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
Category: Health Informatics
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
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
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
Language and Its Discontents
Ludwig Wittgenstein wrote, “the limits of my language mean the limits of my world.” Fortunately, human communication carries multiple layers of signals - verbal and non-verbal, conscious and subconscious - with language or consciousness representing summarizations of all those signals. Similarly, the patient-physician interaction also is laden with signals. Even without considering the vagaries of… Continue reading Language and Its Discontents
The systems above, the (epi)genomes below
In medicine, it is often said the exceptions are the rule and atypical presentations of diseases are typical. However, diagnoses are also often preceded by typical symptoms, accompanied by diseases, and succeeded by other symptoms and diseases. There are patterns in these journeys and they often follow consistent trajectories. A heart attack is announced by… Continue reading The systems above, the (epi)genomes below
Shattered Mirrors
Ibn Khaldun, the 15th century North African historian, wrote “the past resembles the future more than one drop of water resembles another.” Implying that the patterns and lessons of the past are applicable to the present and can be applied to predict the future. Explanations and predictions are the outputs of science and the scientific… Continue reading Shattered Mirrors
I err, therefore I am
When talking about the human mental capabilities, in The Symbolic Species, Terrence Deacon stated that “biologically, we are just another ape. Mentally, we are new phylum of organism.” This wondrous and unfathomably complex organ - the brain - has enabled us to become the most dominant species of the planet. With a unique capacity to… Continue reading I err, therefore I am
Quality Detector
“Data is the new gold” is the mantra of our age. The data scientist has been termed the “sexiest job of the 21st century.” Every industry is driven by the impetus to acquire, curate, and analyze all aspects of their business. We measure and quantify everything with the promise of utilizing this data to drive… Continue reading Quality Detector
The Map is not the Territory
It is hard to even fathom let alone comprehend the size, scale, and complexity of the universe. It takes light 91 billion years to traverse the diameter of the observable universe. That is approximately six times longer than the age of the universe itself. Similarly, the amount of information in the world vastly overwhelms the… Continue reading The Map is not the Territory
Thrashing in the Emergency Department
The work of an emergency physician is an exercise in multitasking. We see multiple patients in parallel and respond to all the responsibilities that come with this patient care in addition to being aware of new, potentially sick patients. A typical workflow includes signing EKGs of new patients, documenting on a patient encounter, responding to… Continue reading Thrashing in the Emergency Department
Truth Springs from Arguments
Nature is saturated with feedback mechanisms ranging in scale from the molecular to the macroscopic. Feedback is defined as the process of mutual causal interaction: where A affects B and B affects A. This interaction creates a circuit of effects, so any change in A, causes a change in B, which in turn causes a… Continue reading Truth Springs from Arguments
Tail Events
The human brain (like any other organ) has evolved for specific environments and is constrained by its chemistry and historical contingencies. In my last post, I discussed the cognitive blind spots that play a role in the epidemic of over-testing and over-treating in medicine. Human decision making is notoriously ill-equipped to distinguish between low probability… Continue reading Tail Events
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