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db's Medical Rants

Internal medicine, American health care, and especially medical education

Last Build Date: Thu, 27 Oct 2016 14:37:07 +0000


Did you get your money’s worth today?

Thu, 27 Oct 2016 14:37:07 +0000

It started as a joke, but it has become a mantra.  I discuss this phrase on the Curbsider’s podcast. Our medical students pay (in my opinion) an obscene tuition.  They are buying a medical education.  Therefore we should remember that they are customers who have paid for our service. As a clinician educator, I try […]

Discussing internal medicine education on a podcast – The Curbsiders

Mon, 24 Oct 2016 12:03:43 +0000

That was a lot of fun.  The Curbsiders invited me to answer questions on a podcast.  Before we knew it, it turned into 2 podcasts.  They released the first one today, in which I answer questions about my philosophy of ward attending rounds, feedback, bedside teaching and writing. Next week they will publish our discussion […]

More thoughts on primary care and all that other care

Mon, 17 Oct 2016 19:17:36 +0000

Spend time talking with non-medical friends and acquaintances.  Ask them about their medical experiences.  Imagine what they want, or ask them what they want. People want to feel that their physician has spent adequate time talking, examining and explaining.  They want to look into the physician’s eyes.  They want the best possible care, but caring […]

Solving the primary care crisis

Mon, 17 Oct 2016 00:05:19 +0000

We do have a primary care crisis.  We believe that primary care delivers better care for less money.   But primary care is under siege. Why The Government Tried To Fix Primary Care And Failed Many physicians do not believe in government solutions.  As I understand the government solutions, they have great complexity. One cannot […]

Tips for IM attendings – Chapter 18 – learning is more difficult than teaching

Thu, 13 Oct 2016 12:22:00 +0000

As a newly minted journal faculty member rounding on the wards, I had great internal pride in my teaching ability.  Like many residents and junior faculty  I assumed that my teaching would result in the learners growing dramatically (especially since I had delivered the messages so brilliantly {please read that phrase with true sarcasm}). During my […]

The statin controversy

Sun, 09 Oct 2016 22:46:54 +0000

A friend asked me recently about statins.  He takes a statin for primary prevention, but is concerned that he has muscle pain and weakness as a side effect.  So he posed the question: “How important is the statin?” The Washington Post had this recent article – Who should take statins? A vicious debate over cholesterol drugs. […]

What is next for the Affordable Care Act?

Mon, 03 Oct 2016 16:59:23 +0000

This well consider NY Times article is a “must read” – Ailing Obama Health Care Act May Have to Change to Survive. Some have claimed great success for the ACA, because 20 million people now have insurance.  These proponents emphasize the increased in “insured” and minimize the importance of the continued problems in the individual insurance markets. […]

Why we should change basic science teaching in medical school

Tue, 27 Sep 2016 10:55:26 +0000

Last night I watched a brilliant TED talk – Sal Khan: Let’s teach for mastery — not test scores – Ted Talk 2016 He makes the point that learners need to master the basics prior to attacking the next steps.  As we consider this in medicine, how do we really learn pathophysiology if we do not […]

Beware how the affect heuristic filters your view of data

Mon, 26 Sep 2016 16:56:27 +0000

The Spock in us would like to see data as hard, fixed, and totally interpretable.  The Dr. McCoy in us understands that data do not have those properties.  Nietzsche once wrote, “There are no facts, only interpretations” In fact we always interpret “facts” in light of our biases.  Our filters come from our preconceived opinions. […]

Why I oppose home strep testing

Tue, 20 Sep 2016 11:27:15 +0000

Yesterday I read this tweet: home strep test likely to reduce inconvenience, cost, strep complications, unneeded antibiotic and antibiotic resistance #medx I disagree, but the reasons are fairly complex. In order to understand this problem, we have to define the possible test, its use, the likely misuse and both the intended and unintended consequences of such […]