Do patients with celiac disease need probiotics?

Conditions
January 28, 2017

One of the most common questions that I receive from patients diagnosed with celiac disease is if they should take a probiotic. The only available treatment for celiac disease, an autoimmune disease characterized by destruction of the absorptive surface of the small intestine which develops in genetically compatible individuals, is a gluten free diet. However, patients and providers often question whether supplementation with probiotics may hasten the healing process.

Probiotics are …

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Why this physician can’t be her family’s doctor

Physician
January 27, 2017

The day I got into medical school, my uncle said to me, “You are going to be a doctor!  We finally have a doctor in the family.  You are going to take care of your uncle in his old age.”  Other family members echoed the same sentiment.  First doctor in the family.  Now, we will all have free medical advice.

As I progressed through medical school, then internship and residency, then …

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Misophonia and suicide: Sound thinking is required

Conditions
January 26, 2017

If you Google “misophonia” you might be shocked to find numerous articles discussing the tragic suicide of 52-year-old Russian-born scholar, Dr. Michelle Lamarche Marrese. Journalist Joyce Cohen was the first to report Marrese’s suicide in the New York Post piece “She could hear everything and it cost her her life.” Cohen explains that she and Marrese had been corresponding about Marrese’s struggles with misophonia for over 14 months, and that …

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There is something rotten inside the medical profession

Physician
January 26, 2017

In the year it has taken for me to finish my medical residency as a junior doctor, two of my colleagues have killed themselves. I’ve read articles that refer to suicide amongst doctors as the profession’s “grubby little secret,” but I’d rather call it exactly how it is: the profession’s shameful and disgusting open secret.

Medical training has long had its culture rooted in ideals of suffering. Not so much for …

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Being a woman doctor in a man’s world

Physician
January 25, 2017

Last week I was in a session with one of my coaching clients, a successful black female physician who is the owner of her own practice. As we were concluding she made a statement to me “I feel like medicine has just sucked the feminine right out of me.”  Immediately I related.

As women in the professional world, we are always in competition with men whether we are aware of it, …

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Patient death by data: A poem

Physician
January 23, 2017

“Afternoon,” the doctor says. “What brings you here today?”
A cough? A cold? A belly ache? Some feelings of dismay?
Well, tell me just what ails you, and I’ll try to do my best,
To sort through all your problems and put your fears to rest.

But give me just a moment — my computer must get started.
Without attention to its needs, your visit goes uncharted.
You say your chest is hurting? And you’re really …

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There’s absolutely no way to stop a cough. Here’s why.

Conditions
January 23, 2017

Coughing is one of the most common reasons parents bring their children to see me. And I can understand why. Coughing is noisy and uncomfortable and gets kids dirty looks in schools and subways. Even worse, coughing keeps kids and their parents awake. We’ve all been there, and no one likes to cough.

But coughing is there, usually, for a reason. Almost all coughs are from upper respiratory infections (that’s fancy …

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It’s time to ask patients about spirituality

Physician
January 22, 2017

From the first year of medical school, we are trained in probing into the most personal aspects of patients’ lives; but when it comes to spirituality, we shy away. In a survey of the U.S. general public, the 2008 Gallup Report demonstrated that 78 percent of people believed in God and an additional 15 percent believed in a higher power. Other studies have shown that religious beliefs and …

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What National Women Physicians Day means to me

Physician
January 22, 2017

“What do you want to be when you grow up?”

It’s a common question we ask our youth, and I remember as young child sharing my aspirations with family members. When I answered “I want to be a doctor when I grow up”, I received positive feedback and praise. As an innocent little girl, I had no idea that there were people in the world who wouldn’t be as supportive of a woman in medicine.

Later …

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MKSAP: 24-year-old woman with sickle cell anemia

Conditions
January 21, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 24-year-old woman undergoes routine evaluation. She is pregnant at 12 weeks’ gestation. Medical history is notable for homozygous sickle cell anemia (Hb SS). She has had multiple uncomplicated painful crises treated at home with hydration, nonopioid analgesia, and incentive spirometry. She requires hospital management for these episodes approximately twice per year. She has declined …

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I demand you consider us humans: A medical student poem

Education
January 20, 2017

Slave, I am not
Servant, I may be

Arrogant, I am not
Ignorant, I may be

Un-engaged, I am not
However, Quiet, I may be.

