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March 13, 2013

Teaching Physicians to Care Amid Chaos

Author Affiliations

Author Affiliations: Institute for Health Policy, Management and Evaluation and Department of Medicine, University of Toronto, and Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada (Dr Detsky); Harvard Medical School, Boston, Massachusetts, and Institute for Healthcare Improvement, Cambridge, Massachusetts (Dr Berwick).

JAMA. 2013;309(10):987-988. doi:10.1001/jama.2013.620

For physicians who were residents in the 1970s (like we were), it was a simpler era for care. A relatively small number of medications were available for treatment and prevention of illness. All patients with acute myocardial infarctions received lidocaine because physicians mistakenly thought it prevented arrhythmic death. The powerful cardiovascular benefits of aspirin were unknown. Blood work and plain radiographs could be ordered (computed tomography was just arriving on the scene), but physicians had to go to the radiology department to view the images. Information was exchanged by synchronous face-to-face and telephone communication or by written notes and letters.