Delivering bad news is part of my job, an important part. It is fashionable nowadays to speak of the doctor-patient relationship as a partnership. In the sense that both doctor and patient have important roles to play for the patient to get good care, that's very true. But even in the best of times, it's a very asymmetric partnership. Even in a run-of-the-mill visit for a sinus infection the pa...

Food allergies are commonly misunderstood, so please bear with me while I first explain what food allergies are and are not. Various foods can cause all sorts of unpleasant effects. Most of these are not allergies. Allergies are only reactions caused by a specific antibody (called IgE) that results in hives, trouble breathing, or a life-threatening condition called anaphylaxis. So, if yogurt g...

I have lots of patients who are incredibly fit. I have patients who have run marathons. I have a patient who rides in rodeos. I have patients who have completed Ironman Triathlons. And I have ...

The power of placebos has long been known. People who believe that they are taking an effective drug frequently feel better. In fact, prior to the discovery of penicillin, it is likely that the placebo effect accounted for much of the benefit of medical care. A study published this week in the j...

It’s a world of measles, a world of flu. It’s a world of mumps and pertussis too. It’s a world that we share, but please stand over there. It’s a small world after all. -- My new proposed lyrics for the ride It’s A Small World

In December I wrote that 2014 was a banner year for measles in th...

Ah, the joys of January 2! Bleary eyed employees return to work, holiday cards fill waste baskets, and everyone contracts influenza. This year’s flu season has started earlier than expected and has already reached high numbers of flu cases in 36 states. California is not one of them, but that likely means we’re a couple of weeks behind the East Coast, not that we’ll be spared. In fact, this...

There are few illnesses as disabling as a stroke. A stroke is the cessation of blood flow to part of the brain. It can cause sudden difficulty speaking, difficulty moving a limb, facial drooping, or the loss of vision in a fragment of the field of view. In many stroke patients the loss of function never improves and the patients remain permanently disabled. Before the 1980s there was no eff...

I haven't written about measles in over two years, but unfortunately it's in the news again. Measles is a very contagious viral illness that causes a high fever, rash, cough, and a runny nose. Complications include pneumonia, brain inflammation and death. Prior to 1963 there were hundreds of thousands of measles cases in the US annually, causing hundreds of deaths. In 1963 the measles vacci...

Tomorrow I expect to sit with my extended family at my sister’s house and consume copious quantities of yummy food. After that, my and her kids will destroy her house in cute ways that will delight the grandparents. Good times. That in itself is a reason for gratitude. Given the fact that most humans who have ever lived spent every winter nearly starving to death, the abundance of food and ...

If you're over 65, there’s a new vaccine you should know about. But before I explain the vaccine, let me introduce you to the bacterium that the vaccine protects you from. The little blue ovals in the above picture are Streptococcus pneumoniae bacteria. You might have guessed by its name that S. pneumoniae is a leading cause of pneumonia, and you'd be right. Pneumonia is a...