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db's Medical Rants



Internal medicine, American health care, and especially medical education



Last Build Date: Mon, 22 May 2017 21:59:46 +0000

 



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 […]



AI + physicians

Sun, 30 Apr 2017 04:57:56 +0000

Some enthusiasts believe that computers the answer to diagnostic errors.  As I have written before, the biggest problem with AI comes from data entry.  Who collects the data and who picks which data to enter? Mukherjee has an interesting article in the New Yorker about AI. The most powerful element in these clinical encounters, I […]



Journalistic malpractice – the diet soda study

Wed, 26 Apr 2017 14:09:42 +0000

Sitting in Israel writing this blog post, drinking a diet coke, and wondering what they were thinking. You have read the headline, or heard it on TV or the radio – diet sodas cause dementia and strokes. That was the headline, but any careful analysis of the study suggests that they did not PROVE anything. […]



Interpreting and evaluating the Centor score

Sun, 23 Apr 2017 20:24:53 +0000

In response to a twitter request,  this post will in detailed fashion discuss the score, how I recommend using it and how to evaluate it.  I will go into more detail than I generally do, because the questions require that detail. The original study, published in 1981 based on data collected in 1980, used logistic […]



A personality trait that may help us minimize diagnostic errors

Tue, 18 Apr 2017 13:45:36 +0000

I found this article fascinating – The Surprising Personality Trait That Massively Improves Decision-Making, According to Science The trait is called intellectual humility! In everyday language, it means the willingness to accept that you might be wrong and to not get defensive when arguments or information that’s unfavorable to your position comes to light. In […]



Thanks for listening

Sun, 16 Apr 2017 10:55:47 +0000

When we walked into the room, you could sense the anger and frustration on the patient’s face, as well as two other relatives in the room.  We knew that the patient had had lung cancer for several months and had failed radiation and chemotherapy.  He had labored breathing and looked miserable. I went to his […]



The best physicians are multidimensional

Sat, 15 Apr 2017 13:55:00 +0000

No, this is not a science fiction reference.  Rather this represents, at least in my mind, the many skills necessary to become a superb clinician.  I write this from the perspective of an internist, but I believe these skills are not specialty specific. History taker – most patient encounters start with taking a thorough history. […]



Exercise in ones 60s – more on my #OTheoryFitness obsession

Thu, 06 Apr 2017 14:10:12 +0000

Regular readers know that I am currently an exercise addict.  Once one becomes eligible for Medicare, thoughts turn to maintaining quality of life and health (if we are fortunate enough to have good health). I play golf regularly, mostly with guys my age.  The great majority of my friends have an exercise regimen with the […]