It was around 2 p.m. when a 380-pound woman came into the ED. She was in her late 30s. The physician went to see her and then ordered IV fluids, some basic blood tests, and a urine sample. At a hospital, everyone’s job is made harder when a patient is obese. Getting the patient on the bed requires more personnel. Inserting an IV -- an intravenous catheter to infuse fluids or ...

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One of the most memorable times from my family medicine training days was the annual residency my intern year. It was the year of the World Cup, and a bonding experience that would later save my life.  Being able to be with not only my residency class, but also the faculty in a relaxed and empowering environment brought a sense of safety that allowed me to reach out to one ...

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The amount of prescribed medications and the number of individuals taking them are increasing rapidly. The share of Americans taking one or more prescription drugs has risen among all age groups. According to the IMS Health Study, the total spending on prescription drugs in the U.S.  reached $310 billion in 2015. This is almost three times more than total drug expenditures in the year 2000. It is forecasted that the ...

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“Bask in the glory, toots. You deserve it!” I received this text message from my very dear friend a few days ago after an extraordinary occurrence. I’m a retired internist, and recently my clinical acumen and intervention saved another friend’s life. That is a statement of fact, not a boast.  And that’s why I’m writing about it. The patient, a retired surgeon, hosted our circle of friends’ New Year’s Eve party a little ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a follow-up visit for gout. Two years ago, he had been treated with allopurinol and developed a hypersensitivity reaction. Over the past several months, he has had recurrent attacks of acute, episodic swelling of the first metatarsophalangeal joints with increasing involvement of other joints, including ...

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Sure, it’s nice to think about cutting back on the work hours and spending more time at home with the kids. Or out on the running trails getting fit and enjoying nature. Or singing in a chorus. But how do you really make that decision? And if you do decide to work part-time, how do you make the most of it? After struggling to juggle two full-time health care careers with ...

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A computer algorithm learning how to play StarCraft like a champ may raise some eyebrows, but when algorithms start to give the skills of a trained physician a run, job security becomes a futile construct. An algorithm now diagnoses melanoma as well as a dermatologist: A consolation for the dermatologists, though: Folks across the hallway -- the radiologists and the pathologists -- are feeling the heat as well. ...

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The Mylan EpiPen debacle may have inadvertently weakened the grip of big pharma on U.S. lawmakers.  Recently, a bill proposed by Senator Bernie Sanders was narrowly rejected by a vote of 52 to 46.  Unexpectedly, 12 Republicans and 1 Independent voted with Senator Sanders in favor of allowing pharmacists and distributors to import cheaper prescription drugs from foreign countries.  The winds of change may finally blow in a bipartisan direction.  ...

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An excerpt from Attending: Medicine, Mindfulness and Humanity. Sometimes a simple gesture and a few well-placed words can signal presence. One day on rounds in the hospital, as we walked into the room, Laura Hogan, a nurse-practitioner on our palliative care team, said three words to the patient: “What beautiful flowers.” ...

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Health behavior was my emphasis in my MPH. Add a faculty development fellowship, time as residency faculty, work in a private practice, and increasing interaction with medical students now as faculty at a medical school; the outcome is not just an emphasis, but a mindset. A mindset of health behavior that is not just for patients, but for physicians, as well. I must have company in this concept as ten invitations ...

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A hospital stay is a right of passage for any patient, but the road to health is often a marathon and not a sprint. Discharge is an essential step in the patient journey, but it can be as exciting for a family as it is daunting. Families can prepare ahead and put all the right pieces in place in order for a “soft landing” home. Here are some of our ...

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America’s health care system is broken and no longer works.  Many practicing physicians are unhappy with the way insurance companies control medicine.  Most patients are unsatisfied with the benefits they receive from the health insurance companies and with the lack of choice they have in who cares for them.  Patients are frustrated with the exorbitant cost of prescription medicine.  They wonder why this system often doesn’t allow them to receive ...

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american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. During the course of our careers as physicians, we have cared for or are aware of an elderly patient in the intensive care unit or ward who has exhibited delirium, or an acute confused state. This is particularly common after surgery and anesthesia. While simply being ...

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My stomach had been in knots that morning. “Are you pregnant?” my classmate laughed after I returned to the gross anatomy lab for the second time after leaving for fresh air. “No,” I spat, dissection through fat and fascia, teasing out muscles from nerves. But, I wondered. After lab, I bought a pregnancy test. I began medical school in my late 20s, already having discussed with my husband appropriate times to start a family during ...

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With all this talk about medical student, resident, and fellow burnout, I thought we might take a break to discuss the small delights that sprinkle throughout medical training. This is not a “You should publish as a trainee” manifesto. It’s more of a DIY guide for those who are interested but can’t find the time or the mentor. And after a decade of rejected manuscripts, unfortunately, I’ve got ...

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Years ago, after I suffered a deep personal loss, my doctor prescribed Prozac, and I joined the millions of Americans who have taken an antidepressant. A few weeks later, I had my first panic attack — heart racing, sweating profusely, gasping for breath — sensations of terror normally reserved for life-threatening events. Attacks continued every half-hour and were so incapacitating that I could not even leave my house. My doctors ...

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My car says it’s 2:10 a.m., 17 degrees. I just left my warm bed — and snoring husband — threw on scrubs and my contact lenses and quickly brushed my teeth and hair. I’m shivering as the car warms up and I hear the crunch of the snow as the car rolls out of the driveway. I’m the first one out on the fresh snow, and it glistens in the ...

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In the United States, the patent protection process — as it relates to the drug industry — has been distorted by the political system, intense lobbying and large campaign contributions. The result has been pricing contrary to the greater good of the nation. Patents originated in ancient Greece. This legal protection assumed greater importance in 15th-Century Venice as a means to protect the nation-state’s glassblowing industry. The first patent granted in ...

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When we think of pollution, we think of our planet: stripped forests paved asphalt black, sterile red rivers, brown-gray skies and creeping slums over once virgin land. We imagine massive dumps of civilized waste, the extermination of species and temperatures which bake the earth like a neglected oven. We mourn the global home in which we live, neglected, abused, in ruin. Do we ever think about ourselves? That is one of ...

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My daughter and I were talking the other day and saying we would like to ask a doctor what his thoughts are about all these ‘natural’ remedies that are available. Recently a friend made the remark, ‘I do everything I can to avoid a doctor.’ I lean more toward the medical system and the knowledge they have acquired over the years rather than relying on these home remedies. What are ...

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