The Society to Improve Diagnosis in Medicine has on its website this quote:

  • 1 in 10 diagnoses are incorrect.
  • Diagnostic error accounts for 40,000-80,000 U.S. deaths annually -- somewhere between breast cancer and diabetes.
  • Chances are, we will all experience diagnostic error in our lifetime.
The current focus on diagnostic error raises an interesting question:  Is this a larger problem in 2017 than in the 1970s and 1980s? In this post, I ...

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Antibiotics save lives, but antibiotics can have negative effects.  When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration.  So we have a Goldilocks problem -- we want antibiotic duration to be just right -- neither too short or too long. Some clinical conditions have adequate research to define the Goldilocks duration.  Community acquired pneumonia only ...

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Over the past decade, I have thought often about the benefits and the problems of clinical guidelines. The first concept that attracted my attention was reading about conflicting guidelines.  Given the same data, different guideline committees would have significantly different recommendations.  At the least, this problem raises questions about guideline validity.  It makes clear that committee perspective could influence recommendations.  Guideline recommendations sometimes are clear and demonstrably evidence based, but too ...

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1973, as we prepare to start our clinical rotations, the chief medical residents taught us the new concept of SOAP notes. Larry Weed developed the concepts of the problem-oriented medical record and notes that included subjective, objective, assessment and plans for each problem.  We wrote our notes each day using his system. I have wondered in many conversations what he would think of the unreadable computer printout notes of ...

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When we walked into the room, you could sense the anger and frustration on the patient’s face, as well as two other relatives in the room. We knew that the patient had had lung cancer for several months and had failed radiation and chemotherapy. He had labored breathing and looked miserable. I went to his bed and asked if I could sit down on his bed. I took his wrist and began ...

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Longtime readers know of my fascination with the affect heuristic. Simply stated, we overvalue the benefits of a concept that we like, and underestimate the problems or vice versa. This article about direct primary care induces conflicting analyses: "Here is the PCP crisis solution, and it’s simple." I like the idea based on this reasoning. Primary care in 2017 has several problems. Both physicians and patients have dissatisfaction with ...

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On November 1973, I had an epiphany.  My first week on my internal medicine clerkship, I realized that I had found my specialty: internal medicine. Prior to medical school, I had worked with emotionally disturbed children in an inpatient hospital.  I really enjoyed the experience, and learned a great deal.  During my first two miserable years in medical school (I disliked how they taught the basic sciences and even more how ...

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Over the past two 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 ...

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Spend time talking with non-medical friends and acquaintances. Ask them about their medical experiences. Imagine what they want, or ask them what they want. People want to feel that their physician has spent adequate time talking, examining and explaining. They want to look into the physician’s eyes. They want the best possible care, but caring matters. Our “system” discourages such care implicitly. Physicians do not get paid to spend time with patients. ...

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A friend asked me recently about statins. He takes a statin for primary prevention but is concerned that he has muscle pain and weakness as a side effect. So he posed the question: “How important is the statin?” The Washington Post had this recent article: "Who should take statins? A vicious debate over cholesterol drugs."

But while nearly all experts agree that statins are beneficial for people at a substantial ...

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