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
Category: Emergency Care
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
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
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 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
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