After reading this excellent study in the BMJ showing no benefit and some risk of harm from annual mammographic screening for breast cancer (see also this discussion in the NY Times) I suggested to a local institution that they should reconsider their Pay for Performance (P4P) initiative which penalizes their clinicians (by lowering their pay) if their female patien

All day long I work with patients who want answers and certainty. My awareness of how few questions have proven answers, and how unpredictable human health and disease can be, is a heavy burden.  This discordance may be why I enjoyed Stuart Firestein’s excellent book, Ignorance,  so much. He makes an excellent case for the value of ignorance.

My institution is striving to become more patient-centered, and is making good progress, but has an odd way of showing it sometimes.

Science is not a linear or predictable path to truth.

Recent debate about the new definitions of psychiatric conditions raises some interesting questions about the difference between normal in a natural sense and normal in a statistical sense. As I read through the DSM-5, it seems to me that it reflects the regrettable and increasingly destructive tendency to demonize eccentricity and mislabeloutliers as pathologic.

It’s easy to take people for granted. 

Things are changing so fast that the Future happened last week and I missed it.

Titus Lucretius Carus (Lucretius) was born about 1 Century BC. His six part poem De Rerum Natura (On the Nature of Things) is 7400 lines of hexameter in the style of Virgil and Ovid mirroring Homer. His is hardly a household name, but when his work was (re)discovered and (re)published in 1417 by Poggio the Florentine it had major impact on the course of the Renaissance.

As a physician for 35 years, I have strived to live up to a quote I first heard from my father: the goal in medicine is to cure sometimes, to relieve often, and to comfort always. During my more than three decades of practice, I have learned that one must combine a willingness to care and ability to hear with an offer to help in order to comfort – let alone occasionally heal. It has been - and continues to be - a glorious and fulfilling career. But it has not been easy or without pain, confusion, fear, or despair.

“One does not discover new lands without consenting to lose sight of the shore for a very long time." 

André Gide (1869-1951)