Disease, Outcomes, and Money

  • Robert M. Kaplan

I can still remember the call. At age 77, Sally, a close friend of the family, had a positive mammogram. I was a professor at the medical school, and her family wanted to know the names of the best breast surgeon and the most distinguished medical oncologist. We all want the best medical interventionists when faced with a potentially fatal illness. After a biopsy, Sally learned that she had a condition called ductal carcinoma in situ, or DCIS. The doctors told Sally that this was a mild form of breast cancer, but the family was unwilling to take chances. She got surgery, chemotherapy, and radiation therapy. Today, Sally is alive and doing well.

After treatment, family members became advocates for early detection in older women. They believed that Sally’s life had been saved because her doctor was “aggressive.” He ordered a mammogram and followed up the positive result with a biopsy, surgery, chemotherapy, and radiation. How can anyone argue with his judgment?

The problem is that Sally...


Preventive Medicine Capita Spending Primary Care Doctor United States Preventive Service Task United States Preventive Service 
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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Robert M. Kaplan
    • 1
  1. 1.UCLA School of Public HealthLos AngelesUSA

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