Both genetic and environmental factors play important roles in one's life. Genetics remains a fixed entity, whereas environment is a variable. Environmental experiences in life can have a positive or negative influence upon the genetic makeup of a given individual. Decision-making in the preschool environment is predominantly controlled by parents. Eventually, the individual, being influenced by the many past environmental factors, becomes the responsible choice maker as to which path in life he/she wishes to travel. It is my belief that it is providential that one is given these experiences to aid in our decision-making. This concept was supported by five of the physicians who shared their stories (chapter 10). All were greatly influenced by role models whom they encountered in their earlier life. This influence factor is not a single event, but a continuum. This forms the basis of the concept that the making of a physician is not a one-time event but represents a continuum. For some of us, becoming a physician was understood as a calling. The stories in this book were shared so that others may develop a greater appreciation of their own environmental experiences and consider them as influential factors in the decision-making of their lives. It is also my hope that this book might be of positive help to the young person considering the medical profession as his or her vocation.

In the late nineteenth century, medical educators intent on transforming American physicians into scientifically trained, elite professionals recognized the value of medical school design for their reform efforts. Between 1893 and 1940, nearly every medical college in the country rebuilt or substantially renovated its facility. In Building Schools, Making Doctors, Katherine Carroll reveals how the schools constructed during this fifty-year period did more than passively house a remodeled system of medical training; they actively participated in defining and promoting an innovative pedagogy, modern science, and the new physician. Interdisciplinary and wide ranging, her study moves architecture from the periphery of medical education to the center, uncovering a network of medical educators, architects, and philanthropists who believed that the educational environment itself shaped how students learned and the type of physicians they became. Carroll offers the first comprehensive study of the science and pedagogy formulated by the buildings, the influence of the schools’ donors and architects, the impact of the structures on the urban landscape and the local community, and the facilities’ privileging of white men within the medical profession during this formative period for physicians and medical schools.

Physician-scientists are unusual creatures. While we are drawn to the clinical challenges of our patients, we are also drawn to the opportunities that our patients’ medical problems bring to science. This book contains the unique experiences and encounters that drew 20 accomplished physician-scientists to this profession. These personal stories are those of people and circumstances that have had profound effects on our career decisions, our creative opportunities, and our lives. These stories also serve to highlight the lessons learned along the way and the distinct attributes of these women and men of medicine and science. Our combined hope is that our collective biographies will enhance the public understanding of our profession, will move people from medicine to science and from science to medicine, and will inspire those who are contemplating this extraordinary profession. “It is a rare gift to benefit from the collective wisdom of so many individuals at the same time. These physician scientists have provided readers with helpful advice and thoughtful encouragement. The interesting and thought provoking essays in Medicine Science and Dreams can be read and digested one at a time or all at once in sequence. They provide lessons to be learned by any physician-scientist, whether just starting out or in the middle of a research career. Schwartz has done readers a great service and has added to the legacy of these prominent and successful physician-scientists.” Book review in JAMA, September 7, 2011—Vol 306, No. 9 by Derek S. Wheeler, MD

Decision making is a key activity, perhaps the most important activity, in the practice of healthcare. Although physicians acquire a great deal of knowledge and specialised skills during their training and through their practice, it is in the exercise of clinical judgement and its application to individual patients that the outstanding physician is distinguished. This has become even more relevant as patients become increasingly welcomed as partners in a shared decision making process. This book translates the research and theory from the science of decision making into clinically useful tools and principles that can be applied by clinicians in the field. It considers issues of patient goals, uncertainty, judgement, choice, development of new information, and family and social concerns in healthcare. It helps to demystify decision theory by emphasizing concepts and clinical cases over mathematics and computation.

