Rotten Tomatoes and Docs?

Bugs & Beyond

As the debate has almost ended, and physician review is now here to stay, what could a physician actually do to survive and help the patient? Nay, prescribing adderall is the obviously not the right way. You can sue the bad reviewers but it is not going to end up any better than a social media disaster on danazol.

We should try to be kind to our patients and take time to understand them, but we must resist these misguided pressures and do the right thing – William Sonnenberg

As ideal these may sound, I doubt this will end bad reviews. Kevin Pho points out some techniques to create a positive vibe and compensate for the bad reviews by asking more of your patients to leave a review. Most patients tend to say nice things. To add to it, have a computer right outside your office that can be…

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Is a bacteria more crowded than a human cell?

Bugs & Beyond

Let us compare just bacterial and human cells to make life easy. When you say crowding, are we talking about crowding caused by macromolecules such as proteins or crowding due to macromolecules, small molecules and ions? I will try to find the density in each type of cell. May the densest cell win!

We will compare E. coli with H. sapiens. I will assume the volume of the bacteria to be 1 cubic micron, and the volume of the human cell as around 1000 cubic micron. There are larger human cells as well smaller ones but this should work. The volume of the nucleus is around 400 – 500 cubic microns – yes they are that big. That leaves us with 500 cubic micron to work with.

Macromolecules: Bacteria are estimated to have around 2 million cytosolic proteins whereas human cells have around 1 billion proteins copies per cell. In…

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Finding what you want to find!

“Because I was looking for it”, says Sherlock Holmes, half-patiently, in the middle of an intense fight with Lord Blackwood. He was referring to the poison-tipped fine-glass needle.

While this story had a happy ending, looking for what you want need not necessarily be the perfect way ahead. The neurosurgical team at Tufts had a tough lesson to learn.


They found what they were looking for
and pretty much shut out everything else.

While the neurosurgeon had asked for omnipaque, the pharmacist had informed the nurse about the unavailability of omnipaque, and had instead supplied them with two bottles of MD-76, which clearly was contraindicated for spinal infusion. The serious warning saying “NOT FOR SPINAL INJECTION” had slipped through multiple barriers not because nobody was looking for it. Rather because everyone was looking at the positive signs such as being handed over by a trustworthy pharmacist or nurse.

You expect them to be correct. What you expect to happen will happen because most of the time it actually does.

This is not the first time serious implications have been served up as a result of confirmation bias. Definitely not going to be the last time. Numerous studies similar to this by Mendel et al have shown that physicians looking for positive evidence find positive evidence and tend to ignore non-conforming signs and symptoms, leading to misdiagnosis. Diagnostic errors by their sheer magnitude in terms patients per year (close to 12 million per year in the US) are a huge drain.

86-8683-T9IU300Z

One possible mechanism to prevent confirmation bias is to have better designed software and protocol-based diagnostic methods. Although this might seem to promote cookbook medicine, there is nothing sexy about making a diagnostic error due to a cognitive bias in the name of promoting individual flair in medicine. Atul Gawande’s essay titled “Big Med” makes a compelling argument for protocol-based medicine. However, the quantum of false equivalency involved in comparing fast-food chains that produce standardized food items to medicine whose menu varies as much as the people it serves is arguable.

References:

1. http://www.bostonglobe.com/lifestyle/health-wellness/2014/08/30/surgical-error-tufts-medical-center-prompts-widespread-changes-operating-rooms/8JFgKrx6FIvLLT6Uja2bkJ/story.html

 

2. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8415519&fileId=S0033291711000808

 

3. http://www.newyorker.com/magazine/2012/08/13/big-med