Status Iatrogenicus

I have not been blogging much for several years because my other academic/scholarly activities have taken precedence. But now that I'm a PGY-26, I have accumulated in my mind a bevy of anecdotes ...

https://www.statusiatrogenicus.com/2024/04/moral-of-story-dont-cause-gratuitous.html

The next time you encounter a patient with an odd constellation of rare or poorly defined diseases (POTS and MCAS is a common duo), especially if a psychogenic one is on the list (e.g., PNES -...

https://www.statusiatrogenicus.com/2023/07/bayesian-implications-for-factitious.html

As has become my custom, I offered a wager on rounds the other day. An nonagenarian had gastrointestinal hemorrhage. He presented with syncope and gross (red) blood per rectum. History was sig...

https://www.statusiatrogenicus.com/2022/05/numeracy-in-medicine-clinical-wagers-to.html

A recent NYT article about cheating at Dartmouth reminded me of some hermetic knowledge of cheating in medical school that I have kept mostly secret for almost a quarter century. Without comment...

https://www.statusiatrogenicus.com/2021/05/cheating-in-medical-school-personal.html

Enough time has passed and enough clinical experience with the behavior of COVID gained that we can now apply some applied physiology to our understanding of this aweful illness.  I don't have ...

https://www.statusiatrogenicus.com/2020/04/applying-applied-physiology-to-covid.html

Here is a response to Deborah Mayo's excellent blog post posing this question .  I encourage you to first read her post.  Here, I explicate my view of the problems that are raised in that pos...

https://www.statusiatrogenicus.com/2020/04/are-vent-protocols-causing-harm-in-covid.html

A woman with upper gastrointestinal bleeding is admitted to the ICU with significant hemoglobin drop from baseline several months before.  The INR was >10 on admission, presumably reflecting sp...

https://www.statusiatrogenicus.com/2019/07/im-not-comfortable-withanalyzing.html

In last week's NEJM, author Matt Bivens reports an extraordinary experience : while inserting a venous catheter, he let go of the guidewire and moments later looked and saw it migrating into the...

https://www.statusiatrogenicus.com/2019/07/the-bermuda-triangle-of-guidewires-do.html

Jason Carr, MD didn't need a test to know what this is Kassirer (and Pauker) got the idea for the Threshold Approach to Medical Decisions  in part (as he tells it in his memoir Unanticipate...

https://www.statusiatrogenicus.com/2019/07/the-truth-doesnt-always-need-test.html

DAH from GPA or CPE/ESRD? If there is one thing you should remember about clinical decision making it is this:  the test is not the truth.  A diagnostic test raises or decreases the prior ...

https://www.statusiatrogenicus.com/2019/05/the-test-is-not-truth-one-week-in-life.html

A recent post described extubating an asthmatic patient with very bad weaning parameters, and I promised to provide a followup telling whether he "flew" or not. He flew. It was a nail-biting...

https://www.statusiatrogenicus.com/2019/02/pitfalls-of-protocols-pushing-limits-of.html

"THE ONLY WAY OF DISCOVERING THE LIMITS OF THE POSSIBLE IS TO VENTURE A LITTLE WAY PAST THEM INTO THE IMPOSSIBLE."  -  Clark's Second Law In prior posts here and on the Medical Evidence Bl...

https://www.statusiatrogenicus.com/2019/01/limits-of-possible-clinical-reasoning.html

Recently, I got permission from a patient to video a subclavian line insertion.  This patient was absolutely terrified of any line insertion as he had had many in the past and a lot of them ...

https://www.statusiatrogenicus.com/2018/11/speed-matters-landmark-guided-left.html

This very nice case report in the current issue of the Annals of the ATS is an opportunity to discuss rational clinical decision making.  The authors did almost everything that I would have ...

https://www.statusiatrogenicus.com/2018/09/activated-charcoal-and-beta-blocker.html

In a recent JAMA Performance Improvement piece, the authors describe the case of a man who presented to the emergency department with dizziness.  He was sedated for an MRI, his history of OSA ...

https://www.statusiatrogenicus.com/2018/05/root-cause-analysis-dig-deeper-or-weed.html

This was intended to be a case report but the amount of work required to publish a case report is just too great to justify it.  The publishing landscape has been flooded with an attendant raft...

https://www.statusiatrogenicus.com/2018/05/confusion-diaphoresis-and.html

Hal Arkes The heuristics and biases program of Kahneman and Tversky, once an obscure niche of cognitive psychology, became recognized among lay persons with Kahneman's Nobel prize in economi...

https://www.statusiatrogenicus.com/2017/11/sunk-kidney-bias-lethal-form-of-sunk.html

The following embedded videos are parts 1-4 of a 5 part talk I've been giving and refining on Applied Respiratory Physiology for about 10 years now.  (It is split into 5 parts because of youtu...

https://www.statusiatrogenicus.com/2017/10/applied-respiratory-physiology-vlog.html

This would be a very informative case report (and it's true and unexaggerated), but I anticipate staunch editorial resistance (even sans puns), so I'll describe it here and have some fun with i...

https://www.statusiatrogenicus.com/2017/09/dipshis-diprivan-induced-pseudo-shock.html

A frequent conundrum of decision making that arises in medicine is when there is a generally indicated therapy, say, anticoagulation for atrial fibrillation , that poses unique risks in a partic...

https://www.statusiatrogenicus.com/2017/08/the-number-needed-not-to-treat-to-harm.html

During MICU rounds last month, there were a lot of troponins ordered, and most of them should not have been.  Invariably when abnormal troponin values are reported on rounds, there is no menti...

https://www.statusiatrogenicus.com/2017/07/screening-in-disguise-you-cant-unknow.html

Herbert Simon, Nobel Laureate Recently I was called to admit a little old lady with a digoxin overdose who had symptomatic bradycardia.  She was in her 70s, had Alzheimer's disease (AD) and...

https://www.statusiatrogenicus.com/2016/08/the-enemy-of-good-is-better-maximizing.html

My wife is pregnant.  Wanting to be a supportive spouse, I attended the first prenatal visit to see one member of her team of midwives.  (Being a "minimalist" I was, like my wife, fond of the ...

https://www.statusiatrogenicus.com/2016/08/medical-decision-making-as-patient.html

I have long wanted to post a video of central line insertion using the traditional landmarks method, and recently I was afforded the perfect opportunity.  The patient needed a dialysis catheter...

https://www.statusiatrogenicus.com/2016/06/the-lost-art-of-landmarking-right.html

In a prior post, Doctorin' with Double Effect,  (a double entendre with Doctrine of Double Effect ) I attempted to tease out ethical issues related to the withdrawal of life support and speci...

https://www.statusiatrogenicus.com/2016/06/doctorin-with-double-effect-part-ii.html