How and Where You Ask The Question Matters: Confirmation Bias

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Do you believe what you see or do you see what you believe?  Confirmation Bias affects the way we search for, interpret, and recall information. It is the powerful tendency of humans to confirm their pre-existing beliefs and give more weight to data that supports their beliefs and less weight to data that tends to refute their beliefs. Francis […]

The Ethics of Deviating From Guidelines

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Unfortunately, it is all too common for physicians to proudly and defiantly deviate from national guidelines or accepted practices related to patient care. This may be motivated by a lack of knowledge that the guideline exists, disagreement with the guideline, a poor understanding of it, or just a rebellion against the norm that makes the […]

How Do I Diagnose A UTI?

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Urinary tract infections (UTIs) are commonly over-diagnosed in emergency departments and ambulatory settings. As many as half of all women presumptively treated with a UTI do not, in fact, have one (here and here). In some settings, the rate of over-diagnosis may be dramatically higher. Some over-diagnosis is necessary; but in ambulatory or acute-care settings, […]

Measuring How Well A Test Works, or How To Find a Hipster

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Imagine we design a test to detect a disease. In the graph below are 500 patients. Some patients have a positive test result and also have the disease; this is a True Positive (TP). Some patients don’t have the disease but nevertheless have a positive test result; this is a False Positive (FP). Most patients do […]

Primer: How To Systematically Read A Scientific Paper

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The ability to read scientific literature critically is one of the foundational skills of physicians. The most common way (and perhaps the most wrong way) that physicians read literature is to read the abstract of the paper (and sometimes just the conclusion of the abstract of the paper) and get a “take-away” message, assuming that all […]

How Do I Diagnose Ruptured Membranes? Bayesian Statistics at its Best

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The diagnosis of ruptured membranes in pregnancy is clinically very important. Decisions about delivering a pregnancy, hospitalization, and even termination of pregnancies, often depend on being correct about this diagnosis. Understanding how to diagnose ruptured membranes is fundamental to the basic practice of obstetrics; but understanding the clinical reasoning and statistics that underlie diagnosing ruptured […]