Fisheries, forests, & emergency care

In my last essay, I made the case that emergency care in the United States is better classified as a common rather than a public good. Due to the passage of the Emergency Medical Treatment & Labor Act (EMTALA), emergency care became non-excludable and because it is resource constrained, it is rival. Patients are streaming… Continue reading Fisheries, forests, & emergency care

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Tragedy of the ED Commons

In his landmark article, Tragedy of Commons (1968), Garrett Hardin asks, “Is ours a finite world? [If so], a finite world can only support a finite population.” In Hardin’s parable, a single group of herders shares a common pasture. The pasture is large enough to support many animals, but not infinitely many. Rationally, each herdsman… Continue reading Tragedy of the ED Commons

Super Ants

The biologist, Nigel Franks, wrote, “the solitary ant is behaviorally one of the least sophisticated animals imaginable...if 100 army ants are placed on a flat surface, they will walk around in ever decreasing circles until they die of exhaustion...yet put half a million of them together, and the group as a whole becomes what some… Continue reading Super Ants

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

The Suitcase of Empathy

Marvin Minsky called words that carry a variety of meanings "suitcase words." Empathy is such a word. Over the last ten years, research into empathy has exploded. The number of research papers in psychological journals, on the topic, has increased dramatically and popular interest in the concept matches what is found in these journals. A… Continue reading The Suitcase of Empathy

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

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

Poppy Powered

Humans have a long and complex history with plants. Long before civilization and even prior to the Agricultural Revolution, humans had realized that plants have a multitude effects on human physiology including appetite suppression, pain relief, energy supply, and immune system stimulation. It has been hypothesized that the adoption of an omnivorous diet was a… Continue reading Poppy Powered

First Do No Harm

The word iatrogenesis is derived from the Greek language meaning “brought forth by healer.” It is defined as the “inadvertent and preventable induction of disease or complications by the medical treatment or procedures of a physician or surgeon.” Iatrogenesis in medicine has been recognized for as long as Western medical history has been recorded. Approximately… Continue reading First Do No Harm

A Bayesian EHR

As an Emergency physician, my job is to make predictions. Throughout the day (and night), I make predictions related to treatment outcomes, management plans, and patient dispositions. These predictions are often fraught with risk (but mostly uncertainty) and I am constantly aware that every decision I make is inherently probabilistic. The framework that most physicians lean… Continue reading A Bayesian EHR

Between a Carbohydrate and a Fat Place

For the vast majority of human history, survival has been a desperate effort with a mixture of luck and lot of vigor. Energy sources have been scarce, and consequently, traits that optimized energy storage and conservation have gained prominence. In response to this history, we have utilized technology to create an environment where energy sources… Continue reading Between a Carbohydrate and a Fat Place

Fat Outside, Fit Inside

In a recent study in JAMA, nearly 75% of men and 65% of women between the ages of 25-54 were classified as overweight (BMI>25) or obese (BMI>30). These numbers have dramatically increased in the last 40 years. In response to this rising epidemic, a multibillion dollar weight loss industry ranging from diet companies and supplement… Continue reading Fat Outside, Fit Inside

The Art of Medicine

David Sackett was widely known as the “father of the evidence-based medicine” movement recently died. He defined evidence based medicine (EBM) as the “conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.” It is a set of best practices based on rigorous experimental data and seeks to… Continue reading The Art of Medicine

Know thy (evolutionary) history

Human evolutionary history has unfolded over millions of years and has transformed us from one generation to the next to its current state. In fact, the process of evolution continues to occur today and humans will be different in many aspects generations from now. If you look at human beings through the lens of evolution, it… Continue reading Know thy (evolutionary) history