Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 22-year-old woman is evaluated for a flare of Crohn disease. A colonoscopy performed 6 months ago showed moderate, patchy, left-sided colitis extending from the descending colon to the splenic flexure. She responded to therapy with prednisone but declined maintenance therapy in advance of conceiving. She is ...

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Go to college, go to medical school, start and finish residency and fellowship, get married, settle down and have children ... There is a certain expectation of what a "successful life" would look like for a physician mom. Some may even choose to stop work and become a full-time stay-at-home mom. Even when my spouse, who works part-time for most of our marriage, took a year off work to be the stay ...

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A couple of years ago I saw a young man with pain in his lower right abdomen. I sent him for an urgent CT scan with a “wet read” to check for appendicitis. It was afternoon, and things were crazy at the office. I forgot all about the pending CT report. I have learned this about myself: I am efficient because I have the ability to hyperfocus, but that has made ...

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Medical appointments are getting shorter by the year. Sometimes it feels like doctors have no time to spend with their patients. What’s to blame for these brief clinical interactions? It could be the electronic health record, or EHR. Because of changes in how insurance companies and the government pay for medical care, doctors increasingly need to document their care on the computer, causing many physicians to spend more time with their ...

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For the month of September, I embarked on the experience of a lifetime, living and working on the largest Native American reservation in the United States. Sprawled across the four corners region of Utah, Arizona, New Mexico and Colorado, the Navajo Reservation in Chinle, Arizona, encompasses an area as large as the entire state of West Virginia. Its population, however, is only about 300,000, making it extremely rural. To leave ...

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Most experienced pediatric intensivists, myself included, have encountered situations in which we, the doctors, believe continuing to support a child is unethical because it is not saving the life but prolonging the dying; whereas the child’s parents believe the opposite -- that it is unethical to withdraw life support because all life is sacred, no matter the circumstances. Sometimes these situations arise because poor communication causes families to distrust the ...

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I am frequently asked the following question: “Should I pay off my student loans before I put money aside to invest in the stock market?” The person asking this quick and simple question is looking for a yes or no answer. The problem I am faced with is there is not enough information in the question to give a proper answer. Therefore, I say, it depends. It depends on how the ...

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I often see patients for follow-up and learn they are not taking the medications either I or another health care provider prescribed. Sometimes the reason is obvious, and other times the patient is reluctant to give up the information. Patients have the right to take or not take medication that was prescribed. But, sometimes by not doing so, they are putting their health at risk. As a doctor, I want my ...

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Mark Kelley wrote a clear piece explaining that friends and providers are still patient’s most trusted medical referral resources in a piece titled, "Why quality reports for hospitals and doctors are interesting but flawed." Mr. Kelley cited unsynchronized, inconsistent systems as a source of frustration rather than insight for patients. The most common online referral database for patients? Yelp. We are living in a health care crisis. Health ...

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Exactly a year ago, on the day of the election, I wrote a piece that touched upon humankind’s turbulent history, basic traits and inevitable propensity for division and conflict based upon an amazing book I read: “A Little History of the World.” I related it to the election that was taking place on that day. A year on, it seems like our country is no less politically ...

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This year has brought about change — the theme of 2017. As it comes to a close and I reflect back, it is so hard to believe what is going on in the world today, let alone just the United States. In 2017, I graduated from my internal medicine residency training program, passed my board exam and celebrated my one-year wedding anniversary. I helped my family cope with my grandmother’s progressive ...

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Editor's note: This article contains a racial slur crucial to the writer's story. It took only 57 hours of working as a new attending physician in Charlottesville, Virginia for a patient to call me the N-word. Fifty-seven hours. In fact, a racial slur found me before I found the shortcut to the hospital cafeteria. So, when torch-bearing White supremacists gathered downtown earlier this year, I saw more confirmation of my conclusion that ...

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As the husband of a physician, I know what it's like to live on a low income while watching your spouse go through the grueling process that is residency. I know what it's like to want a nicer car, a nicer home, and just about nicer everything. One one hand, I think physicians have earned the right to a better than average lifestyle. After all, doctors are some of the hardest ...

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If all politics is local, then Washington’s health care debacle has brought politics to the front stoop of every health care provider in America. There is no escaping it – debates taking place on Capitol Hill are set to affect the very survival of our patients. Irrespective of political leanings, doctors, nurses and providers of all stripes have ethical and professional obligations to speak up and become engaged in order ...

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Yet another round of attempted health care reform has come and gone, and once again, failed. And so, the traditional open enrollment season for health insurance is upon us, and as usual, many Americans are facing outlandish increases in premiums, skyrocketing deductible amounts, and shrinking coverage. Americans are increasingly enslaved and endangered by the rising costs and the growing dysfunction. Fixing things is, to put things in the proper perspective, ...

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Recently, a Leonardo Da Vinci painting, Salvator Mundi (Savior of the World), was sold for $450 million, making it the largest fee for a painting ever sold.  Was it a good investment?  The painting was sold by Leonardo’s heir to King Francis I of France for 4000 gold ducats in 1519, which according to the American Numismatic Society would be equivalent to $575,000 at today’s price of gold at $1277 ...

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As a trainee at a large private health system (residency) followed by a NCI-designed comprehensive cancer (fellowship) in two large metropolitan areas in the United States, I was not prepared to face the challenges of working at a university setting affiliated with a county (public) hospital in more rural west-Texas.  After one and a half years of experience as a practicing urologic oncologist, these are the five challenges I have ...

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I keep a spare set of scrubs in my car. It’s an act of preparedness, informed by experience. A couple of months ago, I came out of an ED room after performing a particularly unsavory procedure and noticed that my left knee was wet. Disgusted, I shared my misfortune with my coworkers, and all of them had the same sympathetic response; they mirrored my grimace and cautiously offered hope: “Maybe ...

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Buying a home is a big deal; it’s one of the biggest and most emotional financial decisions you’ll make in your entire lifetime. Haven’t we all dreamt of the home we’d buy when we grow up? When my wife and I neared the end of our medical training, discussions of where to live (and how many kids to have) began to arise. Like most people, our first home felt like the ...

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In these tumultuous political and cultural times, it’s easy to presume the future is bleak. However, after attending a conference centered around medicine, public health, and medical science innovation, replete with remarkable stories of human perseverance, resilience, and courage, I felt humbled, inspired, and hopeful. In that order. Who cannot be awed listening to the one physician who kept treating desperately ill patients when the entire rest of the medical staff ...

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