Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 36-year-old woman is evaluated in the office for a history of migraine, with and without aura, since age 16 years. She has an average of three attacks each month and consistently experiences an attack 2 days prior to menstruation; this headache is more difficult ...

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Where is the physician outrage? Right. Here. I’m speaking, of course, about the required-transvaginal-ultrasound thing that seems to be the flavor-of-the-month in politics. I do not care what your personal politics are. I think we can all agree that my right to swing my fist ends where your face begins. I do not feel that it is reactionary or even inaccurate to describe an unwanted, non-indicated transvaginal ultrasound as "rape." If I insert any ...

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As an OB/GYN resident, I tried to reconcile quality and cost of care every day. This is the story of one patient who cost the system a lot of money, but I don’t know to this day if it was too much. Cheryl (name changed) had HIV, a history of cervical cancer, and 3 kids. At age 35, she had been cured from cervical cancer after surgery and radiation therapy. However, ...

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I cradled my son's miniature body in my hands. Only moments old, he looked up with large glassy eyes. He was so alert, so perfect. I carried him over to the bedside. The obstetrician worked on the afterbirth as my wife waited patiently to hold her child. At the time, it hadn't sunken in yet how much our solitary lives were changing. The nurses swept the baby away for routine testing ...

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Your doctor’s exam room is getting overcrowded. Modern US health care means that, like it or not, you and your physician are sharing that once private space with an insurance executive constantly hissing in your doctor’s ears to move it along. You are also sharing it with pharmaceutical marketers,  lobbyists from the food industry ... special interest groups of every stripe. Now move over and make room for one more interested ...

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She knew she was supposed to be careful about getting pregnant, although truthfully she didn’t think it could happen because of her blood pressure and kidney problems. The nurses at the county clinic started her on the pill, but her blood pressure went all crazy. They asked her to come back on a Wednesday night when the doctor was there. The doctor asked lots of questions and spent a lot ...

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As a veteran of World War II, my grandfather was a GI Bill success story, the first man to go to college from his impoverished neighborhood in Jersey City thanks to government at its finest.   A card-carrying member of the state teachers’ union, and a politically active Democrat for most of his life, it came as something of a shock to me when, after a few decades of observing big ...

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My patient was veiled in layers of heavy black cloth from head to toe. I could see blood staining her white socks as I waited impatiently for a female Arabic translator. Slowly, I told the patient and her sister that I was worried about her pregnancy, and would need to do a pelvic exam. As feared, I soon saw that she had a miscarriage. “Can I see the baby?” she ...

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Recently, the world’s largest research-based drug company, Pfizer, announced that an automated packaging error led to a recall of the birth control medication, Lo/Ovral-28 and the generic counterpart, Norgestrel/Ethinyl Estradiol. The packaging issue had to do with the placebo pill being placed in the wrong order in the 28-day cycle and an inexact number of placebo (should be 7) or active forms (should be 21) of the medication. The placebo pill ...

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As my husband and I try and make a long term financial plan for paying off my almost $200,000 in loans from medical school, I sit here wondering, why did I pay 200 grand so that I can get peed on, pooped on, bled on, screamed at and sworn at? I’ve delivered a baby without gloves on (it was an emergency).  I’ve been kicked so hard I almost fell off ...

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