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db's Medical Rants



Internal medicine, American health care, and especially medical education



Last Build Date: Mon, 14 Aug 2017 13:14:42 +0000

 



How would one rate physicians – the implications of multidimensionality?

Mon, 14 Aug 2017 13:14:42 +0000

Ratings have become a national obsession.  US News & World Report rates colleges, medical schools, hospitals, subspecialties, etc.  Some private firms develop physician ratings.  Many insurance companies provide physician report cards.  Intuitively most physicians understand that these ratings have serious flaws, yet they persist. H/T to Atul Grover  who tweeted a Malcolm Gladwell article that I […]



Diagnostic errors in 2017 (part 2)

Mon, 14 Aug 2017 01:13:31 +0000

Fortuitously this article just appeared – Malpractice claims related to diagnostic errors in the hospital characteristics significantly associated with diagnosis-related paid claims were as follows: male patients, patient aged >50 years, provider aged <50 years and providers in the northeast region One cannot definitely conclude from malpractice claims data that older physicians are better diagnosticians. […]



Thoughts on diagnostic errors in 2017

Mon, 07 Aug 2017 16:50:29 +0000

The Society to Improve Diagnosis in Medicine has on its website this quote: Reducing Harm from Diagnostic Error 1 in 10 diagnoses are incorrect. Diagnostic error accounts for 40,000-80,000 US deaths annually—somewhere between breast cancer and diabetes. Chances are, we will all experience diagnostic error in our lifetime. (US Institute of Medicine 2015, BMJ Quality […]



Are we developing the next generation of diagnosticians?

Fri, 04 Aug 2017 01:22:40 +0000

A senior consultant lamented to a colleague that he worried about the future of diagnosticians.  Diagnostician once described the epitome of internal medicine.  You could not give an internist a greater compliment.  But this consultant felt (whether he was right or wrong is unclear) that too often our younger colleagues lack diagnostic curiosity. This question […]



Antibiotic duration – a Goldilocks problem

Sun, 30 Jul 2017 21:18:16 +0000

Antibiotics save lives, but antibiotics can have negative effects.  When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration.  So we have a Goldilocks problem – we want antibiotic duration to be just right – neither too short or too […]



FeverPAIN vs the Centor Score

Tue, 25 Jul 2017 16:52:32 +0000

On twitter this week, several British tweeters discussed whether they should use the FeverPAIN score or the Centor score.  Obviously I have a bias here, but I will try to discuss this issue dispassionately. So I downloaded the PRISM study, where the authors proposed FeverPAIN.  The goal of FeverPAIN is to increase the patient cohort […]



Guidelines – a major problem

Mon, 24 Jul 2017 15:44:21 +0000

Guidelines are wonderful; guidelines are dangerous.  Over the past decade I have thought often about the benefits and the problems. The first concept that attracted my attention was reading about conflicting guidelines.  Given the same data, different guideline committees would have significantly different recommendations.  At the least this problem raises questions about guideline validity.  It […]



My OTF brag

Fri, 21 Jul 2017 22:15:08 +0000

First some context – I am a 68-year-old man who started doing OTF Labor Day weekend 2015 (thanks to my daughter). I had lost 35-40 pounds 2 years previously, and had kept them off. I was running regularly prior to OTF. OTF attracted me because I saw that the workouts would complement my running and […]



15 years of blogging – exercise and weight loss

Wed, 19 Jul 2017 18:28:53 +0000

If anyone out there has followed this blog for the full 15 years, they will know that I have written about exercise and weight loss often.  One stimulus involved my own journey to finally have extremely successful weight loss (starting Memorial Day weekend 2013) of 35-40 pounds.  The weight loss took a year and I […]



15 ys of blogging – unintended consequences

Tue, 18 Jul 2017 01:36:38 +0000

When I started blogging in 2002, I did not understand where blogging would go.  I took a rather vanilla name – medical rants – due purely to naivety.  Perhaps if I could have seen the future I would have used the phrase unintended consequences in the blog’s title. Medical care in 2017 suffers often from […]