This is a story of a very special patient. A story that may change your outlook on life. When I first met her, there was an interesting aura that surrounded her. An aura of positivity and contentment. She was listening to her favorite band on her iPhone and humming along. Her carefree countenance was perfectly paired with the jovial tunes. I had admitted her to the hospital for an infected bedsore. She ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated for difficult-to-treat migraine. She has had severe headaches, usually on the first day of menses, since menarche. The pain is hemicranial, pulsatile, and associated with severe nausea and vomiting but no aura. She frequently awakens with the attack already in progress. Ibuprofen was helpful in controlling ...

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For the first couple of years of medical school, the constant stream of exams and the anxiety that came along with each one seemed never-ending. I told myself that it was worth sacrificing my personal health to better the lives of others. I put off addressing my own mental health needs to keep advancing to the next level of education. I let stress manifest itself in new ways that my body ...

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Recently, the widow of Robin Williams made a plea to neurologists. Susan Schneider Williams' plea, in the form of an editorial in the journal Neurology, aimed to help neurologists "understand your patients along with their spouses and caregivers a little more" and "add a few more faces behind the why you do what you do." Her article tells the story of her husband’s tragic physical and psychological battle culminating in his death ...

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Even though I don’t have an outpatient practice, I like to keep in touch with some of my patients after they’ve been discharged from the rehab hospital. Jack is one of my very favorite success stories. I met Jack in a small regional hospital in rural America. He had been admitted with sudden-onset weakness, and during the intake process, he mentioned enjoying occasional evening cocktails when out for dinner. Unfortunately, this ...

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I write this while sitting in our sailing catamaran, swaying in the wind and current eight feet above sand and sea grass.  I know this because I can see right through the water in the Bahamas.  There is clarity here. When I started this journey thirteen months ago, I was burning with anger.  I was angry at insurance companies for developing complex, mutable formularies, coverage policies, and appeal procedures, maximizing my ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 61-year-old man is evaluated for a 10-month history of generalized weakness. He reports no pain or myalgia. History is significant for hypercholesterolemia treated with a stable dose of simvastatin for the past 3 years. On physical examination, temperature is normal, blood pressure is 138/74 mm Hg, pulse rate is 70/min, and ...

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We are assembling too many panels of people in the name of health these days. Too many. They usually seem like a good idea. I’ve been supportive before. I assumed we needed them. More of them. I might have been wrong. There was a day when I believed my food would be toxic, my medicine harmful, and my safety gone without them. But, I’ve come to believe I was mistaken. I was wrong because ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 26-year-old woman is evaluated for a 10-year history of recurrent episodes of acute-onset feelings of fear and anxiety. These episodes initially occurred approximately 4 times per year but for the past 3 months have been occurring once or twice per month, especially when she is under stress. She describes the ...

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Ronald Reagan’s last letter to the American people, penned with his own hand in November, 1994, went directly to the point: “My fellow Americans, I have recently been told that I am one of the millions of Americans who will be afflicted with Alzheimer’s disease.” In this deeply poignant moment, the former president explained that he decided to share his diagnosis “to promote greater awareness of this condition,” with the hope that doing ...

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