"You've got to jump off cliffs all the time and build your wings on the way down." - Annie Dillard Months ago, when my patient and his wife were in my office for the very first time, I could already tell that he would resist any display of sympathy from her and she would clearly be uncomfortable with ever being a caregiver for him. There was tension in the room. He “had not ...

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We’ve known for some time the prevalence of obesity is growing among Americans -- not just adults, but children, too. Obesity is associated with a long list of medical problems, including heart and other vascular diseases, diabetes, and joint problems. It is encouraging that recently the seemingly inexorable growth of pediatric obesity prevalence seems to have reached a plateau. But we still have a future problem looming for population health as ...

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asco-logo I am in the privileged and humbling position of hearing the stories of patients’ pasts. Sometimes the stories are so horrendous that it takes all my energy to stop myself from crying as they recount the brutality of their experiences. I have heard harrowing descriptions of all manner of abuse done to patients when they were children. The abuse was ...

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As many readers are undoubtedly well aware, the doctor-patient relationship has a place of profound significance in health care. The critical importance of this relationship becomes magnified in oncology, where life hangs in the balance, and fear hangs over every soul that walks the invisible line between life and the everlasting night of undrawn death. In the winter of 2015, a needle biopsy was performed on a mysterious tumor in my ...

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Eight weeks after I delivered my third child, I was diagnosed with a four-centimeter lung mass. Yes, you heard that right. For those in medicine, this is terrifying to hear as the first thing that comes to mind is lung cancer. Lung cancer is notoriously hard to treat, typically fatal with a short life expectancy after diagnosis and extremely unfair to a lifelong nonsmoker who has spent 12 years in ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 63-year-old man is evaluated for severe mid-upper back pain following a minor fall 1 day ago. He also notes progressive fatigue of 6 months' duration and a 6.8-kg (15-lb) weight loss. Medical history is notable for an 80-pack-year smoking history, although he is currently a nonsmoker. On ...

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As an internist with “added qualifications in geriatric medicine” I care for a great many elder individuals. In most cases, these are individuals I met 20 or more years ago and have been privileged to share their lives with them as they aged. The circle of life is relentless and unforgiving, so there comes a time when these relationships end. In some cases, it comes when they can no longer care ...

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asco-logoI consider myself lucky to be the father to three wonderful kids: My oldest is now 15 and my twins are 9. They are indeed the light of my life. I get asked every so often, why did you want kids? It is a fair question, I suppose. After all, my partner and I relied on ...

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In a recent episode of the television series, The Good Doctor, a patient played as Robbie Ato does not tell his doctors he has a history of cancer.  You can see his surgeons stare in disbelief as one consulting surgeon recognizes the patient’s name and then alerts the team leader that she treated him three years ago for cancer. This is one of the very most troubling and dangerous acts of ...

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Physicians are no strangers to death. We are baptized into medicine with cadavers as first-year medical students. We learn to break bad news. We lose patients, some that are expected and some we never see coming. Through it all, we maintain a distance, an emotional reserve that enables us to shoulder these losses but still see the next patient with the full attention they deserve. But every now and then ...

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