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 CONTEST IS NOW OVER. MANY THANKS TO ALL WHO PARTICIPATED.

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…

Don’t Shake Hands

Photo: buddawiggi

One of the earliest memories I have is of my father teaching me how to shake hands.  He would always comment to me whenever he received what he considered to be the hallmark of a quality handshake, a firm grip.  Handshakes, he taught me, were important.  The indicated something about the character of the person whose hand you were shaking (though whether he meant a sterling character, a commanding personality, or something else I don’t know—nor am I sure he did himself). Continue reading…

The Right To Die

Photo: rjhuttondfw

The notion that dying is a right seems nonsensical to argue:  death is given to all of us equally without the need of anyone’s sanction.  The right to die well, on the other hand—well, that’s another matter entirely.  A good death is, in many cases, something our fellow human beings have great power to grant or deny, and is therefore, sadly, a right for which we must indeed fight. Continue reading…

One Event, Two Stories

Photo: Kal111

I recently had a patient of mine undergo surgery to remove his gallbladder due to acute cholecystitis.  He’d been out to dinner with some friends and had started to feel nauseated, then developed some right upper quadrant abdominal pain that necessitated ending the evening early.  After a sleepless night, a morning episode of vomiting, and developing a fever, he came in to see me.  I made the diagnosis, called a surgical colleague, and his gallbladder was taken out later that afternoon.

Afterwards, I talked with the surgeon, who reported the operation had gone well, with almost no blood loss.  The gallbladder had looked “as if it was about to burst,” suggesting they’d gone in just in time, he said.  Continue reading…