Medical student Joyce Ho recently wrote an article in which she admitted to discomfort raising the topic of religion with patients.  As a “polarizing” issue that could make the doctor-patient relationship “more unprofessional,” Ms. Ho imagined that patients would fear playing into their doctors’ prejudices, particularly if the doctor were atheist, and that this fear would push some patients away from the inquiring doctor.  Despite her instructor’s recommendation to ask ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 24-year-old woman is evaluated for a 3-week history of painful muscle spasms and twisting movements in the neck and trunk. She says that her neck feels as if it is being pulled backward. She also reports general restlessness and an inability to keep still. Her medical history is notable for asthma, ...

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“I’m so sorry, but it looks like the cancer has spread.” As I heard these words come out of my mouth, I knew that in a split second, a new reality was created in the mind of the patient that I was talking to. I looked at his face and saw that he was trying to remain strong, but in his demeanor, it was apparent that dreams were crushed and that ...

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The worst news in health care is not antibiotic resistance, drug-drug interactions, hospital acquired infections, lack of communication between systems of medical records, and certainly not the alarming rate of obesity in our youth. The worst news is the increasing number of dissatisfied physicians. The physician, also known in the system as a "provider," has been the direct target of assault by the government. The logic has been that if the physician ...

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Summer, 1998 Three Rivers Stadium Pittsburgh, Pennsylvania It was a typical Saturday morning on call. We'd finished rounds and I'd taken the sign-out from the resident who'd worked the night before. I headed to the library, planning to do some board prep before the inevitable beeper call to the ER or ICU. I was a PGY-4 neurosurgery resident, with many previous weekends on duty to my credit. No reason to think this one would be ...

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As physicians, we often write prescriptions for our patients. Where, when, and how patients fill their prescriptions are usually outside of our realm of expertise. But should we be more involved? On occasion, the cost of a medication and possible alternatives will be the subject of my conversation with a patient. I was surprised, however, when one of my patients complained about the price of an antidepressant that I had prescribed. ...

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Look for a doctor who understands healingLook for a doctor who understands healing

An excerpt from In Sickness as in Health: Helping Couples Cope with the Complexities of Illness.

You are not a statistic Ironically, the surgeon who repaired her heart also left her heartbroken. While he and the neurologists may have considered it their obligation to present what they envisioned as ...

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Picture this. You walk into your doctor’s office for an urgent visit for new distressing symptoms.  He (or she) takes your blood pressure, temperature, heart rate.  All within normal limits.  He asks you several questions pertaining to your symptoms, does a thorough exam and perhaps orders a quick in-office lab or two.  You ask him what he thinks is going on. The quandary If it’s a slam dunk diagnosis, the branch point in ...

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What do you do when your ideal residency program does not exist?  This is a truth that all perspective applicants must come to terms with, but I was still hoping that I would be the exception.  I had created my list of everything my top family medicine program must have, including strong research mentorship, dedicated faculty, and a welcoming resident environment, and I had an idea going into the interview season what ...

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Interpreting studies is a dicey thing. Often I find what might be statistically significant translated into headlines that might not really get at the nuance of the study or the results. Take these three for example:

  1. "Pine bark extract improves severe perimenopausal symptoms"
  2. "Two weeks of antibiotic therapy relieves IBS (irritable bowel syndrome)"
  3. "Study: 'Female viagra flibanserin' works"
The first line of the last article: "Need a boost to your sex life. The magic could be in ...

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Apps used to monitor blood pressure need better design Here's a design approach that I really, really dislike: the scrolling wheel that is often used for number entry in iOS apps. I find that the scrolling wheel makes it very tiresome to enter numbers, and much prefer apps that offer a number pad, or another way to touch the number you need. (Or at least decrease the number at ...

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Readers have contacted me about a recent study that links acetaminophen use in pregnancy to the later development of ADHD in children. Is Tylenol yet another thing pregnant women need to avoid? The study, titled “Acetaminophen use during pregnancy, behavioral problems, and hyperkinetic disorders” was published this month in JAMA Pediatrics. Dutch researchers looked at about 60,000 children born from 1996-2002. Their parents have been filling out questionnaires and ...

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I recently spoke to a quality measures development organization and it got me thinking -- what makes a good doctor, and how do we measure it? In thinking about this, I reflected on how far we have come on quality measurement.  A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or ...

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Malcolm Gladwell thinks we should tell people whats it's really like to be a doctor.  And by God I have invested the last seven years in doing just that.  I have written countless blogs, given lectures, and traveled to Ireland.  I have coined the term Caring 2.0 to describe the bidirectional flow of empathy.  Patients will tell us what it is like to suffer with disease, and we ...

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From MedPage Today:

  1. BP Control May Cut Second Stroke Risk in Half. Stroke patients do a poor job of consistently controlling their blood pressure, but those who do may cut their risk of having another stroke in half.
  2. Debulking, IP Chemo Best for Ovarian Ca. Optimal surgical debulking and intraperitoneal (IP) adjuvant chemotherapy afforded patients with advanced ovarian cancer the best outcomes in a ...

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Should medical school be shortened to three years? I say, "no." Here's why. There is way too much to learn in 3 years. Unless medical education is radically changed, it will be impossible for students to memorize all the unnecessary stuff they still have to memorize, complete all their clerkships, and move onto the next phase -- residency training. I do not see how medical students can choose a career path before they have ...

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For years internationalists have being trying to make the argument to ordinary Americans that foreign policy matters -- that we must contend with complex issues overseas like countering terrorism while also focusing resources and energies on economic issues at home. We have posed it as a trade-off. We are making the foreign affairs case the wrong way.  Rather than argue the positive merits of trade or the negative repercussions of unchecked ...

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I believe that family medicine is the solution to American health care. I believe that family doctors give high quality, cost efficient care. Counties with the right proportion of primary care to specialty care have populations who live longer and health care that costs less. Too many specialists and not enough family physicians leads to unnecessarily expensive care and shorter life expectancy. I believe that family doctors provide something intangible to our ...

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From MedPage Today:

  1. Brain Structure Disrupted in Autistic Kids. Autopsied brains of autistic children showed "patches of disorganization" not seen in otherwise healthy children.
  2. Weight-Loss Surgery: It's Not Just About Stomach Size. An increase in bile acids, not just smaller stomach size, helps promote weight loss and better glucose control after vertical sleeve gastrectomy (VSG).
  3. Small, Frequent Meals Don't Rev Metabolism. Dieters ...

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I have a confession. It is a secret I have held for more than 10 years and it is a lesson I have learned from other women. As society continues to debate the terms and conditions required for women to be leaders, what is often missing is the lens of the woman of color. It is time to talk about the socialization of girls, and brown girls in particular, and the guise ...

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