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db's Medical Rants

Internal medicine, American health care, and especially medical education

Last Build Date: Sat, 25 Mar 2017 22:18:12 +0000


Clinician educators – local respect and national anonymity

Sat, 25 Mar 2017 22:17:52 +0000

I spent this week as a visiting professor at the University of Nebraska Medical Center.  My long time friend and colleague, Dr. Robert Wigton, has endowed this professorship.  I gave a few talks, and met with many clinician-educators.  The groups included internal medicine hospital specialists, outpatient specialists and med-peds faculty.  I worked predominantly with junior […]

My developing thoughts on adult pharyngitis

Thu, 23 Mar 2017 11:14:28 +0000

MDCalc invited me to write a blog post about pharyngitis (they had previously asked me to comment on the Centor score). That post includes much of my current thinking – Sometimes it’s NOT just a sore throat – adolescents and young adults are different The other important concept that I did not include in that […]

Things that bug me – 5 – ordering orthostatic BP rather than doing it oneself

Tue, 14 Mar 2017 16:00:38 +0000

This happens too often in my opinion.  A patient comes to the emergency department after a syncopal episode.  The next day on rounds, the intern reports that h/she order orthostatic BP but it was not done. Now, some medical pundits have suggested that the physical exam is no longer relevant.  No serious internist really believes […]

Things that bug me 4 – inadequate specification of symptoms or diagnoses

Tue, 07 Mar 2017 19:33:27 +0000

The patient had diarrhea last night. The patient complains of chest pain. The patient has diabetes (or CKD or heart failure). What do these 3 sentences have in common?  When I hear them or read them, I want to know more! Perhaps explaining what I want to know will make the point clear. Please describe […]

Old school medical education

Fri, 03 Mar 2017 01:47:41 +0000

As I have the opportunity to give my talk titled Learning How to Think like a Clinician, many older physicians want to talk afterwards.  Usually they lament the current state of clinical skills – both history taking and physical examination.  Now I suppose they may overestimate the skills that they currently have and were taught, but […]

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 […]