Last week, a patient with severe gastroparesis came in for an unexpected visit. She seemed very upset, on the verge of tears. Instead of asking her why she was in, I asked her why she was so sad. “My hematologist just retired; I was her last patient. I don’t know who will take care of me like she did. And she wasn’t even old enough to retire,” she said. This took ...

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In July 2016, the U.S. Preventative Services Task Force (USPSTF) published updated skin cancer screening guidelines in JAMA, concluding “current evidence is insufficient” to screen for skin cancer in adults. The guidelines were formulated on a literature review of studies conducted in asymptomatic patients 15 years and older at general risk for skin cancer from 1995-2015; after identifying nearly 13,000 articles spanning two decades of work worldwide, the authors selected ...

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Most people are surprised to hear that the way doctors are recertified every ten years is through a multiple choice test. “Really?” they’ll say. “You take a multiple choice test? As a doctor?” Unfortunately, after all these years that's the most efficient way we can think of to evaluate professionals. But the method is so flawed. And your ability to answer questions on the multiple choice test isn't necessarily linked with ...

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Pathologists ensure the safety of the blood supply.  Here's how they do it.  Created by the College of American Pathologists.

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. In the past several years, there has been a dramatic increase in media attention concerning bills patients receive from health care professionals who are not in the network of providers their insurance company contracted with to provide health services. The out-of-network bills these patients ...

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It is a master of stealth, stretching less than half an inch long and weighing in at 2.5 milligrams with as estimated air speed of 1 to 1.5 miles per hour. It is virtually soundless in flight, registering zero decibels from ten feet. Its tracking systems hone in on targets by detecting infrared radiation from warm bodies, chemicals such as carbon dioxide and lactic acid, body odors from as far ...

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During the first few days that my mother spent in hospice, I silently sat by her bed watching her chest rise and fall, listening to her moan, counting her doses of Ativan, Tylenol, and Morphine, and tallying the days she’d been without food and water. On day five of my vigil, I asked her nurse, “How long can Mom live like this? She hasn’t opened her eyes or eaten or had ...

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After more than fifteen years of being mostly housebound by chronic illness (which includes chronic pain), here are a few of the dilemmas I’ve faced over and over. I’m confident that I’m not alone in my “should I/shouldn’t I?” world. Do I accept an invitation from a friend to get together or do I refuse it? If I refuse the invitation, depending on who issued it, it may be the last one ...

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After surgery for my broken tibia, I realized that there were only four points on the pain scale that really mattered to me:

  1. I’m OK. This acetaminophen/ibuprofen/whatever is enough.
  2. I wouldn’t mind a little something more, preferably something that binds mu
  3. Um, could you please hurry that up?
  4. NOW! NOW!  I need it NOW!
On the 0 to 10 pain scale, who really cares if you are at a 2 or ...

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To close out my first week of medical school, the class was treated to a talk by a stuffy but soft-spoken lecturer on the relationship between poverty, education, and poor population health. "Social determinants of health," he labeled them, a clunky and unwieldy term if ever I'd heard one. In those days, audiovisual aids consisted of an overhead projector for black-and-white transparencies. And boy did that talk have transparencies. Chart ...

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Author.  President.  Teacher.  Doctor.  These are all gender-neutral words which happen to relate to a person’s profession.  However, I find it particularly interesting that while “doctor” is a gender-neutral word, the field of medicine is riddled with institutional sexism. Let me begin by explaining that I am a military physician currently training to become a gastroenterologist.  If being the only woman in any room bothered me, my journey would imply that ...

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After rotating in the ICU, I began to wonder about the limitations of modern medicine. In a short time, we have come a long way with the discovery of antibiotics, high-resolution imaging, and the development of advanced surgical procedures. The medical field saves millions of lives. Nowadays, people do not go to a hospital to die; they go to be healed. As physicians, we are very skilled at extending life. Heart ...

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We are standing at a crossroads in health care. Behind us lies a long-lost, nostalgia-tinged world of unfettered provider autonomy, sacred doctor-patient relationships, and a laser-like focus on the art and humanity of medicine. This was the world of my father, an immigrant and primary care physician in rural California. The world of Health 1.0. While many still pine for these “good old days” of medicine, we shouldn’t forget that those days weren’t really ...

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As a long-distance truck driver, he did not have time to visit a doctor. In fact, the last time a doctor ever examined him was decades ago. When his leg started hurting, he ignored the pain for months before it got too severe and started interfering with his ability to drive.  He showed up in my office in severe pain and limping. And while he tried to joke it off, ...

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Recently a measure was proposed to allow APRNs full practice authority in the VA health care system.  With this measure, the embattled VA hopes to help optimize access to health care for our veterans. A measure to help with the firestorm of problems we witnessed unravel at the Phoenix VA system two years ago. Sounds great, right? Nothing is ever that simple in American medicine. The professional organizations are, once again, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman is evaluated for a 10-year history of recurrent episodes of acute-onset feelings of fear and anxiety. These episodes initially occurred approximately 4 times per year but for the past 3 months have been occurring once or twice per month, especially when she is under stress. She describes the ...

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It is no secret that mental health conditions are prevalent, and recent years have seen an increase in the dialogue on their causes and consequences. However, we do ourselves a disservice when discussing mental health outside the context of the broader system in which care is provided, and the insurance constraints that drive shortcomings in health care delivery. SAMHSA estimated that 58 percent of adults have a medical condition ...

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Dear medical student, resident, or fellow, You will one day forget something. We are currently in a systematic plot to have everyone forget something important. We are quietly unaware it is happening. We are asked to forget how we got here. I want to remind you. I want us all to remember. You undoubtably were more mature than your peers. You undoubtably sacrificed to develop the persona that one day would impress ...

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Summer is heating up, and so is the election rhetoric. In this year's campaign for the White House, when it comes to verbally attacking each other, neither candidate seems to recognize any limits. Personally, I think this behavior reflects poorly on both candidates. In heath care, it's almost impossible to escape this negativity. The media devours and thrives upon it. In our hospitals, televisions in the doctor's lounge, cafeteria and in ...

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My eyes open. The blackness of the call room envelopes me. Consciousness sets in with a lingering disorientation. A small green light, is speaking … ringing. “Are you standing up?” The resident on the other end knows her attending too well. She’s right not to risk my falling asleep mid-conversation. A woman has arrived laboring at 24 weeks gestation. Records aren't available, but she reports her fetus has a diaphragmatic hernia. ...

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