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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The science of complexity lays a conceptual foundation for understanding "complex adaptive systems." What all complex adaptive systems have in common is that they are all bound by the same set of physical laws. Their "behavior," i.e., growth, maintenance, and death, can all be described using the same set of mathematical relationships. These systems (animals, plants, ecosystems, etc.) are the most productive and functionally effective systems known to man. Unfortunately, our ...

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STAT_LogoOver the course of little more than a month, we removed 54 tiny toy magnets from the digestive systems of four children. They were lucky: Despite invasive procedures and operations to repair holes in their intestines, their injuries were treated in time, and they will make full recoveries. In the past, others across the nation have not been ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old man is evaluated during a follow-up appointment for persistent heartburn with chronic cough. He has a 1-year history of gastroesophageal reflux disease and takes pantoprazole twice daily. He reports no nausea, vomiting, or dysphagia. Upper endoscopy performed 1 year earlier showed no abnormal findings. His vital signs and ...

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I’m a doctor. And, like most medical professionals, I’m a bad patient. Two years after my last appointment, I got a CTJ, “Come to Jesus” from my doctor. I called his office for a form. I needed proof that I don’t have tertiary syphilis. For my Thai visa. Why tertiary syphilis, as opposed to HIV, cholera, lepers or bubonic plague? I don’t know. That’s the power of bureaucracies. They don’t have to make sense. ...

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I am a mid-40s female rheumatologist. Fortunately, I consider myself to be fairly healthy; my diet and weight are OK, I run 30 to 35 miles per week, and my only medication is a low-estrogen oral contraceptive that I have been self-prescribing for years. Work and life are busy, and my health maintenance could be better. I have been getting regular mammograms since age 40 (some self-prescribed), maybe I see ...

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Exercising good judgment can mean the difference between life or death. Life can be unforgiving of the choices we make. As we all know, many life events are beyond our control and understanding. But, there is much we can do to shape our paths to a brighter destination. Consider some of the choices listed below that many folks make every day. Are any of them familiar to you?

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 63-year-old woman is evaluated at a follow-up appointment after undergoing right hemicolectomy for colon cancer 1 year earlier. Her paternal grandfather had colon cancer diagnosed at age 75 years. She reports that she has been feeling well and takes no medication. All physical examination findings, including vital signs, are ...

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Recently, Desperate Housewives star Marcia Cross made headlines by discussing her diagnosis of anal cancer and her husband’s diagnosis of throat cancer, revealing that both had been related to the human papillomavirus, or HPV. The move was brave, as the actress broke free from the stigma related to anal cancer and sexually transmitted diseases. More importantly, it was – I hope – inspirational. HPV is something that doesn’t get nearly the publicity ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old woman is evaluated for constipation. She reports passage of hard stool every 3 to 4 days and associated bloating. Her symptoms have been present for more than 10 years and have progressed gradually. Trials of over-the-counter fiber supplementation and polyethylene glycol worsened the bloating, prompting discontinuation. Senna ...

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