For content related to the science and practice of medicine

Nursemaid's elbow

One of the characteristics of a long medical career is the kaleidoscope of educational experiences one draws upon. This afternoon a three year old boy and his father benefitted from one of my early lessons, courtesy of Mary Mahotka, an x-ray tech in the Verona Family Practice Residency Clinic

Why do we treat strep throats with antibiotics

Clinicians like making the diagnosis of strep (streptococcal) throat (and patients hate being told they have a viral sore throat) for the same reasons: a belief in the ability of antibiotics to shorten the illness and prevent serious complications That’s what we doctors were taught, and that’s what we’ve taught our patients. How justified is this belief?  Well, there are problems.

Technically speaking

With regard to the EHR:

(crappy process) + (technology) = (fast, expensive crap)

‘Nuff said. 


The impact of errors in medicine

Not all errors have negative consequences. Many go unnoticed. Occasionally they save lives.

Listening to patients

One morning, in response to my question about how things were going, a young and first-time mother said that everything was fine but that it really hurt when her son nursed because of his tooth. I assured her that it was normal for the nursing to be uncomfortable in the beginning but that newborns do not have teeth. She insisted that her son did. One tooth. Left lower front. Sharp.

Confirmation bias

I will never forget the quasi-humorous sign in the radiology reading room:

I’ll see it when I believe it.

Robert Burton, a former Chief of Neurology at Mount Zion Medical Center, explains it this way:

The art of the apology

It could have been a big deal, but it wasn’t. Our appointment to discuss our options for diagnosing and treating a potential malignancy had been scheduled with the wrong interventional radiologist.

Snowstorm epiphanies

Every year, as winter approaches, I look forward to big snowstorms. Not just because I love Nordic skiing - though I do. Not just because the individually tiny flakes and their accumulation into deceptively gentle drifts are such a useful reminder of the importance of soft power. Not just because of the quiet, or the magic of moonlight glistening on fresh powder, or even the knowledge that the piles of snow against the foundation will help insulate the basement and protect our pipes.

The Reason

At the suggestion of a colleague, I submitted one of my blog posts to the FMEC ‘This I believe’ contest. To my surprise, it was selected as an award winner, and this past Sunday, October 22nd, I attended their annual Northeast meeting to read my essay (accompanied by a slide show of my photographs) and receive my award.

Magical thinking and the persistent ear infection

Over the years, experienced clinicians develop a sensitive and largely unconscious radar that supplements their cognitive analysis of patients. From the moment we enter the room, we are processing multiple subtle and seemingly irrelevant clues: how sick does she look, how nervous, how is he dressed, does he make eye contact, is he alone or accompanied, what is her mood?  Mostly we let this intuition work undisturbed, drawing on it selectively when we want - or on those occasions when it speaks up unbidden - but walking into the exam room to see Ms.


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