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Monday, December 5, 2016

Diet for a hungry, fat, dry, wet, hot, sick planet

I have been privileged this past week to preside one final time as President over the annual meeting of the American College of Lifestyle Medicine, held at a lovely venue in Naples, Florida. The venue is special not just because the hotel did such a fine job hosting us and satisfying our demands for delicious, nutritious, plant-based fare, nor just because of the long boardwalk through mangroves to the beautiful, powdery beach on the Gulf of Mexico. This area, with leadership from local healthcare systems, is a Blue Zones Project, working to turn the habits of the longest-lived, most vital people on the planet into blue prints for new, local norms. What a perfect place to celebrate the primacy of lifestyle in health!

At my initial suggestion, our conference theme this year was Healthy People, Healthy Planet. I wanted to showcase to our membership, and learn more myself about, the implications of human lifestyle choices for not just our own health, but that of everything around us.

My hopes in this area were richly fulfilled, as leading experts from around the world gave illuminating talks on chronic disease, emerging infections, climate change, water supply, biodiversity, soil quality, sustainable agriculture, and more- and how they all relate to the behavior, and in particular dietary choices, of the roughly 7.5 billion Homo sapiens currently on the planet.

This particular professional college traces its lineage to faculty at Loma Linda University, home to the famous Seventh Day Adventist Study, and has always placed a very strong emphasis on plant-based diets for preventing, treating, and reversing chronic disease. I have respected this for the simple reason that it is just where the weight of evidence inclines. But, I have also pushed back against the tendency, whenever and wherever I've seen it, to make claims past the margins of that evidence.

I won't belabor that case here- I've made it many times before, in columns, in peer-reviewed papers and invited commentaries, in an entire textbook, and in the best of company. The evidence regarding diet for human health extends to variations on a broad theme of minimally processed foods, mostly plants, in sensible combinations that are often time-honored, and rooted in heritage and cultural practices.

But this is just the evidence related directly to human health. There is a critical, indirect consideration at one nominal remove: what about the health of the planet? There is, quite simply, no human health left to worry about on a planet no longer hospitable to our species.

That danger truly looms, and more proximally than most of us care to admit. The case was made in its alarming particulars by a veritable parade of luminaries to our conference podium.

Dr. Samuel Myers, director of the Planetary Health Alliance, talked about the many interactions between human lifestyle choices and the health of ecosystems. He then completed the circle in several vivid examples from fieldwork around the world, showing how perturbations of ecosystems often translate into human health threats, from emerging infectious disease, to respiratory disease- a salient issue in Indonesia as rich forests are felled for palm oil production, and the smoke chokes Singapore. Perhaps the greatest surprise in Dr. Myers' presentation was elegantly gathered evidence showing that higher carbon levels in the air, regardless of effects on climate, translate directly to lower nutrient levels in plants- including nutrients already consumed at inadequate levels by millions of people around the world, notably iron and zinc.

Refreshingly, Dr. Myers also called out the routinely overlooked elephant in the room: the size of the global human population. The combination of a growing human population, and growing access to ever more manufactured goods by each of us, is a formula for catastrophe. We must do all we can to stabilize the global population at current levels, and shift our demands for goods and services to those that do not ravage the planet in the making.

In passing, Dr. Myers also noted that animals raised in human agriculture outnumber people by at least 10 to 1. So as we assault the planet by the billions, they do so at our behest in the tens of billions.

Danielle Nierenberg, founder of Food Tank, took us on a worldwide tour of small-scale, agricultural innovations that show promise in defending us against food insecurity, soil degradation, and the civil unrest that ensues when people are hungry and thirsty. All such roads around the world lead to an emphasis on plant foods, grown in variety. They also lead, it's worth noting, to an emphasis on parity and respect and empowerment for women across all cultures, as women figure so prominently in food production where it's needed most, yet face considerable disadvantages in accessing the needed resources.

Dr. Richard Oppenlander took these worries up a notch, highlighting the confluence of immediately urgent threats to the stability of natural systems around the world. The simple message is the most inconvenient of all truths: our species, so good at propagating extinction, could certainly be the architect of our own.

Even as the planetary issues were elaborated, talks in our customary purview- human health- reaffirmed the principles of healthy living to which the College, and the True Health Initiative, are pledged.

We were honored to host Dr. Erkki Vartiainen, Director of the National Institute of Health and Welfare in Finland, and co-director of the rightly famed North Karelia project. Dr. Vartiainen took us through nearly 50 years of data, showing how interventions to reduce saturated fat intake and blood cholesterol levels, salt intake and blood pressure, and tobacco use have translated into stunning improvements in health and life expectancy. With the most recent data, however, he revealed that as the North Karelians buy into some of the currently popular memes, like “butter is back,” with attendant changes in diet, heart disease rates are creeping back up for the first time in decades.

