For a long time, I didn’t feel as if I were getting any older. Because I’ve been at my institution since 1975, I’ve always been surrounded by the people who educated me. Though my teachers and mentors have undoubtedly aged, to me, none of them seems much older than they were when I first met them. And since for most of those years our student-teacher relationship has remained unchanged, when ...

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A wag once said: “There is no such thing as a healthy person, just one who has not had enough tests.” As we make every minor deviation from the average into a disease, that jest is becoming uncomfortably close to the way our current medical system behaves. Part of the problem is that many diseases represent an arbitrary cut-off of a number. Thus, hypertension is defined as a blood pressure above a ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old woman is evaluated during a routine examination. She feels well and has no exercise limitations. Medical history is significant for hypertension treated with enalapril. She does not smoke. At her last examination 4 years ago, her blood pressure was 122/76 mm Hg. Laboratory studies at that time ...

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Busy primary care physicians have a lot on their plates. But when it comes to helping people with diabetes learn how to improve their health, they don’t have to do it all themselves. Diabetes self-management education and support (DSMES) programs, led by a diabetes educator, can provide vital assistance by helping people with diabetes maintain a healthy weight, quit smoking, begin an exercise routine and integrate other self-management behaviors into ...

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I recently had a patient whose blood sugar was well controlled until he lost his health insurance. He purchased his diabetes pills because they’re cheap, but he couldn’t afford the insulin. His diabetes had been well controlled. Now, almost a year later, his hemoglobin A1C was 14, or double what it should be. The HbA1C measures sugar control over the last three months. The bee sting kit or EpiPen cost hike ...

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My husband, who's had type 2 diabetes for 20 years, had been struggling for a long while to lower his hemoglobin A1C — a number that measures how well he's managing his blood sugar over time. When he and I finally investigated the issue, it turned out that someone close to him was thwarting his efforts. This person is an addict. Her drug of choice is sugar — often candy no ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. The aim of medical education is not only to transfer scientific knowledge, but also impart the wisdom accumulated over the long history of medicine that equips us to apply this knowledge for the betterment of our patients. Although much of medical wisdom transmitted in ...

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I met Mr. B during my week on the endocrine service of my internal medicine rotation. My attending told me we were being consulted for this patient’s high sugars and a foot ulcer, and asked me to take the history. I walked into Mr. B’s room and was immediately struck by its stench. Mr. B had undergone a resection of his bladder tumor the day before and as a result was ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old man is evaluated for a new skin rash of 10 days' duration. The rash appeared abruptly and is not tender or pruritic. The patient has poorly controlled type 2 diabetes mellitus. His current medications include metformin and glyburide. Family history is unremarkable. On physical examination, vital signs are ...

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I was in the hospital when I heard the word “apple.”  Without hesitating, I reached into my pocket to see if I had my phone.  But the person speaking was referring to the fruit, not the product.  This got me thinking: “Has technology and our products now become more important than our health?” Technology surrounds us and has become a large part of how we live on a daily basis. I’m ...

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