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Total 22 results found since Jan 2013.
The scope of diagnosis – some thoughts after attending #DEM2018
This past weekend I participated in the Society to Improve Medical Diagnosis annual meeting. I saw many old and new friends. Going to a meeting often stimulates thinking. Because we often talk about diagnostic errors, we must first define diagnosis. As I listened to talks, observed posters, and talked with colleagues a broader concept occurred. Probably others have considered this, and if so, please send me the reference.
Diagnosis has several levels. A patient coming to see either a primary care physician, cardiologist, emergency physician or someone else (including urgent care, nurse practitioners, and physic...
Source: DB's Medical Rants - November 8, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
The American College of Cardiology Fourth Universal Definition of Myocardial Infarction has been published
Source: Notes from Dr. RW - September 21, 2018 Category: Internal Medicine Tags: cardiovascular Source Type: blogs
#5goodminutes Type IV RTA
For a number of years I have advised students and residents to keep a notebook of topics that arise on rounds. Pick 2 topics that we discussed, then read about them for 5 minutes. Everyone has 5 minutes to read about a topic.
The idea here is that cognitive science has shown that we remember better if we both hear about a topic and read about the same topic.
Since I have embarked on this project of one medical tweet each day, I have embraced the 5 good minutes philosophy. So I will use the hashtag #5goodminutes each day, along with other tags.
Today I want to increase understanding of Type IV RTA as many students, re...
Source: DB's Medical Rants - January 3, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Device and drug company payments to cardiologists
Source: Notes from Dr. RW - December 18, 2017 Category: Internal Medicine Source Type: blogs
Do statins negatively impact exercise?
Statins decrease cardiovascular events. Exercise improves both the quantity and quality of life. But some patients experience difficulty exercising while on statins.
Here are a couple of articles: Men Who Take Statins May Exercise Less
What You Don’t Know About Statins and Exercise Can Hurt You
We rarely hear about this conundrum from cardiologists or cholesterol experts, but we do hear from our friends who take statins. While I greatly favor statins for secondary prevention, this conundrum defines a major problem in primary prevention. When the only reason to take a statin is your age (check the latest calculato...
Source: DB's Medical Rants - January 8, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Why do we still use furosemide as our first line loop diuretic?
We currently have 3 loop diuretic options – furosemide (Lasix), bumetanide (Bumex) and torsamide (Demadex). They are all currently generic and available for 50 cents or less per pill.
In the 70s, during my residency I believe furosemide was already generic. The remaining two loop diuretics became available after my residency and thus had higher prices for several years.
Here is the problem. Furosemide is inconsistently absorbed across people and averages only 50% but for some people absorption is even less. Bumetanide and torsamide get absorbed consistently and close to 95%.
Several times this month we had pa...
Source: DB's Medical Rants - December 26, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Diagnosis – the adjectives are just as important as the nouns
This article from the Clinical Journal of the American Society of Nephrology speaks loudly to this problem – The CKD Classification System in the Precision Medicine Era
Chronic diseases of the kidney range from rare inherited disorders, such as Fabry disease, to more common acquired entities, such as diabetic kidney disease. Despite the myriad clinical phenotypes and histopathologic subtypes, even within, for example, diabetic kidney disease, this diverse collective is viewed similarly when estimates of glomerular filtration align. Contrast this approach with that of multiple myeloma, a diagnosis that prompts routine...
Source: DB's Medical Rants - December 6, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Physicians versus computers – the wrong question!!!
Over the past 2 days, listening to separate podcasts, I have heard the same story and now have a better understanding of artificial intelligence. A Freakonomics podcast – The Future (Probably) Isn’t as Scary as You Think
And in general, what’s happened in the past couple of years is the best chess player on this planet is not an AI. And it’s not a human. It’s the team that he calls centaurs; it’s the team of humans and AI. Because they’re complementary. Because AIs think differently than humans. And the same of the world’s best medical diagnostician is not Watson, it’s not a human doctor. It’s the...
Source: DB's Medical Rants - September 7, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Is it time to reconsider the cholesterol hypothesis?
