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Had a friend from a different field ask a question regarding my own. I gave him my answer based on experience and the guidelinesI know and follow, in my field’s practice in the country we work in. He started arguing with me and presented different guidelines, from another country (US, we are in Europe), aimed for his field about how to manage this question. It’s his patient and his decision, why did he bother asking for my “expert opinion” if he wants to follow his guidelines from a completely different country? I think it’s time to recognize that management of the same condition differs from field to field according to skill set and experience, a point to think about when asking another field for a consult….

A 45-year-old woman presents to the emergency department with right sided abdominal pain. There is associated nausea and vomiting. An ultrasound is swiftly done. 

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What does the ultrasound image show? 

I received a strange request. A 26 year old woman who is scheduled to have an elective cesarean section is requesting a prophylactic appendectomy since 'you will be there anyway'. She is very active for her work and says she does not want to be taken off work in the future for appendicitis. She also says she knows someone abroad who had this done. There is no medical history other than previous cesarean section (also the reason for this one). Of course, I won't be removing her appendix in any case but should I even consult a general surgeon? Is this really something people do, in general, or in a different country? 

Hello, what would you suggest for post herpetic neuralgia in a 58 year old with type 2 diabetes and recent reactivation of VZV? We have tried amitriptyline, pregablin and triple cream (containins amitriptyline, ketoprofen, lidocaine). Nothing seems to be working and it is causing disruption to his life. Is there anything else someone could suggest?

I have a 35 yo female patient who is a religios worker and does not intend to be sexually active, asking about HPV vaccine. Is there any point in vaccinating her if its technically an STD? shes not a health care worker or have any contact with skin to skin . do you still give the vaccine to these patients?

A 69 year old man, smoker, is referred for worsening chest pain, exacerbated by exercise. He undergoes coronary angiography and an image is taken - 

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Which arteries are occluded in this angiography image?

A 32 year old man come to clinic becuse of bad breath all the time and feel like somthing stuck in throat. On exam his tonsils are big with white stones inside but no fevers, no sore throats, no infections in past. He ask if he can remove the tonsils but not sure he want surgery. Do you send this kind of case to ENT for removal, or just tell him to do wash and cleaning? I am not sure if stones alone is enough reason.

I started practicing in a new country and am expieriencing huge (professional) culture shock. Doctors acting like they are 'gods', speaking down to their patients and just generally abrasiveness. It took me a long time to be licensed in this country and get a visa to work here. Better position, better pay. Relocated my family here. But this kind of mindset makes me feel like I am losing meaning in my job. Is it my fault? Should I just expect less?

Saw a women in the clinic and had to provide bad news during the meeting (severe IUGR). When I did the sonogram I immediatly saw it was abnormal and did not say anything on purpose but the medical student sitting next to me commented on it and said many times how severe it was, the women started crying and the husband was hysterical. I waited until they left to tell him off but the situation was so bad I wanted to ask him to leave. Have you ever had this sort of thing? I want to refuse the next student coming to my office

I sent a 32 year old patient, male, to MRI due to lower back pain and it was reported that he has a sixth lumbar vertebra but no other abnormalities. Is there anything else that can be done other than analgesia and physiotherapy? He is a firefighter and has taken many days off work for this problem. Is surgery an option?

A 2-year-old child presented with a sudden-onset rash on his hands, forearms, and trunk after taking an antibiotic for a respiratory infection. The lesions were erythematous concentric rings with central clearing. The parents denied fever, joint pain, or mucosal involvement, or any other rash preceding this one. On examination, the rash was widespread but non-tender, and very itchy.

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 I’ve noticed north american doctors in USA and Canada prescribe a lot more analgesia, sometime even opiates, to things I would never imagine prescribing them for. Tooth aches, menstrual cramps, mild procedures, chronic back pain - things I would consider are Panadol + NSADIS worthy receive tramadol and even Percocet. Is it the patient’s expectation in the USA to not experience any discomfort or does is come from doctors?

An 11 years old boy presents with mild dysarthria. Five months ago, he underwent ipsilateral branchial cyst operation. Examination revealed marked hemiatrophy of left side of the tongue, as follows: 

The rest of the neurological examination is normal. 

