Tonight a 17 year-old boy came to the emergency room complaining of headache. As I entered his room, in my usual hurry to do an assessment as expeditiously as possible, so as to get on to the next case and attempt to avoid the inevitable backup of patients so common in our ER, I was struck by the vulnerable demeanor of the patient before me. The triage nurse’s report assured ...

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Pain, in any form, can present a difficult challenge for even the most astute pain physician.  The complexity of treating neuropathic or nerve pain stems from a variety of reasons, ranging from the lack of an obvious source of the pain to the inability of the patients to explain what ails them, to a arduous history that was poorly managed with the wrong medications, allowing the pain to progress to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 27-year-old man is evaluated for concerns noted by his wife of a marked change in overall behavior over the past 6 months, including deterioration in his general hygiene and episodes of talking to imaginary people. His employer has also raised concerns about his work performance. The patient has also noted intermittent tingling in the ...

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The problem with phone medicine is that you have to trust what you hear and act accordingly.  Diagnosing an illness is a multi-dimensional process which incorporates four of the five senses.  Phone medicine limits you to the use of only one, hearing, and relies on your patient’s ability to accurately describe what is happening on their end of the phone. Patient’s mom: “My son is sick.  He’s throwing up and has a ...

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In early 2004, I was at the height of my career as a neurosurgeon in solo practice, but I was also well on my way to clinical depression. I was angry and couldn't relax, and I was always irritated. Even a few days off didn't help because of the mountain of phone calls and paperwork waiting for me upon return to work.  I asked myself, is this burnout? Coincidentally, I happened ...

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With all the media attention to concussion these days, most people are familiar with the term “concussion” and know what it means. If you're not involved in the medical field, and you never watch CNN or ESPN, fine. You might not be in the loop. But it is extremely alarming when we still see the lack of awareness in the medical field. I don't mean to speak ill of other specialties, ...

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In the old days, bullying used to consist of name calling or physical aggression from someone in a position of power over another, typically from a roughly similarly aged peer group. The bullying could be mild such as occasional name calling and having one’s books knocked down when walking in the hallway. This does not mean the effects of the bullying were mild but comparatively speaking, this is generally not ...

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Would you consider a career as a singer if you had involuntary tics from Tourette Syndrome? Well, it apparently didn’t stop 20-year-old Contemporary Christian musician Jamie Grace. In fact, Grace attributes singing with helping her cope with her disease. And now she is being rewarded with a Grammy nomination for best contemporary Christian music song, Hold Me.  The song features TobyMac, who is a Grammy winning Christian recording and hip/hop artist. He ...

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Labels matter. We quickly form judgments based on them. If we hear someone called lazy, the label “lazy person” attaches in our mind even though we may not have even met the person. The same is true for labels given to various medical conditions. If the label for an illness uses language such as “fatigue,” we abstract from our experience and think we know what it’s like to suffer from ...

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Billionaire Teddy Forstmann had been diagnosed with a serious form of brain cancer.  There’s a tragic twist to the story: according to Fox Business News, Forstmann believes that for more than a year, he had been misdiagnosed with meningitis. ABC News wonders, "How could such a misfortune befall a billionaire —- a man able to afford the best doctors, best technology and the most sophisticated diagnostic tests?" They’re missing the point.  ...

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There seems to be a deep, even innate, need on the part of many young men to actually, or vicariously, strike out at other people to cause pain and injury while striving to dominate. In 1996, I wrote an editorial entitled "Blunt Force Violence in America" describing "a modern continuum from street fights to barroom brawls to domestic child, spousal, and elder abuse, to ultimate fighting to extreme fighting, to ...

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Jack and John are identical twins, but have varying interests in life. One day Jack, 43-years old, decides he has had enough of these headaches and calls his family doctor and asks what he should do. He is told that his doctor can see him in 4 days and to take some over the counter ibuprofren. And to definitely go to the ER if the headaches worsen. John, who has also ...

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Mark Twain, the American author and humorist once said, “It ain’t what you don’t know that gets you into trouble.  It’s what you know for sure that just ain’t so.”  In my experience as a geriatrician, I’ve encountered many misunderstandings about this degenerative neurologic disease that devastates both patients and their families.  Countering these can help patients, families, professionals, and all those who have someone in their lives with Alzheimer’s disease. 1. ...

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Recently, the Philadelphia Flyers announced that all star defensive stalwart Chris Pronger has been shut down for the rest of the NHL season with what the team has described as "post-concussive syndrome".  Pronger joins Pittsburgh Penguin superstar Sidney Crosby, teammate and NHL leading scorer Claude Giroux, and Ottawa Senator forward and NHL second leading scorer Milan Michalek out of action due to concussion.  To list every star player currently on the ...

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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 the office for a 10-month history of increasingly frequent headache. The headache is often worse in the morning on awakening. She has recently started keeping a headache diary, which reveals episodes on approximately 25 days of each month. The ...

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