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You are doing a physical exam on the patient to whom this scan belongs:

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I have a 46 year old male patient in my clinic who is quite obese. His mother died a few years ago from triple negative breast cancer and his sister recently underwent a biopsy for a suspicious breast lump - we are still waiting on the results. My patients is totally asymptomatic but do you think despite breast cancer being rare in males, that he ought to get screened? Given his body habitus it might be even harder for him to notice a lump growing in its early stage. 

How would you broach this sensitive topic with him? 

Thanks for your insights. 

A 12-year-old boy presents with recurring episodes of severe pain in his joints and abdomen, often triggered by cold weather or physical exertion. His medical history includes frequent hospitalizations for unexplained fatigue and shortness of breath. Blood smear reveals the following: 

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Please respond to the anonymous poll and as always share your thoughts in the comments. 

I have a 45 year old patient with constipation and dyspareunia. She is healthy and never been pregnant and still getting her period. We have tried a host of different laxatives though none have been effective. She has also undergone a cystoscopy for bladder related issues  that revealed no abnormalities. She experiences pain during intercourse that lasts for hours after. I was talking to a friend who is a physical therapist who said the constipation and pain during sex could be related. He explained that constipation can cause cramping of the pelvic floor leading to painful sex and that physical therapy could really help my patient. 

Has anyone heard of this connection before in your clinic (or personal life)? 

Early-onset and severe genetic obesity from age 2 years old, associated with extreme Hyperphagia.Now she is 17 years old with a weight of 220 kg, 1m70, BMI: 76.

Hypertension, severe sleep apnea, restricted walking distance < 5 meters and complete assistance for all activities of daily living.

GLP-1 analog Dulaglutide 1.5 mg/week, has been tried for 3 months with poor results.

Dear Drs, a little help with this case please. A 76-year-old woman presented with abdominal pain and was found to have an internal hernia causing bowel obstruction. She underwent surgery which was initially uncomplicated. Her medical history included hypothyroidism managed with levothyroxine 150mcg, though she had been partially nonadherent recently. In the postoperative period, she developed complications including an ileus, inability to take medications orally, and remained off levothyroxine for 10 days.

Hi, a 10 year old boy with diagnosed autism spectrum disorder, ADHD. and migranes, was referred to us for raised prolactin. He has been under the care of neurology for migraines

Dear Colleagues,

I need assistance with a case involving the following situation: Since April 2024 to the present, we have a case of a healthy 5-year-old female presenting with a unilateral deficit in the left eye involving the inferior oblique and superior rectus muscles. This occurred during an infection with Human Herpesvirus 6 (HHV-6), characterized by prolonged 

I know summer is almost over (in the northern hemisphere) but I had a question about sun screen and I thought I would ask it here. I heard that over SPF50 there is no real difference (other than price). I was wondering if this is really true or not. I am quite pale and so are my kids and melenoma runs in our family so as you could imagine I am quite hawkish about applying and reapplying and I wanna make sure I am doing everything I can - but if i could get away with buying cheaper sun screen I wouldn't be upset. What do you all recommend?

Dear colleagues,

A friend's 24-year-old daughter was reviewing her medical records and realized she never got the HPV vaccine. Her doctor said she didn’t need it, but I understand the CDC recommends it for women under 27 and it's approved up to age 45. Since guidelines and individual practice can differ, I’m conducting an anonymous poll to see what doctors here actually advise their patients to do. 

Thanks in advance, and I’d appreciate any thoughts in the comments!

A 17-year-old girl presented with linear lesions on her face and abdomen that had persisted for 11 months, causing significant school absenteeism. The lesions appeared suddenly, were asymptomatic, and healed quickly but left behind pigmentation changes and scarring. Despite normal hematological investigations, the patient exhibited an apathetic demeanor and provided an incomplete history. Clinical examination revealed well-defined excoriations, erosions, and scarring, primarily on the face. Dermoscopic findings showed distinct zones of hyperpigmentation, hypopigmentation, and central crusting. 

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How would you continue managing this patient's care?

I have a 58 year old patient who just came back from a monthlong cruise where she claims to have spent much time in the sun without being careful about sunscreen. She has noticed a new mark on her face and I am not sure if this is concerning and warrants further care - though I am inclined to refer her to a dermatologist. 

The UK has approved the use of Lecanemab, a drug for Alzheimer's, which has been hailed as a "wonder drug" for its potential to slow the progression of the disease. Lecanemab targets amyloid plaques in the brain, which are believed to contribute to Alzheimer's, and has shown promising results in clinical trials. The approval marks a significant step forward in treating the condition, offering new hope to patients and their families...Read more.