What is the most likely diagnosis?

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A large-scale meta-analysis published in npj Digital Medicine offers one of the most comprehensive evaluations to date comparing the diagnostic accuracy of generative AI models with that of physicians. The study reviewed 83 articles published between 2018 and 2024, encompassing a wide range of AI models, including GPT-4, Claude 3 Opus, Gemini, and others, and their application across medical specialties like general medicine, radiology, neurology, and dermatology. Overall, generative AI demonstrated a pooled diagnostic accuracy of 52.1%, showing no significant difference in performance compared to non-expert physicians—but a clear performance gap remains when compared to medical experts.

This finding is both encouraging and cautionary. On the one hand, AI models like GPT-4, Gemini 1.5 Pro, and Claude 3 Sonnet showed diagnostic capabilities similar to non-expert physicians, suggesting potential roles in triage, education, and augmenting clinical workflows, particularly in resource-limited settings. On the other hand, expert physicians still outperformed generative AI by a statistically significant margin (15.8% difference in accuracy), emphasizing that clinical decision-making remains firmly in the hands of trained professionals—for now.

The analysis also highlighted that AI performance varies by specialty. Dermatology and Urology showed notable differences, although the dermatology results may reflect AI’s inherent strengths in visual pattern recognition rather than holistic clinical judgment. Importantly, the study found that most research in this space is still of relatively low methodological quality, with 76% of studies at high risk of bias. Many models were evaluated without clarity on their training data or external validation, raising concerns about generalizability across diverse patient populations.

For clinicians, this meta-analysis suggests that while generative AI is not yet a substitute for experienced diagnosticians, it holds considerable promise as a clinical support tool. It may already be capable of assisting with diagnostic accuracy among junior physicians, medical students, or in underserved settings lacking specialty expertise. Moreover, the potential for AI in medical education is noteworthy, as its performance in simulated diagnostic tasks may help expose learners to a broader range of clinical scenarios...Read More

If a diagnostic AI made a clinical error, who do you think should be held accountable: the physician, the hospital, or the developers?

NPJ

From news briefings during morning commutes to long-form podcasts on medicine, politics, and society, audio content has become a dominant force in how the public consumes information. While AM/FM radio still holds the top spot for in-car listening, Edison Research shows a sharp rise in podcast and online audio use—revealing how longer commutes are now fueling a blend of both traditional and modern audio habits. Today, 40% of Americans listen to podcasts at least monthly—a figure that continues to rise each year. New AI-powered apps that convert medical texts and articles into speech are transforming how clinicians consume information; by supporting multitasking and reducing screen fatigue, audio content makes it easier for physicians to stay current with complex global events and the rapid pace of medical advancements.

How often do you listen to audio content, like radio, podcasts, or streaming audio, to stay informed?

I have a 40-year-old healthy woman with mild normocytic anemia found on routine examination – Hb is 9.5, MCV 80. She is asymptomatic except for maybe a little tiredness, with no history of heavy periods, gastro symptoms, chronic disease, or significant blood loss. Iron studies, B12, and folate are normal, as are renal and liver function tests. Celiac antibodies are negative, and  gastroscopy& colonoscopy showed no abnormalities, no hemolytic signs in lab. I am considering peripheral smear, reticulocyte count, because there is no clear cause. What else would you suggest I do?

I have a 60-year-old woman with hyperlipidemia who was started on atorvastatin 10 mg, but she came back complaining of muscle aches within a week. She insists she can’t tolerate it but has never tried another statin. CK levels are normal. Is this true intolerance or a nocebo effect? Would you trial a lower dose, a different statin, or just drop it and try ezetimibe

Failure rate in nirsevimab - a 5-month-old infant, born at term with no significant medical history, presented to triage with symptoms and tested positive for RSV. She received the nirsevimab before leaving the hospital after birth. I'm wondering what are the normal rates of RSV infection after nirsevimab for healthy babies?

