Geographic variation in Medicare spending.

In my third and fourth years of medical school at Duke University, I was totally engaged in learning clinical strategies and algorithms: when to admit a patient with chest pain from the emergency ward, when and how to work up dyspepsia, when to schedule laboratory work and ambulatory follow-up for stable hypertension. These protocols are the nuts and bolts of day-to-day practice. I learned them as an apprentice, trailing fellows and attending physicians on ward rounds and in the clinic, since the level of detail needed to guide these decisions never seemed to be in the scientific literature. After finishing . . .