shutterstock_216645019 asco-logo We all have our fair share of so-called “difficult” patients. And, I would suggest that how we define “difficult” is as diverse as we are as health care providers and as individuals. Some patients come to us with that reputation -- perhaps, a vague descriptor in a referral letter or ...

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shutterstock_117645061 Imagine the United States of America when a simple skin infection from a scrape causes a 10 percent chance of dying.  Out of every 1,000 women who give birth, nine will die, and out of the 1,000 infants born,  up to 30 percent will die.   It is difficult to imagine, but these are the alarming statistics prior to antibiotics in the early ...

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shutterstock_122391511 Leave early. Two words. Simple concept. But, one worth thinking about. James Altucher explains it well, but this is the same guy who also thought he could save his business by becoming more like a Jedi Knight. Admittedly, the Jedi thing seemed to work for him, and his businesses, as well as the uncountable number of people he’s helped since then. ...

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On July 7th, 2015, I cross-posted an article from "Hope Amantine," a pseudoanonymous surgeon who previously blogged at Simple Country Surgeon: "A lesson in the OR that prepared this doctor to be a surgeon." On July 8th, 2015, 11 a.m. Eastern, I was notified by an editor at MedPage Today about the controversy questioning the truthfulness of the story. I then reached out to "Hope," asking whether her story was fictional or not. I ...

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shutterstock_266789546 Last night, one of my close and friends told me the story of her recent trip for her annual gynecology appointment. Her longtime gynecologist had retired, and she was meeting her new physician. After taking a history, the first new physician explained to her that since she always had normal Pap smears, including recent ones from the past several years, she ...

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shutterstock_223663249 Chronic insomnia affects 5 percent to 15 percent of Americans. It is far from only a nighttime problem. As all of us know from occasional sleepless nights, the following day is unproductive and sometimes dangerous. Sleep deprived people are more prone to accidents, and are more likely to have depression, anxiety, diabetes and high blood pressure. It is no surprise then that ...

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shutterstock_207548383 Manny Alvarez is a 23-year-old college student with the misfortune of having not just a devastating cancer -- but the wrong devastating cancer. The chemotherapeutic agents shown to be highly active against his specific tumor cells are FDA approved for the treatment of leukemia, but not for the stunningly rare kind of sarcoma with which Manny has been diagnosed. Nothing is ...

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shutterstock_148383902 I am in my twenties. I am a student in dental school. My seven classmates and I have gathered, notebooks and pens in hand, for the first day of our ten-day rotation at the Veteran's Hospital oncology department. Dr. Steele, a published expert in oral cancer, instructs us to follow him to the outpatient clinic. Some of those he'll examine are initial consultations; ...

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New_Image “What’s up with the ABIM?” “I just got a note about an alternative board. Should I join it?” “Aren’t you glad to be off the Board?” These days, I get these questions from friends and colleagues regularly. When I first joined the board of directors of the American Board of Internal Medicine (ABIM) in 2004, the organization was a well-respected pillar ...

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shutterstock_233804005 The outcry over antipsychotics has ranged far and wide.  Everyone from governmental agencies to senior advocacy organizations have pointed to the abysmal data.  Antipsychotics have a negative impact on morbidity and mortality.  They say we are chemically restraining those who are too fragile to stick up for themselves.  They say we are sedating instead of treating. And I disagree wholeheartedly. I manage a ...

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"Thank you." Looking back on my step 1 study period, I owe my sanity to three things. Numbers 1 and 2 include my best friend and Coffee Toffee ice cream, both of whom prevented me from falling apart at the seams on multiple occasions. Number 3 is a memory from volunteering earlier in the year, and it still stands out as the sole motivating force behind me ever finding my copy ...

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shutterstock_144352681 When I chose a career in pediatrics, everyone had something to say about my decision. While most of my friends and colleagues were supportive, there were more than a few that just couldn’t understand why I would sign up for a lifetime of “ear infections and runny noses.” Even among other medical professionals, it’s not uncommon for pediatrics to be viewed as a less-than-serious ...

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Every week, I am asked by patients if their heartburn medicine causes osteoporosis. The most effective heartburn medicines are called proton pump inhibitors, or PPIs. If you watch more than an hour of TV per week, then you have seen ads for some of them. Nexium, Prilosec, and Protonix are three examples of these medicines. Many of them are now available over-the-counter at reduced dosages. Patients today are incredibly informed, and sometimes ...

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One of the most distinctive aspects of a medical career is the vulnerability we see in essential strangers almost immediately upon introduction. Even without a medical degree, the third-year medical student will find out intimate details of one’s life while taking a history. Patients will reveal their fears of a disease, embarrassing side effects of a new drug, a habit they are ashamed of. Halfway into third year, I have learned the ...

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shutterstock_271375967 California is in the middle of an historic drought, with the government setting limits on how long people can sing in the shower. Farmers in the state may soon need to cut back on planting or production, as ground water dries up. But California is still fruitful ground for testing promising ways to improve how health care consumers, otherwise known as ...

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shutterstock_50320798 The scalpel hits the skin immediately, splaying it open with one smooth swipe. Two more swipes through yellow globular fat and I hit the glistening white fascia layer. If this weren't an emergency, I would stop to carefully cauterize the small bleeding blood vessels in the fat layer, but there is no time for that now. I nick the middle of ...

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shutterstock_113731288 I never really watched medical shows, even before and during medical school. I watched maybe one season of ER, a couple of seasons of Grey's Anatomy and House MD and maybe one episode each of Private Practice, Chicago Hope, Emily Owens MD and other random medical shows. The only medical show I made an exception for was Scrubs, because it was ...

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shutterstock_125243891 Patient-doctor communication often has many facets, wrinkles, and twists.  Medical school prepares a doctor minimally for the ups and downs of these patient interactions.  There is no mannequin who can train each medical student how to deal with every personality, response, or even outburst by each patient.  On the job training is sine qua non. During and after medical school, it took ...

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As a practicing gynecologic oncologist, I have spoken the words, “I’m sorry, you have cancer,” or some version of that sentence thousands of times. And although my delivery is fairly consistent, modified only slightly to improve understanding, my patients’ responses vary from stunned silence to uncontrollable, overwhelming cataplexy. The stalwart emphatically reply “I’m gonna beat this thing,” but the vast majority tentatively wonder “How long do I have?” and retreat ...

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When my sister, Jessica, was a nurse anesthetist student at the University of New England, she had the opportunity to rotate at Johns Hopkins, and she seized it. She was young and fairly new to the medical world and so she did not recognize at first the name of the neurosurgeon with whom she would be working -- Dr. Ben Carson. After receiving multiple comments from numerous people about how great it ...

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