The patient was an 11-year-old female who had been generally healthy until the past 3 months. Polyuria and polydipsia suggested diabetes insipidus. A splenic mass had been removed, but now there was a symptomatic mass in the left femur. The recommended aggressive course of therapy included amputation of the leg. But was aggressive treatment in the patient’s... »

"The next patient is a 5-year-old who is unable to walk," reports the overnight resident at the morning sign-out. "He had a day of fever 4 days ago, leg pain beginning 2 days ago, and yesterday he awoke with refusal to bear weight."

As we get to the differential diagnosis, I try to expand on the list of possibilities rather than merely... »

It was a perfectly reasonable question, just out of the ordinary. A nurse with whom I had worked for years was pregnant. She asked, "Should I spend $1,500 on harvesting umbilical cord blood when the baby is born?"

The year was 1999. Stem cells were a hot topic after the 1998 article published in Science (Science 1998:282;1145-7). There were... »

In 1863, Abraham Lincoln established a Thursday in November as a national day for Thanksgiving. Previous U.S. presidents and Congresses had intermittently appointed days for thanksgiving. After 1863, November became an annual tradition.

A day of thanksgiving can become a day for reflection and self-renewal. It is a time to go beyond thankfulness for mind... »

A mother brings her previously healthy 4-week-old infant to your office with a 101.5 F fever. Pertinent positives are fussiness this morning and poor breastfeeding. There is no cough, vomiting, diarrhea, nor rash. A sibling has a cold. The exam is notable for a fussy infant who consoles with difficulty. Chest has coarse upper airway sounds, but the... »

In 1972, Canterbury v. Spence changed American health law, and with it, the patient-physician relationship. Some ethicists cite this as the beginning of modern medical ethics. Before a patient agreed to a surgical procedure, he was to be informed about its risks and benefits. Failure to do so was negligence. Part III of that appellate court decision gives a... »

It is the frequent juxtaposition of very disparate items that makes medical ethics both outrageously frustrating and ironically amusing. Does one hand of the health care system really have a clue about what the other hand is doing?

Take, for instance, three articles in the March 17, 2011, issue of the New England Journal of Medicine. An op-ed piece by Dr.... »