When I first landed this job as a case manager (social worker), I was given Robert R. as a client. He was at his worst then, soiling himself virtually every day, with no change of clothing available. I remember him wearing a piece of colored cloth around his waist, which served as a belt. When he would come in in such a condition, sometimes even tracking in feces on his shoes, ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old man is evaluated for a 10-day history of abdominal cramping, diarrhea, malaise, and nausea. Diarrhea is watery without mucus or blood. He returned 2 weeks ago from a 7-day trip to Lima, Peru. On physical examination, temperature is 37.7 °C (99.9 °F); the remaining vital signs ...

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"Are you my doctor?" Mary* asked me, as I, a resident physician, approached her bed. "Yes, I am one of the primary medical doctors taking care of you here," I confirmed with my standard, pre-scripted introduction — with little appreciation of the implications of these words. Mary was a 30-something-year-old woman who transferred to our hospital due to worsening alcohol-related liver disease. She had struggled with anxiety and depression since her teenage ...

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"I have a riddle," Paul says, as the dining room falls silent. "You're at the bottom of the stairs. And on the wall, there are three light switches labeled one, two, and three. There's a room upstairs with three lamps, labeled X, Y, and Z. You can turn on and off as many switches as you want while you're downstairs, but you can only go upstairs once. And once you're upstairs, you ...

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I sit in Dr. Victor's small crowded waiting room, awaiting my turn. I am seated between two women, the one on my left probably 45, and the one on my right, somewhat older, both though younger than me. The lady on my right doesn't have much to say beyond telling me where she is from, and she is seeing Dr. Victor for the second time. The woman to my left is ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old woman is evaluated for a 6-month history of loose stools, bloating, and a 3.2-kg (7-lb) weight loss. Her medical history is otherwise unremarkable. Her brother has type 1 diabetes mellitus, and her mother has autoimmune thyroid disease. She reports no other symptoms and takes no ...

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At least a few times a year, I am asked to prescribe antibiotics to people who are not my patients. From my point of view, there is only one answer that makes sense here – no. I have the same reaction when patients call me for a refill or advice when I have not seen them in a year or two. The patient may feel that I will refill their ...

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Doctors dispense medical advice. That’s what we do. Folks come to our office with various medical issues. We talk to them. We poke around some of their body parts. Then, we exercise our medical judgment. We might order a CT scan. We might prescribe stuff. We might simply reassure them and send them on their way. This is a typical day in the life of a health care provider, formerly known ...

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What seems like a tidal wave of pages washes over you. Drowning in a torrential sea of order clarification, bowel regimens, and vital sign deviations — you struggle to stay afloat. Medical school did not prepare you for this. Patients and nurses are calling you, “doctor,” you wish to return to that minimal responsibility role as a medical student. Welcome to your first on-call weekend. These first few days, weeks, and months ...

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There's a pivotal scene in the 2007 Pixar movie Ratatouille, in which the restaurant critic Anton Ego takes a first bite of the movie's titular food. He is then whisked back to a moment in his childhood, during which his mom provides love and comfort through a helping of her homemade ratatouille. This scene is a homage to Marcel Proust's seminal "Madeleine Episode," as described In Search of Lost Time, published almost ...

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In our office, sometimes our secretaries listen to background music. A few days ago, while walking through the office, I heard an iconic song, written and performed by a songwriting legend. Even someone like me, who was never deep into the music scene, automatically recognized the song. I asked our receptionist, a young lady in her 20s, if she knew the song that was playing. She didn’t. I identified the ...

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From time to time, patients ask my advice on colonic hydrotherapy, vigorous sessions of enemas that aim to cleanse the body of toxins that are reputed to cause a variety of ailments. The logic sounds plausible to interested patients. Over time, toxins accumulate and leech into the body, wreaking havoc. Indeed, using the label "toxins" already suggests that these are noxious agents. If one accepts this premise, it is entirely ...

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This eating contest season, there was only one death this year, as far as I can determine. A 41-year-old California man died in August while participating in a taco eating contest at a minor league baseball game. The coroner said he choked to death. In case you were wondering, the Associated Press thoughtfully stated: “It was not immediately known how many tacos the ...

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Residents and fellows around the country have bought into the "medical training myth." The myth states: "Life will get so much better when I finish residency/fellowship." Sadly, too many house staff buy into this false belief and experience tremendous letdown when they graduate. Residents often see their attending stroll into the team room with a cup of coffee at 8 a.m., ready to round. Meanwhile, they think, “I’ve been ...

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I have been treating diverticulitis for 30 years the same way. When I suspect that a patient has this diagnosis, I prescribe antibiotics. This has been the standard treatment for this disorder for decades. I have found that diverticulitis is a slippery entity that has two trap doors waiting for physicians to fall through. It is an easy task to miss the diagnosis. Every physician has done this. The diagnosis can be ...

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Nowadays, patients are used to seeing physicians who are not their doctors. Often, patients may be seeing a nurse practitioner, a highly trained professional for their medical care, instead of a physician. A generation ago, patients nearly always saw their own physician, including if a patient was hospitalized. Imagine that: Your own primary care doctor sees you in the hospital, an event that occurred when dinosaurs roamed freely. The medical universe ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 65-year-old man is evaluated during a visit to establish care. He is interested in colorectal cancer screening; however, he adamantly refuses to undergo colon preparation, and he does not want to modify his diet for screening. He has never undergone colorectal cancer screening. Medical and family histories are ...

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It may seem odd that a gastroenterologist patronizes fast food establishments several times each week. I’m in one right now as I write this. I eschew the food items –though French fries will forever tempt me – and opt for a large-sized beverage. In truth, I am not primarily there for a thirst-quenching experience, but more to ‘rent a table’ so I can bury myself in some reading. Indeed, many ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old man is evaluated for ongoing symptoms of dysphagia. He was previously diagnosed with eosinophilic esophagitis on upper endoscopy and has completed an 8-week course of swallowed aerosolized fluticasone, which did not alleviate his symptoms. He takes no other medications. On physical examination, vital signs are normal; BMI is ...

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When I meet patients in the office, our conversations do not focus exclusively on the medical issue at hand. Of course, if you come to see me with a stomach ache, at some point, I will direct the dialogue toward your abdomen. Often, our conversations are far removed from livers and pancreases, and deal with more personal vignettes and anecdotes. Why does this happen? First, I enjoy it; and secondly, ...

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