A 90-year-old mother is in the hospital for a stroke. Her son gave me the following details:
Two months ago, mom was admitted to the hospital for dehydration. At baseline she had mild dementia and chronic atrial fibrillation.
She recovered well. Before discharge, the primary care physician convinced the family to change her status to “hospice,” arguing that she would get better, more appropriate, and more comfortable care. Her blood thinner Eliquis was discontinued for being “too risky.”
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Interview on the Wake-Up Call podcast.
I had the pleasure of being interviewed by Adam Camac and Daniel Laguros, hosts of the Wake-Up Call podcast. We talked about the history of American healthcare. The interview was broken down into 2 segmenst. Here is part 1 and here is part 2. I highly recommend this podcast. Adam and Daniel are very good hosts and they have terrific guests, covering a wide range of topics. You can subscribe on iTunes.
Direct primary care for the poor
A third-year family medicine resident inquires about the direct primary care model (DPC) and caring for the poor. (more…)
Mukherjee’s error and his critics’
I can’t help but take a moment to comment on the heated response to Siddharta Mukherjee’s New Yorker piece. Theral Timpson summarizes the kerfuffle very well, provides the appropriate links, and gives it its needed context. The two posts by Jerry Coyne are worth reading, if only as a good education about what’s at stake.
The only interjection I will make is to say that neither side is getting it right or can get it right. This is an example of the inevitable confusion that arises when one adopts the wrong metaphysical framework or, more precisely, when one pretends that metaphysics doesn’t matter because empirical science will tell us all we need to know. (more…)
Kahneman versus Klein on medical decision-making
I just finished reading Daniel Kahneman’s bestseller Thinking, Fast and Slow. Regular readers of this blog will probably surmise that I don’t share the Nobel prize winner’s interest in cognitive biases (not that they don’t exist, of course).
Kahneman, like most social scientists, generally espouses an empiricist’s outlook on the human mind (the Humean mind…). For him, decisions are essentially a matter of calculation, and he documents the many ways we fool ourselves, and the many ways we can fall short. In that respect, the book is very interesting and often amusing.
Of course, one benefit of the research Kahneman has conducted with Amos Tversky is to poke holes in the flawed model of the world as made up of fully rational and selfish “Econs” as Richard Thaler put it. That model underlies much of mainstream, neoclassical economic theory.¹
What I found most interesting in Kahneman’s book is chapter 22, which deals with expert intuition, and whether it can be trusted. In that chapter, Kahneman candidly discusses his differences with Gary Klein, for whom he shows much respect. I wrote about Klein and how his insights can help us think about medical decision-making in my post “How experts really decide.” (more…)
A prospective medical student asks for advice
A prospective medical student wrote me this, and below is my response: (more…)
Thoughts on the trustworthiness of the healthcare system
The media periodically report tragic stories of parents who, for one reason or another, shun the medical system and, as a result, allow their children to either die or endure severe complications.
One such story came out yesterday regarding young parents whose toddler became sick. Instead of seeking medical attention, they took the advice of a naturopath over the phone. The child was misdiagnosed and treated with so-called natural remedies despite showing signs of deterioration and lethargy, although at times he appeared to get better.
After a two week period of persistent symptoms, the toddler took a turn for the worse. By the time the parents brought him to the hospital he had sustained profound, diffuse brain damage. There is no detail on what his exact diagnosis was, but it stands to reason that the child would have been better off if brought to the hospital or to medical attention much sooner. The parents are facing criminal charges. (more…)
Peer-review and science’s funding problem
I enjoyed listening to Theral Timpson’s podcast interview of Jason Hoyt yesterday.
Hoyt is the co-founder of Peer J, an open access publisher that is also encouraging biologists to post pre-prints. Peer J offer pre-print hosting for free and is one of those entrepreneurial companies that is trying to find a remedy for the widely perceived science publishing gridlock. Hoyt gives good insights about some of the challenges present in that world.
A couple of years ago, Hoyt also co-wrote an article for Scientific American in which he traces back the history and evolution of science publishing. Amazingly, peer-review of papers was not mandated by most journal until the 1970’s. (more…)
Podcast interview: Mendelspod
A couple of weeks ago, Theral Timpson kindly interviewed me for his Mendelspod science podcast (an excellent show, especially for those interested in cutting edge biotech matters). We talked about philosophy of science and medicine. I really enjoyed the conversation, and I hope you will too. The link is here.
Progress note 03/21/2016
William C. Roberts and “floating hearts.” Did Osler practice evidence-based medicine?
My favorite cardiology journal is the American Journal of Cardiology, mostly because its editor, William C. Roberts, publishes research articles and editorials that I can read, understand, and enjoy.
I’ve never met Roberts, but he seems like a very personable, old school, Southern gentleman. More importantly, as a dedicated academic cardiac pathologist who’s had an illustrious career and been at his trade for more than 60 years, I suspect he has directly examined, touched, and smelled more hearts than all currently practicing cardiologists combined. (more…)