Stanford Patient Education Research Center: Fill & Download for Free

PERC = PercussionPERC = Public Employment Relations CommissionPERC = Perchloroethylene (CAS Number 127-18-4)PERC = Property and Environment Research CenterPERC = Propane Education & Research CouncilPERC = Passivated Emitter Rear Contact (solar cells)PERC = Power Edge Expandable Raid ControllerPERC = PowerEdge Expandable RAID Controller (Dell)PERC = Political Economy Research CenterPERC = Political and Economic Risk Consultancy Ltd (Hong Kong)PERC = Public Employees Relations CommissionPERC = Plumbing Efficiency Research CoalitionPERC = Patient Education Research Center (Stanford University)PERC = Pacific Environment and Resources Center (Oakland, CA)PERC = Polaris Electric Reverse ControlPERC = Piedmont Emergency Relief Center (South Carolina)PERC = Pan-European Reserves & Resources Reporting Committee (standards)PERC = Preferred Equity Redemption StockPERC = Portable Executive for Reliable Control (Java for embedded systems)PERC = Practice Expense Review Committee (healthcare)PERC = Programmable Electrical Rule Checker (semiconductor)PERC = Permanent Employee Registration Card (State of Illinois)PERC = Pulmonary Embolism Rule Out CriteriaPERC = Palisades Emergency Residence CorporationPERC = Pittsburgh Energy Research CenterPERC = Powered Emergency Release Coupling (valve for loading arms)PERC = Personalized Electronic Research ConsultationPERC = Pacific Energy and Resources Center (Sausalito, CA)PERC = Product Evaluation Resource CenterPERC = Per Event Reinsurance CoverI hope this is sufficient for you. It is always adviceable to put the context for the abbreviations which are not so obvious, it saves a lot of time for the person answering the question but it seems people do not understand or they want to waste time for all.

I’m really proud of this book. Unlike many books written for the lay public on medicine topics, I wrote this myself without a ghost writer or co-writer.It started as a request for a pamphlet to explain breast cancer options to newly diagnosed patients. I was teaching at the breast center at UCLA at the time.When it become too large for a pamphlet someone suggest that it be turned into a book.I put together a book proposal and sent it to 10 publishers. The next week I got called by an editor in New York. She told me that she was on her way to a breast biopsy for an abnormal mammogram and happened to see my book proposal on a stack on her desk, took it and read it while she was waiting for a breast biopsy and during the couple of days to get the result. She liked it and bought it.It wasn’t smooth sailing because half way through, as she was making very reasonable editing suggestions and I was doing the re-write, one day she called me out of the blue and said that the experience of reading my book and going through the experience of the breast biopsy which fortunately was benign, she looked at the work she was doing at that time in her life (age of 37). She made a decision to resign, travel a bit and then decide what she really wanted to do with the rest of her life. She turned me over to a colleague.So I ended up going through two different editors that each wanted re-writes on multiple chapters which I fought vigorously because I felt that it would change the tone of the book to more more in line like a text book. But what I wanted was for the book to be as if a patient and family were in the consultation room with me as I answered their questions.I finally wore them down and at the end of the day, felt very good about the final result.From the Publisher"The most thorough patient-oriented book that I have ever seen. This book will be valuable to the literate, educated and medically unsophisticated population. . . . There is a good deal of medical and scientific terminology that is conveyed to the patient." George P. Canellos, MD, Dana-Farber Cancer Center, Harvard Medical School"Almost every question I’ve ever been asked is answered in a clear and thoughtful manner in this excellent resource. I recommend it as important support for patients navigating this difficult journey." Clifford Hudis, MD, Chief of Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center"This wonderful book does exactly what it says: provides the real answers to the many important questions asked by our breast cancer patients." Brian-Leyland Jones, MD, Director, McGill Comprehensive Cancer Center, Montreal"This book provides an accurate and extremely clear approach to complex issues every woman with a breast cancer diagnosis should know. Patients, family members and loved ones will find Dr. Chan's book empowering, and a resource to go back to frequently on their journey to recovery." Francisco J. Esteva, MD, PhD, Director, Breast Cancer Translational Research Laboratory, The University of Texas M. D. Anderson Cancer Center"Dr. Chan’s book is a thoughtful, comprehensive resource for the patient who has been diagnosed with breast cancer. He has been able to simplify, very succinctly, answers to the most complex questions raised by one facing this disease and its treatment. I would recommend this book, without hesitation, to breast cancer patients, who often feel lost in an abyss of complex medical information." Linnea I. Chap, MD, Co-Director, Revlon/UCLA Breast Center, UCLA/Geffen School of Medicine"Dr. David Chan is a well respected, well trained, and inspirational medical oncologist. In his twenty years of clinical practice, breast cancer patients have asked him important questions about their disease and treatment. Dr. Chan has synthesized these questions and their answers in an easily read format. Most patients, in the whirlwind and tumult surrounding their breast cancer diagnosis, will find this book a useful tool for reflection and study. Their spouses and other loved ones are also likely to find David’s book helpful" Douglas W. Blayney, MD, Professor, Department of Internal Medicine, Medical Director, Comprehensive Cancer Center, University of Michigan Medical School“This book is a must read for patients as an entry point into the bewildering word of clinical decision making in the management of breast cancer, providing an understandable framework for lessons on complex topics. I will definitely be keeping a copy of this book in the waiting room for patients in my clinic.” Mark D. Pegram, MD, Director of the Breast Cancer Program, Stanford University.

