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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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old man is evaluated in follow-up after recently testing positive for hepatitis B surface antigen. He underwent testing as part of the immigration process from Somalia. Two other siblings also have hepatitis B virus (HBV) infection. On physical examination, he is a young, healthy-appearing man. Vital signs ...

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According to Hesiod’s version of an ancient Greek legend, because Pandora has opened a jar stuffed full of evil by the Olympian gods, “countless plagues, wander amongst men … earth is full of evils … Diseases come upon men continually by day and by night, bringing mischief to mortals silently.” Curiously that jar was closed before hope was also allowed to escape. Is the legend an expression of how bleak the ...

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Harry understood at last that he was not supposed to survive. His job was to walk calmly into Death’s welcoming arms … All those times he had thought that it was about to happen and escaped, he had never really thought of the thing itself: His will to live had always been so much stronger than his fear of death … It was over, he knew it, and all that ...

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Women who lose part or all of one or both breasts due to breast cancer surgery may choose to have new breasts created with their own tissue -- a process that also may or may not involve breast implants. A wide range of reconstruction procedures is available, including a variety of flaps and options to use either implants or what is known as autologous fat transfer. Each surgery has its own ...

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T was the last patient of a busier than usual morning. “New patient, establish care” was her reason for visit. As I would soon find out with the help of our remarkable Arabic interpreter, T and her family recently moved to our area after spending the better part of 3 years moving from refugee camp to refugee camp trying to escape the ravages of the civil war in their native ...

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There are some questions in health care that can’t be answered with a randomized controlled trial. We can’t randomize babies to inhale secondary tobacco smoke or not to test its health effects. We can’t randomize people to a different number of hours sitting the ER before receiving antibiotics after the decision is made that the patient has a bacterial infection requiring antibiotics. There are some questions where the best available ...

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Lori Wallace sits on a couch with her 11-year-old son and his new pet snake. It burrows under his armpit, as if afraid. Wallace is sure it’s not. “If he was terrified, he would be balled up,” Wallace said. “See, that is why they are called ball pythons. When they are scared, they turn into a little ball.” Wallace is dying of breast cancer, but a stranger wouldn’t know. She has a ...

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7 a.m. began as it always did; the overnight doc was threatening to quit while rubbing her bloodshot eyes and smearing mascara beneath them. Between heavy sighs, she listed the patients transferring into my care ending with Mr. Mandel. “He’s eighty-something,” she explained, “hospice care. Cancer with metastases. Came in from home because family ran out of morphine and he was in a lot of pain. Anyway, he’s actively dying now, ...

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“Doctor, how would you like your schedule template?” As a hematology/oncology physician in a non-profit hospital group, I am reimbursed by wRVU. This is the standard mechanism of reimbursement for large multispecialty groups and academic centers. In this scenario, the more wRVUs you make, the more you get paid. However, there are only so many hours in the day. One of the first decisions each doctor makes when joining a group ...

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