Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes ...

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asco-logo In the second week of April, I headed to San Francisco where I took part in the SWOG Semi-Annual Meeting. To those who might be unfamiliar with us, SWOG is a member organization of the National Clinical Trials Network (NCTN) and is tasked in running clinical trials across disease sites and scenarios, from prevention to ...

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American physicians dole out lots of unnecessary medical care to their patients. They prescribe things like antibiotics for people with viral infections, order expensive CT scans for patients with transitory back pain, and obtain screening EKGs for people with no signs or symptoms of heart disease. Some critics even accuse physicians of ordering such services to bolster their revenue. So what happens when uninsured patients make it to the doctor’s office ...

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The most common hurdle that doctors have is overspending. The notion that good income guarantees great buying power not only delays building financial worth but also confines doctors to lengthier careers than needed.  The solution, in a nutshell, is to make sure that we make prudent financial and career choices to complement our financial velocity. Easy, right? The reality is not so simple.  Psychology is fascinating. Human behavior can function, at ...

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With the transition to residency, I’ve spent a lot of time thinking about next steps in my career. I even did a self-reflection exercise for a class in which I listed out professional decisions that will come up in the next few years (including choices like fellowship selection, type of practice setting, whether to pursue management roles, and more). I then rated the different options on a set of six ...

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What is it? Kratom is a powdered herbal supplement derived from the leaves of a tropical evergreen tree that is native to Southeast Asia and is usually taken orally but can also be brewed into teas. It is commonly used by consumers as an alternative medicine to self-treat opioid addiction and chronic pain.  The leaves contain two compounds, mitragynine and 7-a-hydroxymitragyine, which interact with various receptors in the brain. At low doses the ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. I recently saw a new patient who came to our practice following a lengthy hospitalization. He is in his 80s with a fairly complex medical history typical of many in this age range. Yet, after carefully sifting through my first introduction to this ...

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I'm not much of a tennis fan, but I am a fan of Serena Williams. Who wouldn't be after hearing her story? Her rise to the upper echelon of athletics was remarkable, and her longevity is incomparable. All the while, she has challenged the sporting world's notions about who and what an elite tennis player is supposed to be. I watched her interviews after this year's Wimbledon finals and was ...

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If someone asked you on day one of medical school, as a fresh-faced first year, to name the essential components of a successful career, what would you have answered? A solid education? Good test scores? Publications? An $800 otoscope? Some are more obvious than others. Who of the enlightened among us would have mentioned a proper work-life balance? How about a strong support system — or the right mentor? Navigating the ...

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Although I would never describe the business of primary care medicine as cutting edge, there are a number of innovations that have come and gone during my short tenure running a medical practice.  The business of medicine is fascinating and leaves much room for personalization and creativity.  I have been lucky to operate at the forefront of practice management and learned quickly how to leverage two bleeding edge philosophies ...

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I am a terrible coder. I think I am a pretty good doctor, but when it comes to coding, the process of figuring out which billing code to pick to assign to a bill for an office visit, I am hopeless. No matter how many times I have had the rules explained to me, or how much feedback I have been given about specific visits, or which “pocket guide” to ...

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There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland. But there are even more words than that for “chest pain” among my patients, many of whom do not consistently or fully comprehend the English phrase, “If you have chest pain, call 911 ...

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“Oh, you’re a psychiatrist? I hope you won’t analyze me!” I never know what people actually mean when they say that upon learning that I work as a psychiatrist. I think they’re saying, “I hope you’re not going to spend our time together trying to discern my flaws.” Nobody wants people to seek out, highlight, and exploit their vulnerabilities and faults, so I can understand that. Of course, that’s not what psychiatrists do. Anyway, ...

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Gratitude may be more beneficial than we commonly suppose. One recent study asked subjects to write a note of thanks to someone and then estimate how surprised and happy the recipient would feel – an impact that they consistently underestimated. Another study assessed the health benefits of writing thank you notes. The researchers found that writing as few as three weekly thank you notes ...

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Following one of my recent articles on how physicians can improve their communication skills and ultimately help attain better patient outcomes, I received an interesting comment from a physician. It went something like this: “Sorry, but I’m not an actor.” This response typifies a small (but not insignificant) subset of responses I get when I’m discussing and promoting techniques that any doctor can utilize to better their skills in this area ...

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When we studied ward attending rounds, the thought process represented the top attribute that learners valued.  Learners can learn facts from textbooks, but using those facts requires experience and role modeling. I have given many lectures on clinical reasoning, and I have attended many lectures on clinical reasoning.  These lectures can entertain, but one lecture does little to help our colleagues and our learners. We must structure case conferences as a primary ...

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Dear science, Today my sons, Oliver and Victor, are 15 years old. It is not a miracle; it is thanks to you. Unable to get pregnant I needed infertility therapy. If you had not isolated the hormones, developed tests, and then designed medications for ovarian stimulation and to trigger ovulation I would never have become pregnant. If ultrasound had not been developed I would not have known I was pregnant with triplets and then ...

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STAT_Logo "Better patient care” is the reason hospital and health systems usually give when they merge or acquire one another. Our research suggests that mergers and affiliations might, paradoxically, increase the risk of harm to patients in the short run. Improving the safety of patient care is possible during mergers and affiliations, but requires intentional efforts. What happens after ...

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It's easy to get excited about technological advances such as nanobots that swim in blood to deliver drugs or 3-D printers that print human tissues. However, in our enthusiasm to find the next fix, we are failing to notice the ground slipping underneath the health care industry. Here are four trends that are changing health care but on the surface are too unsexy for us to care about. Trend 1: The doctor-patient ...

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Let’s begin with a quiz question: Patients may be allergic to: A. oxygen B. carbon C. iodine D. none of the above If you answered anything but "D," better keep reading. Consider this scenario: If a patient is allergic to penicillin, you would document “penicillin” in the medical records. It would never occur to you to list “antibiotics” as an allergy, and you certainly would not call it a “carbon” allergy for slang, just because penicillin contains ...

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