He looked tired and worn down, more so than many of the other patients I had seen that day. He didn’t speak English and I did not speak his language, but I could feel his anxiety as it filled the exam room. One of my employees translated, in fact, what his “boss” was telling us. The boss was worried that he was more tired than usual, and not getting his ...

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Mental illness might be smarter than us. It seems to have figured out how to get around asking for our permission and instead to beg for forgiveness once damage to function and health already has been done. That’s the only way to explain the following: it takes not five weeks or three months but 11 years for someone who exhibits signs of mental illness to first seek help for that disorder. That is, if they ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 47-year-old man is evaluated during a follow-up examination. He is obese and has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. He reports that he has always has been overweight, and over the years, his weight has gradually increased to 123 kg (271 lb). During the past ...

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On a Sunday afternoon, I arrived at the hospital for my psychiatry ER shift. As medical students, we keep an eye on the track board for new patients to see. Two names turned bright red, and I chose to follow Jackie Swanson*. Her initial ER evaluation read “Patient is a 30-year-old female here for SI, HI, and AVH in context of recent sexual assault and cocaine use.” She was brought ...

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I recently went to an infectious disease educational session sponsored by the Massachusetts Medical Society and the New England Journal of Medicine called "Epidemics Gone Viral." The focus was preparedness for the next epidemic, which may come from anywhere. John Brownstein talked about how its arrival will be monitored and reported using Twitter and artificial intelligence. With the meeting going viral with excitement as Bill Gates got ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old man is evaluated for a 2-month history of progressive lower-extremity edema, weight loss, and fatigue. Medical history is significant for recreational use of inhaled cocaine; he denies injection drug use. He has no other known medical issues and takes no medications. On physical examination, temperature is 37.2 °C ...

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The devastating opioid epidemic is one of the largest public health problems facing the U.S. Over 2.5 million people in the U.S. suffer from opioid use disorder. Four in five new heroin users started out misusing prescription painkillers. A 2015 analysis by the Centers for Disease Control and Prevention found people who are addicted to painkillers are 40 times more likely to ...

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My name is Lucy. I have stage IV liver cancer. I wanted everything done — even though the doctors told me this disease is terminal. My family, my church and my friends were praying for “the cure.” Though I believed in God and the hereafter, I wasn’t ready to go. 74-years-old with beautiful children, grandchildren, and a great-granddaughter. I woke up confused. In the background — wherever I was — I could hear ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old woman is evaluated for intermittent fever, sweats, fatigue, and dull midchest pain of 2 weeks' duration. Medical history is significant for liver transplantation 6 months ago for primary biliary cirrhosis; she was seronegative for cytomegalovirus and Epstein-Barr virus, and her donor was positive for both. Results of ...

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The interviewees in my book talked about declining quality of health care. Do people even know or remember what it is like to get quality health care? Doctor visits are often too short to be adequately through. Psychotherapy is too often too brief,  with a focus on "quick fix." Psychotherapy isn't just about talking. It involves careful, thorough study and application of knowledge to the issues that patients bring with them. ...

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