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db's Medical Rants

Internal medicine, American health care, and especially medical education

Last Build Date: Tue, 06 Dec 2016 23:36:35 +0000


Diagnosis – the adjectives are just as important as the nouns

Tue, 06 Dec 2016 23:36:35 +0000

You present a patient with a past medical history of CKD, heart failure and type II diabetes.  I hear 3 nouns, but I really do not know much about the past medical history. Cardiologists and coders demand that we further define the heart failure – left or right, if left systolic dysfunction or preserved ejection […]

We should encourage exercise – but how can we be successful

Tue, 29 Nov 2016 19:52:49 +0000

The reasons for encouraging exercise are many.  Readers know that I am an exercise addict.  As a child, adolescent and young adult, basketball was my main addiction.  I remember deciding to stop playing at the age of 44.  As we age, we get hurt more and take longer to recover.  I hated giving up my […]

Thankful to have become an internist

Thu, 24 Nov 2016 11:56:33 +0000

November 1973 I had an epiphany.  My first week on my internal medicine clerkship, I realized that I had found my specialty – internal medicine. Prior to medical school I had worked with emotionally disturbed children in an inpatient hospital.  I really enjoyed the experience, and learned a great deal.  During my first two miserable […]

Developing expertise

Sun, 13 Nov 2016 13:12:06 +0000

Our increased focus on diagnostic errors, while important, needs balance with a spotlight on expertise.  Gary Klein in a wonderful book – Seeing What Others Don’t – teaches us that performance improves when we decrease errors AND increase insights. Many physicians and especially clinician educators have focused on the reasons for diagnostic errors, but we […]

Diagnostic errors

Fri, 11 Nov 2016 10:05:25 +0000

The BBC series Sherlock is brilliant.  In episode 2 (called the Blind Banker) Sherlock enters a crime scene, and hears a rookie detective make pronouncements about a crime.  He quietly asks a few questions about inconsistencies, but the rookie detective is undeterred.  In true Sherlock fashion, he states (in a condescending tone) – “You have a […]

Lessons for organized medicine from the election

Thu, 10 Nov 2016 16:15:34 +0000

Yesterday, KevinMD reprinted a Medrants post – Will someone actually let actually help patients?  This post has had wide reposting on twitter and facebook. As we read and listen to “experts” dissect the Trump victory, one theme seems to emerge – the lack of respect for the working class.  While many remain mystified with Trump’s […]

Sepsis bundles – why sensitivity and specificity matter

Thu, 03 Nov 2016 14:09:38 +0000

Graham Walker(@grahamwalker) tweeted this in response to yesterday’s blog post: Agree w @medrants on Abx usage.  Sepsis guidelines mandating Abx for anything that COULD be sepsis is the problem I responded that his example is brilliant.  Let’s dissect the problem. Sepsis is a severe problem that responds better to early aggressive treatment. Those invested in […]

Antibiotics – principles for best use

Wed, 02 Nov 2016 15:36:23 +0000

As physicians we worry about antibiotic resistance.  Slowly, we understand that we can help slow down the development of more resistance through excellent antibiotic stewardship.  Even Time Magazine has highlighted this problem. In 2 weeks I will be a discussant in a PCORI sponsored workshop for this topic: Smarter, More Appropriate Use of Antibiotics Moderator: […]

Did you get your money’s worth today?

Thu, 27 Oct 2016 14:37:07 +0000

It started as a joke, but it has become a mantra.  I discuss this phrase on the Curbsider’s podcast. Our medical students pay (in my opinion) an obscene tuition.  They are buying a medical education.  Therefore we should remember that they are customers who have paid for our service. As a clinician educator, I try […]

Discussing internal medicine education on a podcast – The Curbsiders

Mon, 24 Oct 2016 12:03:43 +0000

That was a lot of fun.  The Curbsiders invited me to answer questions on a podcast.  Before we knew it, it turned into 2 podcasts.  They released the first one today, in which I answer questions about my philosophy of ward attending rounds, feedback, bedside teaching and writing. Next week they will publish our discussion […]