Becoming a Consummate Clinician

Ary L. Goldberger, MD, is Director of the Rey Laboratory and Professor of Medicine at the Harvard Medical School. He is Program Director of the Research Resource for Complex Physiologic Signals, which is funded by the National Institute of Biomedical Imaging and Bioengineering and the National Institute of General Medical Sciences of the National Institutes of Health. He is also a core faculty member of the Wyss Institute for Biologically Inspired Engineering at Harvard.Zachary D. Goldberger, MD, MS,is an Assistant Professor in the Department of Internal Medicine in the Division of Cardiology at Harborview Medical Center/University of Washington Medical School, in Seattle, WA. He received his medical degree from Yale University School of Medicine and then completed his Internal Medicine training at the University of Washington. He completed a fellowship in cardiovascular medicine at the University of Michigan, where he was a 2010-2012 Robert Wood Johnson Foundation Clinical Scholar.

• Preface ixAcknowledgments xiINTRODUCTION: SURVIVING AND THRIVING IN WARD WORLD 1PART 1 MEDICAL MUSTS AND MUST-NOTS: SIX ESSENTIALS OF WARD WORLD1 HOW (NOT) TO PRESENT A PATIENT HISTORY 132 REEXAMINING THE PHYSICAL EXAM 373 HOW (NOT) TO ORDER AND PRESENT LAB TESTS 674 SEEING IS (ALMOST) BELIEVING: THE IMPORTANCE OF REVIEWING DATA 815 "WORSTS FIRST": HOW TO FRAME A DIFFERENTIAL DIAGNOSIS 936 CLINICAL QUERIES: ASKING THE 3½ KEY QUESTIONS 103PART 2 MEDICAL MASTERIES7 E = MC3: ERROR REDUCTION EQUALS MOTIVATION TIMES COMMUNICATION TO THE POWER OF 3 1158 EVIDENCE-BASED MEDICINE: WHAT AND WHERE IS THE EVIDENCE? 1319 CAUTION! DANGEROUS BIOMEDICAL SEMANTICS AT WORK 14510 SOME SECOND OPINIONS: OUTLIERS, HOOFBEATS, AND SUTTON’S (FLAWED) LAW 16511 A SIXFOLD PATH: FROM DATA TO KNOWLEDGE TO UNDERSTANDING 17312 WHAT IS DISEASE? WHAT IS HEALTH? 181Bibliography and Notes 195Index 203

“The encouragement of all readers to rethink everything we assume to be true and to seek a deeper understanding of what we “know” is priceless . . . The quotes included throughout the book were both valuable and enjoyable.”  (The Hospitalist, 2 November 2014)