Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a routine examination. He feels well other than mild knee pain. He drinks six to eight cans of beer per night. He has no personal history of liver disease, but his older brother was recently diagnosed with hereditary hemochromatosis. On physical examination, vital signs are normal; BMI ...

Read more...

Recently, two significant pharmaceutical breakthroughs have resulted in a renewed debate about the costs of drug therapy. In the last year, a new drug class for the treatment of hepatitis C has been released by two different manufacturers and has been found to cure a once incurable chronic liver disease for nearly 90 percent of patients who are treated with a full course of therapy. The drug appears to be ...

Read more...

Here is a question I get asked all the time by patients: “Is that bad?” This is different than the similar, more appropriate question, “Is it bad?” which is usually asked after being given a specific diagnosis.  For example, after a colonoscopy where a large polyp was discovered and removed I will tell the patient about the findings.  He may ask, “Is it bad?” The answer is usually “No, the polyp ...

Read more...

When getting a medical history, patient attribution can be very helpful.  We are even taught in medical school to specifically ask patients what they attribute their symptoms to.  For example: Doctor: “What do you think is causing this pain in the right upper part of your abdomen?” Patient: “It happens every time I eat a big meal, especially a fatty meal.  I think it has to do with that.” Doctor: “This pain might ...

Read more...

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 ...

Read more...

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 22-year-old man is evaluated for diarrhea and weight loss. The patient has a 3-week history of foul-smelling, large-volume, watery stools associated with abdominal bloating. There is no visible blood or mucus in the stools. He reports a 4.5-kg (10-lb) weight loss, which he attributes to a poor appetite. One month before ...

Read more...

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 1-year history of loose stools. She reports approximately four episodes per day without abdominal pain. She has not had nausea, vomiting, weight loss, bright red blood per rectum, or melena. On physical examination, temperature is 36.7 °C (98.1 °F), blood pressure is 115/85 mm Hg, pulse ...

Read more...

Fecal microbiota transplantation (FMT) is the process of administering a preparation of healthy donor stool to a patient with a certain disease, usually Clostridium difficile colitis, in an attempt to treat the disease.  I covered some of the basics about the microbiome and FMT in a previous article, so this will just be a cookbook-style post on how we do FMT with colonoscopy. First, a healthy donor must be identified.  The donor ...

Read more...

“Hi, it’s Dr. Smith, are you taking consults today?” the voice on the other side of my short-range hospital phone said.  I recognized the caller's name as one of the new hospital doctors, known as hospitalists. “Of course,” I said, “What have you got?” I guess some groups have a specific doctor for the day “take” the consults.  If I am in the hospital, I am always taking consults. “Great,” the hospitalist ...

Read more...

shutterstock_180109973 There has been concern for several years about commonly prescribed antacid drugs called proton pump inhibitors (PPIs) and the heart.  PPIs are used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease, and other acid-related diseases.  Common drugs in the PPI class are omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), and dexlansoprazole (Dexilant), among others. Specifically, there is a potential interaction ...

Read more...

Most Popular