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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Costs are spiraling out of control, access is declining, and our quality of care doesn't match what other developed nations are delivering at half the cost. In the search to reduce costs and bring our ever inflating health care budget under control, the powers that be (insurers, government, health policy wonks (and maybe a few doctors) have looked to individuals with less formal education to perform medical services that were once ...

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I gently rotated his arm as the beads of sweat formed on his forehead.  The pain came in waves.  His face contorted and relaxed in repetitive spasms.  I wondered if my exam was in vain.  The cancer had spread from his lungs to his liver and into his bones.  Once the blood stream had been tainted, the aggressive cells took flight and landed in various organ systems. We already had the conversation.  I ...

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The circle of support in the critical moments of the cancer journeyOn a recent trip to Philadelphia, I caught up with Dan, a friend of mine since college. He is an artist in Philly, where he lives with his wife and daughter. He had asked me about being an oncologist, told me he had read my ASCO blogs. We spent hours discussing everything—parenthood, careers, and mutual friends, and one in particular. Her ...

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