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
Essays
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
Drowned in (False) Positives
In most real-world biological ecosystems where stimuli are often riddled with ambiguity, predictions are inherently probabilistic, and resources are time and computation constrained, organisms are forced to navigate the trade-offs between false-positives and false-negatives and the opportunity costs of (in)action. For example, if a feeding animal senses the presence of a possible predator, at the… Continue reading Drowned in (False) Positives
Death by Dashboards
Due to the glacial pace of evolutionary adaptation in many if not most ways, the genome could be considered a lagging indicator. It is tuned to invariants of a bygone regime - the environment of evolutionary adaptedness (EEA). Life would probably be not as robust and diversified if it had to solely rely on a… Continue reading Death by Dashboards
Fluency and Its Illusions
Although we think of information overload as a contemporary phenomenon, throughout evolutionary history organisms have always had to grapple with a world brimming with noisy data. Ever present and life threatening features such as camouflaged prey, lurking predators, strategizing competitors, invasive species, weather changes, and insecure food supply have always been part of the challenges… Continue reading Fluency and Its Illusions
Plastic Brains
To qualify as a licensed London taxi driver, trainees require comprehensive training and testing that typically takes three to four years. Drivers need to commit to memory and learn the mishmashed layout of approximately 25,000 streets, the location of thousands of landmarks, and the quickest way to navigate between any points in the city. In… Continue reading Plastic Brains
(Mis)matched
The 300,000 year old history of our species is one of migrations made possible by our biological and cultural adaptations. From their East African cradle, homo sapiens now occupy every longitude and latitude of the world. As a generalist species with a penchant for story-telling, socializing, teaching, learning, technology, and engineering, we have transformed our… Continue reading (Mis)matched
The Study of Others
As fundamentally social primates living in and dependent on exceptionally large and heterogeneous groups, other humans are among the most important features of the environment for humans. For humans, having the capacity to infer the intentions, goals, and feelings of others is essential for the Darwinian goals of survival and reproduction. In fact, the networked… Continue reading The Study of Others
The Study of Self
Cover: Strangers to Ourselves The philosopher Karl Jaspers introduced the concept of the Axial Age to describe convergent movements in thought that occurred across the Old World from the Greco-Roman to the Indian and Chinese. This period from approximately 8th century to the 3rd century BCE was the documented birth of the study of self.… Continue reading The Study of Self
The Foggy Road
In his book Surfing Uncertainty: Prediction, Action, and the Embodied Mind, Andy Clark used the metaphor of driving on a foggy but familiar road versus driving on a similarly foggy but unfamiliar road, to highlight the dynamism between the “top-down” predictions and “bottom-up” sensory data in perception. When navigating the familiar but foggy road, memory… Continue reading The Foggy Road
Great Expectations
Visual illusions (see below) provide unique insights into the generative aspects of perceptions and the gaps between perception and reality. They not only illustrate the disproportionate impact our learned and innate knowledge of the world - our priors - have on our perceptions, but also that perception is not a direct reflection of the world… Continue reading Great Expectations
Feelings Felt
We learn early in our education about the five senses - visual, auditory, gustatory, tactile, and olfactory. This processing of information from the “external environment” is termed exteroception. Intermittently, salient sights, sounds, tastes, smells, or touches enter our awareness but for the most part exteroception happens subconsciously. However, the brain not only monitors the external… Continue reading Feelings Felt
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