Frederick Gandolfo is a gastroenterologist and founder, Precision Digestive Care. He blogs at Retroflexions.

White coats should no longer be worn by physicians

Physician
August 6, 2019

Did you know that the traditional doctor’s white coat that you probably associate with your physician actually was a look that doctors “borrowed” from another profession? Back in the early days of doctoring, to add some perceived legitimacy to the title physician, the white coat look was adopted from our colleagues in the hard sciences who did actual experiments in the lab. If you recall, what we doctors call a “white …

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White coats should no longer be worn by physicians

Before starting your own practice, do these 3 things first

Physician
July 10, 2019

If you’re a young doctor reading this, chances are you are employed by someone else. Your paycheck may come from a hospital system or a group of other doctors, but you’re not your own boss. This may be working out just fine for you: I hope you are happy and have a well-balanced work and personal life, and are getting a fair paycheck. I hope you have a sense of …

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Before starting your own practice, do these 3 things first

Don’t forget this common trigger of cyclic vomiting syndrome

Conditions
May 21, 2019

There is a condition known as cyclic vomiting syndrome which causes people to develop episodes or “attacks” of frequent vomiting lasting for a few days at a time without an apparent cause. Sufferers of cyclic vomiting are totally fine between episodes … it’s kind of like a migraine of the upper gastrointestinal tract! Just like treating migraine headaches, treatment of cyclic vomiting syndrome is aimed at identifying and removing triggers, and using …

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Don’t forget this common trigger of cyclic vomiting syndrome

Be the honest doctor instead of the confident one

Physician
October 30, 2018

This is an article about certainty, or maybe lack of certainty?

It is about the need for confidence, without having overconfidence.

Doctor! Don’t be arrogant — listen to your patient — they are telling you the answer.

So believe them, but be a skeptic!

Better yet, figure out the diagnosis, but then don’t believe yourself.

Try to prove yourself wrong at every turn.

The definition of the word hubris is important to understand. One definition of hubris is “exaggerated pride or …

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Be the honest doctor instead of the confident one

Colon cancer screening at age 45: Here’s what a gastroenterologist thinks

Conditions
June 11, 2018

The American Cancer Society (ACS) recently released new guidelines regarding colorectal cancer screening for the average-risk individual. The big news is that they now recommend that screening for colorectal cancer begin at age 45 rather than age 50. This reduction in the starting age was in reaction to recent data showing that colon cancer is increasing in younger Americans for unclear reasons. By screening people at a younger age, the hope is …

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Colon cancer screening at age 45: Here’s what a gastroenterologist thinks

What you should know about colon polyps

Conditions
March 22, 2018

When it comes to colon cancer prevention, the polyp is the key player to know. Colon polyps, called adenomas, are precancerous growths originating from the inner lining of the colon wall. There are other types of polyps in the colon which are not considered precancerous, but for our purposes in this article, we will consider the terms colon polyp and adenoma to be …

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What you should know about colon polyps

Seeds, popcorn, and nuts in diverticulitis: fact and fiction

Conditions
November 2, 2017

Diverticulitis is a common and sometimes serious problem that affects several hundred thousand people each year. Diverticulitis is the condition where small outpouchings or “pockets” in the wall of the large intestine called diverticula become inflamed and infected, and typically presents as a constant lower abdominal pain, associated with fever or chills, and often bloating or constipation symptoms. Despite becoming even more common in recent years, not much is understood …

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Seeds, popcorn, and nuts in diverticulitis: fact and fiction

People who aren’t “pill people”: What do they mean?

Meds
November 17, 2016

“I’m not really a pill person.”

“I was never one for all those pills.”

“I don’t really like taking those pills.”

“I’m not really into taking pills.”

As a doctor, I hear some version of this phrase every day. It’s almost accusatory, like “Hey, Doc — don’t even think about pushing all those pills on me!”

Luckily, since I am a gastroenterologist, I don’t dispense nearly as many medications as doctors in some other fields …

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People who aren’t “pill people”: What do they mean?

How marriage affects men’s colonoscopy rates

Conditions
May 31, 2016

Did you know that married men have a lower colorectal cancer mortality when compared to unmarried men? What about the fact that married men have higher rates of colorectal cancer screening? Interesting, right? In fact, studies showing the association between marriage and favorable behavior regarding colon cancer screening have been published as early as 2010.

More recently, a study published in the journal Preventive Medicine found that married men are …

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How marriage affects men’s colonoscopy rates

The white coat doesn’t mean much anymore

Education
May 6, 2016

I’ll just start this off by saying that I am not exactly sure where I stand on the white coat thing. One part of me loves the white coat as a symbol, a shield against disease, and a place with pockets to put my things; and then there are other days when I just want to throw that germ-ridden cotton barrier to the doctor-patient relationship in the trash, roll up my sleeves, …

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The white coat doesn’t mean much anymore

What you don’t know about anal sex. A gastroenterologist explains.

