You see your gastroenterologist with long-standing stomach pain. You have undergone a reasonable evaluation and all the endoscopic bodily invasions, and imaging studies of your abdomen have been normal. Repeated lab work provides no clue explaining your distress. You have been twice to the emergency room and were sent home with prescriptions that didn’t work. You are frustrated and so is your gastro guy. You are convinced that there is ...

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A patient came to the office and refused to see me, although I was quite willing to see him. I’ll present the scenario followed by the patient’s reason he took an abrupt U-turn. Then, if you are inclined, you may offer your own advice and comment. I performed a colonoscopy on this patient and found a large polyp in the upper part of the large intestine, or colon. The upper part ...

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Over the years, I have heard families bemoan that their relative who was just readmitted to the hospital was sent home too early just a few days ago. Are they right? First, let me say that in some instances they may be correct. It is certainly possible that the hospital, under increased pressure to kick folks out, may have pulled the discharge trigger too soon. The hospital is not always right ...

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Gluten is in the news again. Gluten and probiotics are among the two dietary issues that most consume my patients. I am asked for my opinion on them several times each week. Although my opinion is solicited, these patients have largely already made up their own minds as they are often avoiding gluten and swallowing zillions of "good bacteria" with zeal and enthusiasm. Why do they do this in the absence ...

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Patients are cool.   I did a colonoscopy on a hospitalized man who was saddled with the ravages of obesity, diabetes, sleep apnea and respiratory disease.  My partner had performed the initial consultation, and it was my task to bring light into a dark place by performing a colonoscopy.  I engaged in some conversation prior to the procedure, not simply to acquire relevant medical facts, but also to establish some rapport ...

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Doctors do not know everything. We make mistakes and mistakes in judgment. Sometimes we make the mistake of speaking when we should keep silent. At times, patients ask us questions that we can’t or shouldn’t answer; and yet we do. It shouldn’t be our objective to force certainly into an issue that is amorphous and murky. Here’s a response that I recommend in situations where certainty is elusive. “I don’t know.” I saw ...

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shutterstock_173882891 Patients are entitled to receive medical advice 24 hours a day. If you call your doctor at 3 a.m., you will reach a physician who will advise you. Of course, it may not be your own personal physician as this individual cannot be expected to be available 365 days a year until he retires. Physicians partner with colleagues who share on-call responsibility ...

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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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shutterstock_228969187 Racism and prejudice are endemic in America. Many of us reflexively answer, No, if we are asked if we are prejudiced. I don’t. I say yes. While I do my best to give everyone a fair shake, I grew up in a white suburban family in the latter decades of the last century. My friends, my parent’s friends and all those we ...

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shutterstock_93662965 I was asked to consult on a 43-year old female with abnormal liver blood test results.  It took but a few minutes to determine that she was an alcoholic, which was the likely explanation for her abnormal blood results.  She drank several beers daily over several years. My diagnosis was alcoholism, but did the patient concur? “Do you feel that you are drinking ...

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