Coming in to meet the students, house staff, and patients for the first day on service always excites me. This Monday was no exception. What awaited me? How many patients would I need to see? What lessons could I impart? When I arrived, we had 11 patients, two new, and nine had arrived previously. Going through the list, while routine, always stimulated questions and teaching opportunities. Sometimes the team had questions ...

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I’ve delved into the issue of medical judgment more than once.  I have argued that sound judgment is more important than medical knowledge.  If one has a knowledge deficit, assuming he is aware of this, it is easily remedied.  A judgment deficiency, per contra, is more difficult to fix. For example, if a physician cannot recall if generalized itchiness can be a sign of serious liver disease, he can look this ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated for persistent constipation symptoms of 2 years' duration. She has reflex sympathetic dystrophy syndrome involving the right arm and neck that began 3 years earlier and requires chronic opioid analgesic therapy. She reports passing two hard bowel movements per week. Trials of several fiber ...

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There is a condition known as cyclic vomiting syndrome which causes people to develop episodes or “attacks” of frequent vomiting lasting for a few days at a time without an apparent cause. Sufferers of cyclic vomiting are totally fine between episodes … it’s kind of like a migraine of the upper gastrointestinal tract! Just like treating migraine headaches, treatment of cyclic vomiting syndrome is aimed at identifying and removing triggers, and using ...

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“Does my insurance cover this?” I cannot calculate how often a patient poses this inquiry to me assuming wrongly that I have expertise in the insurance and reimbursement aspects of medicine. If I -- a gastroenterologist -- do not even know how much a colonoscopy costs, it is unlikely that I can speak with authority to a patient’s general insurance coverage issues. Of course, patients assume that we physicians have an expansive ...

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An excerpt from Private Equity in Gastroenterology: Navigating the Next Wave. A long time ago, gastroenterologists ran solo or small group practices. Despite the myriad challenges of running a medical business, doctors enjoyed the independence that private practices offered. But over the years, everything got too complicated. From insurance reimbursements to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 28-year-old woman is evaluated for decreased exercise tolerance and ice cravings for the past several weeks. Medical history is notable for Crohn colitis diagnosed 6 years ago. Her symptoms flared 3 months ago with increased abdominal pain and diarrhea, and she began therapy with azathioprine and infliximab. Her ...

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Although I'm still relatively early in my journey through medicine, it is still notable when a more mundane task becomes a moment I cannot forget. After seeing dozens of colonoscopies for a couple of weeks, I remember one particular patient, who after completing his procedure very joyfully told me while eating crackers and drinking juice that this was the moment he had been looking forward to the most. Over the past ...

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We’ve had several articles from various sources over the years on grooming your social media. Most of them advise paying attention to your physician ratings, but not acting on anything specifically. “Don’t engage” is the mantra. Let’s take a fresh look at this. Like probably everyone in medicine, I have my share of physician rating site reviews. Most are good, some are bad, but all of them I pay attention to. ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 39-year-old woman is evaluated for fatigue, intermittent rectal bleeding, and abdominal pain over the past 2 months. She reports that the bleeding is not accompanied by anal pain or itching. She has experienced an unintentional 2.3-kg (5.1-lb) weight loss since her symptoms started. She has no personal or ...

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One thing that gastroenterologists know about is stool. But, I’m not referring to that kind of stool in this post. Follow along. When we do a colonoscopy, for example, we are relying upon stool, or more accurately a stool, as in a three-legged stool. This metaphor illustrates that the three legs must be equally strong or the stool will not stand. The three pillars of support that a colonoscopist needs include:

We do most of our colonoscopies in our ambulatory surgery center (ASC), which is attached to our office. We are proud of the work that we and our staff do every day and are grateful for the outstanding feedback that we consistently receive from our patients. Some insurance companies will not cover procedures in our ASC so these patients must get "scoped" at the hospital instead. For many of them, this ...

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The New York Times is interested in fecal transplants. This is the euphemistic term for taking feces, poop, crap, sh*t, bowel contents from one person and putting it into another person. There are various procedures for doing this, from drying it and putting it into capsules to making it liquid and introducing it by enema, nasogastric tube or colonoscopy. It is a remarkably effective treatment for a wide range of ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old man is evaluated for constant low-grade epigastric pain radiating to his back that worsens after he eats fatty foods. He has a 2-year history of chronic pancreatitis. The pain has progressively worsened over the preceding 6 months. His weight is stable. He has a normal bowel movement ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old woman is evaluated for recently worsening joint symptoms. She has a 13-year history of Crohn disease characterized by four to six stools daily and mild crampy abdominal pain. She also has a 1-year history of arthritis. She currently has pain in the left knee, right ankle, and ...

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If you throw a pebble today, it's likely to land on an article that talks about how artificial intelligence and its brother — machine learning — are changing health care. Yes, I get it broadly. But I was curious to explore how exactly health care's trends are shaping a single medical specialty. I chose gastroenterology (GI) because I'm most familiar with the space. And here's what I found. Trend #1: Manipulating bacteria ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 75-year-old man is evaluated for progressive dysphagia of 8 months' duration for both solid food and water, and the necessity to induce vomiting several times each month to relieve his symptoms. He also has experienced chest pain and heartburn symptoms. He has lost approximately 6 kg (13 lb) ...

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Here’s what most medical experts agree on: People 50 and older should be screened for colon cancer. Here’s what is more controversial: Whether that screening should start, routinely, at age 45. Recently, the American Cancer Society (ACS) recommended that colon cancer screenings start at age 45. Their recommendation was based in large part on an uptick in the number of people 45 to 50 years old who are being diagnosed with colon cancer ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated 1 month after completing a 14-day course of Helicobacter pylori eradication therapy consisting of amoxicillin, clarithromycin, and omeprazole. Initial upper endoscopy before treatment showed patchy gastric erythema with no ulcers or erosions, and biopsies revealed H. pylori gastritis. Currently, she reports alleviated symptoms. She is otherwise healthy and ...

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In broken English, against the backdrop of the emergency department's chaos and clatter, Mr. Simon relayed his story: unintentional weight loss, gradually yellowing skin, weeks of constipation. He punctuated his list of devastating symptoms with laughter — exaggerated but genuine guffaws. Over the next few days, as the medical student responsible for his care, I was also responsible for handing him piece after piece of bad news — an obstructing gallstone ...

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