Nonmedical people will often ask where a physician went to medical school, but physicians and those hiring them ask, “Where did you train?” After medical school a future physician must do at least three more years of training (called residency) and as many as nine more years including fellowship. As a faculty member of a residency program, I am of course concerned about which medical school an applicant graduated from, but also what they actually did on their clinical rotations dealing directly with patients more than what grades they got in their first year medical school classes in anatomy and biochemistry. After they finish residency they will be licensed physicians and will be able to apply to see patients from specific insurance companies, especially Medicare. Without residency training, they cannot see patients in a hospital or bill most insurance companies for their services. Therefore a physician who does not complete a residency is an inferior physician, regardless of which medical school they graduated from (although it is extremely rare for someone who graduated from a prestigious medical school not to finish a residency). When someone graduates from the program where I taught, they will be asked by colleagues and administrators who want to hire them, “Where did you train?” They can answer, “Oregon Health and Sciences University,” and if they are in Family Medicine, they have trained in one of the top five programs in the country.Therefore, when choosing a physician (if you have a choice) you need to know where they trained and then be able to know what kind of a program that is. If you have a very complicated disease that is also very rare, you probably are best to go to a major medical center which specializes in that disease, or in an extreme case, be referred to the Center for Rare and Undiagnosed Diseases at either Stanford or the National Institute of Health, or the Mayo Clinic. However, it is much more complex. Not only where a person trained, but when they trained can make a difference. MD Anderson is a well-known and reputable cancer center. However, in 2012 a conflict occurred between the president and many of the department chairs. Most of the leading faculty left. As a result, if someone were at MD Anderson between 2011 and 2015 for their fellowship in oncology, they would not have had as good a training as someone who trained there earlier, or is training there now. As a result, the James Cancer Center in Columbus, Ohio, The Barnes Hospital in St. Louis and Dana Farber Cancer Center were infused with some very top quality faculty and these were the better oncology fellowships during the last few years. The University of Washington is now considered the top Diabetes Center, but that would not apply to someone who trained there 15-20 years ago.Stanford has always had a one of the best cardiology fellowships in the Western United States, but the University of Colorado has usually given their fellows more opportunities to perform cardiac catheterization and their cardiac surgeons perform more operations, so which programs trains better? If you are a university hiring a researcher, you want someone from Stanford who has done a lot of research and will discover new things that are still unknown. However, if you are a patient needing a cardiac catheterization or open heart surgery, wouldn’t you be better served by someone with more experience in doing that procedure? If your child has a very unusual congenital cardiac condition, you probably want to go to Harvard or another major research center, but if your child has a typical case of Tetralogy of Fallot, you want to find a surgeon who has already done many surgeries on such children and had very successful outcomes.If you are looking for a physician to be your primary care physician, you want someone who trained at a reputable program in primary care, not someone who mostly did research at a “prestigious medical center.” An internist who trained in the Bronx may have more actual hands on experience than someone from Yale or Duke. However, a subspecialist such as a rheumatologist or head and neck cancer specialist most likely did a residency at a prestigious institution before being accepted into a fellowship.If someone is older and did their training many years ago, the question then becomes-are they staying current. Especially in primary care (family medicine, general internal medicine and pediatrics) physicians have to retake their Board Exams every few years. Is the physician you’re seeing doing that. Especially if the physician is doing “Maintenance of Certification.” This is a rigorous program to keep primary care physicians current. Not all physicians are doing it.The regulations for training programs and even medical schools have changed over the years. Almost 20 years ago, before our program had the reputation it currently has, we sometimes did not get enough applicants for all our positions and would have to take graduates from medical schools outside of the US (usually of questionable quality, especially the for profit schools in the Caribbean that pray on students who don’t get accepted into US medical schools), as well as graduates from schools that had somewhat mediocre programs. Sometimes we had to ask these “doctors” to leave before graduation. Some had to stay on for an extra year of training. A few never passed their Board Exams and could only work in Urgent Care Centers.Things have changed. Medical schools are harder to get into, so no one is accepted into any MD program in the US today that isn’t a genius. However, the person getting into the prestigious medical school will need