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db's Medical Rants



Internal medicine, American health care, and especially medical education



Last Build Date: Wed, 28 Jun 2017 22:26:20 +0000

 



Diuretic use with a h/t to @kidney_boy

Wed, 28 Jun 2017 22:26:20 +0000

Residents and students at our institutions know that I am obsessed with diuretic use.  Early in my career I met Dr. Craig Brater who produced much important knowledge of diuretic use.  Too many physicians use diuretics without careful thought.  I often discuss diuretic physiology and pharmacokinetics. So listening to @kidney_boy talk with The Curbsiders this […]



Larry Weed and SOAP notes

Sun, 25 Jun 2017 23:05:55 +0000

1973, as we prepare to start our clinical rotations, the chief medical residents taught us the new concept of SOAP notes.  Larry Weed developed the concepts of the problem oriented medical record and notes that included subjective, objective, assessment and plans for each problem.  We wrote our notes each day using his system. I have wondered […]



Asking learners questions #meded

Tue, 13 Jun 2017 18:38:45 +0000

I am currently reading Peak Performance a book about the processes that lead to our best performance.  While the book has a general focus on athletics, it discusses principles and studies from many fields.  This quote struck me as very important for medical education. The most effective tutoring systems, on the other hand, all shared […]



Obtaining the HPI – a #meded opportunity

Thu, 08 Jun 2017 11:25:01 +0000

Recently our team was on call, and we had two early admissions.  Fortunately for the team, we had a small census going into call and our patients were relatively stable.  So instead for spending extra time rounding and teaching, we decided to see the two new patients as a group.  We had each intern take […]



Advice for new 3rd year medical students and soon to be interns

Mon, 05 Jun 2017 19:08:44 +0000

Learning clinical medicine is difficult.  It often seems overwhelming.  I offer this advice, as I have for many years to students. Assume that you will be confused and overwhelmed each time you start a rotation.  Some rotations take longer before you feel comfortable.  My specialty – Internal Medicine – is usually the most confusing when […]



The goal of medical education #meded

Mon, 29 May 2017 23:28:43 +0000

I started medical school in 1971 (yes 46 years ago).  Hated the first two years, but loved the 3rd and 4th years and loved my residency. My first month as a ward attending in Internal Medicine was January 1980.  I probably have averaged over 100 days of teaching attending for the past 37 years. What […]



The joy of teaching rounds

Thu, 25 May 2017 21:14:52 +0000

January 1980 I had my first experience as a teaching ward attending.  I loved it.  37 years later, I love it. I just spent most of 4 weeks traveling.  This Monday I started a 5 day stint rounding.  Each day I am excited.  As we discuss patients; as we see patients; I get more excited. […]



15 years of blogging – a retrospective

Mon, 22 May 2017 21:59:46 +0000

May 19th, 2002 I wrote my first blog post.  Blogging had just become an interesting method for expressing opinions. Early in my blogging career I compared blogging to standing on a soap box in Hyde Park.  Bloggers had (and have) the freedom to express opinions.  Readers have the opportunity to comment, ignore or just read. […]



Compression of disability should be everyones health goal

Thu, 18 May 2017 15:24:06 +0000

What are you doing to maintain vigor as long as feasible?  Fries wrote a classic article in the NEJM – Aging, Natural Death and the Compression of Morbidity. Fries argues that chronic disease is our foe – avoiding chronic disease allows us to wait longer until we develop morbidity.  The ideal situation is excellent health […]



Repetition and the basics – #meded

Sun, 14 May 2017 01:50:36 +0000

Discussing a new patient recently, two important teaching points crystallized once again.  The patient was relatively young without any past medical problems.  He had dyspnea, first on exertion, and then at rest.  On exam he was tachypneic with crackles, wheezes and rales throughout his lungs.  After receiving nasal oxygen he “looked comfortable”. His electrolyte panel: 135 […]