Hello, can someone help me out with my daughter's rash? 16 years old, generally fit and healthy and on a combined contraceptive pill for dysmenorrhea. She is getting these itchy rashes/urticaria (see photo) whenever doing activities like swimming in rivers, springs or the sea. Even sometimes when it is raining and cold outside, but not when she showers. We have tried antihistamines but it doesn't help. She has also had a sun allergy since childhood. Is it some sort of allergic reaction? Are the two conditions linked? Anything to give her for symptomatic relief?

Good evening, do you send women mammogram / breast surgeon before starting IVF? It is routine in my practice but I think leads to overinvestigations…

A 71-year-old female with a history of recurrent urinary tract infections and Type 2 diabetes presents with fever, chills, and confusion over the past 24 hours. She also reports dysuria and flank pain.

Vital signs indicate hypotension and tachycardia. Lab work reveals leukocytosis, elevated lactate, and acute kidney injury. Urinalysis shows significant pyuria and bacteriuria. Blood and urine cultures are pending.

What immediate steps would you take to stabilize her, and how would you tailor her treatment pending culture results?

Dear colleagues, 

I would like to share my paper, Optional Vaccines in Children—Knowledge, Attitudes, and Practices in Romanian Parents, with you - 

In our study published on Vaccines, we explored the underlying factors influencing vaccine hesitancy and acceptance among Romanian parents regarding optional vaccinations. Our survey, conducted through a validated online questionnaire, indicated that a significant majority of parents (55.1%) demonstrated very good knowledge about vaccines and vaccine-preventable diseases, with 76% having administered at least one optional vaccine to their children, the most common being the rotavirus vaccine, followed by varicella vaccine and influenza inactivated vaccine. Parents also indicated which optional vaccine they wanted to be included in the National Immunization Program - with rotavirus vaccine topping the list, followed by MenACYW and MenB vaccine. 

The main reasons for not vaccinating or partially vaccinating children included fear of adverse reactions (26.6%), parents’ own decision to postpone vaccination (21.8%) and a recommendation to avoid a particular vaccine from the GP (4.7%) or the pediatrician (7.1%). This data reinforces the need to strengthen doctors‘ communication with the group of hesitant and insufficiently informed parents, as well as the need for continuous medical education among doctors. 

How do you address parental concerns about optional vaccines that are not included in the national immunization schedule?

Full article: Miron, V.D.; Toma, A.R.; Filimon, C.; Bar, G.; Craiu, M. Optional Vaccines in Children—Knowledge, Attitudes, And Practices in Romanian Parents. Vaccines 2022, 10, 404. https://doi.org/10.3390/vaccines10030404

The above text was summarized from the original publication, with permission from Dr Mihai Craiu, by G-Med medical writers through the Quick Upload feature.

Primary care has always been the foundation of modern medicine—the first line of defense, the system that keeps patients out of hospitals, and the one place where long-term health is actually managed. Yet, quietly and steadily, it’s disappearing. Fewer doctors are choosing primary care, more patients are struggling to get appointments, and the entire healthcare system is shifting to compensate.  

The problem isn’t just that primary-care doctors are in short supply—it’s that medicine is adapting to their absence in ways that could reshape healthcare forever. Across hospitals and clinics, the workload once managed by primary-care physicians is being absorbed by a patchwork of alternatives. Nurse practitioners and physician assistants are taking on increasing responsibilities, sometimes with minimal oversight. Urgent care centers and retail clinics are filling in for long-term care, treating patients on a visit-by-visit basis. Telemedicine is expanding rapidly, but often at the cost of continuity. Artificial intelligence is being positioned as a diagnostic tool, with algorithms attempting to replicate the intuition and pattern recognition that experienced doctors develop over years of patient interactions.  

These shifts make healthcare more accessible in the short term, but they come with hidden consequences. Nurse practitioners and physician assistants, while invaluable to the system, do not undergo the same level of training as physicians. Studies have shown they refer patients to specialists more often, leading to increased healthcare costs and unnecessary procedures. Within the Veterans Health Administration, emergency departments that expanded the role of NPs saw a 7% rise in per-patient care costs due to higher rates of diagnostic testing and hospital admissions. Meanwhile, a 2024 study found that NPs referred patients to specialists 35% more often than doctors, increasing healthcare costs and unnecessary interventions.  

