Well folks, we are finally ready to re-launch with “season 2”. During our break we have been making plans to continue bringing you new material. But most importantly we’ve decided to launch a new podcast called “Diagnostica” which aims to bridge the gap between the culture of medicine and the “public”. We’ll keep you updated on this new project.
For now, enjoy a short cognitive autopsy. Next episode, more Bayesian thinking!
NIC AND ART,
Welcome back, enjoyed the episode and thanks Art for sharing it. It is very humbling to hear . Most of the physicians probably have been in a situation like this , at least i have been and hard to share those experiences .
Mahesh
ATHENS, OHIO
Art and Nic
So happy to see you guys back at it.
I recommend your production often, to colleagues, residents and students.
Your efforts are much appreciated and well received.
Art, congrats on your current career decision. So few are brave enough to take a break.
Nic, I hope you are enjoying your Argentinian grill.
I look forward to seeing you both soon.
Proud to call you both friends.
Be well
Shawn Vainio MD FAAFP
Girdwood, AK USA
Welcome back. I listened with keen interest your story of the young mother with breast cancer and presumed heart failure. I am sorry about the outcome and for Art’s obvious pain. One thing I struggle with as a physician is to keep in mind that “common things are the most likely.” But in your patient, I don’t think there was a standout “most common” thing. Low BNP in a thin person has a TREMENDOUS negative predictive value. CXR does not particularly look like HF to me. And even if she were in HF, one would not expect her to code… Read more »
Great stuff..humbling to hear
Great work on the cognitive aspects of medicine! Very much looking forward to the next episode on Bayesian reasoning. I have encountered a dilemma when it comes to Bayesian reasoning, which I wonder if you can help me resolve: In medicine there are acute, life threating illnesses which are rare. Immediate examples that comes to mind are aortic dissection or mesenteric ischemia. Time to diagnosis is crucial for correct treatment pathway. But litterature repeatedly confirms that their presentation is heterogeneous, and the “text book variant” is unreliable and in fact non specific. The rare incidence means that the pretest probability… Read more »
Thanks for the question Jinyang- let’s try to unpack it a bit. Firstly the fact that one diagnosis is more unlikely than another doesn’t require that we ‘deliberately neglect’ the less likely one. We simply keep track of that difference as we accumulate more data. It can sometimes be helpful to use a mental 2 x 2 table which groups your differential diagnosis into “likely and high stakes”, “unlikely but still high stakes”, ” likely but low stakes”, and “unlikely and low stakes.” Particularly in the acute setting when we’re seeing a patient as a snapshot in time… Read more »