Readers know that I went to the University of Virginia as an undergraduate. Since graduating in 1971 I have remained a huge sports fan and academic fan of the university. Those who follow my Twitter account have seen me tweet often about the basketball team. Our coach, Tony Bennett, took his 5 pillars of success from his father, the famous coach Dick Bennett. While these pillars have a Christian origin, I ...

Read more...

Over the years I have strived to develop my bedside manner.  On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection.  This commentary may convince some readers that I have the answers, but I do not.  Sometimes I do very well, but sometimes my skills fall short.  I do try to connect with patients and families, and give them confidence, ...

Read more...

I recently presented my diagnostic talk -- Learning to Think Like a Clinician -- at the Virginia ACP meeting.  Afterwards several physicians wanted to discuss the reasons for diagnostic challenges.  They convinced me that many regulations from CMS and other insurers have influenced policies that increase anchoring and diagnostic inertia. When the emergency department physicians admit to the hospital, they have to give an admission diagnosis.  At least in the United ...

Read more...

"Old school" is difficult, but doable for teaching attendings.  While prioritization is the key, having a basic framework will help. Here are my personal keys: 1. Sit at the bedside and retake the history of present illness on those patients in whom taking the history is clearly a key.  For example, someone admitted with presumed community acquired pneumonia should have a short history including fever and perhaps night sweats and possible rigors.  ...

Read more...

Having now lost more than 30 pounds, I am very close to declaring victory (maybe a few more pounds over the next few months).  A colleague has asked me to write my tips as a handout for patients.  This is a daunting task, but that has never stopped me! The weight loss formula is simple and well known.  Achieving lasting weight loss remains challenging.  The mathematical formula is simple.  Weight loss ...

Read more...

As an internist (yes, I am a specialist, just not a subspecialist), I do no procedures.  Patients pay me (albeit mostly indirectly) for my cognitive skills.  But we live in a culture that seemingly rewards procedures more that pure cognition.  Now I understand that procedures are not mindless.  Physicians doing procedures must think prior to the procedure, during the procedure and after the procedure.  But cognition without procedures seems undervalued. The ...

Read more...

Since prior to my entrance to medical school, common wisdom for treating sore throats involved the prevention of rheumatic fever.  Since group A strep pharyngitis is the cause of most acute rheumatic fever, all efforts have focused on treating group A strep.   Studies in the 1950s showed that penicillin treatment decreased the probability of patients developing rheumatic fever. The prevailing theory in the 50s and 60s, that we should diagnose group ...

Read more...

Most physicians love the profession.  Our medical students and residents want to care for patients, interact with patients and help those patients.  For most physicians, the joy of medicine occurs at the bedside and while investigating patient problems.  The joy does not extend to scut work (defined in the free dictionary as “trivial, unrewarding, tedious, dirty, and disagreeable chores”). Now who defines scut work? Back in the 70's, we would define scut ...

Read more...

The new blood pressure (BP) guideline, released recently in JAMA, has simplified blood pressure management and likely decreased both the number of patients needing treatment and the number of medications they need. Many commentaries have begun to flood the Internet, so of course I must add my thoughts. First, please read Harlan Krumholz thoughts: 3 Things to Know About the New Blood Pressure Guidelines. Here are my main thoughts: 1. This guideline panel ...

Read more...

Pauline Chen has once again written a brilliant piece in the New York Times: Are Today’s New Surgeons Unprepared? While many comments miss her underlying question, her exposition makes the problem clear. How do we gain expertise? Current theory supports the idea of deliberate practice. How do we conceptualize deliberate practice? Start with a sports analogy. You are trying to learn to make a 6 foot putt. In scenario ...

Read more...

5 Pages

Most Popular