When asked to describe my career, I consider myself primarily a clinician educator.  Recently I have reflected on the influences that allowed me to have a successful career doing what I love.  This post is not meant to mention all those influencers, but just some that I recall often.  As I have thought about this post, I quickly realized that all the “heroes” that I recall focused on clinical education. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man is evaluated in follow-up for hepatitis C-related cirrhosis that is complicated by nonbleeding small esophageal varices and ascites. His ascites has recently worsened and has required large-volume paracentesis three times per month. He has been on a low-salt diet, spironolactone, and furosemide. On physical examination, ...

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We all know what, in 1888, Rudyard Kipling pronounced to be the world’s oldest profession. But what’s the world’s second oldest? Hunter-gatherer? Nah, everybody did that. Primitive politician? That’s a tautology. Neolithic attorney? Nope. Too similar to the oldest. I strongly suspect that the second oldest profession was healer/magician. Fire up Mr. Peabody’s Wayback time machine, and you’d probably find that the first healers were regarded as magicians, and the first ...

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Most of us do not know the basics of economics, although we should. It impacts every one of us every day that we are alive. Yet, for most of us, once we get beyond the law of supply and demand, our knowledge of the subject starts to vaporize. I can't explain fiscal or monetary policy. While I regard economics as a science, it seems that experts routinely interpret data differently, ...

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As an oncologist, I have spent my career learning how to break bad news. I am still not entirely sure how to tell my children about the tumor in my pancreas, why I will be gone from our home next week for a Whipple operation, or my excuse for abstaining from wrestling matches for the foreseeable future. I am blessed with two kids, temperamentally diametric: a careful, sagacious nine-year-old daughter and ...

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Well, it’s that time of year again. Fall is near, and ‘tis this season for more pay cuts from CMS and insurance companies. Are there any other health-related professions that receive across the board pay cuts? I know of none. The U.S. health care mega-complex includes not only physicians, but hospital administrators, legions of hospital vice-presidents, insurance company executives, elected politicians, federal employees at CMS, hospital employees, pharmacists, nurse practitioners, physician ...

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I've known that I've had tumors in my pancreas since 2009. Until now I've done nothing about them. This might sound like a counter-intuitive, even foolhardy strategy, especially for an oncologist, who should surely know better than to let his disease gain an advantage through his own inaction. But I don't have the "usual" type of pancreatic cancer, the kind that claimed the life of Patrick Swayze and has sentenced many ...

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I bought a pocket ultrasound in 2011, determined to learn how to perform and interpret ultrasound at the bedside and thus transform my internal medicine practice. I bought it new, and it cost over $8,000. That was a staggering amount of money to spend on something I knew very little about. In 2015 after having performed many thousand ultrasound exams with my little GE Vscan with the phased array transducer, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year-old man undergoes follow-up evaluation for cancer of the ascending colon diagnosed 3 weeks ago. Colonoscopy at that time revealed a fungating mass in the ascending colon. Biopsy revealed adenocarcinoma, and additional studies showed no evidence of metastatic disease. Right hemicolectomy was performed. The pathology report ...

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At 3 1/2 years old, my son was the picture of health. I have an actual picture. He is in jammies, wearing my sunglasses, laughing and chalk coloring the driveway while the sun is shining on his blond hair. That picture frequently flashes in my mind. I posted it on Facebook, my happy, healthy boy. There was no warning and nothing to prepare me for the months ahead. First, it was ...

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