How To Remember Things, Redux


Photo: quapan

I once came up with a metaphor I thought perfectly captured the sheer mass of material my classmates and I were expected to memorize in our first two years of medical school: it was like being asked to enter a grocery store and memorize the names of every product in the store, their number and location, every ingredient in every product in the order in which they appear on the food label, and then to do the same thing in every grocery store in the city. Continue reading…

An Alternative to Willpower for Losing Weight


Photo: flossyflotsam

A common belief, even among doctors, is that almost no one succeeds in losing weight in the long term. And for almost two decades, I’ve counted myself among the skeptics, being able to tally on the fingers of one hand the number of my patients who’ve managed to do it—literally less than five out of multiple hundreds, if not a few thousand.

When I stumbled across the ideas put forth in the slow-carb diet though (“slow” in contrast to “low” because one cheat day a week is allowed), I became excited—and not just for my patients. Though I’ve never had much of a weight problem myself, after nine years of marriage, four years of fatherhood, and a consequent 50% reduction in the time I have available for exercise, I found I’d put on nearly twenty extra pounds. So when my wife noticed me noticing several inches of my abdomen hanging over the sides of my belt one day, she suggested I try the slow-carb diet myself. I did and shed the extra weight in just two months.

Continue reading…

Your Neighbor Is An Alcoholic, Redux


Photo: peteSwede

My patient smiled a toothless grin and told me, “I feel fine, doc.” But he was far from it. His liver enzymes had risen into the thousands, his skin was a pasty yellow I didn’t need the benefit of sunlight to see, and his albumin (a protein whose level indicates the liver’s functional capacity as well as a patient’s degree of malnutrition) had fallen far too low. Further, he’d been admitted to the hospital with a chief complaint of vomiting blood, which turned out to have been caused by esophageal varices, a potentially life-threatening condition seen in end-stage alcoholics. Continue reading…

Cigarette Smoking Is Caused By A Delusion, Redux

Photo: P.13

I leaned back in my chair and breathed a heavy sigh. My patient, Mr. Rodriguez (not his real name), noticed my discomfort. “I know I should quit,” he told me with a guilty shrug of his shoulders.

“Have you ever tried?” I asked.

“Once,” he replied, “but it didn’t stick.”

Mr. Rodriguez had been a pack-a-day smoker for the past 20 years, something he’d only begrudgingly confessed in response to a standard inquiry I make of all my first time patients.  He didn’t see it as a problem himself.  Or at least he hadn’t mentioned it when I’d asked him at the beginning of the visit why he’d come to see me. Continue reading…

How To Raise Your Good Cholesterol

Photo: VinothChandar

Most people know it’s important to get their bad cholesterol (LDL) down to reduce their risk of heart attacks and strokes. Fewer people know that it’s also important to raise their good cholesterol (HDL) for the same reasons. Almost no one knows, however, that a low HDL likely puts them at a higher risk for heart attacks and strokes than does a high LDL. In other words, it’s more important to get your good cholesterol up than to get your bad cholesterol down. Continue reading…

Win An Autographed Copy Of The Undefeated Mind

Photo: skippyjon


This post is going to be a little different from my usual fare and quite brief. My book The Undefeated Mind: On the Science of Constructing an Indestructible Self is set to hit bookstores on November 6th, and today I’m announcing a contest for readers who want to win an autographed copy. Continue reading…

The Human Body From Head To Toe

Photo: adrigu

One of the reasons I was drawn to medicine is that I’ve always been fascinated by the workings of the human body on all its levels. Truly, nothing in nature stands as its equal—flaws and all (and there are a few). So I thought today I’d share just a few of the fascinating facts about the way the human body works that many people don’t know. From the bottom up: Continue reading…

The Five Questions Patients Should Ask Their Doctors

Photo: hang_in_there

I once had a patient in whom I found a small breast lump. She was only thirty-two, and the lump was soft, non-tender, and mobile. But it was new. She examined her breasts monthly and was certain that she hadn’t felt it the month before. And she had a family history of breast cancer. Continue reading…

How To Survive A Hospitalization

Photo: morrissey

Just two weeks ago, my hospital went live with a full ambulatory electronic medical record. Though the roll out wasn’t without its challenges, the software is simply outstanding. There is almost nothing about a patient’s medical history I can’t now access with a few clicks of a mouse button. Not only do physicians have more technology than ever before with which to diagnose and treat patients but also, at my hospital at least, we now have access to all the data our technology provides without ever having to leave an exam room. Continue reading…

Do You Need Antibiotics?

Photo: Nathan Reading

One hundred fifty million prescriptions for antibiotics are written each year in the United States.  By some estimates, one third of them are unnecessary.  One of the most common diagnoses for which antibiotics are inappropriately prescribed is upper respiratory tract infections (URIs).  The overwhelming majority of these infections are viral—infections for which we have no treatment that speeds resolution of symptoms (with one possible non-antibiotic exception, discussed below). Continue reading…