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October 25, 2000

Insuring the Uninsured: Time to End the Aura of Invisibility

Author Affiliations

Author Affiliation: Department of Family and Community Medicine, University of California, San Francisco.

JAMA. 2000;284(16):2114-2116. doi:10.1001/jama.284.16.2114

Most physicians have their stories. Mine dates to one of my first nights on call as an intern in family medicine at San Francisco General Hospital in the summer of 1985. I was summoned to the emergency department to admit a young woman with a presumptive diagnosis of subacute bacterial endocarditis. For a new intern at that stage of unspoiled eagerness when the very act of wearing a pager instills a noble sense of professional duty, this type of call made me hasten to the emergency department in excited anticipation of encountering a patient with a classic but rare disease. Indeed, the patient had all the textbook characteristics of the infection: rheumatic fever in her youth, recent weeks of malaise and low-grade fevers, a holosystolic murmur, and blood cultures sent from clinic 2 days earlier growing chains of gram-positive cocci.