Medical Rants

Mental simulation to aid decision making

February 7, 2012

Regularly readers know that I am currently fascinated with Gary Klein's work.  I am currently writing a discussion for a clinical problem solving exercise.  Using Klein's work, I learned the value of mental simulation that he labels a "pre-mortem" examination.   After we see the results of a decision, we often engage in a "post-mortem". [...]

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Higher education – who is the “customer”

February 6, 2012

Throughout my career I have worked as a medical school faculty member.  I took my first job with the naive belief that my main job involved teaching medical students and residents.  Over the years I have learned that those who do this job extremely well still may not advance, unless they do the other things [...]

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The danger of weekend admission

February 5, 2012

We who work in hospitals know that most hospitals do not work as well on weekends as during the week.  I have worked at several hospitals over the years, and every hospital is understaffed on weekends. Patients 'more likely to die' if admitted at weekends The study, in the Journal of the Royal Society of [...]

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The danger of assumptions in medicine

February 3, 2012

Early in my academic career I became fascinated with decision analysis.  I still like decision analysis as a strategy to make explicit the structure of a problem.  However, over time the major weakness of decision analysis became very clear.  The problem derives from the assumptions. As usual, I will use pharyngitis to frame the problem. [...]

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More on naturalistic decision making

February 2, 2012

This week my team presented a patient who had puzzled them.  The patient complained of 3 weeks of facial swelling.  She had diabetes mellitus type II with severe gastroparesis.  She had both a feeding tube and a port (she used the port for saline boluses when she became volume contracted). She had gone to several [...]

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The importance of “intuition” – system 1 thinking

January 31, 2012

When discussing cognition intuition does not refer to ESP, rather definition #3 in dictionary.com - a keen and quick insight.  Physicians use this form of intuition often.  We learn patterns and use pattern recognition to make quick diagnoses and decisions.  Sometimes we call these patterns "illness scripts". One can easily argue that experts develop more refined [...]

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Why do I have …? I dunno

January 30, 2012

Time to share a frustration.  While some diseases and symtoms have clear causes, not all do.  If you smoke for 30 years, 2 packs a day, and develop COPD, or coronary artery disease, or lung cancer, then I know why.  If you drink 2 pints of vodka daily and develop cirrhosis, I likely know why. [...]

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The “green journal” addresses HVCCC

January 29, 2012

Bravo!  As regular readers know, ACP is championing high value, cost conscious care.  Browsing some blogs today I find that the American Journal of Medicine has started a new feature that physicians should consider when trying to provide HVCCC.  Here is the editorial introducing this new feature - Diagnostic Imaging: Powerful, Indispensable, and Out of Control [...]

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The puzzling overdose

January 26, 2012

Several readers nailed this one – valproic acid (Depakote).  Valproic acid does cause hyperammonemia This syndrome can occur with overdoses, but can also occur on apparently stable dosing.

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Saving money in health care – ACP’s HVCCC

January 26, 2012

High Value Cost Conscious Care does not just represent a slogan.  HVCCC represents an attitude.  We at ACP believe that physicians can help decrease health care costs.  We see waste in the system and will do our best to decrease the waste. Yesterday I tweeted - Appropriate Use of Screening and Diagnostic Tests to Foster High-Value, [...]

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