A 4-year-old girl presented to the office with her mother, who was concerned about a skin problem affecting her heels. According to her mother, the patient’s symptoms were present for six months or more. The child’s symptoms included a severe itch that caused constant scratching, pain and cracking of the skin leading to bleeding.
Previous home treatment included the application of various over the counter creams including hydrocortisone, antifungals and hand lotions. These treatments did not help. She had no prior treatment by a physician for this problem.
Her past medical history was

Difficult patients are challenging enough but when the difficult patient is also a postoperative patient, the challenge becomes a medico-legal risk. Difficult patients are not difficult because they have special medical needs. They are difficult because they challenge our defenses, stretch our tolerance and patience, or demand much more of our time than we can give. However, it is possible to care for these challenging patients if you know how.
Taking on a difficult patient can spiral into a battle of wills and wits that you are destined to lose. That is why it is necessary to understand you

When documenting a patient’s vascular condition, a new lightweight technology may be an option.

The Smartdop^® 30EX is a bidirectional portable Doppler with an integrated printer and large visual LCD display, according to the manufacturer Koven Technology. The company notes the product also has an automatic cuff inflator for quick, simple, accurate ankle brachial index (ABI) and tibial brachial index (TBI) testing.
With the Smartdop 30EX, the company says one can save up to 30 waveforms for later reference or print them out. Koven notes one can also download the optional Sm

I used to play a game called Risk with a group of friends during the early years of my practice. We would gather at somebody’s home or office, bring pizza and beer, and start the game.
Risk is a game where you try to conquer the world with little plastic armies, using dice and strategy to gain continents and countries. As the night wore on and the beer and pizza were ingested or thrown at other players, our “risk” tolerance grew. A strategy I enjoyed was irritating another player by slinging insults about his profession and then conquering his countries. My friends/opponents returned th