Your coat is long, mine short
Your knowledge mile deep, mine mile wide
You have seen 100 patients this week, I have seen 10
You trained for 10 years, this is my first

If I look scared, it’s because I am
If I seem intimidated, I indeed am
If I appear confused, I in fact am
If I …

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What this physician learned from being a doughnut waitress

Physician
January 20, 2017

In high school and college, I waitressed in a Dunkin’ Donuts shop that sat between Boston Common and the Combat Zone’s porn shops, strip clubs, and bars. The wages paid for school, clothes, rent, and food. At the time, I didn’t realize this job would provide useful skills for my later medical career, an early pre-med training of sorts.

Look the part. I donned the bubblegum pink polyester uniform that clearly identified …

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A medical resident’s guide to personal finance

Physician
January 19, 2017

Let’s start with the most important part first. Your primary goal while in residency/fellowship is to become a great doctor. The kicker is that you also have to devote some time to your finances and not completely neglect them. We will outline the few financial items you should worry about while in residency.

Student loans

If you don’t have student loans, go ahead and skip to the next item; however, the unfortunate …

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Why America fails at psychiatric care

Physician
January 19, 2017

An article released in the JAMA sites evidence that the suicide rate in America has risen by 24 percent in the last 15 years associated with a significant reduction in the numbers of psychiatric beds available. The U.S. has had a lower capacity for psychiatric patients than comparable countries in Europe for years, but between 1998 and 2013 that number dropped even further.

Waiting in the ER for days

This …

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The debate over how many hours an intern can work misses the point

Education
January 17, 2017

I still don’t know how I did it.  I don’t know how I got through life as a lower-level neurosurgery resident.  I vividly remember the horrific call nights and weekends.  There are certain sensations you get when you have gone weeks without more than two or three hours of sleep at a time.  It wasn’t the foggy thoughts that bothered me most, or continually feeling cold, or even when I …

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My primary care doctor sent me to the emergency department

Physician
January 16, 2017

My wife who is eight months pregnant went to a routine prenatal appointment last week. She told the OB doctor that she was concerned she had pink eye. OB providers, along with pediatrics, family medicine, and internal medicine all constitute primary care providers (PCP) and pink eye is a common primary care condition.

Surprisingly, the OB physician referred her to the nearest acute care facility. Attributing this provider’s recommendation as rare …

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Obesity and empathy: A physician’s New Year’s resolution

Physician
January 16, 2017

Empathy is the cornerstone of quality patient care. It is no surprise that the fundamental moral code that has facilitated human kindness for thousands of years is what drives physicians to commit to their oath today: Treat others as you would have yourself treated.

When it comes to the disease that is obesity, I can empathize. I’ve struggled with obesity for as long a time as I can remember. There are …

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An order of ceviche, please. With a hospital visit on the side.

Physician
January 16, 2017

It’s October, and I’m a second-year medical student. My best friend Carly and I have just finished a backpacking trip through South America. We fly out tomorrow from Lima, Peru, and we have just one thing left to do: eat shrimp ceviche, the classic South American dish of raw seafood marinated in lime or lemon juice, oil and spices.

We wander along the busy streets until we find the restaurant our …

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A day in the life of a radiologist

Physician
January 16, 2017

“Life is just a short walk from the cradle to the grave, and it sure behooves us to be kind to one another along the way.”
– Alice Childress, American playwright, actor, author (1912-1994)

I am awakened in the wee hours by the sound of rain.  Ordinarily I would return to bed in hope of stealing more sleep from night, but this particular day I know I have to rise at 4:30 …

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A medical school goes pass-fail: Why this change must happen everywhere

Education
January 14, 2017

Well, I’m officially that old, bitter resident. I had to walk uphill to medical school 10 miles there and back. “In my day,” medical school was fail, pass, high pass, or honors. I recently found out that the medical school I graduated from has changed the first two years of basic science courses to simply pass/fail (while retaining the honors/high pass grades in clinical rotations). I am so annoyed!  Why …

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