Wednesday, December 18, 2024

A Foolish Consistency: Policy, Practice, and Rationality in Medical Decision Making

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"A foolish consistency is the hobgoblin of little minds, adored by little statesmen and philosophers and divines" - Ralph Waldo Em...
Wednesday, July 5, 2023

Bayesian Implications for Factitious Disorder

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The next time you encounter a patient with an odd constellation of rare or poorly defined diseases (POTS and MCAS is a common duo), especial...
Sunday, May 22, 2022

Numeracy in Medicine: Clinical Wagers to Estimate Probability in Diagnosis

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As has become my custom, I offered a wager on rounds the other day. An nonagenarian had gastrointestinal hemorrhage. He presented with synco...
Tuesday, May 11, 2021

Cheating in Medical School? A Personal Tale in the Wake of the Dartmouth Scandal

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A recent NYT article about cheating at Dartmouth reminded me of some hermetic knowledge of cheating in medical school that I have kept mos...
Wednesday, April 22, 2020

Applying Applied Physiology to COVID: Silent Hypoxia and The Work of Breathing

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Enough time has passed and enough clinical experience with the behavior of COVID gained that we can now apply some applied physiology to ou...
2 comments:
Sunday, April 12, 2020

Are the "Vent Protocols" causing harm in COVID?

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Here is a response to  Deborah Mayo's excellent blog post posing this question .  I encourage you to first read her post.  Here, I expl...
1 comment:
Monday, July 29, 2019

"I'm Not Comfortable With"....Analyzing Decisions Involving Risk

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A woman with upper gastrointestinal bleeding is admitted to the ICU with significant hemoglobin drop from baseline several months before.  ...
Monday, July 22, 2019

The Bermuda Triangle of Guidewires: Do They Just Fly Away Never to Be Seen Again?

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In last week's NEJM, author Matt Bivens reports an extraordinary experience : while inserting a venous catheter, he let go of the guide...
2 comments:
Friday, July 5, 2019

The Truth Doesn't Always Need A Test: Thresholds for Medical Decisions

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Jason Carr, MD didn't need a test to know what this is Kassirer (and Pauker) got the idea for the Threshold Approach to Medical Dec...
1 comment:
Saturday, May 25, 2019

The Test is Not the Truth: One Week in the Lonely Life of a Bayesian Clinician

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DAH from GPA or CPE/ESRD? If there is one thing you should remember about clinical decision making it is this:  the test is not the tru...
1 comment:
Wednesday, February 13, 2019

Pitfalls of Protocols: Pushing the Limits of Extubation

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A recent post described extubating an asthmatic patient with very bad weaning parameters, and I promised to provide a followup telling whet...
Friday, January 25, 2019

Limits of the Possible: Clinical Reasoning of a Harrowing Extubation

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" The only way of discovering the limits of the possible is to venture a little way past them into the  impossible."   -  Clark...
Tuesday, November 27, 2018

Speed Matters: Landmark Guided Left Subclavian Vein Central Venous Catheter Insertion & the "Deep Spot"

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Recently, I got permission from a patient to video a subclavian line insertion.  This patient was absolutely terrified of any line inser...
Saturday, September 29, 2018

Activated Charcoal and Beta Blocker Overdose: Clinical Decision Making and the Risks of Dichotomization

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This very nice case report in the current issue of the Annals of the ATS is an opportunity to discuss rational clinical decision making....
Tuesday, May 15, 2018

Root Cause Analysis: Dig Deeper, or the Weed Will Keep Growing Back

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In a recent JAMA Performance Improvement piece, the authors describe the case of a man who presented to the emergency department with dizz...
1 comment:

Confusion, Diaphoresis, and Hyperventilation Aboard a Private Airplane

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This was intended to be a case report but the amount of work required to publish a case report is just too great to justify it.  The publis...
13 comments:
Monday, November 20, 2017

Sunk Kidney Bias: A Lethal Form of Sunk Cost Bias

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Hal Arkes The heuristics and biases program of Kahneman and Tversky, once an obscure niche of cognitive psychology, became recognized a...
3 comments:
Tuesday, October 31, 2017

Applied Respiratory Physiology Vlog. Parts 1,2,3,4: Respiratory Failure Explained as Workload Imbalance

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The following embedded videos are parts 1-4 of a 5 part talk I've been giving and refining on Applied Respiratory Physiology for abou...
Tuesday, September 26, 2017

DIPSHIS: Diprivan Induced Pseudo-Shock & Hypoxic Illness Syndrome

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This would be a very informative case report (and it's true and unexaggerated), but I anticipate staunch editorial resistance (even s...
2 comments:
Sunday, August 27, 2017

The Number Needed Not To Treat To Harm (NNNTTTH): A Heuristic for Evaluating Trade-offs in Medical Decisions

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A frequent conundrum of decision making that arises in medicine is when there is a generally indicated therapy, say, anticoagulation for at...
Wednesday, July 19, 2017

Screening in Disguise: You Can't "Unknow" that Troponin, But You Can Dismiss It After Careful Thought

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During MICU rounds last month, there were a lot of troponins ordered, and most of them should not have been.  Invariably when abnormal tr...
3 comments:
Saturday, August 13, 2016

The Enemy of Good is Better: Maximizing versus Satisficing in Clinical Medicine

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Herbert Simon, Nobel Laureate Recently I was called to admit a little old lady with a digoxin overdose who had symptomatic bradycardia....
1 comment:
Thursday, August 11, 2016

Medical Decision Making as a "Patient": Pregnancy Leads to A Trip Down The Rabbit Hole - A Personal Story

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My wife is pregnant.  Wanting to be a supportive spouse, I attended the first prenatal visit to see one member of her team of midwives.  (B...
6 comments:
Tuesday, June 14, 2016

The Lost Art of Landmarking: Right Internal Jugular Insertion Video

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I have long wanted to post a video of central line insertion using the traditional landmarks method, and recently I was afforded the perf...
4 comments: