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 the tension between the top-down predictions and bottom-up sensory data. When navigating the familiar but foggy road, memory of that road… 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 implicitly, explicitly, and innately acquired knowledge of the world - our priors - has on our perceptions, but also that perception is not a direct reflection of… 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 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 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

Medicine, the science of uncertainty

In a recent article, it was estimated that at least $200 billion is wasted annually on excessive testing and treatment. The impact of the overly aggressive, extraneous care is not only financial in nature but also generates mistakes and injuries believed to cause 30,000 deaths each year. In 1979 the founders of the field of behavioral… Continue reading Medicine, the science of uncertainty

Desktop Medicine

As I discussed in my last post, Claude Shannon defined information as the number of bits needed to communicate an arrangement or state of a system. The fundamental problem of communication is not to make oneself understood, but to reproduce “at one point either exactly or approximately a message selected at another point.” The destination… Continue reading Desktop Medicine

It from Bit

The universe is composed of energy, matter, and information. However, it is not energy nor matter that makes the Earth unique, but information. No known place in the known universe holds more information than Earth.  It is said, our planet is to information what a black hole is to matter and what a star is… Continue reading It from Bit