Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated in the emergency department for loss of consciousness. Her son, who brought her in, says she seemed confused and agitated when he spoke to her on the telephone less than 2 hours ago. The patient has an 8-year history of type 2 diabetes mellitus. She had strict ...

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Thanks to the popularity of medical television shows, most people have witnessed hundreds of fictional cardiac arrests in their lifetime. In most of these scenes, the patient loses consciousness, and the medical team rushes to the bedside: “He’s in v-fib.” “Get me the paddles.” The team performs urgent chest compressions for a few seconds.  Then they place the metal paddles on the victim’s chest: “Clear!”  Kathump. The patient’s heart is back to normal again, tragedy ...

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August 17, 2010. Maris is a 57-year-old woman in excellent health.  She has not seen a doctor in years. Divorced, she lives by herself, but spends occasional evenings with her daughter and son-in-law.  A successful businesswoman, Maris gardens, serves on the board of a community theater and plays a mean game of bridge. It is 10:11 a.m. when Maris presents to the emergency room. Three hours earlier, her legs became wobbly while ...

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If you’re a 3rd- or 4th-year resident, chances are you’re no stranger to unsolicited job offers showing up in your email inbox. Maybe it’s a few a week, or maybe it’s a few a day, but they are always there. The emails find you. I’ve been out of residency for years and I’m still getting them. The macro reason for this flood of unsolicited job offers is obvious: You’re in high ...

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I came across an interesting article in the New Yorker last week: "Why Chinese patients are turning against their doctors." It is a fascinating account of the evolution of the health care system in China, highlighting the major changes that have led to increased patient-doctor homicides. In a nutshell, in ancient China, traditional medicine reigned king, and people scoffed at the idea of Westernized medicine. This started changing in 1949 ...

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Adapted from a keynote address given to the graduating medical class at the University of Toronto. When I was asked to give the keynote to graduates of the class of ’14, it was an honor that nevertheless filled me with terror and a bit of wistfulness. My sense of fear in giving advice to these amazing young doctors comes from not being sure I belong in the same company. They are whip smart, ...

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I live and work in the house medicine. You would think that those of us who have chosen this profession would actually know what dying looks like. Furthermore, one would hope that if the doctor could identify dying, he or she could share this with the patient and family (given that this is fairly significant medical information). I never cease to be amazed that most doctors cannot speak straightforwardly and compassionately about ...

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It was January 1, 2000, and I was an intern in emergency medicine at the University of Arkansas for Medical Sciences. I had gone to sleep the night before listening to celebratory fireworks and congratulating myself for surviving Y2K.  Now I was walking into the emergency department of our large, level 1 trauma center where I was furthering my medical training.  Like most urban ERs, this one was a busy place ...

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Most of the time I feel as though I am running in quicksand attempting to bring patients to a place of grace and dignity in dying. On occasion, there is someone who jerks me out of my quicksand and plants me squarely on stable shore and then proceeds to show me what grace and dignity in the face of death really look and feel like. Please meet Mr. Jefferson. Mr. Jefferson had long, lacy ...

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You know it’s going to be one of those days when one of the first tweets on vacation inquires about the closest hospital. Victor, one of my 11-year-olds, had something in his eye courtesy of a big gust of wind outside of Westminster Abbey. He was complaining enough to let me flip his eyelid and irrigate his eye on the square in front of Big Ben. (I’m sure several people thought ...

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