Patients are increasingly demanding, and understandably so, that since they pay for their medical tests, they should receive results directly and immediately without waiting for physician review or interpretation.  Recent articles in the lay press about this issue are accompanied by scores of online patient comments insisting that physician reporting and interpretation is too often unreasonably delayed, often inaccurate, or just plain unhelpful, so why bother waiting at all? Dr. Google ...

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I recently followed a brief spat on Twitter between a journalist and a doctor.  It did not go further than a few irritable tweets, but I had to agree with the doctor’s point of view. The journalist had written an article about the death of a South African shack fire victim, admitted to hospital with 100% burns, and the contrast in perceived care he received compared to that of a ...

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"I gave at the office." I am an American taxpayer just like most of you, the audience. My tax dollars, and yours, fund the great majority of health-related research in the United States, mostly through the National Institutes of Health. Thus, I, and you, the taxpayers, own the results of that NIH funded research. We paid for it. Then, why, for goodness sake, do I, the owner, or my physician, another owner, have ...

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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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