6/2/26 – A Clock or a Cloud?
Where I write about Karl Popper’s clock/cloud framework to ask whether medicine’s diseases behave like predictable mechanical systems or irreducible complex ones — with consequences for how we treat cancer, cardiovascular disease, and neurodegeneration.
3/9/26 – Metaphors We Live By (and Through)
Where I write about how the metaphors embedded in medical language — war, machines, markets — structure clinical thought and action, shaping what treatments we pursue and what we overlook.
12/29/25 – The Set and the Setting
Where I write about the placebo effect from ancient healing traditions to modern medicine, arguing that mindset and context are not confounds to be controlled away but active ingredients in the therapeutic encounter.
10/27/25 – Back Scratchers
Where I write about humans as universally social, symbolic, and ritualistic beings — exploring grooming, shamanism, and the social determinants of health through an evolutionary lens.
8/12/25 – Through Thick and Thin
Where I write about Gilbert Ryle’s thick/thin description framework and how EHRs compress rich patient experience into lossy data — and what medicine loses when the wink becomes a twitch.
5/14/25 – The S.O.A.P Factory
Where I write about clinical documentation from Egyptian papyrus to the modern SOAP note, examining how the format shapes cognition, drives burnout, and serves interests beyond the patient encounter.
3/10/25 – The Swiss Army Knife
Where I write about whether the best clinical tools are flexible and multifunctional or sharply single-purpose — and why “bestness” is always context-dependent, not intrinsic.
1/14/25 – EHR as the Sun
Where I write about how EHRs, since HITECH (2009) made them ubiquitous, have become the gravitational center of clinical work — illuminating care in some ways while distorting it in others and driving physician burnout.
11/12/24 – Riskology
Where I write about risk stratification as the ED’s core competency — how emergency physicians use biomarkers, imaging, and probabilistic reasoning to rule in and rule out high-morbidity diagnoses under time and information constraints.
9/9/24 – Windows to the Soul
Where I write about radiological imaging as the telescope of medicine — extending perception into the body’s interior, while generating incidentalomas, false positives, and a cascade of downstream risk.
7/8/24 – In the Blood
Where I write about biomarkers from CBC to high-sensitivity troponin to D-dimer — what blood tests reveal, how Bayesian reasoning governs their interpretation, and the limits of a booming global biomarker market.
5/22/24 – In the Shadows, Between the Lines
Where I write about the shadow decisions an emergency physician makes across ~10,000 decisions per shift — which tests to order, what to act on — and how AI and affordances might help navigate decision fatigue.
3/26/24 – The History and Physical pt 2
Where I write about the H&P from Hippocrates to the modern ED, examining how triage, interoception, language, and therapeutic alliance shape what clinicians find and what patients feel.
2/14/24 – The History and Physical
Where I write about the H&P as a ritual of sense-making — how physicians translate a patient’s narrative into clinical reasoning.
12/19/23 – In the Beginning…
Where I write about the sea squirt digesting its own brain upon finding a home — a vivid entry point into embodied cognition, affordance theory, and why minds exist to guide action in the world.
11/1/23 – Fitness Functions
Where I write about the software engineering concept of a fitness function applied to a broken ED — burnout, errors, misdiagnosis, and unfilled residencies as signals that the system is optimizing for the wrong things.
9/5/23 – Mind Through Matter
Where I write about how physical experience shapes mental states — the body as the substrate of cognition, mood, and perception.
7/17/23 – Sand Castles
Where I write about the fragility of health, systems, and certainty — how easily structures built with care can erode.
5/8/23 – Drowned in (False) Positives
Where I write about how over-testing floods clinicians and patients with false signals, leading to harm disguised as thoroughness.
3/14/23 – Dashboard Medicine
Where I write about the proliferation of clinical dashboards and metrics — when measurement becomes noise rather than signal.
2/1/23 – Fluency and Its Illusions
Where I write about cognitive ease — how the feeling of understanding can be mistaken for actual knowledge, in medicine and life.
12/13/22 – Plastic Brains
Where I write about neuroplasticity — how experience reshapes the brain — and what this means for learning, habit, and healing.
