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db's Medical Rants

Internal medicine, American health care, and especially medical education

Last Build Date: Thu, 08 Mar 2018 14:37:43 +0000


The importance of exercise

Thu, 08 Mar 2018 14:37:43 +0000

Exercise helps keep us healthy.  Numerous studies document these benefits.  Yesterday I tweeted another link – For Heart Disease Patients, Think Exercise, Not Weight Loss  These studies do not expect vigorous exercise, but they do measure movement.  Both movement and some resistance training help keep us healthy. Here is another link – this one on […]

Many medical nouns need adjectives

Mon, 05 Mar 2018 16:41:03 +0000

Last week on twitter I wrote a series of tweets about necessary qualifiers.  Here are the tweets which represent an incomplete sample of the problem: 1st tweet on  importance of qualifiers w/ “diagnoses” Do not label the patient as COPD exacerbation without saying why: Differential includes acute bronchitis, pneumonia, pneumothorax, left side heart failure, anemia, […]

Mystery fiction and being a better internist

Sun, 25 Feb 2018 12:00:25 +0000

As a child, mystery fiction captivated me.  Probably the Bobbsey Twins, then the Hardy Boys and Nancy Drew started the passion.  I remember the TV show Perry Mason, which led me to reading books from the Earl Stanley Gardner series.  Lt. Columbo captivated me.  Discovering Sherlock Holmes was an epiphany.  And throughout my life, I […]

The Fusobacterium story as of 2018 – a very long post

Sun, 11 Feb 2018 14:09:34 +0000

Over the past 15 years I have developed an obsession to understand Fusobacterium necrophorum both as a cause of adolescent/young adult pharyngitis and the development of suppurative complications. Most readers know that I started studying Group A strep pharyngitis in 1980 (first publication in 1981), and wrote multiple articles about strep pharyngitis in the 80s and […]

Why I love inpatient IM ward attending

Sun, 28 Jan 2018 16:03:29 +0000

38 years and I still get excited making rounds.  45 years ago I discovered that I was meant to be an internist – it was my first week on the IM rotation.  Prior to that week I had no idea! Internal medicine combines understanding medical science and people.  Internal medicine requires detective work and compassion.  […]

Tips for IM attendings – Chapter 21 – make rounds a conversation

Sat, 20 Jan 2018 12:46:11 +0000

Recently I observed rounds someone else’s rounds.  During those rounds, interns or students reported to the attending physician who took notes.  Interaction was minimal, and other members of the team totally ignored the interactions. This week I realized that our rounds were conversations.  We take cues from each other, and use these cues to improve […]

The #5goodminutes project

Thu, 18 Jan 2018 17:02:37 +0000

As readers and twitter followers know, I have embarked on a yearlong project – tweet a relatively short internal medicine topic each day.  This project came from advice I have been giving learners for several years – each day after rounds pick 2 topics to read about for 5-10 minutes.  This educational theory comes from […]

Try to avoid vancomycin/pip-tazo

Mon, 08 Jan 2018 14:11:11 +0000

This weekend I started listening to the Curbsiders end of the year spectacular.  Matt’s pick of the year was an upcoming meta-analysis about the risk of the vanc/pip-tazo combination.  We developed awareness of the renal toxicity from this combination a couple of years ago.  At our community hospital program we almost never use the combination. […]

#5goodminutes Type IV RTA

Wed, 03 Jan 2018 12:33:44 +0000

For a number of years I have advised students and residents to keep a notebook of topics that arise on rounds.  Pick 2 topics that we discussed, then read about them for 5 minutes.  Everyone has 5 minutes to read about a topic. The idea here is that cognitive science has shown that we remember […]

The daily clinical post #KashlakChief

Mon, 01 Jan 2018 16:00:40 +0000

In honor of becoming the Chief of Medicine at Kashlak Memorial (for those who are not aware, this the imaginary hospital that hosts the Curbsiders podcast. This position comes with great responsibility (insert your Spiderman quote here). Each day I plan to tweet a clinical thought based upon either my reading or a recent patient.  […]