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The Digital Chart Cannot Feel the Node

By Join Y. Luh MD

In an era dominated by EHRs, imaging, and AI, Dr. Join Luh argues that careful observation and physical examination remain medicine's most powerful diagnostic tools.

A Remarkable Repair of Multiple Venous Lacerations after Liver Trauma

By Yucel Yuksel MD

A remarkable surgery saving a young trauma victims life after liver laceration along with compromise of the hepatic vein and inferior vena cava

ACES and Childhood Trauma

By Mansi Kotwal MD MPH

A pediatrician reflects on childhood trauma, adverse childhood experiences (ACEs), and the lasting health consequences of fear, violence, and family separation.

The Myth of the Objective Physician: What Every Doctor Brings Into the Room

By Devin Maya Wadhwa, MD, FRCPC

The essay explores the concept of physician objectivity and reflects on how our experiences, values, and personal histories inevitably shape the way we care for patients. It argues that while objectivity remains an important ideal, self-awareness may be just as essential to good clinical practice.

The Day the Denials Stopped: A Modest Proposal for Physician Noncooperation

By Arthur Lazarus, MD, MBA

In this satirical essay, Arthur Lazarus, MD, imagines a nationwide physician boycott of insurance utilization review, exposing the ethical tensions, bureaucratic inefficiencies, and patient harms embedded in prior authorization and coverage denial systems.

An Ode to Odious A1C

By Frank Cacace MD FACP

Through poetry, this piece critiques the overreliance on HbA1c as a quality metric, highlighting the social, economic, and structural factors that shape diabetes outcomes beyond a laboratory value."

The Silence Afterward

By Michael M Karch, MD

A powerful reflection on the psychological weight surgeons carry after difficult operations and the silent burden hidden behind confidence and composure.

At the Crossroads of AI Recruitment and Deepfake Fantasy

By Arthur Lazarus, MD, MBA

From AI recruiters to deepfake candidates, this sharp satire explores the absurdity of automated hiring and its impact on physician leadership and professional identity.

Review the Workup for Primary Biliary Cirrhosis and Understand its Complications

By John Joseph Pack MD

Discover how Primary Biliary Cirrhosis can lead to vitamin deficiency and hypercholesterolemia and osteoporosis

In the Beginning...

By John Joseph Pack MD

A sleepless ICU night unfolds into a harrowing code blue as an exhausted physician confronts mortality, medical uncertainty, and quiet dread after a fatal intubation—an evocative, cinematic portrait of medicine in the early AIDS era, where unanswered questions linger long after the monitors fall silent.

The Surgeon

By John Joseph Pack MD

Trauma surgeon Gus Kappler, MD at Phu Bai’s 85th Evac Hospital is jolted from temporary calm by a frantic radio call from the battlefield.

The Gridiron

By John Joseph Pack MD

The gridiron becomes the Colosseum—rookie Colt McQueen battles for glory as brutal hits, roaring crowds, and hidden costs test the true price of victory

Coercive Psychiatry and the Rising Threat of Involuntary Commitment

By Arthur Lazarus, MD, MBA

A forgotten asylum ledger reveals women once institutionalized for “novel reading,” political opinions, grief, and reproductive autonomy. This essay examines the troubling history of coercive psychiatry, the medicalization of dissent, and the modern ethical risks of involuntary psychiatric commitment in an era of expanding social control.

How to Differentiate Spleen from Kidney on Physical Examination

By Hosam Alrefaai

Keys to help define a left upper quadrant abdominal mass on physical examination

Rethinking Surgical Culture: Lessons from Aviation

By Nandita Mahajan MD

Aviation-style teamwork, psychological safety, and structured communication can transform the operating room from a collection of experts into a coordinated expert team. This piece explores how Crew Resource Management (CRM) principles, from dynamic briefings to post-op debriefs, can reduce preventable errors and strengthen surgical culture through leadership, communication, and shared accountability.

Rob Fowler MD and His Contributions to Ebola Virus Disease Part 4

By John Joseph Pack MD

A gripping firsthand account of the Ebola crisis through the eyes of critical care physician Dr. Rob Fowler, exploring the realities of outbreak medicine, the evolution of supportive care, frontline fear and resilience, and the global fight to improve survival against one of the world’s deadliest viruses.

Rob Fowler MD and His Contributions to Ebola Virus Disease Part 3

By John Joseph Pack MD

An intense account of global outbreaks including H1N1, SARS, MERS, and Ebola, following critical care physician Dr. Fowler as he confronts collapsing healthcare systems, resource scarcity, and frontline medical crises from Mexico City to Guinea during some of the world’s deadliest epidemics.

Rob Fowler MD and His Contributions to Ebola Virus Disease Part 2

By John Joseph Pack MD

A compelling profile of critical care physician and epidemiologist Dr. Rob Fowler, tracing his journey from rural New Brunswick to the front lines of the SARS outbreak in Toronto, where his leadership, clinical insight, and epidemiologic training helped shape Canada’s response to one of the first modern coronavirus epidemics.

Rob Fowler MD and His Contributions to Ebola Virus Disease Part 1

By John Joseph Pack MD

A gripping fictional vignette set in 1970s Zaire that traces the terrifying emergence of Ebola virus disease through the eyes of a father fighting to save his son amid superstition, political turmoil, collapsing infrastructure, and unimaginable human suffering.

Understand the Differences between STEMI and non-STEMI Myocardial Infarctions

By John Joseph Pack MD

Differentiating STEMI from NonSTEMI myocardial infarctions is of critical importance.

