I felt a woman’s uterus without her permission. How this happened, and why I thought I had done the right thing at the time, tells us something important about medical education and shows us why doctor/patient interactions often play out like conversations between earthlings and aliens. To understand my inappropriate actions, you need to know something about the physical exams that we physicians conduct on our patients. More specifically, about the ...

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Facing advanced cancer, who among us wouldn’t look to our oncologist for expert advice on whether another round of chemotherapy makes sense?  But do you know what your oncologist cares about, and can you be sure her recommendations map onto your own treatment preferences? A recent study lead by Michael Kozminski (I was senior author) shows that American oncologists downplay the value of treatments that improve quality of life, ...

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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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LeBron James exploded past his defender and raced towards the lane.  Serge Ibaka, the Thunder’s mountainous center, planted his feet and raised his hands straight up into the air.  LeBron ducked his left shoulder and plowed right into Ibaka, who went crashing backwards into a nearby cameraman. Offensive foul? Maybe if it had been the first quarter.  But given that this was the last minutes of a tightly fought game, the referees ...

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A recent economic analysis concluded that patients with metastatic cancer value their treatments significantly more than regulators recognize, with many expensive new therapies looking like veritable bargains to most patients. Yet the study ignored the values really driving oncology spending—the warped incentives oncologists have to promote their own bottom line by prescribing expensive treatments. Let’s start with the economic analysis, another in a series of studies by a USC team of ...

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In a new study published in JAMA, my colleagues and I found that even after accounting for productivity, women working as physician researchers at American Medical Schools are paid $13,000 less per year than their male colleagues, a difference that amounts to hundreds of thousands of dollars over the course of their careers. But does this difference stand as evidence of discrimination? Many claims of gender inequity in pay have suffered ...

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I first realized something was amiss when I picked up my prescriptions and the pharmacist explained that she could not fill the anti-malarial medications as prescribed: "Your medication plan only pays for 30 days of pills, and your prescription was for five pills." The pharmacist continued: "Your PBM [that's an acronym for pharmacy benefits management company, the type of company that coordinates many peoples' medication coverage] only fills this medication ...

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