When you go to the internet or phone book today, there are hundreds of physicians listed in most urban areas. In the next two decades, you can expect more difficulty finding a physician in your hometown — a major physician shortage is looming. In the last year, I have noted many mid-career physicians are leaving the practice of medicine. While the growth of mid-level hospital administrators has ballooned at nearly
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Decisions regarding medical care are often not very straightforward due to the uncertainties, risks, and limited options involved. But, above and beyond the actual choices to be considered, the process of how the choices are made has become a red-hot topic. And the value of the patient -- as opposed to the doctor -- as the driver of medical decision is, quite curiously, just beginning to be recognized in a ...

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Cardiac neuroses are often iatrogenic in origin. A well-meaning but careless comment by a physician can change a person’s sense of well-being in an instant. The effect can be permanent and devastating. Many clinicians who complain about overly anxious patients don’t appreciate their personal role in the genesis of this problem. Our words matter. They can reverse the good we do with our medications and procedures. If you are a heart ...

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"Help!" I yelled out of our open apartment door. I was seven years old, and my family had recently emigrated from Egypt to the U.S. We'd been feeling elated that week because, after months of interviews, my father had matched into a pediatric residency. That morning, he'd awoke feeling nauseated. My mother and sister went to buy some soothing food. I noticed that he'd vomited in the bathroom; now he was feeling ...

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Unparalleled reductions in cholesterol levels are now possible with a new class of cholesterol medicine, a PCSK9 antibody, reported in one of the large national cardiology meetings recently. But this latest example of high-tech cholesterol treatment comes with a staggering price-tag, $14,000 a year for the new genetically engineered injectable.  As a preventive cardiologist, I began to wonder if this is the best way to spend our money. A few caveats ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. ...

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Knowledge is power. Increasingly, patients are demanding and receiving access to levers in the medical machine that would have been unthinkable a generation ago. The informed consent process, which I support, can overwhelm ordinary patients and families with conflicting and bewildering options. Television and the airwaves routinely advertise prescription drugs directly to the public. Consider the strategy of direct-to-consumer drug marketing when millions of dollars are spent advertising a drug that ...

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"So, that's it? Huh. Well, there's not much to say.  I didn't think I wanted it ..." "It" was a heart lung transplant.  He, my patient, was 30 years old. We had just learned that he was 100% sensitized with antibodies to any donor.  He would not be offered a transplant as he was certain to reject the precious gift of these organs.  As he would have said, his body had ...

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Carrie Fisher’s sad, premature death is an occasion to reflect upon the poor job the news media does in reporting medical news. The initial report from TMZ had the headline “Carrie Fisher Massive Heart Attack on Plane.” If one equates “heart attack” to the more precise medical term “myocardial infarction,” as is usually done, then this is certainly diagnostic overreach on the part of TMZ. From their report, ...

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A couple of weeks ago I started taking medicine to lower my blood pressure and another to reduce my cholesterol. This was a controversial move, given my deep distrust of the practice of medicine, when it is practiced on me, and especially regarding pharmaceuticals. I know that, as a woman of 55 with a very active and healthy lifestyle, no chronic diseases and, most importantly, as a nonsmoker, I am at ...

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