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db's Medical Rants



Internal medicine, American health care, and especially medical education



Last Build Date: Mon, 08 Jan 2018 14:11:11 +0000

 



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.  […]



My suggested New Year’s resolution for physicians and patients

Sun, 31 Dec 2017 14:44:45 +0000

Exercise! This should come as no surprise to regular readers.  I admit to an exercise obsession.  Each day I make plans to do something. As I read the research, exercise is the best preventive tool we have.  While exercise alone cannot create weight loss, it does make it easier.  Most committed exercisers start to modify […]



My descent into guideline fatigue syndrome (GFS)

Mon, 25 Dec 2017 16:19:30 +0000

It started slowly.  My former resident and present colleague, Terry Shaneyfelt first authored Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature This paper alerted us to the problem.  But guideline fever continued to rage.  Almost every specialty and subspecialty society decided that they needed to join the […]



More on sepsis

Wed, 20 Dec 2017 22:59:52 +0000

A great comment from Dr. Cory Franklin: As an ICU physician and one of the people who drafted the initial “Sepsis guidelines” in 1991-1992, I want to point out they were not drafted with the intent of clinical use, rather as study criteria for the evaluation of sepsis drugs, in that case Xigris (unsuccessful). i […]



The IDSA takes an admirable position in not endorsing the new Sepsis Guidelines

Mon, 18 Dec 2017 18:10:05 +0000

Wow!  This article explains wonderfully the problem of guidelines.  Confirmation bias will impact all guideline panel members.  As you read the IDSA explanations, you can see that they have focused on the unintended consequences of markedly increasing sensitivity and therefore markedly decreasing specificity.  The reference for the IDSA article (abstract only unless you have access).  […]



Ward attending notes to my younger self

Sat, 16 Dec 2017 13:04:39 +0000

Finishing my 38th year of internal medicine ward attending, I wish I knew then what I know now.  I estimate the equivalence of at least 10 full years of ward attending, I think this meets the magic 10,000 hour number.  Hopefully, these notes to myself will help some newly minted ward attendings.  The job is […]



The Emperor of Performance has no clothes

Sat, 09 Dec 2017 13:42:47 +0000

Our greatest and worst attribute is seeing and saying that the Emperor has no clothes.  It requires intellectual honesty, a willingness to overcome confirmation bias and perhaps some hubris.  Often we make others uncomfortable with the raw honesty of such proclamations. For years many blogs have decried performance measures.  I have written about this problem […]



On setting achievable goals for behavior change

Sun, 03 Dec 2017 23:58:59 +0000

Long time readers know that I lost approximately 40 pounds in the year starting with Memorial Day 2013.  When I started, I did not have a big goal, rather I had a small goal.  The day I started, my goal was to lose 8 pounds.  After losing 8 pounds, I made a 5 pound goal. […]