Are you optimistic about this new drug? 

Mail Online 

Recently I have seen many people using the "heat-not-burn" electronic cigarettes and I am not sure what to think about this trend. I know they are supposed to be better than regular cigarettes and vapes but the CDC seems ambivalent.I am curious if any of you have insight on these products and what you tell patients who ask about them.

Thanks in advance! 

A 22 year old woman presents to the ED after fainting for the 3 time in one week. She has never fainted before these episodes began and describes a fluttering feeling in her chest.

Medical Boards around the world are considering new regulations for doctors aged 70 and older due to an increase in complaints against them. In Australia, for example, they are proposing options that include mandatory detailed health assessments or general health checks to ensure their fitness to practice. The current rule, requiring doctors to self-assess their health, might be retained. Concerns about age-related cognitive and physical decline and the rising number of patient complaints have driven these proposals. While aiming to enhance patient safety, these measures might be seen as discriminatory and could potentially prompt older doctors to retire, affecting the healthcare workforce...Read more. 

What appropriate and respectful  measures could help ensure fitness to practice? 

The University of Sydney 

Hello, a case with a 47 y/o male with a history of diabetes and hypertension, who presented to the emergency department with headache, blurry vision, and nausea. He was knocked over by some wavesat the beach four days ago and suffered from a brief episode of loss of consciousness. He also has a history of heavy alcohol use. 3months ago, he started taking 50mg of chlorthalidone. Now he hashas severe hypoosmolar hyponatremia of 99, potassium of 2.2, magnesium of 1.1, lactate of 3.7, high anion gap of 14, glucose of 212 and serum osmolality of 214 (mOsm/kg). Urine output is normal. CT head also didn't show any findings. We are currently waiting for urine osmolality results and we have updated the nephrology team as well. Given his dire situation, what could be the cause of his severe electrolyte imbalances, is the loss of consciousness relevant?

A 4-year-old female with developmental regression over 1 year, including loss of purposeful hand movements, speech, and motor skills. Also shows  hand-wringing, irregular breathing, and frequent unexplained crying, microcephaly and muscle stiffness. 

This concerns me as possible Rett syndrome but I have never actually seen someone with this before. Do you have any insights on what this is and how to manage this patient?

Help me out here. My husband and I were at the emergency department over the weekend with our 9-year old who had fractured his leg. In the waiting room, we argued over whether we should identify ourselves as doctors. I personally think it's unethical to pull the 'I'm a doctor' card and hope for favors this way (eg. jump the queue etc.). On the other hand, my husband argues that we don't really get any benefits as doctors working in the NHS anyway.. 

G-Med has conducted poll exclusively for physicians to gain insight into physician satisfaction with their current income. The poll included 336 physicians who were asked whether they believed they were being paid what they're worth. According to the results, over 50% of physicians did not feel that they were being paid what they deserved, with only 20% stating that they were content with their current income. Additionally, 20% of the respondents believed they could earn more if they worked in a different country, which could indicate that there are significant pay disparities in different regions of the world. Moreover, 4% of physicians reported that they earned more before the COVID-19 pandemic, which suggests that the pandemic may have had an adverse impact on physicians' salaries.

It is crucial to acknowledge the importance of fair compensation for physicians' dedication and expertise. These results reveal that there is a significant proportion of physicians who do not feel adequately compensated for their work. This could have implications for physician recruitment and retention, as well as patient care quality. It is vital for healthcare organizations and policymakers to address the issue of physician pay and ensure that physicians are fairly compensated for their contributions.

With a worsening doctor shortage, with more than half of med school applicants being rejected from medical school. Dr. Jesse M. Ehrenfeld, president of the American Medical Association, highlighted this crisis, noting the severe impact on rural communities and medical education. The demand for physicians is projected to rise significantly by 2034, but simply increasing medical school admissions, which has been happening significantly in the past 22 years, is not enough due to limited clinical training sites and faculty. Experts emphasize the need for more residency programs and teaching doctors, as well as innovative solutions like those implemented by Texas A&M's Rural and Community Health Institute, to effectively address the shortage and improve healthcare access.

Regardless of where you practice medicine (in the US or not), please weigh in in the comments about how the doctor shortage has effected your practice... Read More

U.S. News

Do reports like this make you anxious about the future of healthcare?What do you think we can do to most effectively address this issue?