The mud is deep and thick and black. The smoothness of its surface is deceiving, drawing me closer to it with promises of contentment. It lures those who dare to tread upon it into its hidden depths. Hopes are dashed as one struggles for freedom. It is tenacious: Lift one foot upward and the other sinks deeper into Mother Earth. A sense of futility in escaping its grasp erodes the ...

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The tale of two physicians There once was a physician who had no idea what personal finance was. She was living the American dream, but with lots of student loan and credit card debt. During her residency, she paid minimums on all her debts, but had neither a savings account nor a retirement account. During fellowship, there was a slight jump in her income, and she used that as an opportunity to ...

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As more patients and clinicians are searching for holistic approaches to health care, Ayurveda, or the traditional medical system of India, has been gaining popularity in the Western world.  Unfortunately, many allopathic physicians still view this system as “quackery” because of its focus on the “intangibles” of health.  However, Ayurveda has contributed immensely to the foundations of modern medicine, which many may not know.  Sushruta was an Indian scholar and ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated 1 month after completing a 14-day course of Helicobacter pylori eradication therapy consisting of amoxicillin, clarithromycin, and omeprazole. Initial upper endoscopy before treatment showed patchy gastric erythema with no ulcers or erosions, and biopsies revealed H. pylori gastritis. Currently, she reports alleviated symptoms. She is otherwise healthy and ...

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When a baby arrives dead in your emergency department ... ... the world stops. You stop breathing. You are gasping for air. She is limp; she is cool; she is pulseless. Chest compressions on the tiniest six month old I have ever met are done with the finger pads of my index finger and middle finger. Quick, synchronized beats. I look at her blue, blue lips. It should never be like this. Her eyes ...

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I remember September 27, 2018 like it was yesterday. When Ashley* picked me up from my apartment Thursday morning, I thought it would be like the 138 past Lyft rides I’ve taken since 2017. I was wrong. After I waived to Ashley from the curb, I got settled into the right back seat. The doors locked, and she asked me the usual question. “You from here?” “Yes, I’m a local.” “That’s great! I’m from ...

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Six months have elapsed since exiting the pageant of my hospital via retirement.  Like many people who devote countless hours to professional activities, some mandated, some by compulsion to detail, this windfall of unstructured time, no matter how well planned, can prove disorienting.  My final destination was a small inner-city hospital, preceded by twenty years affiliation with an enormous comprehensive regional center.  The people there, near where I live, have ...

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In broken English, against the backdrop of the emergency department's chaos and clatter, Mr. Simon relayed his story: unintentional weight loss, gradually yellowing skin, weeks of constipation. He punctuated his list of devastating symptoms with laughter — exaggerated but genuine guffaws. Over the next few days, as the medical student responsible for his care, I was also responsible for handing him piece after piece of bad news — an obstructing gallstone ...

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Most doctors well into their tenure of medical already have a general idea about how other specialists spend their days (except for radiation oncologists, where no one else knows what they do).  However, as a medical student, I had incredibly limited insight into the variety of means to practice medicine. Even as an attending physician, I am still discovering how creative some medical specialties allow one to be.  For instance, ...

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Dear friends— especially my colleagues, I recently failed a class (I have been working on a PhD in psychology) and found myself immobilized and disengaged from life, personal happiness and joy. I actually didn’t even tell my husband, who is my true confidant of my feeling and thoughts, until the following day. I found myself in that familiar place of guilt and shame. I thought I had transformed a lot of ...

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I was a resident. He was a physician in a position of power. He took things too far, and I spoke up. Here are some of the actual comments I received. “He’s just a flirt.” “You must have misunderstood him.” “What were you wearing?” “Somebody must have hated him, to do that to him.” “Perhaps, he just really, really liked you.” “Maybe you had a crush on him too and encouraged him.” I had started a new ...

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Heart health starts in childhood to avoid cardiovascular disease, hypertension, obesity, and diabetes. Kids today have developed so many bad health habits that they are facing heart attacks in their 30s. Many experts predict they will be the first generation to have a lower life expectancy than their parents.  But it doesn’t need to be this way. Parents like you have a significant influence over your kid’s habits. By modeling ...

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Think all the way back to your grade school years. Did you know that your personality traits were starting to be honed for the work you do today? Let me give you some examples about myself and see if you can relate. I remember the praise and exhilaration of being the only kid in the class to get a 100 percent on an extremely difficult second-grade spelling test.  My teacher told ...

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I’ve been concerned lately. Here’s why. In 2001, I got sick with what the doctors assumed was an acute viral infection, but I never recovered. I’m mostly housebound, often bedbound. My diagnosis is the little understood (but much misunderstood) myalgic encephalomyelitis, also known as chronic fatigue syndrome or ME/CFS. I describe it as “the flu without the fever.” This means that fatigue is only one of many symptoms I contend with ...

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Like many accountable care organizations, Austin Regional Clinic (ARC) in Texas is building a record of success on the Medicare Shared Savings Program’s (MSSP) so-called “Track One.” Now looming, however, is an automatic transfer of ARC to the MSSP’s riskier “second track” after years of hard work implementing our value-based, population health treatment model. On the first track, ARC and other ACOs assume “upside risk,” getting rewarded for taking on overall ...

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A few years ago, I wrote a KevinMD blog post about how cumbersome it was to complete notes in the electronic medical record (EMR). I proposed a solution in our residency clinic but encountered resistance in the adoption process that eventually led to its abandonment. For someone just trying to solve a problem, it was very frustrating, to say the least. Despite the advances in the past few ...

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You may have noticed your child seems to be bored of their bag lunch and most of it being brought back home or dumped in the garbage. Lunch is an important meal to get kids the energy they need to get through the second half of the school day. Strive to include some protein, fruits, veggies and healthy sources of fats. Now, you don’t have to buy gourmet or even ...

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At midnight on February 15th, if Republicans and Democrats don’t come to an agreement about border security funding, the American people will be facing the possibility of a third government shutdown since President Trump took office. The most recent government shutdown -- the longest in history at 35 days -- left nearly 800,000 Americans furloughed or working without pay. Federal benefits that millions of Americans depend on, such as the ...

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Once again, we find ourselves stuck between a rock and a hard place. Increasingly, providers are being pressured to improve access for our patients, which we certainly think is a good thing. We want our patients to come in, whether it's for their annual physicals, for ongoing routine management of their chronic health conditions, or for acute issues best handled in the ...

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Physician Speaking by KevinMD is a boutique speakers bureau founded by Kevin Pho, MD. Today’s spotlight physician speaker is Dr. C. Nicole Swiner. C. Nicole Swiner, MD, known as “DocSwiner,” is a family physician, two-time best-selling author, blogger, speaker, wife, and mother. She was voted as one of the 10 best doctors in North Carolina in 2017 and is also affectionately known as the “Superwoman Complex” expert and ...

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