The crisis isn’t limited to the US—it’s a growing problem worldwide. The World Health Organization estimates a global deficit of 4.3 million physicians, nurses, and other health professionals, with Europe facing its own primary-care crisis. Despite a slight increase in the number of general practitioners per capita in recent years, many countries still have severe shortages, leading to delayed care and overburdened emergency rooms. In England, the NHS is approaching a tipping point where more patient appointments will be handled by non-physicians than by GPs, fundamentally changing the way care is delivered. In the US, the Association of American Medical Colleges predicts a shortage of up to 124,000 physicians by 2034, with primary care being one of the hardest-hit areas. The impact is already being felt— in 2021 alone, an estimated 117,000 physicians left the workforce, citing burnout, retirement, and stress from the pandemic.  

The loss of primary-care physicians is not just a workforce issue—it is fundamentally changing healthcare delivery. Where once primary care was about prevention, continuity, and relationships, it is now becoming a system of quick consultations, reactive treatments, and fragmented care. Patients are spending more time managing their own referrals, navigating a system that no longer prioritizes coordination. What does a world without primary care look like? Rising healthcare costs, overwhelmed emergency rooms, and worsening health outcomes as chronic diseases are caught too late. The real question is: are we truly prepared for the price of letting primary care disappear?

A patient got back from a consultation (not hematology....) and the doctors told him with an absolute tone that he needs   more iron. Ferritin was 29, Trasferrin saturation was 30%, hemoglobin and RBC normal, MCV and MCH within limits. I know ferritin can reflect iron stores but I thought it’s a little early in this case to determine he needs more iron, the patient has a history with constipation and really fears more iron tablets….. how do you treat these labs results? Does ferritin really reflect iron stores to it’s fullest or is TS enough to determine need for treatment? Cant get a straight answer from Up to date….

A 19-year-old college student presented with recurrent episodes of palpitations, dizziness, and shortness of breath lasting several minutes. He denied chest pain or syncope. On examination, his heart rate and rhythm were normal. A 12-lead ECG revealed a shortened PR interval and a delta wave. No structural abnormalities were noted on echocardiography. 

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The other day at clinic, I saw a 1 Y/O with symptomatic croup. He has already been to the ER and treated with steroids and adrenaline, and came again with 3 days of fever. The child was happy and well appearing, otherwise healthy, and the father insisted I refer to an X ray for suspected pneumonia because his “older child had something exactly like that but they missed pneumonia”. With an otherwise normal exam, I explained in length how he doesn’t require any radiograph, he looks fine, and the fever is all part of a viral illness. The father was not willing to accept my explanation and instead I suggested to perform a lung point of care ultrasound, and low and behold a large lobar pneumonia on his LUL. I prescribed amoxicillin and felt embarrassed after insisting for so long theres no way the child has pneumonia. I apologised to the father who continued to scold me how doctors are too proud to admit their mistakes and I should learn to be more careful with my diagnosis. I know POCUS are oversensitive and the child was well appearing, not dyspneic or tachypneic, and would have been fine even without the antibiotics. But what do you do when you’re faced with your mistake? Am I even wrong for performing the POCUS?

The global fight against HIV is facing a crisis as hundreds of doctors, researchers, and public health experts sound the alarm over sweeping US aid cuts. With the abrupt termination of funding to key international health initiatives, millions of lives are now at risk, and decades of progress in battling HIV, tuberculosis, and malaria could be undone.

At the center of the controversy is the near-elimination of the President’s Emergency Plan for AIDS Relief (PEPFAR)—one of the most successful public health initiatives in history. Since its launch, PEPFAR has saved an estimated 26 million lives worldwide, providing antiretroviral treatment, prevention programs, and crucial support to communities hardest hit by HIV. Now, with US funding slashed, access to life-saving care is being cut off, ongoing medical trials have been abruptly halted, and leading research institutions, including Johns Hopkins University, are losing funding and staff.