Dr. Christopher Gardner, Director of the Prevention Research Center at Stanford University, shattered myths about the need to eat meat to get adequate protein, and highlighted the opportunity to put the joy of delicious food in the vanguard of efforts to move toward health-promoting, planet-friendlier, plant-predominant diets.

Dr. Michael Greger made a compelling case (with customary lilt and panache) for the capacity of the status quo to deny what in time become self-evident truths, using the history of tobacco to illustrate. Caught up in the denial of tobacco's terrible harms were not just the obvious industries and usual suspect, including athletes, actors, and individual doctors- but the formal structures of medicine, like the AMA. The evidence was available, but lots of money was in play- and the weight of evidence was long disregarded, as people died.

The parallels with food today are striking. Big Soda uses money to fight soda taxes, obscure the obvious connection of their signature product with obesity and diabetes, and try to influence our understanding of energy balance itself. Big Sugar has, we learned recently, has long fought to limit the list of crimes against human health for which they are held to account.

Big Dairy has long made sure there is a wedge of cheese in every formal dietary recommendation. Big Beef not only fights to include meat in all dietary guidelines, but against all reason and decency, fought effectively to expunge any consideration of sustainability. And again, the major health organizations, from the USDA to the NIH, to the AHA, are somewhat complicit in denial of the truth.

That simple, environmental truth is that we must eat less meat- much less. This is the truth both for those long favorably disposed, and for those who find it monumentally inconvenient. The truth is not a contestant in a popularity contest; it's just the truth. Many of the environmental scientists revealing this truth are not yet vegetarian, and many in this conversation don't want to be- but they are doing what honest scientists do, and following their data where they lead.

The audience of diverse health professionals at our meeting was, by all indications, inspired to do everything in our collective power to propagate the message, and advance the mission: diet and lifestyle can, and therefore must, change at scale to help save the planet. In case you want in on it right away, two direct substitutions would make an excellent start: drink plain water instead of soda, and eat more beans and lentils in the place of all varieties of meat, but especially beef.

There has, indeed, long been a reasonably broad theme representing “the” optimal diet for human health, couched within a small portfolio of other lifestyle practicesdiverse authorities call by different names, but prioritize in common. The planet's many imminent perils, and unchecked population growth may, however, be narrowing down our dietary options rather rapidly. This is directly analogous to human health threats. When a person is still mostly healthy, there tend to be many ways to stay that way. The treatments for advanced disease are much more narrowly circumscribed. What happens to patients in ICUs is generally unpleasant, and highly protocolized. The planet is fast headed toward the ICU.

Fortunately, the imperatives of lifestyle for our own health promotion are highly confluent with the needs of the planet. Experts tell us, however, that the needs of the planet may be more urgent, and less accommodating. For now, we can address both by moving our diets away from processed foods, soda, and animal foods, and toward ever more vegetables, fruits, beans, lentils, nuts, seeds, whole grains, and plain water. It may not be too long, though, before a planet of both the starving and the obese, of parched fields and rising seas, of rising temperatures and dwindling aquifers, of dying birds and bats and bees- leaves us no choice at all.

Epilogue: I recognize the above may seem a bit gloomy, and rightly so; but all is not lost. We are, alas, very late to this party- and even now willing to consider, at least, electing a President of the United States who overtly denies climate change is even happening. That we will undo enough to reverse our calamitous momentum seems all but impossible. But we are an ingenious species, and along with what we fix by undoing our mistakes, I am hopeful, and even optimistic, that we will fix much more by exploiting our inclination to invent. I am admittedly non-expert in this area, but I envision new technologies, and soon, running on carbon-neutral, renewable energy sources already available, that are used to sequester and repurpose atmospheric carbon; desalinate our rising seas and produce abundant fresh water; systematically divert food waste into constructive use; and more. To borrow a line from The Martian, in the face of overwhelming odds, we are going to have to “science the sh#@ out of this,” and I believe we can. I believe we will. But as we count on our engineers to “science” us out of this mess of our own devising, none of us should spend another day blithely propagating the problem; it's plenty big enough already to test the limits of our ingenuity.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Thursday, December 1, 2016