This post is purposely controversial. I write it because I believe that mounting evidence suggests that we should encourage “out of the box” thinking about this issue. This post is hypothesis challenging. I may be right or I may be wrong. I hope we get some debate on my speculations.
The latest blow to the cholesterol hypothesis – Dashing Hopes, Study Shows a Cholesterol Drug Had No Effect on Heart Health
“We had an agent that seemed to do all the right things,” said Dr. Stephen J. Nicholls, the study’s principal investigator and the deputy director of the South Australian Health and Medica...
Source: DB's Medical Rants - April 4, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Cardiologist Arrested For Murder After Cathing Patient to Death.
Tallahassee, FL -- The Tallahassee medical community was stunned Friday after state prosecutors charged local Cardiologist Stan Wellington with first degree murder for the cathing death of James Binkmann. Prosecutors claim the 79 year-old patient was killed by a four hour cathing rampage that ended with cardiac arrest just as a left pinky artery stent was being deployed.Prosecutors released a transcript of the frantic 911 call they received from a float nurse in the cath lab the morning of the patient's death. "This is damning evidence," said State Prosecutor Denny Fleming.911: 911. What is your em...
Source: The Happy Hospitalist - July 20, 2015 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs
For your health, generalists have great lasting value
First, we must address semantics. This post – Generalists vs. Specialists – stimulated these thoughts. Often in organized medicine we (especially internists and family physicians) emphasize that internists (whether inpatient or outpatient focused), family physicians, pediatricians, general surgeons, etc. are specialists, while we reserve the term sub-specialists for cardiologists, or vascular surgeons, or gastroenterologists. For the sake of consistency with common usage, I will refer to generalists and specialists rather than specialists and sub-specialists.
The essay’s point (as I interpret it) fo...
Source: DB's Medical Rants - July 6, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
The affect heuristic and conflicts of interest
Understanding the affect heuristic leads one to expand their understanding of the term “conflict of interest”. My simple explanation of the affect heuristic follows:
If you like something, you overestimate the benefits and underestimate the risk. The contrary holds also. If you dislike something, you underestimate the benefits and overestimate the risks.
This concept helps us understand that we should consider multiple conflicts of interest. Clearly the pharmaceutical and device industries have taken advantage of this concept. They hire very likable representatives. This representatives treat physicians very we...
Source: DB's Medical Rants - May 25, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Medical talks in India – part 3
The trip is wonderful thus far and very interesting. Yesterday and today we are in Hyderabad in southern India. Hyderabad has a large IT presence and is famous for its biryana which we had for dinner last night. It was outstanding.
Some observations thus far:
1. Internists throughout the world treat mostly the same diseases and have the same concerns.
2. Infectious diseases are decreasing in India with improved public health – cholera has become much less common.
3. Non-communicable chrnoic diseases – diabetes, heart disease, hypertension, etc are increasing rapidly in India. They have significant numbers of CK...
Source: DB's Medical Rants - May 14, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Heart Hospital Scrambles After All Cardiologists Call In Stuck After Snowstorm.
Boston, MA - Massachusetts Heart Hospital was forced to scramble over the weekend after every single cardiologist called in stuck after a snowstorm dropped over two feet of snow on the city. House Supervisor Jan Stevenson was notified of the hospital wide physician shortage after nurses started complaining nobody had rounded on any patients for nearly 48 hours, which isn't always unusual."Some nurses became concerned after the first 24 hours, but we decided to hold tight because it was actually nice having none of the doctors around. After 48 hours, out of physician courtesy, we called every single ...
Source: The Happy Hospitalist - February 6, 2015 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs
Level 2 vs. Level 3 H & P Coding Comparison.
This lecture will assist physicians and other non-physician practitioners (NPPs) determine if their initial hospital admission note documentation meets criteria for a level 2 (mid level H&P) or a level 3 (high level H&P)evaluation and management (E/M) code. Recovery Audit Contractors will likely continue to target high level initial hospital encounters for improper payments. Physicians and other NPPs must continue to pursue documentation education to prevent accusations of overbilling and to prevent under billing for work provided. I am an internal medicine physician with over 10 years experience ...
Source: The Happy Hospitalist - April 10, 2014 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs
