Class Act

Balancing patient information with our professional and relational duties to patients and families without appealing to paternalism.

December 2, 2016
Balancing patient information with our professional and relational duties to patients and families without appealing to paternalism.

A commentary by Antonella Surbone, MD PhD FACP, Ethics Editor on  yesterday’s article “Is There Such a Thing as Too Much Information?”

The insighftul and challenging piece Is there such a thing as too much information? by Mariya Rozenblit addresses a key issue in today’s medicine: how much information do we need to provide to our patients to enable them to make autonomous informed choices about their health, illnesses and treatments. She provides many data and examples from the literature to illustrate the potential damages …

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Mental Pathologies at the Root of Modern Medical Training: Lessons from the Life of Professor William Stewart Halsted

November 3, 2016
Mental Pathologies at the Root of Modern Medical Training: Lessons from the Life of Professor William Stewart Halsted

By Jafar Hamid Al-Mondhiry, MD, MA

Peer Reviewed

A critical care attending once told me that “learning scars” are some of our greatest teachers. And he was right. Many times, a sense of anxiety and rigorous self-criticism has pushed me to improve and develop more than I would have otherwise. This is the natural state of medical trainees: scared to fall behind their well-matched, naturally gifted, and occasionally outright competitive peers; scared to fall short in the eyes of evaluators; scared to stumble in front …

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The Rising Tide of Food Allergy

October 20, 2016
The Rising Tide of Food Allergy

By Kristina Cieslak, MD

Peer Reviewed

Food allergies affect approximately 8% of children and 5% of adults, with a steadily increasing prevalence .  Risk factors for the development of food allergy are numerous and include genetics, sex, and ethnicity . Indeed, children with a parent or sibling with peanut allergy are seven times more likely to develop a peanut allergy of their own, and peanut allergy demonstrates a 64% concordance rate among monozygotic twins as compared to 7% among dizygotic twins . The …

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Wedge

October 7, 2016
Wedge

By Kyra Edson

Peer Reviewed

Wedges are triangular tools that have traditionally been used to split wood along the grain. The mechanical advantage of a wedge is its ability to accomplish this split with less force and less waste of material. Its tapered end is snugly secured inside a small defect, and then a force is applied in order to separate a piece of wood neatly and precisely.

As a medical student at the Manhattan Veterans Affairs hospital, I witnessed this powerful tool wreak havoc …

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Breaking the Cycle: Shining a Light on Physician Depression and Suicide for the Next Generation

September 16, 2016
Breaking the Cycle: Shining a Light on Physician Depression and Suicide for the Next Generation

By Andrew Hallett

Peer Reviewed 

For decades, surveys and public data have shown staggeringly high rates of suicide, suicidal ideation, and depression among physicians when compared to the general population.1-4 Male doctors are 40% more likely to commit suicide than other men, and female doctors are 130% more likely to do so than other women, according to a 2004 analysis in the American Journal of Psychiatry.5 With expanded access to care and new regulatory requirements under the Affordable Care Act increasing pressure on doctors, a …

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Physicians and Medical Innovation

April 15, 2016
Physicians and Medical Innovation

By Vivek Kumar

Peer Reviewed

As healthcare workers, we learn about the most intimate factors governing patients’ lives. We learn about their fears, goals, and motivations on a daily basis. We are on the front lines and see the cracks in the system that prevent optimal health. With all of this privileged knowledge, healthcare workers should be at the forefront of medical innovation. Surprisingly, however, very few physicians engage in entrepreneurship, despite the significant need and variety of roles available .

In the current medical …

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Exercise-Induced Rhabdomyolysis: How Fitness May Actually Be Hurting You

March 17, 2016
Exercise-Induced Rhabdomyolysis: How Fitness May Actually Be Hurting You

By Jessica Morgan

Peer Reviewed

CrossFit and SoulCycle. To many people these words mean nothing. However, ask any twenty-something or college student and they will probably tell you they have participated in a class or two, or have a friend who participates. Depending on whom you approach, you might even get the sense that these are not just exercise classes, but more like a spiritual experience or a tight-knit community of like-minded individuals, all striving for physical excellence. Some have accused these programs of being …

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Don’t Tie Me Down! Do Neckties Spread Infection?

February 24, 2016
Don’t Tie Me Down! Do Neckties Spread Infection?

By Gabriel Campion

Peer Reviewed

For over a century, neckties have been a staple accessory in the wardrobe of the American professional man. Although white-collar dress codes have trended toward a more casual style, the quintessential physician still wears the white coat, a stethoscope draped around the neck, and, if male, a necktie. This is understandable. No one would accuse a profession using an oath that originally swore “by Apollo the Physician and by Aesculapius ” to be one that easily strays from tradition. However, …

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Hirudotherapy: An Ugly Means of Avoiding Uglier Outcomes

January 22, 2016
Hirudotherapy: An Ugly Means of Avoiding Uglier Outcomes

By Jonathan Bekisz

Peer Reviewed

“Do you want to see something gross? Go into the soiled utility room and check out what’s in the jar.” Never one to pass on the opportunity to “see something gross,” I poked my head in and examined the tiny glass jar that sat on the counter. Living up to its billing, within the container sat about a half dozen leeches. Contrary to my assumption that any role these segmented worms had in the field of medicine went away with …

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Lies My Patients Told Me: “I Take My Medications Every Day.”

January 15, 2016
Lies My Patients Told Me: “I Take My Medications Every Day.”

By Rebecca Sussman

Peer Reviewed

Reviewing medical evidence has become such a habit that sometimes it feels almost impossible to think independently. I’ve always been a top-down thinker; I go with my gut instinct, and then look for the evidence to support my assessment.

The problem is that very often it feels like what patients need most is not the precision of a particular etiology or the selection of a medication that is perfectly and precisely tailored to their condition and comorbidities; what they need …

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Is It Time to Reconsider Who Should Get Metformin?

December 11, 2015
Is It Time to Reconsider Who Should Get Metformin?

By Lauren Strazzulla

Current FDA guidelines for the use of metformin stipulate that it not be prescribed to those with an elevated creatinine (at or above 1.5 mg/dL for men and 1.4 mg/dL for women). It is also contraindicated in patients with heart failure requiring pharmacologic treatment, and people over age 80, unless their creatinine demonstrates that renal function is not reduced. These guidelines are in place to prevent lactic acidosis, an understandably feared complication of metformin. However, metformin is, by consensus, the initial drug …

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Are We Overusing Proton Pump Inhibitors?

November 13, 2015
Are We Overusing Proton Pump Inhibitors?

By Shimwoo Lee
Peer Reviewed
Case: A 31-year-old man with poorly controlled type 2 diabetes was hospitalized for community-acquired pneumonia. His home medications included esomeprazole. When asked why he was receiving this medication, the patient said it was first started during his prior hospitalization for “ulcer prevention” eight months ago and that he had continued to take it since. He denied any history of upper gastrointestinal symptoms. Esomeprazole was tapered off during this admission. When being discharged after successful treatment of his pneumonia, he was …

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