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db's Medical Rants



Internal medicine, American health care, and especially medical education



Last Build Date: Sun, 15 Jan 2017 13:22:54 +0000

 



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 […]



Measurement for the sake of measurement makes no sense

Thu, 12 Jan 2017 16:35:47 +0000

Often over the past decade we have decried the rush to measurement.  For those who believe that we can measure quality easily. Enthusiasts have advocated for P4P without any data supporting this intrusion.  Now the Annals of Internal Medicine has published a review that features this conclusion: Pay-for-performance programs may be associated with improved processes […]



Do statins negatively impact exercise?

Sun, 08 Jan 2017 18:17:34 +0000

Statins decrease cardiovascular events.  Exercise improves both the quantity and quality of life.  But some patients experience difficulty exercising while on statins. Here are a couple of articles: Men Who Take Statins May Exercise Less What You Don’t Know About Statins and Exercise Can Hurt You We rarely hear about this conundrum from cardiologists or […]



Direct primary care – the answer or the problem?

Sun, 08 Jan 2017 00:00:18 +0000

Long time readers know of my fascination with the affect heuristic.  Simple stated, we overvalue the benefits of a concept that we like, and underestimate the problems 0r vice versa. This article about direct primary care induces conflicting analyses – Here is the PCP crisis solution and it’s simple I like the idea based on […]



Things that bug me 2 – lack of understanding eGFR

Fri, 30 Dec 2016 17:25:51 +0000

Once upon a time, we had to estimate GFR from the creatinine using an app or even a calculator.  Now almost all labs provide estimated GFR, but this is both a positive and a negative. I rarely find a resident (or attending physician) who understands the principles behind eGFR, and thus too often they interpret […]



Recent thoughts concerning #OTheoryFitness

Thu, 29 Dec 2016 17:30:21 +0000

Over the past 16 months, I slowly became an Orange Theory Fitness (OTF) addict.  My daughter convinced me to try a workout Labor Day weekend 2015.  I began doing a few sessions over the following 3 or 4 months.  At the beginning of this year, I went “all out”. Currently on the wards, and my […]



Additional thoughts on diuretics – a followup to the furosemide rant

Tue, 27 Dec 2016 16:54:47 +0000

Yesterday’s screed about loop diuretics initiated more twitter activity than any blog post this year.  Who knew? Several comments bear documenting. Important information on comparative absorption and duration of diuretics – A wonderful long range colleague (you should follow @kidney_boy on twitter) posted this infographic concerning this question on his blog.  This is a most […]



Why do we still use furosemide as our first line loop diuretic?

Mon, 26 Dec 2016 23:00:00 +0000

We currently have 3 loop diuretic options – furosemide (Lasix), bumetanide (Bumex) and torsamide (Demadex).  They are all currently generic and available for 50 cents or less per pill. In the 70s, during my residency I believe furosemide was already generic.  The remaining two loop diuretics became available after my residency and thus had higher […]



Things that Bug me 1 – improper use of diuretics

Thu, 22 Dec 2016 14:01:12 +0000

This month on our VA ward team we have had 3 admissions that involved complications of over diuresis for systolic dysfunction.  We also see patients who do not have adequate diuresis. Diuretics greatly help symptoms in patients with systolic dysfunction and volume overload.  But diuretics are primarily symptom relief medications. I often ask students and […]