It was a small deer tick, hidden by the crus helix, embedded in the cymba conchae, the crevice just above the ear canal of my seven-year-old patient halfway through my Saturday clinic. He was worried that it would hurt. His parents hadn’t wanted to try removing it on their own. I had a hard time even seeing the small tick as it was sitting at an angle where I saw it ...

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Nearly 30 years ago, I attended the labor of a Vietnamese woman on an island off the coast of Thailand. The woman had malaria. She died a few hours after giving birth to her stillborn child. That experience has never left me. It has fueled in me a passion for global health, and especially for alleviating suffering and death from tropical diseases such as malaria. It is also worth remembering, however, that ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 44-year-old woman is evaluated for a 2-month history of a painless right neck mass. Medical history is unremarkable, and she takes no medications. She is a lifelong nonsmoker. On physical examination, vital signs are normal. A 5-cm right anterior neck mass is palpated. The remainder of the examination is unremarkable. An initial ...

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I want you to know about colds, and integrity. Every day I see a hand full of colds. Viral upper respiratory infections. Bronchitis. Coughing, sneezing, congestion, fever. You come to me because you are miserable, and I appreciate that you trust my advice. I want you to know that I can commiserate with you. I don’t want you to feel miserable either. Truthfully, as odd as this sounds, I wish could find ...

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Two months into my private practice career, I was assigned a “no doc” patient, a term referring to a child without a regular physician.  This one, in fact, did have a pediatrician, who called me to say “the family fired our group because we have not been able to diagnose the illness in their six-week-old son. He is your responsibility now.” If I have learned anything over the last 15 years, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old man is evaluated for right-sided chest discomfort and cough of 2 weeks' duration. His chest discomfort is described as a vague, painful sensation on the right. The cough occasionally produces a small amount of sputum; he reports no hemoptysis or shortness of breath. He has felt feverish with mild ...

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I recently read a book by Dr. Barbara Natterson-Horowitz a UCLA cardiologist who also happens to be a consultant for the Los Angeles Zoo. In her book Zoobiquity, Dr. Natterson-Horowitz demystified the story of HIV (Human Immunodeficiency Virus) transmission from monkeys in West and Central Africa to humans. Most physicians today, including me, have a limited knowledge of zoonosis (the science surrounding bugs that can be from animals to humans) ...

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Thirteen years ago, I received a call from the mother of a college freshman who was concerned because her son had been diagnosed with mononucleosis during finals week.  She felt something was not quite right and asked me for advice. “Trust your instinct, go get him, and bring him home.” She brought him to my clinic the following day.  He looked mildly ill.  His vitals were stable; he was fatigued, slightly dehydrated, ...

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On November 18, the World Health Organization (WHO) declared that Zika will no longer be classified as a public health emergency, while maintaining that the epidemic remains “a highly significant and long-term problem,” and emphasizing that this change in designation did not represent a downgrade, but rather an escalation in its long-term importance. Most major news outlets rushed to report the news, with headlines focusing on the end of the emergency ...

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