Minutes from melting in the summer heat, I dumped my stuff at a table and homed in on the hospital café’s soda display for something -cold. The gentleman at the next table glanced my way and said, "Are you in the medical field?" "Yes sir, I’m a medical student." He eyed my drink and asked, "Did you hear that diet soda can increase your risk of diabetes by 70%? Even just a few ...

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I used to think medicine would get easier over time. It makes sense, right? You see patterns, you learn how treatments work, and you just get to know stuff. Experience should make it easier to diagnose and treat. That’s not been the case for me. In fact, it’s closer to the opposite. In the exam room, as I look up to the patient from my stool, and before I stand at ...

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In 2009 I wrote a post titled “Quality or Conformity," where I pointed out that many of the quality measures in primary care have more to do with whether doctors follow guidelines than if they deliver care that helps patients live long and well. There is a tendency to focus quality efforts on measuring what is easy to measure, rather than what matters the most. That phenomenon is called ...

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Approval from the U.S. Food and Drug Administration to market a new drug is a critical waypoint along the path to profits for pharmaceutical manufacturers. Unfortunately, recent case studies have illustrated that FDA approval does not necessarily provide assurances of effectiveness and safety. In last month's Georgetown University Health Policy seminar, we discussed two examples, anemia drugs and the diabetes drug rosiglitazone (Avandia), which were ...

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Like many other Millenials who grew up in the age of Lara Croft and Brangelina, I greeted Angelina Jolie’s announcement that she had undergone a preventative mastectomy and reconstruction last month with sadness for her loss and admiration for her heroic decision and very public disclosure. I hope her story will lead other women to undergo screening and potentially save lives, but real improvement in women’s health outcomes requires ...

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As a medical student nearly two decades ago, I remember how excited I was to begin my rotations on the wards. After two intense years in the classroom, I felt that I had a good fund of knowledge that I could finally apply in a clinical setting. Still, very soon after beginning my ward rotations, I noticed that while I was able to adequately manage my patients’ symptoms, I could ...

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After a long day on the internal medicine ward at St. Elizabeth’s Medical Center, I rushed across town to lead that evening’s two-hour group diabetes visit at Union Square Family Health Center in Somerville, MA.  So when my preceptor asked me if I’d lead the group on a field trip after the two-hour visit, it was the last thing I wanted to do. Although we had discussed taking our Brazilian patients ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated for a 2-day history of severe muscle weakness. The patient experienced significant weight gain and developed hypertension and type 2 diabetes mellitus 2 years ago. She also reports developing muscle weakness of the lower extremities 6 months ago. Her diabetes is only partially controlled by metformin; her blood glucose ...

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Office-based medical practice is changing fast. The government is providing incentives to those practices that use electronic prescribing and electronic records systems and will soon penalize those that don't. Health reform will shortly deliver many newly insured patients to your office. A host of new patient care models aimed at making healthcare more team-based are emerging. Reimbursement tied to outcomes will demand a greater level of patient management and engagement ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 71-year-old man is evaluated in the emergency department for new dyspnea on exertion. He has a 15-year history of type 2 diabetes mellitus and has had a number of changes in his medications over the past 12 weeks to improve glycemic control. His dosage of metformin has been increased to 1000 mg/d, glyburide ...

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