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db's Medical Rants



Internal medicine, American health care, and especially medical education



Last Build Date: Thu, 16 Feb 2017 19:47:05 +0000

 



Things that bug me 3 – vanc and pip/tazo

Thu, 16 Feb 2017 19:47:05 +0000

For many residents, hospitalists and other physicians, vancomycin and piperacillin-tazobactam has approached reflex status.  The patient has a fever, looks sick (perhaps even septic) and has no obvious infection so we start vanc and pip/tazo. For yours this combination bothered me, because it implied the lack of a careful thought process.  If we just write […]



Why you should read the Undoing Project

Sun, 12 Feb 2017 16:20:21 +0000

The Undoing Project, the new Michael Lewis book (Big Short, Blindside, Moneyball), tells the story of Kahneman and Tversky – 2 Israeli psychologists who challenged assumptions of rationality and decision making.  I first heard Tversky at a Society of Medical Decision Making meeting.  He presented their work and emphasized the concepts of heuristics and biases. […]



An insight on the challenge of changing behavior ( h/t @gretchinrubin )

Tue, 07 Feb 2017 17:14:39 +0000

Veteran readers know that I had a major behavior change in 2013 – becoming an exercise addict and improving my eating habits.  I lost approximately 35-40 pounds, and have kept that weight off for almost 3 years now.  The big question that my friends and acquaintances ask me is how did I do it.  My […]



Meet your exercise goals, not others’

Wed, 01 Feb 2017 14:48:48 +0000

Over the past 2 days I listened to a wonderful podcast – Life at the Back of the Pack: The positive spirit of the Sub-30 Club; Ted Spiker on leading from the back. Ted Spiker writes a wonderful blog – the Big Guy Blog.  Several years ago, he had a goal of breaking 30 minutes […]



Advice for students and residents – always remember that the patient is a person

Mon, 30 Jan 2017 16:18:55 +0000

The title could (and should) provoke controversy and concern.  Yesterday, I was giving feedback to my interns and resident after a 2 week VA rotation.  We had an interesting 1/2 month.  Several patients stand out, not because of their disease, but because we focused on them and how to help them. A phrase I often […]



Estimating maximum heart rate is difficult – attn @OTheoryFitness

Sat, 28 Jan 2017 22:32:17 +0000

Orange Theory Fitness encourages working to achieve zones that your maximum HR defines.  When I started, I knew that the routine formula (220-age) for men did not work for me.  I am 67, which predicts a maximum heart rate of 153, yet multiple times I have proved that my maximum is around 170.  Given this […]



On binge drinkers

Thu, 26 Jan 2017 17:44:19 +0000

Doing hospital medicine, we often have patients come in for complications of binge drinking – acute pancreatitis, GI bleeding, trauma, hypothermia, etc.  Many such patients know they are alcoholics, and have spent considerable time not drinking.  Over time (often I am a slow learner) I have realized that most such patients are drinking to become […]



The joy of being a teaching and learning internist

Tue, 24 Jan 2017 17:44:15 +0000

Since December 1st, I have made attending rounds all but 10 days.  As usual, this stretch has invigorated me. As an internist (I am eschewing the phrase general internist because I believe that the adjective general is redundant), my teams care for a wide variety of patients.  Some patients have given us diagnostic challenges, while […]



Understanding why we have strong differences interpreting the same “facts”

Sun, 15 Jan 2017 13:22:54 +0000

In the past I have written about the affect heuristic.  The affect heuristic is a swift, involuntary response to a stimulus that speeds up the time it takes to process information. Researchers have found that if we have pleasant feelings about something, we see the benefits as high and the risks as low, and vice […]



#PeakPerformanceWeek @OTheoryFitness

Fri, 13 Jan 2017 14:40:38 +0000

Today we finished Day 5 of Peak Performance Week.  For those who have not yet tried OTF (Orange Theory Fitness), I will try to explain the brilliance of this week. We all work out for personal reasons.  Some start to assist with weight loss or weight maintenance (exercise is not enough, but it does help […]