While the specific term "placebo" didn't enter the medical lexicon until the late 18th century, ancient physicians were intimately aware of the effect. The ancient Greek, Indian, and Chinese traditions all leveraged the capacity of belief, trust, and suggestion to facilitate healing. However, with medicine’s scientific turn, the placebo has garnered a negative connotation of… Continue reading The Set and the Setting
Essays
Back Scratchers
It has proved to be a difficult endeavor to pin-down specific human universals. Exceptions appear to be the rule. Nonetheless, although the specifics vary, in broad terms it can safely be claimed that humans are universally social, symbolic, and ritualistic. Humans across time and space have and continue to be bound in webs of relationships… Continue reading Back Scratchers
Through Thick and Thin
The philosopher Gilbert Ryle developed the framework of thick and thin descriptions as a means to describe and understand human behavior. He illustrated it via the parable of the wink and a twitch. Although both actions can be superficially described and categorized with a thin description such as ‘closing and reopening the eye,’ a deeper,… Continue reading Through Thick and Thin
The S.O.A.P Factory
Ebers Papyrus Clinical documentation has a deep pedigree that dates back more than 4000 years to the ancient Egyptians. Transcribed onto papyrus in a format surprisingly similar to modern day case presentations, clinical documentation appeared to have served the dual purpose of teaching apprentices and guiding the management of future patients. Subsequently, Greek physicians continued… Continue reading The S.O.A.P Factory
The Swiss Army Knife
Are the best tools Swiss army knife-like - flexible, adaptable, multifunctional, and easy to use? Or is a knife-like tool - optimally sharpened, single-purposed for cutting - ideal? When framed as a simplistic dichotomy, it is obvious that tools do not have a universal or intrinsic “bestness,” but are context dependent and best viewed instrumentally… Continue reading The Swiss Army Knife
EHR as the Sun
The HITECH Act was passed in 2009 to promote and expand the adoption of health information technology with the objective to improve care processes, the quality of care, and overall health system productivity. Although the push to digitize medical records has mostly been accomplished, as Electronic Health Records (EHRs) have become ubiquitous in healthcare, the… Continue reading EHR as the Sun
Riskology
Risk-management is a foundational competency of not only the emergency physician, but the department (ED) as a whole (future essay). Utilizing a suite of tools and processes, the department aims to identify and stratify - often surreptitious - risk in an environment that is time, attention, and informationally constrained. It is tasked to rule-in/rule-out high-morbidity… Continue reading Riskology
Windows to the Soul
The development of technologies such as the telescope and microscope were transformational events in human history. They extended human perception to the far and the small, to the big and the near. Thereby upending our understanding of the universe and our place within it. Similarly, radiological imaging has extended our power of perception, not to… Continue reading Windows to the Soul
In the Blood
AI Generated (input: 'blood tests') Biomarkers have been used for centuries as indicators of human health or for the diagnosis of pathological conditions. The term is incredible diverse and inclusive but most commonly refer to blood tests. Biomarkers have become essential tools in clinical medicine and brimming with potential. By one analysis, the global biomarker… Continue reading In the Blood
in the Shadows, between the Lines
It has been estimated that an emergency physician makes 10,000 decisions in an 8 hour shift. I am not sure how that statistic was derived, but as an emergency physician I can experientially attest to the feeling of decision fatigue during many shifts. Many and the most salient of those decisions revolve around what tests… Continue reading in the Shadows, between the Lines
The History and Physical
The history and physical exam are firmly established methods in the practice of medicine, with an ancient pedigree. Their origins can be traced 2500 years ago to Hippocrates, who naturalized the concept of disease and introduced the methodology of the history and physical exam. Diseases no longer needed divine explanations, but could be studied like… Continue reading The History and Physical
In the beginning…
The life-cycle of the sea squirt is unique and instructive. As a free-swimming larva it has a three-hundred cell nervous system with sensors, a spinal cord, and an organ of balance which helps it find a suitable location for reproduction. Upon finding such a location, it lodges itself into the sand and proceeds to most… Continue reading In the beginning…
Fitness Functions
If the “burnt out” attrition of emergency physicians, the shortage of emergency nurses, the unfilled emergency medicine residency positions, the prevalence of errors (here and here), the persistence of misdiagnosis, or the news headlines (here, here, and here) are relevant indicators, then the emergency department (ED) could be considered a failed - or at least… Continue reading Fitness Functions
Mind Through Matter
Cognition - the ability to detect, record, and assimilate salient features of environments - is a fundamental feature of all biological agents. It enables organisms to move from a perpetually reactive state to one that is predictive, it decreases surprise and novelty, and its products reduce the demands of physiological and psychological homeostasis. Utilizing the… Continue reading Mind Through Matter
Sand Castles
Termites build mounds, beavers construct dams, bees assemble hives, and spiders weave webs. The drive to build is ubiquitous in the natural world and is an evolved strategy to cope with uncertain, complex, and dangerous habitats. This force, known as niche construction, reduces the environment to manageable and predictable units, shields organisms from known risks,… Continue reading Sand Castles
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