The senior psychiatry resident at the University of Washington School of Medicine warned me ahead of time. She laughed as she said, “He’s weird. You’ll get used to him.” When I first met with him, the psychiatrist lazily spun in his chair, his left hand tucked into his pants, his thumb hanging out. After he told me his expectations as my supervisor, he patted my right thigh as he ended the ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated for a 2-day history of right anterior knee pain and swelling. The pain began suddenly and has increased in intensity. He currently rates his pain as an 8 on a 10-point scale. He has no knee instability and reports no fever or ...

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It used to be that doctors knew best. We told you what to do, and you obediently complied. The world has changed, and the paternalistic system of yore has given way to the shared decision model where patient autonomy is respected. The old way: “Well, I’ll be setting you up for surgery soon.” The new and improved way: “Let’s discuss all of the reasonable options with their respective advantages and drawbacks. Then, ...

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Primary care doctors don’t usually have scheduled blocks of time to read incoming reports, refill prescriptions, answer messages or, what we are told the future will entail, manage their chronic disease populations. Instead, we are generally expected to do all those things “between patients.” This involves doing a little bit of all those things in the invisible space between each fifteen-minute visit, provided we can complete those visits, their documentation and ...

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The media, politicians, celebrities, athletes and other groups have questioned the fitness and mental health of the president, but one group has largely refrained: mental health professionals. This recently changed. One of the latest efforts is a book, a collection of assessments by 27 psychiatrists and mental health providers, called "The Dangerous Case of Donald Trump." Indeed, the book’s editor publicly renewed her concerns on ...

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Concussions and football have come up before, and the news so far has been discouraging. We want kids to stay active, and football is one of the most popular boys’ sports out there. But we know that some prominent professional athletes have had serious, cumulative brain damage from years of football – sometimes brain damage that has destroyed their lives. What about high school football, or football ...

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Before I went to medical school, I had little interest in politics. It wasn’t that I didn’t care about my country; I spent seven years serving in the United States Navy and have always taken pride in being an American. I suppose the reason for my political apathy was because things had always gone pretty well for me. I grew up in a conservative, upper-middle-class family with two working parents. I ...

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The high-pitched wail of the pneumatic saw cutting through the tibia, and the little bits of tissue the blade flung onto the surgeon’s gown were not enough to get to me the first time I saw a surgery, during my senior year in high school. It was the smell. Sliding down the wall in the corner of the operating room, wondering if lunch would stay put, I began to question ...

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The fall is over, and winter has come, which means I have just wrapped up a busy season of medical school interviews. Most interviews are conducted in a similar fashion with an hour of introduction, speeches by the dean, presentations of facts I already knew from the website, and finally the interviews. Within the first hour, I understand the reason: “We are the best medical school at (fill in the blank).” ...

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There's currently an image in heavy circulation making its way around the internet of a hospital patient's chest tattooed with the words "Do **not** resuscitate," accompanied by what is assumed to be the man's signature. This 70-year-old patient arrived at an emergency department unconscious with elevated blood alcohol levels. He did not have any form of identification on him, and his health care providers did not have an identifiable means ...

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