11/1/22 – (Mis)matched
Where I write about evolutionary mismatch — our ancient biology encountering modern environments — and the chronic disease toll that follows.
9/19/22 – The Study of Other
Where I write about how we come to understand other people — through empathy, inference, and the limits of theory of mind.
7/28/22 – The Study of Self
Where I write about interoception and self-knowledge — what it means to really know one’s own body, feelings, and internal states.
6/10/22 – The Foggy Road
Where I write about navigating uncertainty in medicine and in life — making decisions when the path ahead is obscured.
4/5/22 – Great Expectations
Where I write about how prior beliefs and expectations shape what we perceive — predictive processing applied to clinical reasoning.
2/28/22 – Feelings Felt
Where I write about the role of emotion in cognition and decision-making — why feelings aren’t noise, they’re data.
1/10/22 – Language and Its Discontents
Where I write about how the words we use in medicine shape what we see, say, and do — and where language leads us astray.
10/26/21 – Worlds Far and Wide, Near and Close
Where I write about scale and perspective in medicine — how distant forces (economics, policy) and intimate ones (genes, behavior) both shape health.
8/30/21 – The Person and the Situation
Where I write about the classic psychology debate applied to medicine — how much of patient behavior is character vs. circumstance?
7/12/21 – The Wanderer
Where I write about exploration — of ideas, of the body, of what it means to wander through knowledge without a fixed map.
6/15/21 – Steep Hills
Where I write about the difficulty of change — behavioral, systemic, and physical — and what it takes to climb against resistance.
5/5/21 – The Systems Above
Where I write about how macro-level systems — social, political, economic — determine health outcomes as much as anything a doctor does.
3/30/21 – The Systems Above, the Genomes Below
Where I write about multiple scales of health — how genes and social structures interact to produce health and disease.
2/26/21 – Histories
Where I write about the importance of personal, family, and population history in understanding a patient’s present condition.
1/6/21 – The Arrow of Time
Where I write about medicine’s relationship with time — causality, prognosis, disease progression, and the irreversibility of biological processes.
12/5/20 – Charnel Grounds
Where I write about confronting death and decay — drawing on Buddhist imagery as a path to clearer understanding in medicine.
11/6/20 – Ash Heap of History
Where I write about the logical tetralemma applied to medical dogma — how ideas rise, fall, and sometimes linger past their usefulness.
10/5/20 – The Art of Progress
Where I write about what counts as progress in medicine — rethinking how we measure improvement in systems, outcomes, and knowledge.
9/8/20 – Shattered Mirrors
Where I write about broken feedback loops in healthcare — when the system can no longer see itself clearly enough to self-correct.
7/1/20 – Works Somewhere… Works Everywhere?
Where I write about the generalizability problem in medicine — why treatments proven in trials often fail to transfer to the real world.
6/2/20 – Evidence of, Evidence for
Where I write about the distinction between evidence that something exists and evidence that something works — a critical epistemological divide.
5/4/20 – Intuitions in the Wild
Where I write about how gut feelings and fast thinking function in the clinical environment — when to trust intuition, and when to check it.
4/1/20 – Wild Places
Where I write about nature and the human body as wild, complex systems — both resistant to neat control and rich with emergent behavior.
2/27/20 – A Tale of a Springbok
Where I write about prey-predator dynamics to illuminate human stress physiology and the chronic disease toll of a body always on alert.
1/31/20 – Unknown Unknowns
Where I write about Rumsfeld’s taxonomy applied to medicine — the dangers of what we don’t know we don’t know in clinical practice.
12/23/19 – The Present of Things Past
Where I write about how past experiences — biological, psychological, social — live on in the present body and shape current health.
12/3/19 – The Single Aim
Where I write about the value of focus in medicine and life — what happens when a system or person pursues one clear goal.
10/28/19 – The Problem of the Criterion
Where I write about a philosophical puzzle — to evaluate evidence we need criteria; to set criteria we need prior evidence. Medicine’s circular dilemma.
8/30/19 – Culture Clash
Where I write about when medical culture collides with patient culture, institutional norms, or its own internal contradictions.
7/2/19 – Similarities in Dissimilars
Where I write about the power of analogy in medical reasoning — finding structural similarities across seemingly unrelated phenomena.
