Cardiovascular disease -- including coronary atherosclerosis and cerebrovascular disease -- remains the number one cause of mortality in the United States. One out of three people in this country will die of cardiovascular causes.  Although I can’t say that the other top causes of mortality are particularly attractive -- cancer, chronic lung disease, accidents and dementia -- premature cardiovascular death can certainly be very devastating and it makes sense to do ...

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How should patients determine the quality of their doctor? This is an interesting question that has now reached mainstream media status as evidenced by a Wall Street Journal article by Laura Landro, a very accomplished veteran health care reporter. With the best and brightest going in to medicine, the requirement for more rigorous training than anywhere else in the world by (some might say) "exceptional, world class" medical educators and longstanding ongoing mandated continuing medical ...

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Would you tell me, please, which way I ought to go from here? That depends a good deal on where you want to get to. I don't much care where – Then it doesn't matter which way you go. - Lewis Carroll In the new world, payers will increasingly ask before reimbursing medical imaging: why did you bother finding out? This is why we must pay attention to clinical trials. An instructive case is in the ...

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“I used to be strong, I wrestled the bull,” Sumner Ball said, “but now I can’t even wrestle the rooster.” On the far side of eighty-years-old, he looked lively and trim, and his weathered face hinted at a smile as his blue eyes peered straight into mine. “I think these cholesterol pills are hurting my muscles,” he declared. “I don’t think they’re good for me.” “Is it your back?” I scanned through his last ...

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Should we follow a Mediterranean diet? We’ve known for quite some time that weight loss can reduce the risk of developing insulin resistance and type 2 diabetes. However, a healthy diet alone (without weight loss) may also help to reduce risk. In a recent Spanish study (published in the Annals of Internal Medicine), 3,541 men and women ages 55-80 at risk for diabetes were followed for ...

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I trained in internal medicine and cardiology at the tail end of the era of lifetime board certification by the American Board of Internal Medicine. In fact, my timing was perfect -- I was “boarded” in medicine in 1987, and in cardiovascular disease in 1989, which (I am pretty sure) were, respectively, the last years that the ABIM offered certificates without an expiration date in those disciplines. Late last year, I ...

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Most of us would agree that health care costs are too high in America.  They must be controlled or else we won’t have a sustainable health care system here.  And we should acknowledge that, on average, all doctors in America are paid higher than their overseas counterparts.  But we should also agree that expenses for doctors to earn a degree, maintain that degree and licensure, and pay their malpractice premiums ...

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The unidentified cause of one mans hypertension: Racism Meet Damien, my Facebook friend, photographer, and IT guy. This morning, he messages me: “I would like to make an appointment.” I reply: “For?” “High blood pressure.” I offer to see him, but he never comes in. Weeks later, he writes, “I got busy Pam. How are you? High blood pressure pills keep making me sick. I am doing the best I can. On bad ...

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Obamacare has promised to provide all of us with quality medical care that is affordable and accessible. The very name of the law is the Affordable Care Act, which I have maintained will be short on both affordability and quality care. Most of the country agrees with me. The postponement for a year of the corporate mandate to provide insurance in businesses with at least 50 full time employees was a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated for exertional chest pain of 3 months' duration. He describes the chest pain as pressure in the midsternal area with no radiation that occurs with walking one to two blocks and resolves with rest or sublingual nitroglycerin. No symptoms have occurred at rest. Medical history is significant ...

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