The Case

In How Doctors Think, author Dr. Jerome Groopman reflects on the reasoning process that doctors use to arrive at a diagnosis. He refers to the problem of physicians becoming “locked in” to a diagnosis so early in the process that they overlook the important clues. The result, very often, is an incorrect diagnosis and inappropriate treatment.

The best example I can recall involved my twin brother, John.

He had developed chronic pain in his right hip and was referred to an orthopedic surgeon for advice. The surgeon obtained a CT scan of the hip. It showed some activity at the head of the femur, suggesting the possibility of a cancerous growth. My brother called me from San Francisco (he was on a business trip) and I advised him to arrange a visit with an oncologist at the university hospital located in his hometown. I flew up to be with him during a day of consultations and examinations.

The oncologist, with knowledge of a possible malignancy involving the head of the femur, ordered a new CT scan of the hip. It showed evidence of increased blood flow, furthering the conclusion that there was a tumor. At that time, I asked whether the pain could be due to aseptic necrosis (bone death caused by poor blood supply) of the hip. The response: “Oh no, the nuclear scan would not light up like this. It would be just the opposite.”

A chest x-ray was obtained as part of the workup for presumed metastatic carcinoma. The radiologist noted numerous tiny densities throughout both lungs. Equipped with the referral note from the oncologist and the interpretation of the CT scan, he said to me, “This has to be metastatic carcinoma.”

Late in the afternoon, the oncologist informed John that all findings indicated cancer that had traveled to his bone and lung. (The three main cancers in men that metastasize to both bone and lung are prostate, lung, and lymphoma.) A biopsy of the hip lesion was arranged, and we returned home where John sat down with his family and shared what the doctors had said. He told everyone that he had enjoyed a good life and was ready to die. Many tears were shed.

But John looked very healthy for a man with a tumor that had metastasized to his lungs and bone. Except for his hip pain, he felt well. Sure enough, when the biopsy was done, there was no cancer found. Evidence of aseptic necrosis was found, however, which was healing spontaneously. This explained the findings on the CT scan. Again, there was much cheering and more tears among the family members—this time, though, it was tears of joy and relief.

(The report of a chest x-ray taken some years earlier in another city was tracked down and found to be identical with that of the current chest x-ray—findings thought to be scarring from old granulomas, small areas of inflammation due to tissue injury.)

Within a matter of weeks, John’s hip pain disappeared!

Please provide an assessment of what the facility can do going forward to create a culture of quality and safety.

“Criminologists have long debated whether there is [an association] between weather and violent crime. The author of the article "Is There a Season for Homicide?" (Criminology (1988): 287 - 296) classified [1352] homicides according to season, resulting in the accompany data.”
Results of the author’s study found the following counts of homicide in the population studied.
• winter = 311
• spring = 320
• summer = 401
• fall = 320
Does it appear that homicide counts differ by season? You must identify the correct analysis and present results in APA style.

The author of an introductory textbook on business statistics completed a study using 30 undergraduate statistics students selected at random from a large university. The students were given a comprehensive test that took them an average of 90 minutes to complete with a sample standard deviation of 15 minutes. Construct and interpret the 90% confidence interval for the population mean time it would take for all statistics students at the university to complete this test.

the Elements of Style, read the following excerpts -- both from the same author, George Orwell, and explain the different stylistic forms he uses in each.

Excerpt from 1984

Power is not a means; it is an end. One does not establish a dictatorship in order to safeguard a revolution; one makes the revolution in order to establish the dictatorship. The object of persecution is persecution. The object of torture is torture. The object of power is power.

Excerpt from "Shooting an Elephant"

In Moulmein, in lower Burma, I was hated by large numbers of people – the only time in my life that I have been important enough for this to happen to me. I was sub-divisional police officer of the town, and in an aimless, petty kind of way anti-European feeling was very bitter.

The textbooks needed for the class are: "Government 10 (GOVT 10): (9th or 10th edition)" Author: Sidlow

Read chapter 1 of the textbook

1. Is it possible to have liberty if there is no order in society? Validate and explain.

2. Why does the textbook state that government is involved in one's life from birth to death?

3. What does this mean? Give an example.

The author makes a compelling argument why we should get rid of the tipped salary of $2.13 per hour for tipped employees. What do you think of the author's argument? Do you think we should get rid of the special salary for tipped employees? Do you think the salary originally originated from discriminatory practices? How would your resolve the issue?

Critical Question: What are the descriptive assumptions? find important assumptions made by the author. first to determine the conclusion and the reasons.

Passage: Should it be legal for newspaper and television reporters to refuse to reveal their confidential sources? Indeed it should. The reporter-informant relationship is, after all, similar to those of priest and penitent, lawyer and client, physician and patient---all of which have a degree of privacy under the law. Moreover, if that relationship were not protected, the sources of information needed by the public would dry up.

The Life of Pi

1. What does the author tell us in the introduction? What expectations does it set?

2. What religions does Pi practice? How does he find each? How does he describe each? What are some reactions to his multi-religious practices?

3. Explain how Pi’s twin concerns of theology and zoology are illustrated by Mr. Kumar and Mr. Kumar or the sloth.

4. Reflect on what story means to you. What is “the better story” according to Pi? How does this relate to religion, to Pi’s life in general, and to truth?

5. The “official report” gathered by the Japanese investigators is supposed to be the “truth” but is filled with doubt.What does this suggest? ****Please keep in mind that these questions are to be based on the novel NOT the movie. The movie is very different from the novel. Thank you.   : ) ****

Douglas Adams (1952–2001), author of The Hitchhiker’s Guide to the Galaxy, compared humans to a puddle of water as a way of illustrating anthropocentric thinking, or what he called “the vain conceit” of humans.

He wrote: "Imagine a puddle waking up one morning and thinking, “This is an interesting world I find myself in, an interesting hole I find myself in. It fits me rather neatly, doesn’t it? In fact, it fits me staggeringly well. It must have been made to have me in it.” Even as the sun comes out and the puddle gets smaller, it still frantically hangs on to the idea that everything is going to be all right; that the world was made for it since it is so well suited to it."

1. A very well-known author, Dan Green was visiting a friend to talk about topics for a new book. The friend, Mr. Snoop said that he had been at a party when he heard about something called the Da Vinci Code. Mr. Snoop told Green all about the Da Vinci Code. Green was very excited and rushed to his office. Over the next two days, Green wrote a book called the La Vinci Code. After the book was released to stores around the country, Green sold all rights to BS Studio. BS Studio made a TV movie from the book, which changed the location setting from Paris to Fullerton and changed the character names.Discuss all legal issues