5/31/19 – I Err, Therefore I Am
Where I write about medical error reframed not as failure but as an inherent feature of human cognition and complex systems.
4/30/19 – The Zombie Zone
Where I write about the dangers of rote, automatic practice in medicine — going through the motions without genuine attention.
3/29/19 – 😴💤
Where I write about the science and clinical importance of sleep — and how profoundly it affects every system in the body.
2/1/19 – The Dose Makes the Poison
Where I write about Paracelsus’s foundational principle updated for modern medicine — context, quantity, and timing determine whether a thing heals or harms.
12/31/18 – Hormesis
Where I write about how low doses of stress or toxin can strengthen biological systems — the paradox of what doesn’t kill you.
12/4/18 – Only Entropy Comes Easy
Where I write about thermodynamics as a lens on health — why maintaining order in biological systems requires constant energy and effort.
10/29/18 – Nature, Red in Tooth and Claw
Where I write about evolution’s ruthless logic and what it means for how our bodies were built — optimized for survival, not for modern health.
9/4/18 – Carrots & Sticks
Where I write about the behavioral economics of incentives in healthcare — what motivates patients and providers, and what backfires.
8/15/18 – Forest, Fisheries, & Emergency Care
Where I write about resource management theory applied to how EDs handle scarce time, attention, and capacity.
6/7/18 – Tragedy of the ‘ED’ Commons
Where I write about the ED as a shared resource — and what Hardin’s tragedy of the commons teaches us about overcrowding.
5/4/18 – Super Ants
Where I write about lessons from ant colonies on emergence and collective intelligence — what decentralized systems achieve without central control.
4/2/18 – Imperfectly Precise
Where I write about the trade-off between precision and accuracy in medicine — why being exactly wrong can be worse than being approximately right.
3/1/18 – Quality Detector
Where I write about what constitutes quality in healthcare, who gets to measure it, and whether our metrics capture what actually matters.
2/8/18 – The Map is Not the Territory
Where I write about models in medicine — all are wrong, but some are useful — and the case for epistemic humility about clinical frameworks.
1/8/18 – To Explore or Exploit?
Where I write about the exploration-exploitation tradeoff applied to medicine — when to try something new vs. stick with what works.
11/30/17 – The Suitcase of Empathy
Where I write about empathy as a layered, effortful capacity — not a simple feeling but a packed suitcase of cognitive and emotional work.
11/3/17 – Stereotypes
Where I write about how stereotypes function in clinical reasoning — sometimes usefully, often harmfully — and how to think about them honestly.
10/3/17 – Thrashing in the Emergency Department
Where I write about the CS term “thrashing” applied to the ED — what happens when overwhelming task-switching destroys efficiency.
9/5/17 – Thoughts Think Themselves
Where I write about challenging Descartes — how much of our thinking is under conscious control, and what neuroscience says about agency.
8/2/17 – Truth Springs from Arguments
Where I write about dialectical reasoning in medicine — how productive disagreement and debate sharpen clinical and scientific knowledge.
6/30/17 – Tail Events
Where I write about the stochastic nature of health — rare, high-impact events at the tail of distributions that dominate medical outcomes.
5/30/17 – Medicine, the Science of Uncertainty
Where I write about uncertainty as medicine’s defining characteristic — and why that’s not a bug, it’s a feature.
5/1/17 – Desktop Medicine
Where I write about how the computer has reshaped the clinical encounter — for better and worse — and what has been lost behind the screen.
3/31/17 – It from Bit
Where I write about Wheeler’s “it from bit” applied to biology and medicine — how information, not just matter, is fundamental to understanding life.
2/28/17 – Poppy Powered
Where I write about the pharmacology, policy, and tragedy of the opioid crisis — hiding in plain sight.
2/1/17 – History of the Joy Plant
Where I write about the deep history of the opium poppy — from ancient use to modern addiction — as a lens on pharmacology and human nature.
11/30/16 – Sugar Daddy
Where I write about how sugar became central to the modern diet and the metabolic disease epidemic — a history and a reckoning.
10/31/16 – Evolution is Cleverer Than You
Where I write about Orgel’s second rule — evolution will always find solutions we didn’t anticipate — applied to medicine and health interventions.