Conditions
March 10, 2016

Although it is still early, 2016 is already shaping up to be a year to remember in science: Long-postulated gravitational waves were finally discovered, the CDC scrambles to battle Zika virus on multiple continents, and long-awaited clinical testing begins for a new HIV vaccine.

But these accomplishments all pale in comparison to the monumental study published in the American Journal of Gastroenterology titled “Read more…

What you don’t know about anal sex. A gastroenterologist explains.

Should you have a precolonoscopy visit? The answers may surprise you.

Conditions
February 23, 2016

Your primary care doctor has been nagging you for years. Your wife and brother seem to be in on the scheme too. Every once and a while one of your coworkers even says (with a chuckle) “C’mon Bob, you’re fifty-seven, you really need to get it done!”

“OK, enough,” you finally say, “I’ll go for a colonoscopy!” So at your next visit you ask your primary doctor how to set it …

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Should you have a precolonoscopy visit? The answers may surprise you.

Noise pollution is an epic problem in hospitals

Physician
February 5, 2016

Me: Hello Mrs. Smith, my name is [BEEP!] Dr. Gandolfo and I am a [BEEP!] gastroenterologist. [BEEP!] Your doctor wanted me to [BEEP!] talk to you about something that showed up on [BEEP!] your CT scan.

Mrs. Smith: Who are you? I [BEEP!] didn’t hear your name?

Me (louder): It’s Fred Gandolfo, I am the [BEEP!] stomach doctor. [BEEP!] I need to talk to you about [BEEP!] that CT scan you had.  You see, there was … [BEEP!] [BEEP!] [BEEP!] Can you straighten your …

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Noise pollution is an epic problem in hospitals

Gastroenterologists are the tattoo artists of medicine

Conditions
January 25, 2016

Everywhere you go, you can see people from all walks of life sporting some pretty cool tattoos. Tattoos are so popular nowadays that they’re almost conformist. I consider myself really hip since I don’t have any tattoos; how avant-garde! However, that doesn’t mean I don’t appreciate good ink when I see it. As a matter of fact, I even dabble as a tattooist sometimes.

It is common practice to leave a permanent tattoo at …

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Gastroenterologists are the tattoo artists of medicine

A young woman with anemia. A colonoscopy reveals a surprise.

Conditions
October 11, 2015

Overtesting and over treatment are big problems in modern medicine.  It sometimes goes like this: Have a minor complaint? It’s probably nothing, but we should do an exhaustive workup because there is a 0.00001 percent chance it could be cancer, maybe.

However, if you happen to be that one patient in 10 million that had cancer, and we actually found it early by aggressive testing, then you would be glad you went for …

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A young woman with anemia. A colonoscopy reveals a surprise.

Is that bad? A difficult question doctors can answer in many ways.

Physician
September 29, 2015

Here is a question I get asked all the time by patients: “Is that bad?”

This is different than the similar, more appropriate question, “Is it bad?” which is usually asked after being given a specific diagnosis.  For example, after a colonoscopy where a large polyp was discovered and removed I will tell the patient about the findings.  He may ask, “Is it bad?” The answer is usually “No, the polyp …

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Is that bad? A difficult question doctors can answer in many ways.

Doctors should beware the attribution sign. Here’s why.

Physician
September 19, 2015

When getting a medical history, patient attribution can be very helpful.  We are even taught in medical school to specifically ask patients what they attribute their symptoms to.  For example:

Doctor: “What do you think is causing this pain in the right upper part of your abdomen?”

Patient: “It happens every time I eat a big meal, especially a fatty meal.  I think it has to do with that.”

Doctor: “This pain might …

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Doctors should beware the attribution sign. Here’s why.

How to perform a stool transplant

Conditions
August 25, 2015

Fecal microbiota transplantation (FMT) is the process of administering a preparation of healthy donor stool to a patient with a certain disease, usually Clostridium difficile colitis, in an attempt to treat the disease.  I covered some of the basics about the microbiome and FMT in a previous article, so this will just be a cookbook-style post on how we do FMT with colonoscopy.

First, a healthy donor must be identified.  The donor …

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How to perform a stool transplant

Doctors now diagnose in code. ICD code, that is.

Physician
August 16, 2015

“Hi, it’s Dr. Smith, are you taking consults today?” the voice on the other side of my short-range hospital phone said.  I recognized the caller’s name as one of the new hospital doctors, known as hospitalists.

“Of course,” I said, “What have you got?” I guess some groups have a specific doctor for the day “take” the consults.  If I am in the hospital, I am always taking consults.

“Great,” the hospitalist …

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Doctors now diagnose in code. ICD code, that is.

Do proton pump inhibitors cause heart attacks?

Meds
July 18, 2015

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There has been concern for several years about commonly prescribed antacid drugs called proton pump inhibitors (PPIs) and the heart.  PPIs are used to treat gastroesophageal reflux disease (GERD), peptic ulcer disease, and other acid-related diseases.  Common drugs in the PPI class are omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid), and dexlansoprazole (Dexilant), among others.

Specifically, there is a potential interaction …

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Do proton pump inhibitors cause heart attacks?