The art of eliciting the medical history requires medical knowledge, cultural knowledge, and many “people skills.”  History taking is not science, but rather, art, because it requires interpretation and clarification.  Patients with the same symptoms express them differently.  A major feature of the art of medicine involves learning how to interpret different descriptions of the same phenomenon. A few examples might clarify these concepts. The patient tells you that they have chest ...

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Around 30 years ago, LRZ taught me a most important lesson.  LRZ, one of my most fondly remembered patients, was a classic blue collar guy.  He had a wonderful, gregarious personality.  He had significant systolic dysfunction, yet still worked hard for the city.  Amongst other things he did, he shoveled the salt into trucks on snow and ice days.  He functioned well most days. One day he came to see me. ...

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The term, "evidence-based medicine" (EBM), provokes strong feelings from its proponents and its skeptics.  I spent a full day recently in discussions about EBM.  As the day proceeded I understood that evidence is wonderful when it fits the clinical question, but that too often the clinical question does not, and probably will not have adequate evidence. We have great evidence for some clinical questions.  We all know that ACE inhibitors decrease ...

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Charles Bukowski once said, “Wherever the crowd goes, run in the other direction. They’re always wrong.” How does one become a master?  What process do we use to have the highest probability of success? Here are some examples. "Picasso was an extraordinary craftsman, even when measured against the old masters. That he chose to struggle to overcome his visual heritage in order to find a language more responsive to the modern world ...

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Readers know that I believe that servant leadership should inform leadership and management decisions.  We who have the privilege of having leadership positions at medical schools, therefore, have as a primary responsibility to our students. Being a medical student, while a reward and a privilege, is nonetheless a stressful experience.  The first two years at most U.S. medical schools have the students grinding through the basic sciences related to medicine.  The volume ...

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Ran into a radiology colleague today.  He will retire soon, and was happy to discuss the stress on radiology.  I have observed more interpretation errors (or at least I think I have) over the past five years.  We now strongly stress that the learners review all films and question radiology reads. My friend opined that volume expectations have become unsustainable.  We order too many imaging studies.  When you ask physicians to ramp ...

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This post is purposely controversial.  I write it because I believe that mounting evidence suggests that we should encourage “out of the box” thinking about this issue.  This post is hypothesis challenging.  I may be right, or I may be wrong.  I hope we get some debate on my speculations. The latest blow to the cholesterol hypothesis: "Dashing Hopes, Study Shows a Cholesterol Drug Had No Effect on Heart ...

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This year marks 33 years of administrative positions in academic medicine.  When I first started, I suspect I made many major mistakes.  I learned through the time-tested school of hard knocks.  As I reflect on my own career, and those whom I have observed, I have come to believe the famous saying, "Culture eats strategy for breakfast." Look at ward attending physicians.  The same attendings have “good teams” every ...

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An anonymous medical student has this post on KevinMD -- A star medical student feels like he made a terrible decision:

And so, medical students learn quickly how to play this game. We enter noble. We leave jaded. We leave seeing that the smart move is to get out of it. And so the smartest of the smartest, the ones lucky enough to have a choice, go into fields where ...

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Donald Ross (an obvious pseudonym) has practiced in a medium sized town for around 20 years.  I count him as a protege as we worked together during his residency.  As a clinician educator, we work with many interns and residents, and sometimes we develop lifelong relationships.  Donald Ross and I share a love of golf, ACC basketball (although we root for rival teams), and internal medicine.  We periodically communicate through ...

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