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A new issue of leaflet is now available.

The Permanente Press, in conjunction with The Permanente Journal presents this medical literary and arts e-journal, leaflet -- to open greater opportunity to share the creative visual and written works of physicians and nurses.

Health care professionals and employees are encouraged to submit original poetry, prose, and artwork for future issues.

The Permanente Journal advances knowledge in scientific research, clinical medicine, and innovative health care delivery.

On the Cover


Rock of Ages
by Sally J Cullen, MD, MS


This photograph was taken in Zion National Park in Utah. The monument pictured was formed by millennia of cascading water cutting through and eroding the sedimented and lithified Navajo Sandstone. The incredible rock layers of Zion are part of a system stretching from Bryce Canyon to the Grand Canyon.


Dr Cullen retired in 2012 after more than 32 years practicing medicine. She now uses photography to show how our national parks are our great heritage, and how they can be our great legacy if we protect and celebrate them. More of Dr Cullen’s photography may be seen at:

Case Study

An Idiosyncratic Reaction to Clopidogrel


Aaysha Kapila, MD; Lovely Chhabra, MD; Allison Diane Locke, MD; Pranav Patel, MD;Atul Khanna, MD; Chakradhar M Reddy, MD; Mark F Young, MD


Clopidogrel is an irreversible antiplatelet agent that antagonizes the adenosine diphosphate P2Y12 receptor on platelets disrupting fibrinogen—platelet complex formation. The authors report on a rare but clinically significant case of clopidogrel-induced hepatotoxicity in an elderly white woman.


Clinical Medicine

Image Diagnosis: aVR, the Forgotten Lead


Donald P Mebust, MD


The 12-lead electrocardiogram has been referred to as an “11-lead study” on the basis of the false assumption that lead aVR yields only limited information. However, it can provide information in the management of several medical conditions.


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