The United States does not have enough doctors. Every year since the 1950s, internationally trained and osteopathic medical graduates have been needed to fill residency positions because there are too few American-trained MDs. However, these international and osteopathic graduates have to significantly outperform their American MD counterparts to have the same likelihood of getting a residency position. And when they do, they often end up in lower-prestige training programs, while American-trained MDs tend to occupy elite training positions. Some programs are even fully segregated, accepting exclusively U.S. medical graduates or non-U.S. medical graduates, depending on the program’s prestige. How do international and osteopathic medical graduates end up so marginalized, and what allows U.S.-trained MDs to remain elite? Doctors’ Orders offers a groundbreaking examination of the construction and consequences of status distinctions between physicians before, during, and after residency training. Tania M. Jenkins spent years observing and interviewing American, international, and osteopathic medical residents in two hospitals to reveal the unspoken mechanisms that are taken for granted and that lead to hierarchies among supposed equals. She finds that the United States does not need formal policies to prioritize American-trained MDs. By relying on a system of informal beliefs and practices that equate status with merit and eclipse structural disadvantages, the profession convinces international and osteopathic graduates to participate in a system that subordinates them to American-trained MDs. Offering a rare ethnographic look at the inner workings of an elite profession, Doctors’ Orders sheds new light on the formation of informal status hierarchies and their significance for both doctors and patients.

On average, a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong—with catastrophic consequences. In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make. Groopman explores why doctors err and shows when and how they can—with our help—avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health. This book is the first to describe in detail the warning signs of erroneous medical thinking and reveal how new technologies may actually hinder accurate diagnoses. How Doctors Think offers direct, intelligent questions patients can ask their doctors to help them get back on track. Groopman draws on a wealth of research, extensive interviews with some of the country’s best doctors, and his own experiences as a doctor and as a patient. He has learned many of the lessons in this book the hard way, from his own mistakes and from errors his doctors made in treating his own debilitating medical problems. How Doctors Think reveals a profound new view of twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together.

Both genetic and environmental factors play important roles in one’s life. Genetics remains a fixed entity, whereas environment is a variable. Environmental experiences in life can have a positive or negative influence upon the genetic makeup of a given individual. Decision-making in the preschool environment is predominantly controlled by parents. Eventually, the individual, being influenced by the many past environmental factors, becomes the responsible choice maker as to which path in life he/she wishes to travel. It is my belief that it is providential that one is given these experiences to aid in our decision-making. This concept was supported by five of the physicians who shared their stories (chapter 10). All were greatly influenced by role models whom they encountered in their earlier life. This influence factor is not a single event, but a continuum. This forms the basis of the concept that the making of a physician is not a one-time event but represents a continuum. For some of us, becoming a physician was understood as a calling. The stories in this book were shared so that others may develop a greater appreciation of their own environmental experiences and consider them as influential factors in the decision-making of their lives. It is also my hope that this book might be of positive help to the young person considering the medical profession as his or her vocation.

An orphan leaves Dark Ages London to study medicine in Persia in this “rich” and “vivid” historical novel from a New York Times–bestselling author (The New York Times). A child holds the hand of his dying mother and is terrified, aware something is taking her. Orphaned and given to an itinerant barber-surgeon, Rob Cole becomes a fast-talking swindler, peddling a worthless medicine. But as he matures, his strange gift—an acute sensitivity to impending death—never leaves him, and he yearns to become a healer. Arab madrassas are the only authentic medical schools, and he makes his perilous way to Persia. Christians are barred from Muslim schools, but claiming he is a Jew, he studies under the world’s most renowned physician, Avicenna. How the woman who is his great love struggles against her only rival—medicine—makes a riveting modern classic. The Physician is the first book in New York Times–bestselling author Noah Gordon’s Dr. Robert Cole trilogy, which continues with Shaman and concludes with Matters of Choice.

Medical Decision Making provides clinicians with a powerful framework for helping patients make decisions that increase the likelihood that they will have the outcomes that are most consistent with their preferences. This new edition provides a thorough understanding of the key decision making infrastructure of clinical practice and explains the principles of medical decision making both for individual patients and the wider health care arena. It shows how to make the best clinical decisions based on the available evidence and how to use clinical guidelines and decision support systems in electronic medical records to shape practice guidelines and policies. Medical Decision Making is a valuable resource for all experienced and learning clinicians who wish to fully understand and apply decision modelling, enhance their practice and improve patient outcomes. “There is little doubt that in the future many clinical analyses will be based on the methods described in Medical Decision Making, and the book provides a basis for a critical appraisal of such policies.” - Jerome P. Kassirer M.D., Distinguished Professor, Tufts University School of Medicine, US and Visiting Professor, Stanford Medical School, US

Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries. "The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review