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On Being a Doctor |1 September 1994

Ask, and It Shall be Given You

Theodore B. Schwartz, MD

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Copyright ©2004 by the American College of Physicians
2004
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These days, with “managed competition” and “cost control” reverberating in our ears, we must remind ourselves that the modern practice of what I call restorative medicine must often rely heavily on laboratory procedures, frequently expensive, for diagnosis and treatment. For example, experts now insist that the specific cause of Cushing syndrome can no longer be firmly established without catheterization of both petrosal sinuses, usually accompanied by measurement of the response of plasma ACTH to corticotropin-releasing hormone. Big money.
There is another less obvious but no less worrisome consequence of the emergence of laboratory data as the major determinant of the patient's status. Increasingly, data stored in the chart displace hands-on encounters between physician and patient. This departure is particularly noticeable in academic institutions where teaching rounds at the bedside may be replaced entirely by discussions in the comfort of the small conference room.
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Schwartz TB. Ask, and It Shall be Given You. Ann Intern Med. 1994;121:376. doi: 10.7326/0003-4819-121-5-199409010-00011

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Published: Ann Intern Med. 1994;121(5):376.

DOI: 10.7326/0003-4819-121-5-199409010-00011

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