Steve is lying almost flat in the hospital room, an IV attached to his arm.  I am happy to see he is more comfortable, last night’s crisis has passed.  He smiles as I enter and walk to his side.  I touch his hand as I sit down on the pressed clean blanket.  And then … a shrill loud wail breaks the silence … lights flash above his bed … fear ...

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All too often the most powerful illusions seduce us through truthful whisperings.  Let’s start with an obvious truth: Living a long and happy life after a cancer diagnosis is better than living a short miserable one. Given a choice between receiving a diagnosis of metastatic cancer—an incurable life-ending-it’s-already-spread-to-your-brain neoplasm—versus the diagnosis of a localized, snip-it-out-and-it’s-done tumor: Who wouldn’t choose the latter? And yet this simple truth causes doctors to embrace unproven screening ...

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A few days ago, I received a question that stopped me in my tracks. I was giving a talk to a local church group on the importance of patient advocacy, and most everyone was nodding. Yes, doctors don't always listen -- let's do something about it! Yes, we need to control of our health. Then someone raised her name. Her name is Susan, and she is the owner of a mom-and-pop grocery in ...

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As doctors in training, we learn to think in patterns of symptoms and can often use "clinical judgement" to fit a patient's presenting symptoms into a diagnosis.  This generally works well, until we are presented with an unfamiliar pattern.  For example, in the early 80's I saw a 60 year old shoe salesman with fatigue and a low grade fever.  He had general malaise and some muscle weakness.  His exam ...

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I love being a medicine attending in the summer. It's often more intense work since everyone's in a new role. Bright, fresh interns. Excited new residents. And the medical students - the new third-year students who have toiled in the classroom finally get to focus on patient care. Their enthusiasm over hearing a mitral regurgitation murmur, over watching a paracentesis, and, well, their enthusiasm over everything, is infectious. Perhaps it's a ...

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I knew it would happen sooner or later, and earlier this week it finally did. In 2003 US News & World Report pronounced my hospital, UCSF Medical Center, the 7th best in the nation. That same year, Medicare launched its Hospital Compare website. For the first time, quality measures for patients with pneumonia, heart failure, and heart attack were now instantly available on the Internet. While we performed ...

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In the debate over health care reform the issue of choice is often brought up.  I’m not referring to a women’s right to choose or the birth control controversies but the simple idea of individuals being able to choose their health plan or physician. However most physicians would probably agree that for much of health care, especially unexpected and sudden illnesses, the idea of choice is an illusion.  Patients rarely choose ...

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"The plural of anecdote is not data." A recent lead editorial in the Sunday edition of the New York Times was entitled "A Formula for Cutting Health Costs" and contained the byline "Alaska natives have something to teach doctors and patients in the rest of the world." I read the editorial with interest, hoping that a new perspective, vision, idea, or insight would be mentioned that would provide a sustainable cost solution ...

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Ralph Coates, PhD of the Center for Disease Control (CDC) described in the June 15, 2012 issue of Morbidity and Mortality Weekly Report that by looking back at a U.S. study done between 2007-2010 called “Use of Selected Clinical Preventive Services among Adults,” health providers need to do a more comprehensive job of offering preventive services. According to the report, only 47% of patients with documented heart and vascular disease were ...

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In today’s healthcare environment, nearly half of all new physicians are salaried employees of a hospital or healthcare system. Now, more than ever, physician leadership is of paramount importance. With increasing pressure to increase care quality and simultaneously lower healthcare delivery cost, it is essential that physicians and administrators  work together. Physicians must continue to grow into executive roles and lead both healthcare systems as well as manage other doctors ...

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