5 things physicians realize when they're sick

There are so many insightful stories out there about what happens when physicians experience life as a patient or family member. They always make sobering reading for everyone in health care. Over the years I've heard dozens of these stories from fellow physicians, describing experiences when they've unfortunately been sick themselves. It's an inevitable fact of life for everyone that they will be the patient one day, but it's often an especially life-changing experience for anyone who already works at the frontlines of medicine. Based on these experiences, here are 5 pieces of universal feedback:
1. Listening
It's remarkable how often physicians as patients feel that they are not listened to. Imagine that most of the time as well, everyone knows that they are doctors—and it still comes across like that! This isn't necessarily the fault of the hard-working medical professionals taking care of them, but more a consequence of the typical hectic and busy health care environment. Remembering the basics such as sitting down and talking face-to-face with your patients, not being distracted by the computer, and taking all complaints seriously (as most of them usually always are) goes a long way.
2. Brief time slot
Following on from the above, it's amazing how little time doctors actually spend in direct patient care. A doctor may have dozens of patients to see, and can easily forget during a crazy workday that their patient may have waited several hours just to see them. It's the part of the day that's most important to them and the patient will usually hang onto your every word. Even if a doctor is only in the room for 3 minutes, don't forget how much those few minutes mean to your patient.
3. Ability to get rest
One of the most common complaints doctors hear when they walk into a room first thing in the morning, is that the patient couldn't sleep at night. Often passed over with a shrug of the shoulders—not really too much we can do about the noise at night, either from outside the room or a noisy neighbor! But how it hits home when a doctor is a patient that the thing we need most when we're sick is a decent rest.
4. Care coordination
This is something that all doctors, especially those in the generalist specialties, recognize as a huge problem. There are simply way too many cooks in the health care kitchen, a subject I've written about previously. It sometimes feels like the amount of specialists that see medically complex elderly patients could fill a small phone book. While most of these specialists are absolutely needed, it becomes a problem when neither the patient nor the family knows who the “captain of the ship” is, and they are getting mixed messages from every direction.
5. The bill
Doctors conscientiously go about their day and strive to give their patients the best possible care. We hardly spare a second thought for the cost of everything we're prescribing and ordering. With the simple click of a mouse, a test costing several thousand dollars is ordered. Only when one receives a hospital bill, does one realize how crazy the prices are! Everything itemized down to the smallest Band-Aid. Likewise, the headaches our patients have to go through dealing with insurance companies is another thing that's often hidden from doctors.

There are certainly many more observations that could be listed in addition to the above, but these are 5 of the most common. We all need to do better and improve patient experience in areas where we can. Regular feedback like this should give all health care leaders pause for thought.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.

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Monday, November 28, 2016

How dieticians can save the world

I was honored, and genuinely delighted, to take the stage at FNCE 2016 (the annual meeting of the Academy of Nutrition and Dietetics, for those who don't know the lingo) with Dr. Walter Willett of Harvard, and Kathleen Zelman of WebMD, our session moderator. Kathleen was fresh from her speech, earlier the same day, as this year's recipient of the Academy's prestigious Lenna Frances Cooper Award.

As for Walter, the most published and cited nutrition researcher in history, he needs no introduction to anyone nominally tuned in to matters of food and health. I will simply note two things. First, this was, in a sense, the “Walter and Dave Show, part 2”, as he and I co-chaired a conference last fall on the same theme: the common ground of healthful, sustainable eating. That conference was sponsored by the not-for-profit Oldways, which advocates for “health through heritage.”

The one other thing I will say about Walter is that I respect and love him almost like a father. Only those who know how much I love and respect my actual father will appreciate just what that means. Moving on.

Walter provided a thoroughly evidence-based review of the fundamentals of healthful, sustainable eating, reprising the themes laid out at the Common Ground Conference a year ago, and updating the case with studies published since. I followed with a discussion of how we can be so prone to perpetual, pseudo-confusion in the first place when the relevant evidence is so abundant and so clear.

In particular, I talked about how scientists can seem like they disagree even when they agree far more; how a whole sequence of mono-nutrient fixations have been converted into nutrition boondoggles spanning decades; how the harms of sugar were not discovered by some currently best-selling diet book author last Thursday, but rather have been salient for years; and how utterly appropriate the recommendations of the 2015 Dietary Guidelines Advisory Committee were, before politicians adulterated them under the influence of lobbying, or bullying, if there really is any difference.

We are not clueless about the basic care and feeding of Homo sapiens. On the basis of massive aggregations of science, even mean applications of sense, the global consensus of diverse authorities from many relevant fields, and the experience of whole populations over generations, a diet emphasizing minimally processed vegetables, fruits, beans, lentils, whole grains, nuts, seeds, and water preferentially for thirst, is unassailably right for people and planet alike. So it is, and so we said.

