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 that ...

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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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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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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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“We pass through the present with our eyes blindfolded … Only later when the cloth is untied can we glance at the past and find out what we have experienced and what meaning it has.” – Milan Kundera Two days ago, during a clinical skills session on lymph node examination, my classmates insisted that I get what appeared to be an enlarged lymph node in my neck checked by the physician ...

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Last summer, I published a post called "Alternative Medicine is Kicking Our Ass." In it, I focused on one particularly slick alt-thyroid site that has done a masterful job of sowing doubt regarding the advice mainstream physicians give to our patients about the thyroid. Not only that, but the site has called into question our competency as doctors, citing "evidence" that supposedly proves (it doesn't) we ...

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