The Future of Quality Measurement and Management in a Transforming Health Care System

David Blumenthal, MD, MPP
JAMA. 1997;278(19):1622-1625. doi:10.1001/jama.1997.03550190090053.
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A MIDDLE-AGED MAN came to see me recently complaining of stomach pain and low-grade fever. He was tender in his left lower quadrant. I thought he had diverticulitis.

As he was dressing, he said, almost to himself, "I forgot to do the test where you push on a part of the stomach where it doesn't hurt and see if that makes it hurt where you are having pain." He was referring to the physical examination for rebound tenderness, which he had.

"How did you know about rebound tenderness?" I asked.

"I found out about it on the Web," he said. "I looked up 'abdominal pain' and then 'left lower quadrant pain.' I decided I might have diverticulitis. Then I went to some medical school's Web site and they had a section for the physical exam."

I told him I wanted him to see a surgeon, and the choice would be


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