During the Q&A that followed our brief presentations, a dietitian in the audience asked what to me seemed a beautiful, and refreshingly humble question: what can dietitians do better to help advance the public understanding of the fundamentals just discussed?

My part of the answer was that we only have the strength, or even the volume, to get anything meaningful done, if we are unified. If genuine understanding of the common ground of health-promoting, sustainable eating is to become common knowledge, it must do so courtesy of common cause.

Why? Well for one thing, we live in a massively noisier world than anyone before us has ever known. It's almost shocking to me to hear myself talk about the “pre-Internet” portion of my career to young colleagues, but there actually was such a thing! I miss it, to be honest.

Now, though, we are all irrevocably caught up in the endlessly amplified echoes of every opinion, expert and more often otherwise, courtesy of the blogosphere and social media. If our best understanding of eating well is the signal we hope to transmit, the challenge of doing so rises directly with the volume of static it must overcome.

Accordingly, those of us who have relevant expertise, and truly do mostly agree, must lead with that message. All too often, it is our native tendency to do otherwise.

It's our tendency because we are human, and all want to talk about “the thing“ that matters most to us, be it passion, priority, or pet peeve. But there are two salient problems in this domain. The first is that non-experts also have their passions, priorities, and pet peeves related to nutrition, and in cyberspace, they can readily broadcast those in the guise of facts, their lack of relevant qualifications generally undeclared, and routinely overlooked. If actual experts, dietitians and others, broadcast a comparable scattershot of disparate opinion, how is the public to know what's what, let alone who's who?

While there is plenty of room for variation among the prioritized particulars any one of us might favor, the basic theme of eating well for longevity, vitality, and the sake of the planet is simply not negotiable. Experts know that, and can both help the public know it, and distinguish expertise from impersonations of it, by reaffirming it every chance we get. Non-experts, hoping to be heard in the cyberspatial din, need to subordinate reliable, time-honored, evidence-based understanding to titillation and provocation. Experts can afford to do the opposite.

That does not preclude the appendage of personal priorities. Maybe you think artificial sweeteners are the absolute worst. Or maybe you think they are much preferable to sugar. Maybe you want to make a case for including dairy in the diet, or maybe, for excluding it. Maybe you think sodium gets too much attention, or maybe you think, not enough. Maybe you are convinced that artificial dyes and flavorings contribute to behavioral disorders in children, or maybe you consider that evidence inconclusive. Maybe you are all about gluten, or GMO foods, or resistant starch, or the microbiome.

By all means, tell the world, but to use a food metaphor, tell the world where the common cake ends, and your bit of favored frosting begins. If our commonality is the cake, and our differences relegated to the icing, we can have that cake, and serve it, too.

I meet very few, if any, dietitians who don't agree with the proposition that diets and health would improve (in the U.S. and other developed countries) with more vegetables, fruits, whole grains, beans, lentils, nuts and seeds and water in the place of almost any other beverage almost all the time. Over the years, however, I have met many who tended to talk much more about some narrowly bounded, personal priority, than the expanse of common ground we share.

The result of that is the obvious: the public doesn't know we agree nearly as much as we do. Deriving the impression that no two nutrition experts agree or hold the same opinion for more than 20 minutes at a stretch, the public learns distrust of us, if not disgust with us, which opens the door wide to a never-ending parade of fools and fanatics with something to sell.

We have the strength to change prevailing diets and health for the better only in unity. If we collectively defend the fundamentals of healthful, sustainable eating, and then append our personal priorities, whatever they may be, we can be the change we hope to see in the world, and stay true to ourselves as well. We can be greater than the sum of our parts, yet still part over given particulars as inclined.

The answer was intrinsic to the lovely, humble, generous spirit of the question. We can each take the most effective stand in support of our personal priorities for health if we do so resolutely, consistently, and emphatically on the common ground we share.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Wednesday, November 23, 2016

Can post-election anxiety be a clinical diagnosis?

How are you feeling post-election?

In the practice of medicine, we use validated questionnaires like the PHQ-9 to screen for depression or the GAD-7 to screen for anxiety.

My wife, a family doctor, administered the GAD-7 to a patient of hers this week; post-election, I started wondering how many Americans could be diagnosed with generalized anxiety disorder right now.

Go ahead and take the quiz yourself. What's your score?

A score of five or more indicates mild symptoms. Ten or more moves you to moderate. Fifteen or more means you are highly likely to have diagnosable anxiety disorder, what the experts call generalized anxiety disorder.

If you're in this highest category, think about getting help. You can start with your primary care physician. She can help you directly or refer you to other community mental health resources that can be helpful.

Generalized Anxiety Disorder (GAD), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item is required in children.
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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