Dr. Manish Shah is trying to figure out why Thelma Shoe's nose keeps bleeding. At least once or twice a week, the 73-year-old has been getting nosebleeds that last up to an hour. Shoe's no stranger to the clinic; she has emphysema, cirrhosis of the liver (from medication she took for tuberculosis), and has already had heart-bypass surgery.
Shoe was Shah's first patient at Duke's outpatient clinics three years ago, when he was a first-year resident, and the two have established a comfortable rapport. "Oww, that hurts!" she says, wincing as he inserts an otoscope into each nostril. "That hurts? I'm...