Sheila’s jaw is clenched. Sweat is beading on her forehead. I make a slow audible inhale, non-verbally inviting her to do the same. We’ve been talking about the nightmares which started shortly after she began receiving help with personal care. I remind her that she is safe — the day she was raped is decades in the past. Her conscious mind knows this, of course, but for people with posttraumatic ...

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The Society to Improve Diagnosis in Medicine has on its website this quote:

  • 1 in 10 diagnoses are incorrect.
  • Diagnostic error accounts for 40,000-80,000 U.S. deaths annually -- somewhere between breast cancer and diabetes.
  • Chances are, we will all experience diagnostic error in our lifetime.
The current focus on diagnostic error raises an interesting question:  Is this a larger problem in 2017 than in the 1970s and 1980s? In this post, I ...

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It was late afternoon. The woman who had seen my colleague, Dr. Wilford Brown, a few days earlier was sitting in my exam room. Her chart note read like a typical unnameable virus: headache, body aches, fatigue, low grade fever. She had always seemed like a level-headed resolute woman, but she had called three days in a row for medical advice because she felt so poorly. And it all sounded ...

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An excerpt from The Other Side of the Bed: What Patients Go Through and What Doctors Can Learn. As soon as I’d opened my mouth, I regretted it. In the hospital, it’s bad luck to say “It looks quiet,” or anything to that effect. At the sound of those words, ...

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Victim: Female nurse, age 25 Time: circa 1980 Place: A hospital in a sleepy Southern town with fifty beds, six emergency department beds, one nurse, one doctor and one secretary. It was an unusually quiet Friday night in this small emergency department. We all knew Friday was "party day": pay day, play day, alcohol, pills, drugs, loud music and lots of really bad decisions. Not only did we cover the entire city, but we also ...

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My partner Judith had pain in her sinus cavity caused by a tumor called a plasmacytoma. After her biopsy, her surgeon called Friday afternoon with the results. She asked him to wait fifteen minutes until I could be home with her to get the news. He had no flexibility and said he could speak either then or Monday. She chose to speak with him then on the phone still alone. ...

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We cannot let the anecdote rule over us.   We don’t make sound policy if we are swayed by isolated emotional vignettes.  Of course, a vignette describes a living, breathing human being, but we must consider the greater good, the overall context and the risk of letting our hearts triumph over our heads when making general policy.  Consider these examples. If an expensive drug treatment program keeps five addicts clean for six ...

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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 a 4-month history of intermittent, nonprogressive solid-food dysphagia. He has a long-standing history of heartburn that has been well controlled with once-daily proton-pump inhibitor (PPI) therapy for the past 5 years. Results of a screening colonoscopy 4 years ago were normal. ...

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Eighteen months ago, I wrote about my plan for maximizing menopause preparedness. As with so many missions, this one has experienced both successes and failures. Since January 2016, I have grooved my exercise routine in the most awesome way. I am all over the TRX, doing Spiderman push-ups, incline presses, pistols and more. I ...

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“I think my friend has attempted suicide” an 11-year-old child haltingly admitted after I introduced myself as a crisis counselor with a national hotline and asked how I could help.*  Over the next half hour I learned that this child and her friend had been facing ongoing cyber- and face-to-face bullying at school that was such a common occurrence the caller sounded nonchalant. The caller’s friend, however, had already attempted suicide at least ...

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