Inquisitive reader Amy asked me if I had any opinions about online screening for depression. The British Medical Journal recently published a debate on this issue. What an excellent question, Amy! I read the opposing arguments, and these are my thoughts: First, I see two different issues. The first is whether the 9-question Patient Health Questionnaire (PHQ-9) is an appropriate tool to use to screen for depression. The second is ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is seen for follow-up evaluation of Parkinson disease, which was diagnosed 10 years ago. Although his symptoms initially were well controlled with medications, he has experienced increasing fluctuations in motor symptoms, specifically tremor at rest and slowness, within the past 3 years. Medications are ...

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As I sit in the exam room waiting for my first patient of the afternoon, the phone rings. It rings four more times before I realize that Amanda Ringwald, our eighty-year-old receptionist, hasn't come back from taking a rare lunch break. I pick up the phone and say, "VA Hospital. Marianna Crane." Oops, I'm not back at the VA anymore. "Senior Clinic," I quickly add. "Hello, my friend." The familiar voice makes my ...

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Devastating. That alone cannot fully describe the extent of the destruction of property, the displacement of tens of thousands of residents, the injuries and loss of life in the wake of Hurricanes Harvey and Irma. As Americans, our hearts ache for those affected by the flooding. As a medical student, former international development worker in Afghanistan and EMT in South Africa, I also lay awake thinking about the many infectious ...

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We tend to like threes. Hendriasis, in Greek — one through three, is a figure of speech used for emphasis in which three words are used to express one idea. For example: Veni vidi, vici. Location, location, location. Or one of the anthems of my youth — sex drugs and rock n' roll. Monty Hall had three doors on "Let’s Make a Deal." Even Uncle Junior, the patriarch in the “Sopranos,” ...

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With the attempts to repeal and replace the Affordable Care Act, it is a good time to educate our leaders on an opportunity to significantly reduce the incidence of the most expensive and common preventable, pre-existing condition: What your mother did or didn’t eat when she was pregnant with you. Yes, it is a pre-existing condition that determines how you die. Confused? Let me give you a little scientific context. Recently I was ...

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I love breast cancer awareness month. As a breast medical oncologist, it gives me an opportunity to spread the message of how important early detection is for improving the success of breast cancer treatment. I am surprised regularly at the number of women who either are not doing mammography at all or who do it every couple of years when they remember. We know that women who are participating in ...

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Nearly every American is touched by serious chronic illness, either as a patient or as a caregiver. The federal government recognizes the far-reaching effects of such conditions, and agencies like the National Institutes of Health and Centers for Disease Control and Prevention conduct surveillance of these diseases. Such research allows us to better understand the burden of different diseases, develop new treatments and prevention practices, and protect the public’s health. ...

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Dr. Tara Zandvliet was inundated with calls and emails from parents last year, after California passed a law nixing personal beliefs as an exemption from school vaccinations. Suddenly, many parents sought exemptions for medical reasons. Someone even faked two medical exemption forms purportedly written by the San Diego pediatrician, copying a legitimate document she’d provided for a patient and writing in the names of students she’d never treated, she said. She ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old man is evaluated for elevated blood pressure noted recently at a local health fair. He has no other medical history and takes no medications. On this visit and on two subsequent nurse visits, the patient's blood pressure measurements are less than 140/90 mm Hg. BMI is ...

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