Everybody hates curbside consults – the informal, “Hey, Joe, how would you treat asymptomatic pyuria in my 80-year-old nursing home patient?”-type questions that dominate those Doctor’s Lounge conversations that aren’t about sports, Wall Street, or ObamaCare. Consultants hate being asked clinical questions out of context; they know that they may give incorrect advice if the [...]
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“Doctor, Step Away From That Cookbook!”
A middle-aged man develops chest pain at home. Minutes after calling 911, he’s in an ambulance, whizzing through traffic to the nearest emergency room. The paramedics radio ahead, and by the time the patient arrives in the ER, the hospital’s heart attack team has been activated. A stat electrocardiogram shows an ST-elevation myocardial infarction (STEMI), [...]
Denying Reality About Bad Prognoses: Not a Benign Problem
The human capacity to deny reality is one of our defining characteristics. Evolutionarily, it has often served us well, inspiring us to press onward against long odds. Without denial, the American settlers might have aborted their westward trek somewhere around Pittsburgh; Steve Jobs might thrown up his hands after the demise of the Lisa; and [...]
Putting the “A” Back in SOAP Notes: Time to Tackle An Epic Problem
A colleague recently sent me a remarkable video – of Professor Lawrence Weed giving Medical Grand Rounds at Emory University in 1971. It’s fun to watch for many reasons: the packed audience composed mostly of white men in white jackets and narrow ties, the grainy black and white images a nostalgic reminder of Life Before [...]
On Becoming Chair of the ABIM: Why the Board Matters More Than Ever
On September 10, 1986, soon after I completed my residency in internal medicine, I “took the Boards” – the certifying examination administered by the American Board of Internal Medicine (ABIM). A few months later, I learned that I passed the exam, and that success, combined with an attestation by my residency program director, rendered me [...]
The New and Improved “Understanding Patient Safety” and the Evolution of the Safety Field
Let me get the Shameless Commerce portion of this post out of the way: the second edition of my book, Understanding Patient Safety, was published this month by McGraw-Hill. I hope you’ll consider picking up a copy. That done, I’ll turn to something more interesting: the rapid evolution of the safety field, as seen through [...]
Gregory House, MD, RIP
The final episode of the show House, MD airs on FOX tonite. I wrote the following op-ed piece for USA Today; it’ll appear there tomorrow morning and is reproduced here with permission. Dr. Gregory House hung up his stethoscope and cane for the last time last night and shuffled off into eternal life in the [...]
Bedside Ultrasound for Hospitalists: Our Time Has Come
In 1949, the English-born physician John Wild, working at the University of Minnesota, discovered that he could determine the thickness of bowels injured in the war by bouncing sound waves though the abdominal wall. Over the next 30 years, medical ultrasound technology improved markedly, ultimately leading to the many uses we’re all familiar with. Once [...]
Role Models of Diagnostic Excellence: Goop Dhaliwal and the Car Talk Guys
In a “Clinical Problem Solving” session at my annual Hospital Medicine conference last week, I presented a fiendishly hard case to Gurpreet Dhaliwal, a UCSF associate professor of medicine based at our San Francisco V.A. You can imagine how hard this is for the discussant: he’s hearing a case for the first time, absorbing and [...]
“What is… Wegener’s Granulomatosis?”
A terrific article in The New York Times Magazine this summer described the decade-long effort on the part of IBM artificial intelligence researchers to build a computer that can beat humans in the game of “Jeopardy!” Since I’m not a computer scientist, their pursuit struck me at first as, well, trivial. But as I read [...]
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