An open letter to Secretary of State Marco Rubio, signed by high-profile figures in global health, warns that six million deaths could occur in the next four years if these cuts are not reversed. The letter, signed by Nobel laureate Francoise Barre-Sinoussi and hundreds of others, paints a dire picture of what happens when political decisions take precedence over public health. The loss of research funding means that study participants around the world are being left stranded mid-trial, delaying or even derailing progress on new treatments and prevention strategies.

The US government has framed these cuts as a necessary move to reduce spending, while White House advisor Elon Musk has openly boasted about gutting USAID, the primary agency responsible for global humanitarian aid. But for the millions of people dependent on these programs, the consequences are immediate and irreversible. Even if legal challenges eventually overturn the decisions, the suffering and loss of life happening now will not be undone...Read More

What are your thoughts?

MedicalXpress

I recently looked after an incarcerated woman who gave birth. I was very troubled by the fact that she had to be handcuffed nearly the whole time, with the exception of the time she was actively pushing. Yes, I understand that I work at a standard hospital, which is not secure. But really, where is she going to go? Surely there is a more ethical way. I felt so helpless having to watch these silly rules implemented by non-healthcare staff onto my patient. Am I in the position to insist otherwise?

An 82-year-old man has been experiencing increasing forgetfulness and difficulty managing daily tasks over the past 3 years. His family reports that he often misplaces items, repeats questions, and struggles to recognize familiar faces. Recently, he has become more withdrawn and confused about time and place. Occasionally he gets agitated which is uncharacteristic of his historically patient and calm diposition. 

Imaging reveals simmilar findings to those in the following image:

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

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I had a patient refuse a surgery because they said it would make them lose their spirit. It’s not the first time I face such beliefs, and it can be so hard to explain the medical reality in a way they can accept. I respect their views but feel conflicted knowing the health risks. What are ways to navigate cultural differences in practice?

50 years old women, with CV history of NSTEMI, DM, HTN, currently on ACEI and aspirin, already finished DAPT and not on brillinta anymore (heard it’s more common now to keep brillinta). She is on HRT for the past year and the cardiologist who is following her doesn’t like it because of her CV history and said to try dermal HRT patches. She really hates vasomotor symptoms, mood swings, dryness, and is better on systemic HRT so i am thinking to switch but wouldn’t like to risk her with the CV history. Is dermal HRT better than oral treatment in these cases? Would it have decreased effect in terms of symptoms? thank you

A 45-year-old male with a history of gout presents with severe right flank pain and hematuria. He denies fever or dysuria.

CT imaging confirms the presence of a 6 mm uric acid kidney stone in the right ureter.

What strategies have worked best for your patients in preventing recurrence with UA kidney stones? 

A 63-year-old woman with advanced cancer refuses chemotherapy, believing that prayer alone will heal her. Her oncologist struggles with the ethical dilemma—should he push for treatment, knowing it might extend her life, or respect her faith-based decision, even if it means a shorter prognosis? These are the tough realities many doctors face, where science meets belief, and the right course of action isn’t always clear.

For many patients, illness is not just a medical experience—it’s a deeply spiritual one. Research shows that up to 78% of patients with cancer consider spirituality important in their healthcare journey, and many make medical decisions based on religious beliefs. Some refuse blood transfusions, others fast despite health risks, and many look for divine intervention when medicine reaches its limits. Yet, despite this profound influence, modern medicine often treats spirituality as an afterthought, leaving a critical gap in holistic patient care.

Consider a young Muslim patient diagnosed with diabetes who insists on fasting during Ramadan, despite the dangers. His endocrinologist has two options: firmly advise against fasting or work with him to adjust his insulin schedule to minimize risks. Many physicians are trained to focus solely on medical facts, but real-world medicine isn’t always that simple. Sometimes, patient-centered care means meeting patients where they are—faith and all. Studies even show that when doctors acknowledge a patient’s religious beliefs, patients report greater satisfaction with their care. However, most physicians aren’t trained for these conversations, leading to missed opportunities for trust and collaboration.

