Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old man is evaluated for his quarterly diabetes care follow-up visit. Point-of-care HbA1c level is not at goal for this patient, who has high function, long life expectancy, few comorbidities, good support, health literacy, and access to care. Medical history is significant for hypertension, hyperlipidemia, and obesity. His family history ...

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As doctors, we simply want to spend more time with our patients. As a doctor for 13 years, and someone who now recruits doctors as a large part of my job, I’m witnessing the battle for more time with patients wage on, but there are no winners. Patients are waiting longer for hurried appointments. We spend more of what little time we have, prescribing and referring out because we’re racing ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 40-year-old woman is evaluated for amenorrhea of 4 months' duration. She has had weight gain, facial hair, alopecia, and debilitating fatigue. Her medical history is significant for psoriasis. She seems to be gaining weight in her face, abdomen, and neck. She also bruises easily. Her only ...

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Measuring metrics is a common catch-phrase in health care. The goal of capturing certain data is to improve patient outcomes. But, as doctors, we were taught to treat the patient and not the numbers. While optimizing clinical outcomes is a needed goal with all the complexities in medical treatment currently, the system seems to have gone too far in its quest for targeted numbers. If, for example, a patient suffers metastatic ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 45-year-old man is evaluated during an annual routine health maintenance visit. History is notable for type 2 diabetes mellitus (diet controlled) diagnosed 3 months ago. Family history is significant for his father who developed end-stage kidney disease due to diabetes at age 68 years. He reports ...

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Dear alternative medicine, Hi, it's HD again. You may remember me from the last time we entered the squared circle, "Endocrinology vs. Naturopathy: Steel Cage Death Match." I had hoped that you might internalize a couple of the lessons I tried to teach you: "Know your assay" and "know your pre-test probability" — but, shocker, it didn't happen. You regrouped, and you've come back more formidable than ...

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How would you like to double your chances of winning the lottery? Just buy two tickets! Statistically, this is true, but is that a reason to spend more money on something that most likely offers no return on investment? Yet, in medical research, study after study shows impressive improvement in relative risk for this, that and the other intervention but a small or even negligible effect on absolute risk. For example, I just ...

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There are some sad truths about being an aging male. Your muscle mass usually declines. You start feeling tired more easily. And there’s a good chance either you start losing interest in sex or start experiencing a decline in sexual performance. Here’s another truth: Your testosterone level probably ain’t what it used to be. Which raises a question: Would testosterone supplementation restore some of your youthful vitality? That is certainly what manufactures ...

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As the calendar turns to early October, I’m reminded that this is the 6th anniversary of Steve Jobs’ death. At the time of his death, I was a medical student and my wife had just completed six months of chemotherapy. I was surprised to learn that Jobs had died from complications of cancer and shocked to discover that he had initially refused conventional cancer treatment in favor of alternative medicines. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister, and brother) of the disease. History is significant for hypertension, for which he takes losartan and amlodipine in the morning. On physical examination, temperature ...

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