9/23/16 – Fountain of Youth
Where I write about the biology of aging — what drives it, what slows it, and why our evolved lifespan differs from what we wish for.
8/26/16 – First Do No Harm
Where I write about primum non nocere in a modern context — the many ways medicine can harm while intending to help.
7/29/16 – The Average is for the Average
Where I write about why population-level statistics often fail individual patients — the case for personalized, precision medicine.
5/24/16 – Solvitur Ambulando
Where I write about “it is solved by walking” — movement, embodied cognition, and physical activity as medicine.
4/11/16 – A Bayesian EHR
Where I write about how electronic health records should reason probabilistically — updating beliefs as new information arrives.
3/14/16 – Hunger Games
Where I write about the biology of hunger and fasting — how the body responds to scarcity, and what that means for health and longevity.
2/26/16 – Between a Carbohydrate and a Fat Place
Where I write about the macronutrient wars — fat vs. carb — and what the evidence actually says about diet and metabolism.
1/19/16 – Over-pharmaceuticalized
Where I write about the medicalization of everyday life and the over-reliance on drugs to solve problems better addressed by lifestyle.
9/3/15 – Brain Drain
Where I write about physician burnout, cognitive overload, and what happens to clinical judgment when the mental tank runs empty.
8/4/15 – What’s the DALY
Where I write about the Disability-Adjusted Life Year and why it matters — how public health measures the burden of disease.
7/2/15 – Fat Outside, Fit Inside
Where I write about metabolically healthy obesity — why BMI is a crude tool and cardiorespiratory fitness may matter more than weight.
5/28/15 – The Art of Medicine
Where I write about medicine’s irreducibly human elements — judgment, intuition, and craft — alongside its scientific rigor.
5/12/15 – The State of the Emergency Department
Where I write about what ails the ED — overcrowding, systemic dysfunction, and the pressure on a system at the edge.
4/21/15 – Metabolic Ghetto
Where I write about how poverty, environment, and structural inequity trap people in cycles of metabolic disease.
4/9/15 – The Exposome Exposed!
Where I write about the exposome — the totality of environmental exposures over a lifetime — as a complement to the genome.
3/27/15 – Technology Driven Triple Aim
Where I write about how technology can (and can’t) help achieve better care, better health, and lower costs simultaneously.
3/12/15 – Know Thy (Evolutionary) History
Where I write about our ancestral past as a diagnostic tool — understanding chronic disease through the lens of what we evolved to do.
2/18/15 – My Journey with Metabolic Syndrome
Where I write about my own experience with metabolic syndrome and what it taught me about health.
1/30/15 – The Digital Divide
Where I write about unequal access to health technology — who benefits from digital health tools and who gets left behind.
1/6/15 – Data Rich but Information and Knowledge Poor
Where I write about the paradox of big data in healthcare — more data than ever, but wisdom is still scarce.
12/4/14 – What is Health
Where I write about a foundational question — how do we define health, and why the answer shapes everything about how we practice medicine?
6/18/14 – How Do We Get Patients Engaged In Their Care?
Where I write about patient engagement as both a goal and a puzzle — what motivates involvement in one’s own health management.
5/16/14 – Electronic Health Records – Unfulfilled Potential, Hated by MDs
Where I write about the EHR problem — why a technology with so much promise generates so much frustration.
3/27/14 – How Can the iWatch Improve My Health?
Where I write about wearables and their potential — and limits — for personal health monitoring.
2/11/14 – Sagarmatha Beckons
Where I write about the call of high goals and high places — Everest as a metaphor for the challenges of medicine and personal striving.
10/29/13 – A Real Life Example…
Where I write about a clinical case used to ground abstract ideas in the messy reality of actual patient care.
10/10/13 – Compassion Fatigue
Where I write about the toll of caring — how repeated exposure to suffering erodes clinicians’ capacity for empathy and engagement.
9/23/13 – Obesity
Where I write about obesity — its causes, consequences, and why simple narratives of willpower miss the point.
9/18/13 – Salient Statistics
Where I write about how to make sense of health statistics — what makes a number salient, misleading, or genuinely informative.
S-Fxn 