This book describes some fun times---and some bittersweet times. In Book 1 Dr. Wade tells us of his mainly lucky teen years, his mother's horrible iron deficiency and how to diagnose it, and how to decide if a medication or surgery is the best or the worst thing to do. Book 2 and later books go through his college years, med school, San Francisco General Hospital Internship, the Navy in San Diego and the Western Pacific, his lovely and brilliant wife, and his medical practice.However, one of the main pursuits of Dr. Wade's professional career was his attempt to improve the care of patients by using a better method of diagnosis. In other words a method to make the correct diagnosis, accurately and quickly. The correct diagnosis is pivotal to excellent care---all else, the tests, the medications, the surgery, all depend on having a correct diagnosis. To accomplish that goal, Dr. Wade authored a book and developed a computerized differential diagnosis program. The diagnosis program within seconds, gives the doctor a list of the more likely diagnoses and lists them in a decreasing order of probability. A knowledgeable doctor can in just a few seconds go down the list and decide what to do next.But, doctors would not use this program. Instead, they relied on their memory, a notoriously inadequate approach to the huge number of diagnostic possibilities. This book describes the frustrations, the obstacles, the stupidity, the illogic, the inconsistencies, the hostility, and the disbeliefs Dr. Wade encountered over the years. But finally---victory.Many of the vignettes sprinkled through the book are medically instructive, and many are merely fun for the author to recall. We hope the reader enjoys the book, and learns something from it."Satus est initius mederi quam fini." (It is better to doctor at the beginning than at the end.) Erasmus
After being an ER doctor for over twenty years, traveling all over, running international medical missions, and working at a cancer hospital, Jeff Wade has collected many stories. Some of these he has been telling for decades. In Tales from the ER and Other Places, Dr. Wade shares a lifetime of interesting, funny, educational, and sometimes disgusting stories, with medicine being at the center of most. And whether the stories are incredible and humorous or touching and sad, they offer a compelling and engaging window into the life and times of a doctor and his passions --and his patients.
In the late 1980s, a promising new treatment for breast cancer emerged: high-dose chemotherapy with autologous bone marrow transplantation or HDC/ABMT. By the 1990s, it had burst upon the oncology scene and disseminated rapidly before having been carefully evaluated. By the time published studies showed that the procedure was ineffective, more than 30,000 women had received the treatment, shortening their lives and adding to their suffering. This book tells of the rise and demise of HDC/ABMT for metastatic and early stage breast cancer, and fully explores the story's implications, which go well beyond the immediate procedure, and beyond breast cancer, to how we in the United States evaluate other medical procedures, especially life-saving ones. It details how the factors that drove clinical use--patient demand, physician enthusiasm, media reporting, litigation, economic exploitation, and legislative and administrative mandates--converged to propel the procedure forward despite a lack of proven clinical effectiveness. It also analyzes the limited effect of technology assessments before randomized clinical trials evaluated decisively the procedure and the ramifications of this system on healthcare today. Sections of the book consider the initial conditions surrounding the emergence of the new breast cancer treatment, the drivers of clinical use, and the struggle for evidence-based medicine. A concluding section considers the significance of the story for our healthcare system.
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