Increasingly, we see functions executed by machines that were formerly performed by living breathing human beings. Examples range from the mundane to the preternatural.

  • Order food and drink from an iPad. No server needed.
  • Driverless auto travel. This may lead to a resurgence in prayer.
  • Pilotless air travel. Hard times ahead for the Airline Pilots Association.
  • Making precision tools from 3D printers.
  • Gourmet meals created with a voice-activated command.
  • Theater ...

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One day I found out that it was National Limerick Day. I didn’t even know there was a National Limerick Day. I investigated other "days" and found out that September 7th was National Grateful Patient Day. So, this grateful patient will start her post with a limerick: There was a patient in a flimsy gown, Who was also wearing a frown. She was getting a bad cold, And feeling cold and old, She wanted another ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated for a 4-week history of heartburn that awakens him at night. The symptoms occur about three times per week. He has been taking over-the-counter antacids with incomplete relief. Food triggers include coffee and spicy foods. He has not had unintentional weight loss or difficulty ...

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In a prior post, I shared my heretofore reluctance to prescribe medications for my hepatitis C (HCV) patients.  In summary, after consideration of the risks and benefits of the available options, I could not persuade myself -- or my patients -- to pull the trigger.  These patients were made aware of my conservative philosophy of medical practice. I offered every one of them an opportunity to consult with another ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman is evaluated in follow-up after recent surgery for endometrial cancer. Her family history is significant for colon cancer in her sister (diagnosed at age 45 years) and her mother (diagnosed at age 65 years). Her maternal grandfather was diagnosed with rectal cancer at age 47 years. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 46-year-old man is evaluated for intermittent rectal bleeding of 3 months' duration. He is otherwise well and takes no medications. His father had a few polyps removed from the colon when he was 71 years old, but no other details are known about his father's medical history. The ...

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A patient with progressive neurologic disorder had a gastrojejunal tube placed for feeding. In a nursing home, the tube fell out and was replaced with a Foley catheter. He was sent to the hospital for placement of a new tube. When he arrived in the interventional radiology suite, the Foley catheter was not visible. A new gastrojejunal tube was successfully placed, and the patient was sent back to the nursing ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 70-year-old man is evaluated in follow-up for heartburn of 7 years' duration. He has frequent nocturnal reflux but has not had odynophagia or dysphagia, and his weight has been stable. He was recently started on once-daily omeprazole with good control of his symptoms. He has a 30-pack-year history of cigarette ...

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A patient came to see me with lower abdominal pain.  Was she interested in my medical opinion?  Not really.  She was advised to see me by her gynecologist who had advised that the patient undergo a hysterectomy.  Was this physician seeking my medical advice?  Not really.   Was this patient coming to see me as her day was boring and she was bored and needed an activity?  Not really. After the ...

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The most high-powered rotation in my medical school was endocrinology. There, you got to see things most doctors never come close to diagnosing themselves. Uppsala University’s Akademiska Hospital served as a referral center for the Swedish population north of Uppsala, an area the size and shape of California. Back in the seventies, laboratory testing wasn’t as sophisticated as it is now. We didn’t have CT scanners even at the major hospitals, ...

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