My patient is a brilliant, 30-something-year-old highly educated woman with type 1 diabetes. I’ve known her for many years, since she was a teenager.  She is sweet and fun, even though she can be fierce and fiery at times. She has type 1 diabetes. She has been living with this life-altering, life-threatening disease for many years. Even as a child, she always took charge of her life and consistently maintained her ...

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A few years ago, a close friend of mine met a guy who knocked her off her feet. It had been a while since she'd met anyone whom she really liked and she was deliriously happy, so much so that we didn't see her for two months. By the time we did, she'd become both a rabid soccer fan and French bulldog lover, neither of which she'd been eight weeks prior. ...

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For a mere biennial fee of $525, I remain part of the medical community with a newly renewed medical license from my home state. I still have time to make a decision on renewal for the state from which I retired two years ago, only because their board extended its deadline three months to allow its physicians to complete the CME that our pandemic made more difficult. It costs less but ...

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“Last question,” the woman from the insurance company said. Good, I thought; I was eager to get back to seeing patients. “How long have you been taking care of Sarah?” “I’m not sure,” I replied, “How old is she?” “She’s 34.” “Then I have been taking care of her for 35 years.” “Doctor, I’m not sure you heard me correctly; she is only 34.” “I heard you perfectly,” I retorted, “She has been my patient for 35 ...

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As a young medical doctor in academia in the early 1980s, most of my research was conducted in male rats. I was told that the estrus cycle in female rats would interfere with data interpretation. Investigators were reluctant to test medications in women of reproductive age, because of the concern about pregnancy.  Older women were enrolled in clinical trials, but men and women's imbalance favored men. Medical schools were teaching ...

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We all go to work in the morning, looking forward to the day. I know I have about 26 patients and about 20 other tasks to do for the day. I know that my medical assistant has about the same ( or more ), and we are ready to go. “Good morning Sophia,” I say to my medical assistant as I walked into the office. She has already roomed the first ...

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I am a board-certified endocrinologist, and I have been in practice for 15 years. I have seen and helped thousands of patients with various endocrine disorders over the years, and I have really gotten to understand in depth the conditions that I have specialized in. Approximately one year ago, after I have learned about the Ideal Medical Care movement, I have decided to join and open my own private practice. It ...

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The COVID-19 crisis has forced upon us the rapid adoption of telemedicine with all its advantages and flaws. It has certainly allowed physicians to evaluate patients safely and to assess them while continuing to allow them to physically distance.  It many cases, it has allowed for the recognition of an exacerbation of a chronic illness that the patient had otherwise neglected, fearful that leaving their home and going ...

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The current news cycles concerning COVID-19 today are frightening. The media has portrayed COVID-19 as an amazingly deadly virus. And to some people, that is very true. But not to about 98% of those who are COVID-19 positive. The death rates still hover around 2%, and that is only out of the known – testing positive – cases.  But who is the most vulnerable? If you read the news, this ...

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Empathizing with others' suffering is one of the most human expressions in life. For empathy to nurture, like any other emotion, it needs time and space, and in none other professions, this maxim is codified as profoundly as in medicine. Even in the times of pre-modern medicine, humans had the temptations to heal fellow humans' suffering from ailments about which they knew little and had no therapeutics to offer. Nevertheless, ...

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It is a fluke of the news cycle that if we don't hear a product warning frequently, we can "forgive" that product and think it has somehow become safe. While no one would "forgive" cigarettes, lead in drinking water or mercury in tuna, the public has definitely softened on the danger of hormone replacement therapy (HRT) for menopause. So it is noteworthy that a recently released ...

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I’m a member of the ACR (American College of Radiology). One of their recent online postings is entitled: Choosing Wisely. Number three (of ten things physicians and patients should question) is: "Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam." In only 2 percent of cases, will it make a difference in management. Thirteen years ago, I was working on the queue of cases ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 54-year-old woman is evaluated for flushing of the face of 1 year's duration. These episodes occur two or three times per week and last about 30 minutes. She went through menopause at age 50 and is on estrogen and progesterone hormone therapy. She also experiences episodes of anxiety, ...

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Michelangelo once said, “The sculpture is already complete within the marble block before I start my work.” The same insight applies to the scientific potential that resides inside young people. Curiosity is imbued within every human being since our birth, and before we can find the words to explain why, we experience the urge to turn over rocks. Often, efforts to promote science among young people aim to impress upon them what ...

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One of the great nuisances in medicine is diagnosis coding. According to Medicare and insurance companies across the U.S., each and every disease must have a unique number. Everything must be quantified and recorded. Why? To facilitate analysis, number-crunching, regulations, reimbursements and, of course, we sometimes joke, to perpetuate the jobs of the coders. They usually know the nuances better than the doctors. Is it truly possible to describe Mrs. Brown's ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old woman is evaluated for management of type 2 diabetes mellitus diagnosed 3 months ago. She was asymptomatic at diagnosis with an initial HbA1c value of 9.7%. Her initial interventions included lifestyle modifications with weight loss and metformin. She is motivated to continue to lose weight. Medical history ...

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In August 2014, a 13-year-old boy with Type 1 diabetes died after being treated by self-described “master herbalist” Tim Morrow who was tried for child abuse resulting in death and practicing medicine without a license. He had told the boy’s mother to stop administering insulin and instead prescribed herbs which he sold. According to one report, Morrow told the parents that insulin was poison, and if they took ...

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Eli Lilly and Co. recently announced with some fanfare that it was manufacturing a generic version of its own best-selling insulin brand, Humalog, which it would sell for half off — $137.35 versus about $275.

David Ricks, the chief executive of Lilly, said the company was making this seemingly beneficent gesture because “many patients are struggling to afford their insulin.”

But they’re struggling, in large part, ...

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Samuel was an English gentleman hailing from London. Close to 10 percent of the U.S. population, over 30 million people, lives with diabetes. Five years ago, Samuel was diagnosed with type 2 diabetes. Taking lisinopril and glipizide, he also goes on hour-long walks every morning at 6:30 a.m. to keep his A1c at his comfort number of 5.5. It has not always been this way for Samuel as he was ...

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I chose endocrinology to be my lifelong profession out of love for the complex interactions of endocrine glands and intricate feedback loops. I take pride in preventing medical complications, prolonging life expectancy, and providing complex care to type 1 and type 2 diabetics. At times, this field of work requires spending hours -- either with the patient or before or after patient visits -- counseling, examining blood glucose data and ...

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