Understand the Workup for AutoImmune Hepatitis

By John Joseph Pack MD

Autoimmune Hepatitis may be a fulminant or insidious disease at presentation. Understanding what labs to send, when suspected, is important.

Understand the Significance of the Silhouette Sign

By John Joseph Pack MD

The silhouette sign can be used to pinpoint which lobe or lobes of the lung are affected from an alveolar filling process.

Winter's Formula is Used to Predict Adequate Compensation for Metabolic Acidosis

By John Joseph Pack MD

Use Winter's Formula to predict whether or not compensation for Metabolic Acidosis is compensatory

How to Perform the Mini-Mental State Examination

Use the Mini-Mental State Exam to help diagnose Dementia.

Understand the Glasgow Coma Scale

By John Joseph Pack MD

Be able to recognize and score Traumatic Brain Injury using the Glasgow Coma Scale

Ralph Waldo Emerson

By John Joseph Pack MD

Tryon Edwards

By John Joseph Pack MD

Albert Camus

By John Joseph Pack MD

Understand the Formula and Results of the Serum-Ascites Albumin Gradient

By John Joseph Pack MD

SAAG is a simple calculation with high diagnostic value. Learn how one threshold redirects the ascites differential.

Recognize Calciphylaxis in patients on Hemodialysis

By John Joseph Pack MD

Calciphylaxis is rare but devastating in dialysis patients. Recognize the skin findings that should trigger urgent concern.

Follow the Creatinine Level Closely When Using Intravenous Acyclovir

By John Joseph Pack MD

IV acyclovir can injure kidneys if the creatinine trend is missed. Know the monitoring clue that keeps treatment safer.

Consider Cannabinoid Hyperemesis Syndrome in the differential diagnosis of a patient with a history of cyclical nausea, vomiting, and abdominal pain

By John Joseph Pack MD

Cyclic vomiting with cannabis use has a telltale pattern. Learn when cannabinoid hyperemesis should rise on the differential.

Know the Physical Exam Findings of Testicular Torsion

By John Joseph Pack MD

Testicular torsion is a time-sensitive diagnosis. Know the physical exam findings that should accelerate urgent evaluation.

Recognize Possible Hematogenous Origin of Staph Aureus if it is Isolated From the Urine

By John Joseph Pack MD

Staph aureus in urine may not be a simple UTI. Learn why this culture result can point to a bloodstream source.

Painless Hematuria in the Older Adult Requires Cystoscopy if CT Urogram Fails to Provide a Definitive Source

By John Joseph Pack MD

Painless hematuria in older adults demands a malignancy-minded workup. Know when cystoscopy remains necessary after imaging.

Be Aware That, Although Rare, Glioblastoma Can Spread Extracranially

By John Joseph Pack MD

Glioblastoma rarely spreads outside the CNS, but when it does, the pattern can surprise clinicians. Know what to watch for.

Differentiate Botulism From Myasthenia Gravis and Guillain-Barre Syndrome

By John Joseph Pack MD

Botulism can mimic other neuromuscular disorders. Learn the clinical pattern that helps separate it from MG and GBS.

The Risk of Hydroxychloroquine-Induced Retinopathy Rises Dramatically After 5 Years

By John Joseph Pack MD

Hydroxychloroquine retinopathy risk changes with time and dose. Know when screening becomes especially important.

Review the Causes of Toxic Megacolon

By John Joseph Pack MD

Toxic megacolon can complicate IBD and infection. Review the triggers and warning features that should raise urgency.

Understand the Various Locations to Safely Attempt a Paracentesis

By John Joseph Pack MD

Paracentesis safety depends on choosing the right site. Review the landmarks that reduce avoidable procedural risk.

Understand the Difference Between Calcium Chloride and Calcium Gluconate for Hyperkalemia

By John Joseph Pack MD

Calcium chloride and gluconate both stabilize myocardium in hyperkalemia, but their differences matter when seconds count.

Understand the Treatment of Hyperkalemia in an Emergency Setting

By John Joseph Pack MD

Emergency hyperkalemia treatment follows a sequence. Learn which steps stabilize the heart and shift potassium quickly.

Review the Diagnostic Criteria for Spontaneous Bacterial Peritonitis

By John Joseph Pack MD

SBP can present subtly in cirrhosis with ascites. Learn the paracentesis finding that turns suspicion into diagnosis.

Vitamin B12 Deficiency

By John Joseph Pack MD

A concise pearl on B12 deficiency testing and the metabolite clues that can reveal what a borderline level misses.

Vertigo

By John Joseph Pack MD

Use the HINTS exam to separate benign vertigo from dangerous mimics, but only when the presentation fits the right pattern.

Acute Appendicitis

By John Joseph Pack MD

Classic appendicitis signs can sharpen your exam, but the sequence of symptoms may reveal the diagnosis before imaging.

Inflammatory Arthritis

By John Joseph Pack MD

Morning stiffness duration can change the arthritis differential. Learn the timing clue that points beyond osteoarthritis.

Cauda Equina Syndrome

By John Joseph Pack MD

Cauda equina syndrome is easy to miss until key bladder and sensory findings appear. Know when back pain becomes emergent.

Spinal Cord Compression

By John Joseph Pack MD

Severe back pain with new urinary retention can signal more than a disc problem. Know when cord compression enters the differential.

Streptococcus Pyogenes Pharyngitis

By John Joseph Pack MD

Group A strep pharyngitis has a recognizable pattern, but the right clinical clues determine when testing and treatment matter.