Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 56-year-old woman is evaluated during an appointment to establish care. She has a developmental delay, and she is known to have pulmonary hypertension due to a congenital cardiac condition. There is no history of cardiac surgery. She is on low-dose aspirin and thyroid replacement therapy. On physical examination, blood ...

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Pain usually cannot be “treated” like a standard ear infection. Treating patients in pain requires setting realistic expectations, using a variety of approaches, and patience. One patient I treated months ago highlights these points. At 6 a.m., I was ready for the change of shift at the hospital. The night doctor who took care of my patients was frustrated. He snapped, “You really should have had a better plan for her. ...

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Are you a media whore? Or do you worry you might be labeled one by your colleagues – if not to your face, then behind your back? In the process of delivering hundreds of media engagement workshops, I’ve heard dozens and dozens of you express this fear, using precisely this language. You've made it clear that the mild put-down of "microphone hog" I was familiar with has now been replaced with ...

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STAT_Logo With nearly 80 percent of internet users searching online for health-related information, it’s no wonder the catchphrase “Dr. Google” has caught on, to the delight of many searchers and the dismay of many real doctors.

What’s received little attention from physicians or the public is the company’s quiet metamorphosis into a ...

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“Cha-ching!” goes urgent care. For your rhinovirus, adenovirus, or seasonal allergies you get a strep screen, flu swab, CBC, and chest X-ray. You get a steroid shot, Rocephin, and Z-Pak. A week later, you present for medical care again, because your virus is no better, and you want a stronger antibiotic. In the meantime, your body’s normal healthy bacterial flora has been altered and will take six weeks to six months ...

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In health care, we enjoy a unique opportunity to create special relationships with our work. Few enter these professions for practical reasons, and fewer still survive rigorous training without genuine belief in what they might accomplish. And cliched though they may be, the many mission statements which purport the "art of caring" do convey something real. But to even for the naïve, spending enough time around health care produces a certain ...

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Jim Henson, creator of the Muppets and Sesame Street, died at the age of 53. His diagnosis was toxic shock syndrome/streptococcus pneumonia — a deadly bacterial infection. We were on vacation when we heard the news: The genius who opened the imaginations and hearts of our children ... maybe you too ... was gone. We were devastated and saddened that the magic Muppet man had died. One year later, our ICU admitted ...

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“For the rest of my life, I’ll never see her again or smell the scent of her unwashed hair. I’ll never hug her soft squishy hips or sigh when she tells me to stop sleeping, get up, and enjoy the day.” This runs through my head before I start sobbing in my car. Most of the time I feel fine, but when I confront the finality of my grandmother’s existence, tremendous ...

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Medicine is currently struggling with the problem of physician burnout and the specter of diminishing wellness. Despite concerted efforts, burnout continues to expand. In light of this, being vigilant for limitations in the current framing of the issue is prudent. Words express the conceptualizations of our world and frame ideas. Such framing is meant to be revealing. However, frames and the words that construct them may also be constraining. One approach ...

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During rounds, in between seeing patients, the medical student pulls out his phone and scans a dating app for new matches. In the team room, a resident opens Facebook before responding to a non-urgent page. Each of these instances may seem trivial enough, but I’ve seen both lead to poor evaluations, reprimands, or others whispering terms like “unprofessional.” In the medical world, there’s an implicit understanding that while you’re at work, ...

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As each calendar year closes, organizations compile best/worst lists: TV shows, movies, exceptional people that bring character or immortality to our year as it fades into history. Medicine has its heroes and scoundrels. I would expect that all physicians can instantly name five teachers who shaped them and five guys they scored as real zeros on their evaluation forms. For the benefactors, we not only gave them higher scores but assimilated ...

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In the last decade, specifically in the last five to six years, we have seen the gradual disempowerment of America’s physicians as well as their unfortunate patients. Starting with health management organizations, managed care, all the way to the insurance exchange, doctoring has been forcefully wrestled away from physicians only to be placed into the hands of large insurers, administrators and the United States government. The common denominator was never about improving ...

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We as physicians need a dose of our own medicine as a booster ever so often. I went in for a simple procedure. A lumbar epidural steroid injection for pain which has recently become more than tolerable at times — nothing disabling. Nothing that stops my everyday life and living. I didn’t think much of the procedure at all because I am at the other end of operating room procedures on ...

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In medical school, we learn about Broca’s area, the region of the brain that when injured prevents a person from translating their thoughts into spoken word. When this area is damaged, from a stroke or traumatic injury, the person can hear a partner declare their love or a child cry, but are unable to vocalize a response. Silenced by their injury, their voice is trapped. In a similar way, as medical ...

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The day is etched in my memory. The knock at the door. Two detectives and one police officer. I knew the news was bad. We sat at our dinner table, and the dreaded words came: “Your daughter is dead.” “How?” I asked. “She hung herself during the night.” My body went numb, and the moment became surreal — like I was watching myself in a movie rather than being part of the conversation. ...

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About halfway through the internal medicine residency, there comes a time when a resident must decide on what he or she plans to do after three years of training. We may come across a second-year resident saying: What should I do next? Should I become a hospitalist or plan for a fellowship? But in what? Cardiology and gastroenterology are fascinating careers, but is my resume ready for a competitive match? ...

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I would like to offer some words of encouragement to what many call the “non-traditional” students pursuing medicine. The term encompasses people in different aspects in their lives. It may be someone in a different line of work looking at medicine as a second career or another just getting started that didn’t take the traditional path in undergrad. My own journey I started medical school at 28 after spending six years as a ...

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Perhaps you have already heard of crisis pregnancy centers (CPCs). I see highway billboards for them on most of my long drives throughout the rural midwest. Recently, I received an email from a student interest group offering medical students to tour them. That inspired me to write this because, as health care professionals, we have a lot of privilege and responsibility and are hopefully trained to respect facts and evaluate ...

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My local hospital in an affluent suburb of New York City displays its Outstanding Patient Experience Award 2018 and Magnet Recognized status on its website. My experiences tell a different story. This hospital is located approximately five to seven minutes from my home and is my go-to in an emergency. I have multiple medical conditions, which despite my best efforts sometimes require emergency care and unfortunately admission. I was working ...

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Recently, a child was on a waitlist for five months to get into my practice. For this article, I will call him Tiny Tim. Tiny Tim, now five years old, has a skin condition known as eczema or atopic dermatitis. When we first met, virtuously every area of his body was covered with wounds from constant scratching. Skin that breaks easily and heals poorly can give bacteria access to other parts ...

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