a very high MCAT score and near perfect grades plus some scientific research experience. This may exclude some excellent students whose grades are a little lower, but have excellent communication skills. As a medical school faculty, I have seen students do extremely well in the first two years (which is mostly classroom learning), but struggle in the last two, which are clinical. When I was in my fellowship at Ohio State University, the number one student in the 3rd year class was asked to limit his training to pathology, so he would never deal with living patients.For the last 20 years the curriculum at American and Canadian MD schools has been fairly closely monitored by the accreditation body for medical schools. I was an honor student, but did not have a 4.0 as an undergraduate. That year there were 40,000 applicants to Stanford for 100 places. I didn’t get in there, but after a couple of years of graduate school, I was admitted to a brand new school with no reputation. We ended up with 3 faculty from very prestigious medical schools, including Harvard. We got the same exams during our scientific classes. Those of us in the top half of the class did just as well as those in the top half of the class at Harvard. The education at most MD schools is pretty homogeneous whether you go to Duke, University of Michigan or some other prestigious medical school or little known schools such as the University of South Alabama or Howard. In residency we had graduates from some of the top schools and some “bottom” level schools, yet we all excelled and got excellent positions, including my fellowship in endocrinology at Ohio State University.The training in residencies and fellowships sponsored by MD institutions are governed by the Committee on Graduate Education and they all must meet high standards and rigorously test their residents annually. Therefore, they all turn out excellent physicians during the last 10 plus years, but each physician may vary in their procedural or clinical skills, especially communication skills. Unfortunately, 15 or more years ago, residencies graduates some physicians with outstanding communication skills, but not good actual medical knowledge of anything but routine cases (which make up 90% of what a physician sees, but they could miss the diagnosis or correct management of cases that were less common). These physicians often have an excellent reputation with their patients and the public at large, but are known to have deficits by their colleagues. As long as they know their limitations and refer those cases they can’t manage to others, it’s not a problem, but there are some who go many years before their state board finds out. Also, the strictness of state boards varies a lot from state to state. I have practiced in Oregon (very strict state) and Arizona (not so strict).There are many physicians in the US who did not go to medical school in the US and it would be difficult for the lay person to know the quality of their medical school. If they graduated from a prestigious residency and/or fellowship, then they are every bit as qualified as a physician who graduated from a prestigious school.The other difficulty in the US, is that there are two types of medical schools: those that grant an MD degree and those that grant a DO degree. Both groups sponsor residency programs and there are even a few DO fellowships. For the last few years, all residencies and fellowships are governed by the American Committee on Graduate Medical Education. So all graduates, both DO and MD, must meet the same standards. However, a few years ago, many of the DO programs were week in assuring that their graduates had adequate exposure to a wide range of patients with different presentations of different disease.The rapid increase in the number of DO schools has in some ways improved the quality of the residents in graduate medical education. Good residencies are expensive and most are very dependent on State Legislatures for funding. A few years ago there were far more residency slots than there were graduates form US medical and osteopathic schools. Weaker residencies had to fill those slots with graduates from medical schools outside the USA. DO graduates often are weak in basic research, but are usually quite strong in communications skills and in most cases speak English as a first language. They are more familiar with American culture and these things make learning much easier when it comes to taking care of Americans, who may not just “do what the doctor say,” as patients do in many developing countries, or are poor, of a different culture, sexual orientation or gender identity. American medical students understand this more than students from developing countries, especially paternalistic countries. So a foreign medical graduate may have excellent scientific skills and the potential to make a great surgeon, they may have difficulty with clinical and communication skills. Unfortunately, so many DO schools are being created, that the US may soon graduate more students from medical school that there are residency slots to finish training them. Those who do not get into a residency program are often forced into research, yet these are often students with little research experience or desire. We are short 30,000 physicians in the US, especially in primary care and the cognitive specialties of Endocrinology, immunology, rheumatology and infectious disease. These specialties do not generate much revenue for a hospital or medical school, so without funding from the state, these programs do not get created. State Legislators need to wake up to this impending catastrophe.