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db's Medical Rants



Internal medicine, American health care, and especially medical education



Last Build Date: Sun, 19 Nov 2017 13:05:03 +0000

 



Being a physician – lessons learned from Harry Bosch

Sun, 19 Nov 2017 13:05:03 +0000

I just finished listening to the latest Michael Connelly mystery – Two Kinds of Truth.  His main character in many books is Harry (short for Hieronymus) Bosch.  Bosch is a police detective who epitomizes characteristics that we see in the best clinicians.  Here is a compilation of what I find in this novel as well […]



Things we discussed last week on rounds

Mon, 13 Nov 2017 23:47:12 +0000

Each week on rounds several very interesting topics arise.  In December I plan to discuss these issues on a daily basis, but today I am reflecting on 5 days of ward rounds last week.  I just plan to list some issues, not include the discussions or why we focused on those issues.  Please feel free […]



Tips for IM attendings – Chapter 20 – why we ask questions

Thu, 09 Nov 2017 13:27:47 +0000

I had a wonderful dinner with some medical students last night.  Earlier in the day at morning report I had asked them multiple questions.  Given the ongoing debate over pimping (a debate that will likely never end), I asked them to reflect on the questioning. They had several thoughts (all positive) and during the discussion […]



The neverending IM rounds debate – what is the best style?

Sun, 05 Nov 2017 13:05:47 +0000

I could stop with one sentence – there are several styles that work.  Let me explain. Internal medicine rounds have several goals.  First, we owe our patients the best diagnostic evaluation and then the best care. We owe our patients careful explanations of the day’s plan, and the overall plan.  Too often we have to […]



The major medical issues of 2017

Fri, 03 Nov 2017 00:25:43 +0000

Periodically we should reflect on what challenges face patients and physicians.  Over the past few days I have worked on a list of the issues that concern me the most.  I welcome suggestions for expanding the list. Diagnostic errors – all patient care requires that we make the proper diagnosis.  Too often we make errors.  […]



The story of the FeNa test

Tue, 24 Oct 2017 15:44:43 +0000

Previously published at Centor’s Corner (an MDCalc blog)   September, 1976: I was a 2nd year internal medicine resident at the Medical College of Virginia. My attending physician, Dr. Carlos Espinel, had just published a now-classic article: The FENa test. So that month, I had the wonderful opportunity to understand the rationale behind a test that […]



The challenge of “evidence based” sore throat guidelines

Mon, 23 Oct 2017 17:16:35 +0000

In 2007, Matthys and colleagues published a classic article: Differences Among International Pharyngitis Guidelines: Not Just Academic Jan Matthys, Marc De Meyere, Mieke L. van Driel, An De Sutter Ann Fam Med. 2007 Sep; 5(5): 436–443. doi: 10.1370/afm.741 PMCID: PMC2000301 RESULTS We included 4 North American and 6 European guidelines. Recommendations differ with regard to the use of a rapid […]



Role models in #meded

Sun, 22 Oct 2017 13:07:49 +0000

In the 70s when I trained, we had no add-on curricula; we had no milestones; we had little interference from governing bodies.  What we did have was role models. In the current century, when I talk with students and residents (and I do that very often) they talk about what they see or do not […]



Tips for IM ward attendings – Chapter 19 – the attending as coach #meded

Mon, 16 Oct 2017 00:19:14 +0000

Today I have been listening to a podcast featuring a boxer.  This boxer discusses coaching and its importance. Anyone who has competed in a sport can relate to the importance of accurate coaching.  Coaching requires immediate feedback, both positive and negative.  The feedback works best when you receive it immediately after you perform. What do […]



The adverse consequences of premature diagnosis

Tue, 10 Oct 2017 11:35:14 +0000

I have spent 3 days at the Society to Improve Diagnosis in Medicine.  Whenever I come to this meeting, I have insights from listening to talks and many conversations with leaders in the field. When one considers diagnostic errors, one must consider two important factors – physician factors and system factors.  We have a major […]