We’ve all been through difficult times. It may be the death of someone we love or suffering abuse with no one to help. In life, many events fly at us that are hard to manage. Many of us just suffer silently through the pain, not allowing anyone in. And even while we do that, we also know that is not the healthiest response.
Many patients come to me struggling with anxiety …
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A 77-year-old woman is evaluated for frequently fluctuating INRs (<1.8 to >3.5) while taking warfarin therapy. She has undergone INR testing every 1 to 2 weeks and frequent warfarin dose adjustments. She reports a consistent dietary intake. Medical history is notable only for recurrent deep venous thrombosis. She takes no other medications.
On physical …
There are at least 50 words in the Eskimo languages for snow, 25 in mainstream Swedish, and supposedly 180 or so in the Sami language of the nomadic inhabitants of the northernmost parts of Norway, Sweden, and Finland.
But there are even more words than that for “chest pain” among my patients, many of whom do not consistently or fully comprehend the English phrase, “If you have chest pain, call 911 …
Long ago primitive sharks had ridges running down their sides from gill to tail. Later, muscles grew into the folds, and eventually, the central portion of each ridge receded while the ends enlarged to form fins both fore and aft. All was well.
Then one day several hundred million years ago, a fish was swimming blissfully in a shallow pool. The tide went out …
Urgent care centers are way ahead in prescribing unnecessary, potentially harmful antibiotics that are doing no one any good – at least no patients any good. The owners of the urgent care centers are the ones who are benefitting. And you and your family are being bilked, misled, and harmed.
A recent study published in JAMA Internal Medicine looked at the proportion of antibiotic prescriptions that were made for viral respiratory …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old woman is evaluated for a new-patient visit. Medical history is significant for an eating disorder. Although she has maintained a normal weight for the past 20 years, she notes that prior to that time her weight would fluctuate in a range correlating with BMIs of 17 to 19. She has otherwise …
All of our 200+ bones have names, which facilitates describing them when we cannot actually hold them or point directly at them. It might be easier to remember the names if they were familiar ones like Robert, Sally, and Kevin, but no such luck. Latin was the original language of science, so the bones received Latin names. Some of those were derived …
The keto diet has recently garnered much fame for its apparent ability to improve diabetes and obesity – results so impressive the Journal of the American Medical Association recently highlighted the diet and thereby christened it as something more than a low-carb craze. However, not all the evidence supports such a positive outlook, leading the diet to straddle the increasingly blurred lines between faddist snake …
Recently, a journalist with NPR asked her audience if sleeping with your baby is as dangerous as doctors say. In short, yes, it is very dangerous.
In the article, Michaeleen Doucleff repeatedly trivializes the danger of parents co-sleeping with their baby. She uses anthropological evidence to reassure parents that sleeping with their infant is safe if parents don’t drink, smoke, or use illicit drugs. She makes light …
People with liver failure and cirrhosis die every year because there are not enough livers available. Who should receive the treasured life-saving organ? There is an organ allocation system in place, which has evolved over time, which ranks patients who need liver transplants. Without such a system, there would be confusion and chaos. How can we fairly determine who should receive the next available liver? What criteria should move a …
Where I practice, the process of referring a patient suffering a mental illness is quite infuriating. The wait to get in to see a psychiatrist or psychologist can be months all the while patients are suffering. Worse yet, with certain insurances, there are just no mental health providers available for any of their covered patients. The failure of treating mental health disease in the U.S. is glaring.
In the U.S., approximately …
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old man is evaluated for symptoms of dysphagia that began 2 weeks ago. When he eats, he starts coughing after the first bite of food and occasionally has nasal regurgitation.
On physical examination, blood pressure is 135/90 mm Hg, pulse rate is 78/min, and respiration rate is 12/min. Left-sided weakness is noted in both extremities, …
While infertility may be a problem affecting nearly 7.3 million women in the United States between the ages of 15-44, it is a topic that women often don’t discuss. Rather, they suffer from the emotional pain that accompanies hormone injections, multiple procedures, and sometimes miscarriage. How is it best to treat this vulnerable population that rarely gets the attention it deserves? The answer lies in a team approach to medicine.
According …
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What is borderline personality disorder (BPD)? According to the National Institute of Mental Health, unstable moods; impulsive and reckless behavior, and unstable or volatile relationships may be indicative of BPD. People with BPD often have high rates of co-occurring disorders, such as depression, anxiety disorders, substance abuse, and eating disorders, along with self-harm, suicidal behaviors, and completed suicides. They often make poor life choices and take unwise risks. Thus, adults with …
Having worked at both community hospitals and major medical centers, the issue of ultrasound in pregnancy has revealed itself to be more complex over the years. As a resident, I worked with an obstetrics office that only scanned their own patients who had private insurance and would send uninsured or Medicaid patients (often with a high risk of inadequate prenatal care) to the hospital late in the day to be …
Cyberbullying is a major and growing public health problem associated with increased risk of greater psychiatric morbidity and mortality among children and adolescents. Its prevalence, varieties, associations with other forms of maltreatment, risk factors and deleterious effects in different populations are poorly understood.
Furthermore, effective, evidence-based approaches to screening and prevention in different populations are lacking. Developing such approaches is challenged by the rapidity and unpredictability with which electronic social media …
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Leaving the nursing profession is bittersweet. My heart left nursing a while ago when I came to the realization that nursing left me first. It never was a two-way relationship. The profession left me without acknowledgment of work-related stress, specifically post-traumatic stress (PTS).
First responders and emergency workers often hear the phrase, “It’s just part of the job.” So we all just deal with it — or not. I’ve heard this …
I’ve been practicing as an interventional pain management physician for over six years. It was a long road to get here — four years of medical school, four years of residency in anesthesiology and one year of fellowship (in addition to the four years of undergraduate education). So people say, “You must really love what you do.” Sure, during residency there was light at the end of the grueling tunnel …
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 …
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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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