Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated for a 2-month history of diarrhea with three to five loose stools per day. She has mild abdominal cramps, bloating, intermittent nausea, and mild anorexia that has resulted in the loss of 2.3 kg (5.0 lb). She has had no fever or blood in the stool. ...

Read more...

Imagine a smoking ban in the privacy of your own home? For over 2.3 million residents of public housing, this will be their reality. On November 12, 2015, former Secretary of Housing and Urban Development (HUD), Julian Castro, announced HUD’s policy for “smoke-free” federally funded public housing. The policy requires that residents refrain from “using tobacco products in their units, common areas, and within 25 feet of public housing and ...

Read more...

As a physician and businessman, I wish the future looked better for PCPs. But history suggests things will get still worse. The history of business teaches us disruptive innovation always starts from below. The “untouchable” market leader is threatened by a less expensive version of its own product. The smug incumbent ignores the unprofitable downscale threat. Then the new competitor decides to go upscale, is forced to innovate as a result, and ...

Read more...

A few years ago, I was in a position where I was quickly going down the route of hospital administration. I thought it was interesting at first, but realized it wasn’t quite my cup of tea, at least in the circumstances that I was exposed to. What I didn’t like about it was the feeling that I was losing touch with the front lines. And wherever my career takes me, ...

Read more...

When it comes to the uterus, people tend to have incredibly strong opinions. In fact, many of the people with strong beliefs don’t even have a uterus of their own. I would venture even further to say that if you asked many of these “opinion-havers” where the uterus was in a woman’s body or exactly what its function was, they would have no idea. Yet, here we find ourselves, 44 years ...

Read more...

She burst into tears when I asked if she wanted to get pregnant. Eman, a beautiful young woman from Jordan, sat in my family-practice office with her husband, Ali, and two adorable children about one and two years old. With her scarf and dark clothing covering all but her pale face and enormous sable-brown eyes, Eman looked closer to fourteen than twenty-four, and scarcely old enough to have any children. "How can ...

Read more...

Kafui Dzirasa, MD, PhD is a physician-scientist. Watch his compelling story on Black Men In White Coats.

We long for the moments in our life that justify our course, that illuminate the banalities of our daily routine, and that instill within us a mission that suddenly harmonizes all that you have done and all that you hope to do. My first year as a physician-in-training consisted of an insurmountable study load, a constant quarrel with the torturous alliance of fatigue and self-doubt, and the simple reality being a ...

Read more...

It was my turn to be on call during Christmas. I held the long list of patients signed out to me, and began my rounds early that morning in the hopes that I could be home in time to open presents with my family that evening. I went from room to room on the surgical floor, talking to patients. I knocked on one door and pushed it open. A white male ...

Read more...

Sometimes medicine offers us wonderful, almost unimaginable gifts. Heart attacks that were devastating, life-altering events a few decades ago are now treated with expediency and skill that our grandparents couldn’t imagine. A couple of days pass, and the victim is home with stents in occluded arteries and directions to modify activity and diet. Pneumonia, once the "old person’s friend" (so called because it took the aged to eternity), is far less ...

Read more...

I’m humbled by the honor to practice medicine.  We have the opportunity to be frontline participants in an ever evolving cascade of events in the lives of others.  Our decisions, directions, and split second actions have the ability to unite families, sustain breath or literally a beating heart.  Although biased, I can’t think of many professions more fulfilling and honorable.  There are issues and concerns, but they pale in comparison ...

Read more...

“We must not allow a mineshaft gap!” famously spoken by George C. Scott as General Turgidson in Dr. Strangelove as the post-nuclear holocaust planning begins in earnest. For some reason, this quote goes through my mind as I sit through meetings, assemblages and retreats that talk about the future state of medicine in a large gobble-gobble network that has aspirations to provide population health as an Accountable Care Organization to ...

Read more...

Mukhwas are the Indian equivalent of an after-dinner mint. Sweet and flavorful, but typically only distributed through one tiny spoonful at a time, mukhwas are the perfect way to completely clear your palate, wiping clean the last remnants of a tantalizing meal. A small dosage of the mukhwas completely nullifies the aftertaste, so that the attention is no longer on the meal that has just passed. It’s the gustatory equivalent ...

Read more...

During the first year of medical school, one of the most nerve-wracking, but exciting, experiences was learning how to interview and examine patients. At that time, we mostly worked with “standardized patients” -- people who are trained specifically to play the role of a scripted medical case. Although working with them seemed incredibly challenging at the time, the rules of engagement were in fact very favorable to us. Asking a question ...

Read more...

As part of trying to figure out where telehealth and video visits fit into the primary care setting, this week I got an amazing tour from the director of our emergency department, during which he showed me the program they've developed over the past year. An incredible system, they take patients from triage who report to the emergency department with nonemergent issues, and move them to a consultation room off to ...

Read more...

I’m probably crazy. I ride my motor scooter to and from work at the hospital. Some consider it unsafe. Perhaps it is, but feeling the wind and rain, those unfiltered elements. And after 12 hours inside a controlled environment, it's too refreshing to pass up. So at 2 a.m. Friday night, I'm zooming (you always "zoom" on a scooter) through the industrial district after a tiring admitting shift. I see ...

Read more...

"Mom, that's a little unreasonable,” piped up my 9-year-old from the backseat as we drove by an ER billboard that prominently displayed an average wait time of four minutes. “That would be stressful, seeing everyone that fast.” Even my kids understand how absurd some of today's time metrics are. “Hospitals probably make more money showing shorter wait times on a billboard because people want to go there because it's faster,” ...

Read more...

It is no secret that physicians are disenchanted with the changes in medicine and can be overheard saying that they do not want their children to go into the profession. Has the practice of medicine deteriorated to the extent we say it has, and are there more appealing options? According to a Doctors Company survey of 5,000 physicians, 9 out of 10 physician respondents indicated an unwillingness to recommend health care ...

Read more...

A study of over 890,000 Medicare beneficiaries shows that states with malpractice environments unfavorable to physicians do not see improved postoperative outcomes for 11 different types of mostly elective major operations. States with higher general surgery malpractice insurance premiums had significantly more episodes of postoperative sepsis, pneumonia, acute renal failure, and gastrointestinal bleeding. Those with higher numbers of paid claims per 100 physicians had more postoperative myocardial infarctions, surgical site ...

Read more...

STAT_Logo Propelled in part by the unalloyed hopes I cultivated in medical school, I got through my internal medicine residency training largely free of questions about medicine’s limitations. Ailing strangers entered my life in the hospital and I helped them leave nearly restored to health. This was exactly the kind of physician I expected to be. That changed when I ...

Read more...

Most Popular