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db's Medical Rants

Internal medicine, American health care, and especially medical education

Last Build Date: Sun, 30 Apr 2017 04:57:56 +0000


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 […]

Metacognition about teaching

Mon, 03 Apr 2017 18:00:58 +0000

During my early years as a faculty member, instinct guided my teaching style.  I really did not think carefully about teaching style or techniques. Meeting Kelley Skeff and spending a month learning about teaching at Stanford changed that.  He provided me a vocabulary and examples to allow me to develop metacognition.  What do I mean […]

Mentoring for clinician educators

Sat, 01 Apr 2017 14:33:37 +0000

In visiting many institutions and talking with many young clinician educators, the lack of mentorship for these positions appears striking.  No one would hire a researcher without adequate training, nor a subspecialist without the appropriate fellowship, yet we often hire physicians directly out of residency and give them the responsibility of being a ward attending […]

ACP delivers a position paper on administrative burdens

Tue, 28 Mar 2017 00:08:43 +0000

Talk with any physician and he/she will tell you how ridiculous the administrative burdens have become.  Several years ago the ACP began working on a major position paper about this issue.  Today the paper – Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians – appears […]