And then there’s end-of-life care. A devout Christian man in the ICU insists that his doctors “do everything possible” to keep him alive, even as his organs fail and his suffering increases. His family clings to hope, praying for a miracle. The medical team knows that aggressive interventions may only prolong pain, but how do you tell a grieving family that their faith in divine healing won’t change the inevitable? Studies suggest that patients who receive spiritual support from their medical teams are more likely to opt for palliative care over aggressive interventions, leading to better quality of life in their final days. But when spiritual needs are ignored, patients and families may feel abandoned or misunderstood, adding emotional distress to an already difficult situation.

So, what’s the right approach? Should doctors engage with patients’ spirituality, or is that crossing a professional line? Have you faced a situation where religion shaped a medical decision in ways you didn’t expect?

Help! I have seen over 20 toddlers in the past week with severe URTI and nasal congestion, I recommended supporative care for the parents with nasal saline but they’re looking for something more efficient…. Do you recommend nasal xylometazoline routinely to kids? Pseudoephedrine? Or do you stick with saline?

Wanted your opinion on something –

39 year old women, 3rd pregnancy, 14 weeks. Felt a lump in her right breast the other days, it’s barely noticeable, was a little tender to touch, not very large, and new. Sent for US because of the pregnancy, BIRADS was 3B and biopsy was recommended and I'm hearing thoughts both ways.

Breast cc can definitely occur at this stage and we should investigate each lead to it’s fullest. On the other hand breast changes can occur with pregnancy and she wants minimal intervention because she’s still nursing her younger kid (11 months old). What do you think?

Breast surgeon consult is booked for 10 weeks from now which is late in the pregnancy to make any hard choices….

A 73 year old woman with well treated hypothyroidism and a remote history of smoking presents to the emergency room with acute lethargy and weakness which started when she woke up 3 hours ago. Additionally she has a self described heaviness in her chest that does not radiate. 

ECG reveals the following: 

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I wanted to get your thoughts on something I’ve been dealing with in my practice.

I work in a public healthcare system, but as you know, dental care is largely private. I often get patients coming in and asking me to write prescriptions based on their dentist’s recommendations. Most of the time, it’s for antibiotics—usually amoxicillin—and I’m not saying it’s never justified, but it’s a lot of antibiotics coming through my office. The problem is, I often have no idea what I’m actually treating. Some patients don’t even bring me a visit summary or any written explanation; they just expect me to write the script because "the dentist said so."

Honestly, it doesn’t feel very professional to keep doing this, especially since I’m technically signing off on something without having the full clinical picture. I don’t want to dismiss the dentists’ judgment, but at the same time, it’s still my medical license on the line. I’ve tried asking patients to bring documentation from their dentist, but compliance is spotty, and sometimes they look at me like I’m being difficult for no reason.

How do you handle this kind of situation in your practice? Do you write the prescription based on the patient’s word? Do you call the dentist to confirm or ask for a written note? I want to make sure I’m handling this responsibly without creating unnecessary barriers for the patient

I have patient with very uncontrolled hypertension, already had one minor stroke, poor compliance with the meds. She’s the “alternative” type and I know she sees a lot of other therapists who use natural remedies and I'm usually fine with it as long as they don’t cause any harm. She recently told me shes seeing another doctor, who specializes in blood pressure, I was naïve to assume it was a nephrologist but it’s actually a  full on Chinese HERBALIST who has a PHD and calls himself a doctor on social media. I think its gross neglence and misleading information, I want to complain somewhere but where?????

I overheard a colleague speaking with a young patient with advanced NSCLC. She'd progressed on first-line chemo, and the options for second-line treatment were limited. My colleague avoided discussing survival rates and focused on treatment options like immunotherapy. When the patient asked if she'd see her kids grow up, he emphasized potential treatment benefits rather than the harsh prognosis.

It got me thinking…do we soften the truth to keep their hope alive, or are we really just shielding ourselves from the weight of reality? And in doing that, are we being unfairly dishonest without even realizing it?

A 7-year-old boy presented with a burning, blistering rash on his hands and forearms for the past 2 days. History includes playing outside during a family picnic drinking lemonade, no exposure to animals or new substances, no allergies, no recent illness. On examination, the affected areas were erythematous, with irregular, streaky hyperpigmented patches and some vesicles. The child was otherwise healthy and afebrile.