He looked tired and worn down, more so than many of the other patients I had seen that day. He didn’t speak English and I did not speak his language, but I could feel his anxiety as it filled the exam room. One of my employees translated, in fact, what his “boss” was telling us. The boss was worried that he was more tired than usual, and not getting his …
Would you know human trafficking if you saw it?
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 …
No more excuses for mental health: Technology offers new hope for intervening early
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 47-year-old man is evaluated during a follow-up examination. He is obese and has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. He reports that he has always has been overweight, and over the years, his weight has gradually increased to 123 kg (271 lb). During the past 2 years, he has …
MKSAP: 47-year-old man with hypertension, type 2 diabetes mellitus, and obstructive sleep apnea
On a Sunday afternoon, I arrived at the hospital for my psychiatry ER shift. As medical students, we keep an eye on the track board for new patients to see. Two names turned bright red, and I chose to follow Jackie Swanson*. Her initial ER evaluation read “Patient is a 30-year-old female here for SI, HI, and AVH in context of recent sexual assault and cocaine use.” She was brought …
We must advocate for our most vulnerable patients
I recently went to an infectious disease educational session sponsored by the Massachusetts Medical Society and the New England Journal of Medicine called “Epidemics Gone Viral.” The focus was preparedness for the next epidemic, which may come from anywhere. John Brownstein talked about how its arrival will be monitored and reported using Twitter and artificial intelligence.
With the meeting going viral with excitement as Bill Gates got on …
6 steps to stop your smartphone from going viral. Literally.
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 28-year-old man is evaluated for a 2-month history of progressive lower-extremity edema, weight loss, and fatigue. Medical history is significant for recreational use of inhaled cocaine; he denies injection drug use. He has no other known medical issues and takes no medications.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure …
MKSAP: 28-year-old man with lower-extremity edema
The devastating opioid epidemic is one of the largest public health problems facing the U.S. Over 2.5 million people in the U.S. suffer from opioid use disorder.
Four in five new heroin users started out misusing prescription painkillers. A 2015 analysis by the Centers for Disease Control and Prevention found people who are addicted to painkillers are 40 times more likely to be …
6 ways to address the opioid epidemic
My name is Lucy.
I have stage IV liver cancer. I wanted everything done — even though the doctors told me this disease is terminal. My family, my church and my friends were praying for “the cure.”
Though I believed in God and the hereafter, I wasn’t ready to go. 74-years-old with beautiful children, grandchildren, and a great-granddaughter.
I woke up confused. In the background — wherever I was — I could hear …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 35-year-old woman is evaluated for intermittent fever, sweats, fatigue, and dull midchest pain of 2 weeks’ duration. Medical history is significant for liver transplantation 6 months ago for primary biliary cirrhosis; she was seronegative for cytomegalovirus and Epstein-Barr virus, and her donor was positive for both. Results of pretransplant testing for tuberculosis …
MKSAP: 35-year-old woman is evaluated for intermittent fever
The interviewees in my book talked about declining quality of health care. Do people even know or remember what it is like to get quality health care? Doctor visits are often too short to be adequately through. Psychotherapy is too often too brief, with a focus on “quick fix.” Psychotherapy isn’t just about talking. It involves careful, thorough study and application of knowledge to the issues that patients bring with them. …
Answering your questions about the mental health benefits of psychotherapy
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 …
An emergency physician makes the case for circumcision
A baby acutely ill with leukemia seems like the polar opposite of a woman with Alzheimer’s disease (AD), with her slow, insidious deterioration. Yet each disease can be progressive and fatal. I’ve cared for both, in different ways. Can a childhood cancer doctor like me have insights about that other end of medicine, older adults with dementia?
As a husband and caregiver, confronting my wife’s Alzheimer’s disease, I am appalled by the …
A pediatric oncologist looks for progress in Alzheimer’s disease
In Toronto on April 23, 2018, Alek Minassian intentionally drove a rented van into pedestrians, killing ten and injuring at least 15. Later the same day, Constable Ken Lam of the Toronto Police Service arrested Minassian after a brief, tense standoff. As seen in a widely circulated video, Minassian dared the officer to shoot, and feigned drawing a gun, most likely to commit “suicide by cop.”
Constable Lam, however, …
Firm words and a cool head: managing assaultive behavior
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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old man is evaluated in follow-up after a diagnosis of ulcerative colitis. Ten days ago he was started on prednisone, 60 mg/d, but his symptoms have not improved. He has six to nine bloody bowel movements per day and moderate abdominal pain. He has decreased his oral intake because eating exacerbates his …
MKSAP: 38-year-old man with ulcerative colitis
Any debate as to whether chronic traumatic encephalopathy (CTE) is a legitimate neurological malady that affects football players is slowly being put to bed. Repetitive hits to the head resulting in sub-concussive trauma and that concussions are the culprit here. Clinical findings associated with CTE include memory loss, depression, anxiety, violent behavior, mood disorders and heightened suicidality, among other impairments. It tends to progress with time and can lead to …
Preventing CTE is a no brainer
A recent article and accompanying commentary in the journal Pediatrics describe what we currently know about children who have died from influenza over the past decade or more. The Centers for Disease Control (CDC) has collected information about this since the 2003-2004 influenza season. In that first report, there were 153 deaths. Since then there have been at least 100 influenza deaths annually among children. Several characteristics have not changed. …
Influenza in children: reducing the death rate
Medicine is an honorable profession. We meet people at a vulnerable point in their lives — when it comes to cancer, it is often at their most vulnerable. In oncology, care is typically multidisciplinary, and one of the most important advances in my own professional career has been this team approach. To see a patient with …
Patients can live with metastatic cancer
“I can’t stand the site of blood!”
We’ve all heard that adage. Blood can provoke emotional reactions from even steely muscle-bound bodybuilders. We gastroenterologists routinely receive fearful phone calls from patients who have observed even minor rectal bleeding. Fortunately, in most of these cases, there is a benign explanation for the sanguinary seepage.
If blood repels you, then gastroenterology should not be on your short, or even long list of professions under …
A surprising cause of rectal bleeding
Many medical organizations have recently been promoting focused and individualized lab testing for routine screening or when pursuing a diagnosis. Research has shown that the “shotgun” approach to lab testing usually leads to further invasive testing which has not been proven to significantly alter morbidity or mortality.
Additionally, tests rely on pre-test probabilities and can have false-positive or negative results and …
A physician makes the case for some routine labs
When it comes to the opioid epidemic, physicians are some of the best drug dealers around with almost unrestricted access to the purest substances. As the opioid epidemic spirals out of control, physicians continue to be able to provide their patients with a variety of options, including oxycodone, morphine and fentanyl. Many people would be surprised to know that physicians don’t need any additional training to prescribe opiates to their …
Primary care physicians are on the front line of the opioid epidemic. Help them.
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