Parents are sometimes surprised to find out that migraines are the most common cause of recurrent headaches in children. Yes, kids get migraines -- and many adults who get them started getting them as children, even if they weren’t diagnosed correctly. (And many adults who get migraines are still not being diagnosed correctly. Do you get “sinus” headaches? They’re almost certainly migraines. Yes, I know you feel congested with them. Yes, ...

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radiological-compass Use this compass to navigate the seas of morning portables and follow up radiographs. James Chang is a radiologist and author of Oh Doctor, The Places You Will Go… He blogs at Poor MD and can be reached on Facebook.

Every clinician knows that “framing” -- how we present information to patients -- has a big impact on decisions they make about their care. Even something as simple and apparently transparent as talking about survival versus mortality is important, with “a 90 percent chance of living” sounding a lot better than “a 10 percent chance of dying” even if both phrases convey the same estimate of risk. Things get even dicier ...

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I both look forward to and despise Sunday mornings.  I awake just before the sun and am on the road by 5:15 a.m.  Although I dread being upright so early on the weekend, I rejoice because it is the only trip to work, all week, at a leisurely pace.  I see the new admits at the nursing home, run by the hospital if necessary, and return just as my family ...

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In modern medicine, we’re surrounded by EMR systems, lab tests and increasingly complex medical equipment. But I sometimes stop and wonder: Where does my intuition fit into the equation? Case in point: The other day, I had one of those days that happens in hospital medicine where nothing goes right. A patient admitted right at change of shift, with a diabetic foot ulcer as a chief complaint, was found to have ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman is evaluated for a 3-month history of gradually progressive abdominal distention. Her medical history is notable for a 20-year history of obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension. She also has had a 10-year history of elevation of serum aminotransferase levels, which was attributed to nonalcoholic fatty ...

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We go to the doctor when we are sick. But what happens when doctors get sick? Who cares for them? All too often, physicians are threatened, harassed, even terminated for being ill. After reporting on a psychiatrist fired for having cancer and a pediatrician bullied for her brain tumor, I’ve heard from many more physicians who are now courageously stepping forward to tell the truth — ...

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Theresa Miller is one of the hardest working women I know. She doesn’t come into the office very often. She no longer needs my prescription for her heartburn medication, as it costs less for her to buy it over the counter these days. Today I saw her for a preoperative clearance. She finally decided to get an operation for her chronically sore shoulder. She had injured it many years ago>. In ...

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This is a story of two deaths. These patients' stories intersected on the same morning, in the same building, in two adjacent rooms, has left me thinking about them. I was surprised to see Mrs. Stevens' name on my schedule today. She came to the office last week, and I felt sure that she'd be too weak for another visit. But I was glad she'd made it, as I've become quite ...

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I remember the early trials of thrombolytics; not for stroke but for MI. During my residency, we were still comparing tPA with streptokinase. It was pretty incredible stuff. Now we’ve moved beyond that positively "medieval" method of treating heart attacks and have advanced to incredible interventions in coronary and cerebrovascular disease. Furthermore, we are able to rescue more and more people from the brink of death with advanced medications and with ...

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Customer service is all the rage these days in most facets of our lives. America leads the world in this area (however much of the public here take it for granted). I’ve traveled all over the world, and the concept of customer service in many other parts of the globe, including highly advanced and prosperous other Western nations, still leaves a lot to be desired. It’s always reassuring to know ...

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When I was in medical school, “real” doctors saved lives. Period. Specialists who focused on a patient’s quality of life, (the plastic surgeons, bariatric surgeons, holistic practitioners, infertility experts, etc.) were considered sellouts. (We won’t even consider the med school status of future psychiatrists.) We disparaged these doctors because they could be saving lives and chose not to, because they were often paid (God forbid) out-of-pocket by their patients, and because they ...

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If you’re like me, you’re getting a bit restless hearing about what may or may not happen to the Affordable Care Act (Obamacare). As doctors, we are trained to act. While administrators plan new quality improvement programs, we take each day as an opportunity to improve our practice and work more closely with our teams. While our clinics and hospitals try to figure out how to streamline workflows in our EHRs, ...

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Pediatrician-rapper Young IV with some holiday safety tips.

A Christmas Carol by Charles Dickens is one of the most beloved stories of all time. It is a classic story with a theme that resonates as we end the year and commence a new one. The story revolves around the main character examining his past, present, and future. He realized that key events have shaped his life and turned him into the man he is. Before the story ends, ...

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“I want to die, I want to die,” she repeated over and over as the trauma team stabilized her body. The patient, a female in her late 70s with Parkinson’s disease, presenting with a self-inflicted gun shot wound to the head.  It was at that moment I saw the complex cruelty of her situation. The despair in which she found herself and in the manner in which she sought to ...

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I will not argue that drugs are “bad” and holistic care is “good.” I have seen the way medications can transform a person’s life for the better, and I could never invalidate the experience of someone living with mental illness. But I will argue vehemently that holistic, preventive, and integrative health measures should come first, and medication should be used as a secondary option. The current structure of psychiatry -- ...

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The ultimate goal of every young physician while in medical school and residency should be to become a remarkable doctor. However, what if one of the biggest factors of being a great doctor was not addressed from the start? Financial wellness may not directly correlate with being an incredible doctor, but stress can and does, and today's young medical professionals have a lot on their plates — beginning with $200,000 in ...

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As a physician from Ghana brought up in a very religious family, I must admit that when it comes to gay rights and other issues related to sexual minorities I was as far to the right as anyone could be.  My first experience with openly gay individuals was when I came to the United States. Needless to say, gay behavior in Ghana was so stigmatized as to be nonexistent in ...

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Recently, my friend had a patient. The guy, patient with a history of autoimmune disease came in with pain, anxiety, and tachycardia.  She walked in and felt the psychosomatic overlay. What was her intervention? Meds? Psych? Nope. She closed the door, held his hand, pulled out her mom self and let him tell her for 15 long minutes about his hard life. The nurse watched the monitor as his heart rate dropped in ...

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