Don’t Get Caught Listening to Your Patient!

The pupil and the teacher, one just a little ahead of the other.  William Osler Don’t Get Caught Listening to Your Patient! D. Micah Milgraum, MS4, Philadelphia, Pennsylvania Abstract: A fourth year medical student blunders while learning not to take everything a patient says at face value. Keywords: pityriasis rosea, medical student, tinea, listening, medical lingo, pimping, embarrassed, ringworm, patient presentation, lesson learned, herpes, dyshidrotic eczema During the fourth day of my first dermatology rotation, I enter one of the clinic’s patient exam rooms to meet a 42 year old man sitting on the examination table holding his palms out towards me. “What brings you into clinic today?” I ask. … Continue reading

The Relativity of Time in Dermatology

By Leonard J. Hoenig, MD Abstract: Rarely, human aging can dramatically speed up or slow down, resulting in devastating clinical consequences for patients. Two case histories are presented to illustrate this “relativity” of the human aging process. One patient suffered from progeria and aged rapidly, dying prematurely at 17 years-old. The second patient suffered from syndrome X and seemed not to age at all, remaining a toddler till her death at age 20. Despite their many handicaps, both patients lived inspiring lives that brought much love to their families and friends. To read a PDF of Len Hoenig’s inspiring article go to THIS LINK and click on Download. Key Words: … Continue reading

Air Care: Thoughts about Health Care from 39,000 Feet

If the rich could hire the poor to die for them, the poor would make a very nice living. Yiddish Proverb Air Care: Thoughts on Health Care from 39,000 Feet. by David J. Elpern I’m sitting in Economy traveling from the City of Angels the Big Apple. Just in front of me is the First Class (FC) section. The cabins are separated by a curtain and I watch a stylish stewardess hovering over a passenger there. The FC passengers get the best attention money can buy. Food, drinks, a table cloth for their meals! Solicitous smiles from the stews. We, in coach, get a small packet of pretzels, soda, juice … Continue reading

Longing to Belong

Nor cast one longing lingering look behind Thomas Gray, Elegy in a Country Churchyard by Richard Ratzan, M.D. Abstract: On the eve of retirement after 45 years as a physician, the author reflects on a lifelong inclusion in medicine, from early childhood days as the son of a medical couple to a career in emergency medicine. He anticipates with dread the day when he will no longer belong in the ranks of those who are unquestionably healers. Keywords: retirement, profession, collegiality, nostalgia, autobiography, clinical medicine, emergency medicine Two years ago I walked out of my emergency department ending 43 years as an employed academic physician. Although I realized at the … Continue reading

My Singing Angel

by Jane E. Babin (This was originally published in Cell 2 Soul in 2006) When I entered Massachusetts General Hospital last April to have a feeding tube placed in my stomach, I was very apprehensive. Don’t get me wrong. I had every confidence in the surgeons and staff at this prominent facility. Also, this procedure is done routinely. My cause for concern was my ALS, aka, Lou Gehrig’s disease. At the time, I had not yet had my tracheotomy. Because ALS is a neuromuscular disease that had begun to affect my diaphragm, I was afraid of any sedation that could compromise my already weakened ability to breathe. Try as they … Continue reading

Health Anxiety: Tables and Appendix

Table 1. Demographic Data Age 0 – 9            5 10 – 14        8 15 — 19      20 20 – 29       41 30 – 39       10 40 – 49       23 50 – 59       28 60 – 69       39 70 – 79       39 80 – 84       12 85 – 89       14 > 90            2 Male =            97 Female =     115 Trans =            1 (87 yo woman with confusion) New Patient                      34 Returning Patient            188 Table 2. HA Questions Are you worried a lot about a particular health problem? Y N Do you tend to worry about your health in general? Y N Have you ever … Continue reading

Health Anxiety in a Dermatology Practice

Abstract: Health Anxiety is a common affliction of patients seeking medical attention, yet many physicians are unaware of it.  We surveyed 222 consecutive patients in a dermatology practice in Massachusetts and found that upwards of 49% self-reported some level of health anxiety, suggersting that it appears to be pandemic in the dermatology population of patients. Keywords: health anxiety, dermatology, Massachusetts, actinic keratoses, cryotherapy, survey,, Tyrer Introduction Patients see doctors with varying degrees of concern regarding their health. Some, require tests or treatments. A subset of patients have severe health anxiety (HA) and cannot be reassured by tests, procedures or pharmaceuticals but may be helped (at least temporarily) by a sympathetic … Continue reading

It’s Freezing in our County: Medicare Reimbursement in 2012

by David J. Elpern and Mariah L. Ferrara Abstract: We have documented the access to dermatology care in the Berkshire County, Massachusetts. Of the six dermatologists practicing in the area only two accept Medicaid patients and for one of these, the wait for an appointment was over six months. Our data show unequal access to dermatologic care in Western Massachusetts Keywords:  dermatology, access to care, Medicaid, dermatologist, medical insurance. Berkshires, Massachusetts, cryotherapy, liquid nitrogen Introduction: It is clear to Medicaid recipients nationwide that they have difficulty in obtaining health care from large numbers of private practitioners There are many reasons for this, but chief among them is that physicians are … Continue reading


The Business of Medicine: Old paradigm and new  I wish I was a young buck looking for my first job. Recently, I received an email promoting a new position: Hi Dr. …, Hope this email finds you well! I’m contacting you regarding a Dermatology Opening in [a scenic rural area]  Please see below for details and send CV if interested. Seeking a BE/BC Dermatologist to join its medical staff.  Join the most trusted hospital in the area due to its highly trained physician staff and its arms-length affiliation with the University of [X] Hospital in {Y]. The community itself is an attractive university town located in the Foothills of the redacted … Continue reading

Health Anxiety

seen every day in medical offices Health Anxiety: lurking in plain sight All practitioners will learn useful information from this article. Excerpts “Many patients, despite how much they would like to, cannot do what we would like them to do: ‘stop worrying.’” As physicians, we see a few such people every day. Health Anxiety seems to be epidemic (perhaps, endemic) in our communities, yet it is poorly recognized. “People with health anxiety do not ask relief from somatic symptom, but rather only desire freedom from worry about disease. A key component of health anxiety is rumination, so that patients cannot stop thinking about a disease once the thought has come … Continue reading

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