It's a Sunday evening in a local South Texas emergency room with the expected ER traffic for a weekend evening. Lots of simple traumas: ankle sprains, abrasions, lacerations, falls, common URI symptoms, and fevers. The EMS radios in with a call of a five-year-old male who has altered mental status. The patient is brought in around five minutes later and placed in an open emergency room. The patient is accompanied by ...

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Vaccines have been hailed by virtually all medical experts, as well as medical historians, as the among the greatest triumphs of public health to occur in the past two centuries. Yet since Jenner first proposed vaccination for smallpox using the vaccinia, or cowpox, virus there have been both skeptics of its effectiveness and people who thought it was dangerous. That is, they had the risk/benefit ratio of vaccination exactly backwards, ...

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Seventy percent of the children and adolescents I see in clinic are obese so I have many opportunities throughout my clinic day to talk about exercise and nutrition. Although the general message is the same, precisely how I deliver the information matters more than I could have imagined. I found this out quite accidentally. It was toward the end of the day, two months after the firestorm in Santa Rosa, California. ...

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The year was 1997, and I was an intern. I remember the morning vividly. Rounds had ended, the nurses had just started their shifts. The hospital was hustling. I felt a buzzing sound and looked down to see a page from my mother, then another and another. The frantic paging made my heart race and I wondered what could possibly be wrong. I ran to the nearest phone and heard ...

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In my early days as a pediatrician, I felt a little bit at a loss when parents asked specific parenting questions. Of course, I could offer them advice and refer resources, but it was as a physician unaware of the nuances of parenting. For example: The tactile temperature A thermometer gives one measurement, not a range. When parents respond, “Yes, at least 102-degrees," I was initially puzzled. The clarification, "I could feel it. ...

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Mental illness might be smarter than us. It seems to have figured out how to get around asking for our permission and instead to beg for forgiveness once damage to function and health already has been done. That’s the only way to explain the following: it takes not five weeks or three months but 11 years for someone who exhibits signs of mental illness to first seek help for that disorder. That is, if they ...

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Speeding through town, I had just dropped off a kid at football practice. I raced back to the church to drop off another kid, then drove quickly to a soccer practice for a third. At about 7:00, I start to lose my cool. I'm used to my husband being late. But tonight I was frustrated. I sat in the parking lot with two babies, strapped in their seatbelts, fidgeting and ...

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I met David on the internet. It was to become on of the closest, most intense relationships of my life.  For you see, a few months before he crossed my path his daughter finished the same protocol for the same type of brain tumor that my daughter just had started.  They had successfully traversed the waters that to me were completely unknown -- and frankly terrifying.  On the pediatric brain tumor listserv, ...

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Whether to circumcise a newborn male child is not the simple, binary “yes/no” question it appears to be. Rather, the choice is affected by an astonishing array of issues: religion, culture, health and hygiene, sexually transmitted infections, expense, pain and medical recommendations. Some cite ethical concerns regarding usurpation of a child’s free choice. Others claim an equivalency between neonatal male circumcision and the practice of female genital mutilation. As a practicing ...

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We had no choice in becoming the “crazy” family that left a hospital against medical advice. Our four-day-old daughter was completely helpless, her condition deteriorating and the staff was ignoring our concerns. I carefully turned off the blue lights, removed her from the isolette, placed her in a car seat and eloped from the pediatrics unit. As a hospitalist, I constantly obsess over medical errors. The majority are more subtle than ...

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