The Physician As Teacher

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(Listen instead) Teaching for a good physician is a natural extension of her talents. We teach every day. We teach our patients and their families. We educate our communities. We teach ourselves by reading and synthesizing new information. We cannot be a doctor without being a teacher (it’s what the Latin word doctor means, in […]

A Little Skepticism, Please

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(Listen here instead) Good clinical thinking is good critical thinking. Critical thinking in medicine requires a variety of tools in our cognitive armamentarium. We must be aware of our biases. We must understand what constitutes good evidence and bad evidence. But perhaps the most important characteristic of a good critical thinker is a large dose […]

A Tale of Two Teachers

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  (Hate reading: Listen instead!) One of the most important experiences in my life occurred when I was a freshman in High School. I was assigned to a rather easy Algebra 1 class. We will call the teacher Mr. Bad. Mr. Bad was late in his career and was uninspired and uninspiring. His pedagogical method […]

Cancer Screenings and Over-diagnosis: Pick The Outcome That Matters

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Source What are the principles of a good screening test? The test should identify a clinically important disease that, if left untreated, will cause significant morbidity/mortality. It should be inexpensive and noninvasive. The disease being screened for should have a preclinical, pre-symptom phase for which there is a good intervention available. The test should be […]

How Do I Make a Differential Diagnosis? Or, Pelvic Pain

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The differential diagnosis, used appropriately, can serve as one of the most powerful de-biasing tools. When we interview a patient, review records, perform physical exam, etc., we begin to focus on certain areas and eliminate other things from our consideration. Much of this is due to inappropriate bias. For example: Framing effect: The patient tells […]

It’s Either Normal … Or It Isn’t? Watch Out For The Drift

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It’s Either Normal … Or It Isn’t? Is this true? Well, yes. This black and white statement sounds false to anyone with even a little bit of Bayesian thinking, but let me explain. Let’s imagine that we develop a test for an imaginary hormone called Mollynium. We study a “normal” population and we determine that normal […]

How Should I Pick a Speciality?

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This time of year is always full of anxious medical students desperately trying to meet deadlines and decide what field of medicine they want to go into for the rest of their lives, even though, so far, they have only been exposed to three or four specialities on their clinical rotations. Sounds stressful. Here’s some […]

Reader Questions (#1)

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Shoulder dystocia. Q. How should we define it? Is it any vaginal delivery requiring more than downward traction to deliver the anterior shoulder? Is it further stratified by usage of additional maneuvers or time? This obviously gets very subjective… A. In the literature, the two most common criteria used to define shoulder dystocia are, Delivery requiring two […]