research and advocacy for over 20 years. I've seen a lot of passion, anger, and rhetoric around the issues. The health care crisis is simple in that everyone needs health care. The question is what to do about it and who should pay for it. It's not an easy answer. For starters, we have turned into a culture of entitlement. This includes health care. It ...

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We were once a nation noted for its achievements. We are now a nation that gets nothing done, unable to make even the slightest movement forward despite multiple national crises -- a desperately broken health care system, a horrifying opioid epidemic, sickening gun-related mass murders, the threat of nuclear war, and massive storms resulting from man-made climate change. In the face of such monumental challenges, when bold action is needed, ...

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Every now and then, when some people learn what kind of work I do, they say, “You’re doing God’s work. Thank you.” They mean well, so I accept the compliment, though I also tack on, “I also like what I do. It’s meaningful work for me.” So many of the people I see, whether in my current job or in my past jobs working in other underserved communities, have a lot going ...

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