Martin Seligman, PhD, in his book Authentic Happiness, references a colleague, Mike Csikszentmihalyi, when discussing the concept of “flow.”  For Seligman and Csikszentmihalyi, flow is that feeling one gets when fully engaged or “in the zone” with an activity during which the passage of time seems suspended.  Often, the activity is aligned with one’s natural, signature strengths. For me, flow comes when I’m mountain biking: There are moments without thoughts, it’s just ...

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A recent case that I saw in consultation at the patient’s request highlights the pervasive problem of overdiagnosis and overtreatment of endometrial hyperplasia. This 46-year-old woman was diagnosed with simple hyperplasia without atypia within an excised endometrial polyp, for which both her gynecologist and pathologist recommended hysterectomy. The basis for this recommendation was a perceived increased risk of endometrial cancer, either currently lurking within her uterus or to be developed ...

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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 episodic migraine without aura that first presented in high school and has persisted into the third trimester of her current pregnancy. The headache attacks occur two to four times monthly and last 12 to 24 hours. She experiences moderately severe pain, significant nausea, no vomiting, and ...

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To put this post in perspective the pain of childbirth is said to be equivalent of amputating a finger. The joint statement of the American Congress of OB/GYN and the American Society of Anesthesiologists sums pain control during labor and delivery quite nicely: “There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In ...

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This post by Paul Levy got me thinking about informed consent, and a case I saw recently got me to take a little time and write about an issue frequently ignored in medical school. A bit of background for non-medical readers. Informed consent is a term in medicine for when doctors get the agreement of the patient to do something to said patient.  For example, before a patient is cut ...

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The New York Times has reported on a woman who wanted to deliver vaginally and claims she was forced to have a repeat C-section (her third C-section) against her will. I can’t comment on the veracity of her claims, however a forced C-section is never, ever acceptable. It doesn’t mater if the fetus has an agonal rhythm (is visibly dying on the monitor), as an OB your role is to ...

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Wendy Davis, gubernatorial candidate for Texas, has a new memoir Forgetting to Be Afraid. In it she describes terminating two pregnancies. One termination appears to have been in the second trimester for fetal indications and the other she describes as an ectopic pregnancy. She writes, “The only medical option was to have surgery to terminate the pregnancy and remove the affected fallopian tube -- which in Texas is technically ...

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A 33-year-old woman in Indiana, Purvi Patel, presented to an emergency room with vaginal bleeding and when it was obvious that she had very recently delivered a baby the doctors on call notified the authorities. The body of her 28-week gestation infant was recovered. The pathologist believed the baby had taken a breath so Ms. Patel was with charged with neglect of a dependent. Sometime later the police ...

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Hospitals should not control the decisions of pregnant women Doctors, hospitals and judges have over the years attempted to control the decisions of pregnant women. In a recent Florida case, it’s not clear whether the controllers sought to protect the fetus, the woman or both. They may have wanted to protect the hospital from potential liability. The case involved a 39-week-pregnant woman. According to a Read more...

Top stories in health and medicine, September 4, 2014From MedPage Today:

  1. Battle Over Abortion Clinic Restrictions Heats Up. The nation's fight over abortion continues unabated, but the battleground has shifted -- instead of seeking to limit who can obtain abortions, the latest legal attacks on abortion now focus on who can perform them.
  2. CDC Head: Ebola Likely to Worsen. The ...

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