I recently read some statistics that shocked me, but not really. In the U.S., 60% of medical students come from families with incomes in the top 20% of the nation. Meanwhile, only 3% come from families with incomes in the lowest 20%. Not much socioeconomic diversity in the house of medicine. Now, I realized early on that I didn’t have a lot of company in this respect, but I didn’t think ...

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Recently I was the only witness to testify against local medical marijuana legislation.  The bill, already endorsed by all members of the Council of the District of Columbia, would allow use of marijuana for “any condition for which treatment with medical marijuana would be beneficial, as determined by the patient’s physician.”  As I waited hours for my turn to highlight the medical evidence about marijuana’s health effects, I sat silently, taking in ...

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For the better part of the last two decades I have practiced psychiatry in a variety of different American health care systems, and over these years I have, on numerous occasions, heard psychiatric services referred to in manner that imply (often subtly) that such services are not medical care.  These references come not only from patients, but nurses and doctors (including myself) too. “Yes Mr. Jones you need to follow up ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 65-year-old woman is evaluated for a prodrome of pain on tip of the nose followed by a painful eruption involving the right periorbital tissue. On physical examination, all vital signs are normal. There are grouped vesicles on an erythematous base on the tip of the nose and about the right eye. Which of ...

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The mission creep of maintenance of certification Up until 1988, being board certified in pediatrics was a voluntary process of passing the board exam once in a career. The American Board of Pediatrics (ABP) apparently realized this process didn’t make them much money, so in 1989, they abruptly ended “lifetime certification” and required an open book test and the associated fee every seven years.  I was in pediatric residency during this maintenance of certification ...

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Why you should love your doctor Doctors spend their 20s and 30s studying while most of their friends are at parties and enjoying their youth. Doctors may amass up to $500,000 in debt for the honor of one day caring for you and your family. Doctors delay childbearing and starting their own families so they can care for your family. Doctors miss their own kids’ ballet recitals and baseball games ...

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The administration issued a report recently that says individuals who selected plans in the federal health insurance exchanges have a post-credit premium that is on average 76% less than the full premium for the plans they selected. And, 69% are paying less than $100 after the subsidies -- 46% are paying $50 or less. The administration also pointed out that 65% of individuals selecting the silver plan in the federal exchange chose ...

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You’d think, being land-based mammals, we’d all be able to agree on the basic fact that humans breathe air, and that newborn human babies ought to be born into the air.  You know, so they can breathe. That’s how human babies have always been born, and that’s how all other primates are born, and that’s how all other land mammals are born. (Hats off to our cetacean cousins for their ...

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I'm impressed by how much we struggle with seemingly simple health decisions when faced with sorting through too much information. Buying sunscreen: It's a simple task, right? Most of us do it every year about this time. And among actions we can take to reduce our risk of cancer in general and skin cancer specifically, this choice is fairly important. So my colleague was surprised to hear this snippet of conversation as she contemplated ...

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Dear Jane: Thank you for asking me about my perspectives on medical school. Here are some general principles that you might find useful in your own training: 1. View everyone as your teacher. Everyone you encounter will teach you something. Be open to what they have to offer. Yes, your professors and attendings, the “official” teachers, will educate you. Patients, however, will often be your best teachers. Listen to what they say, watch how ...

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A recent meta-analysis by an accomplished international team of researchers, published in a prestigious medical journal, shows that high intake of saturated fat is exactly as bad for health as a high intake of sugar and refined starch. The study also suggests there is something far worse. The study, which pooled data from prior research and in the process aggregated findings for over 500,000 people, compared the rates of coronary ...

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“Everyone I know agrees that President Obama’s problem is that he isn’t liberal enough.  Everyone I know believes that the problem with Obamacare is that it gives insurance companies too much power, when what we really need is a single payer system where the government runs everything, like Canada.  Everyone I know believes that  the answer to gun violence is to ban guns,  and if the Supreme Court won’t allow that, to at least license, ...

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I have made several observations as to why developmentally challenged people are losing out in our health care systems. Given that there are 11 million children in the United States with an emotional, developmental or behavioral condition, we really can’t afford to neglect this important issue. My first observation is that primary care remains a chronically undervalued component of health care delivery in the U.S. Despite the 60 million Americans who ...

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A simple trick to remember your doctors recommendations An excerpt from The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy.

You’ve told your story. Your doctor gets it. He has completed the physical exam. He formulates a plan to get you better. The next skill you should master may be as important as being a great storyteller. Your doctor has told you the ...

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Most physicians recall the medical school ritual of unboxing our first stethoscope. From the first physical diagnosis course, we were all solemnly instructed as to the importance of the physical examination in the diagnosis and of management of illness. Given that perhaps the most notable use of the stethoscope is cardiac auscultation, it would seem that this should hold particularly true for cardiology. And yet, on moving from classroom to bedside, ...

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I am not strongly against the death penalty on principle or on moral grounds -- assuming, of course, that it could somehow be narrowly and efficiently restricted to a very few egregiously deserving and certainly guilty criminals. I don't even find it particularly appalling (or cruel and unusual) punishment that a killer may have some few minutes of physical discomfort before expiring during a clumsily administered execution. My experience as a ...

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Whenever I talk with groups of medical professionals about job frustration and burnout, there’s a theme that shows up that’s hard to ignore. I call it “the pain of perfection.” Most of us pursued careers in medicine to help others. And if we’re honest, we must admit that we have type A tendencies infused in our bloodstream. Can I see a show of hands, please? That part of us, the one that strives ...

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Replacing transcriptionists with physicians is a fools bargain My general internal medicine practice is equidistant from the three academic institutions and a Veterans Administration facility, and thus I have patients who receive primary, secondary and tertiary care at each of these institutions. The notes I receive back from one of these organizations are hands down the best of the four institutions. These notes are personal, concise, precise and clear. If ...

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A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject? In emergency situations, patients often arrive at the hospital unconscious or with severely impaired decision-making capacity. Progress in medical practice depends on results from carefully designed research; yet in these emergency cases such patients are unable to fulfill one of the ...

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It is a trade secret among patients of many practices: If you’d like to be seen by your personal physician with no waiting and without an appointment, just ask for a free blood pressure check and then mention to the medical assistant that you are not feeling well at all. They can’t send you home without being seen and they don’t have enough to go on to call an ambulance; ...

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