Get off my lawn!

Led a small group of first year med students through a couple of clinical cases; first one was sudden onset headache in a young man. We talked about how to generate a differential diagnosis, thinking about what’s urgent and what’s most likely.

One of the students goes, “What about epidural hematoma?”

“Good thought,” I say, writing it on the whiteboard. “What do you think about the fact that the patient’s talking to you and lucid?”

Blank stares.

“OK, so epidural hematomas can have a lucid interval, where the person might look and sound ok until the hematoma hits a threshold size and they decompensate quickly.”

Click-click as they type away (I would rather have said *scribbles* but kids these days with their laptops and snazzy equipment, they wouldn’t know a pen if it hit them in the face.) They seem disengaged; how can I make this relevant for them? Diseases mean very little unless you know, or know of, someone who has it.

“You know, like Natasha Richardson.”

Blanker stares. Finally, one of the students goes, “Who?”

*sigh* “She was skiing and fell, and when the paramedics got there she sent them away, then she went back to her hotel room and died.”

Later on, during a case of parkinsonism, I mention post-encephalitic parkinsonism, Awakenings and Oliver Sacks — no recognition. And when we were talking about dementia with Lewy bodies, I tell them, that’s what Robin Williams had, and they are like “huh?” So I decided not to tell them that Dudley Moore had PSP, because I don’t want to have to explain who Dudley Moore was.

Then after class, I submitted my application for an AARP card, because clearly I’m an old lady now.

fellowship · health policy

RIP Hans

I learned the other day that Hans Rosling, Swedish public health professor, died earlier this month of cancer.

I was walking down the street minding my own business, and I was so shocked by this that I stood stock still in the middle of Hamilton St listening to the rest of the podcast (BBC’s More or Less, if you are a fellow podcast fiend).

I never met Dr. Rosling, but everything I learned about global health in medical school, I learned from his videos on YouTube. (I think this says quite a lot about the quality of the global health curriculum at my school….) Yes, his presentations always had snazzy graphics, but his most important points were sound — that the data tells a story, and that the story challenges our preconceived notions about structural inequalities in wealth, health, and life.

Much of his work and legacy live on at Gapminder.org, but the world will miss you, Hans.


Hickam’s Dictum

The second thing you learn in medical school (right after “the patient is the one with the disease”) is Occam’s Razor: the simplest explanation is the best one. If the patient has five symptoms, give him one disease that explains all five, not five unrelated problems.

What they don’t teach you, at least not right away, is Hickam’s Dictum: the patient can have as many diseases as he damn well pleases. I always thought this was the product of a straight-talking New Yorker, probably a Brooklynite, some larger than life Sir Lancelot Spratt who didn’t mince words and ate interns for lunch. But no, the internet tells me that John B. Hickam was a real person, chair of medicine at Indiana.

Anyway, I was thinking about old Dr. Hickam today, because I had a referral who had essential tremor, generalized dystonia, myoclonus, parkinsonism, two symmetric ditzels where his nigra ought to be AND a hummingbird sign. He was like a grab bag of movement disorders! I had two different attendings see him with me (and they both agreed with me that the primary problem was X but couldn’t explain problems Y, Z, and Q). Ended up videotaping him for future reference, but geez Louise! Why don’t patients read the textbooks??


Time travel



The game says Carmen Sandiego converted her dollars to yen. What country uses yen?




You’re so smart!




This Likert questionnaire database needs converted to a weighted numerical score based on intensity, frequency, and duration. How do I automate this so I don’t have to manually calculate it for everyone?


Like this [does magical computer things]


You’re so smart!

No matter how old I am or how complex the problem, my mom has got my back.


I posted this on my personal facebook page earlier today, but as facebook is a bubble, I want it to get a wider audience. Also because facebook doesn’t allow links or citations, and as a physician and a scholar, I live for links and citations. This is the one and only time I’m going to mention politics on this blog. Discussion is welcome; rudeness is not. 

So, I’ve been reading a lot lately about how poor little Trump voters are feeling harassed because everyone assumes they are racist and misogynists. I’ve been reading a lot about how the liberals and the women and the minorities need to stop being so condescending, to reach across the divide, to forgive these people for voting Trump. Because we’ve hurt their feelings by calling them names, and it’s up to us to apologize.


First of all, I’m sure people who voted for Trump don’t think of themselves as racist or misogynist. Very few people do, outside of the KKK and Steve Bannon (*cough*). But there have been a lot of studies looking at implicit bias and unconscious racism, both in HR decisions (which resume to pick up) and, hitting closer to home, in medical decision-making (undertreating pain). Unconscious racism is very much a thing, a pervasive, pernicious thing. Similarly, unconscious sexism or internalized misogyny; check out the Heidi-Howard story, for instance. I can quote this stuff to you all day long, because I have been guilty of this shit myself, have educated myself about it, and I am trying every. Single. Day to be aware of it and to do better.

But to the bigger point, that calling out someone’s unconscious bias, holding someone accountable for what they’ve condoned, is somehow worse than the bias itself.

Also no.

Let’s remind ourselves that Trump’s views were never secret. At every one of his rallies and at every one of his debates, he made it clear that his was a campaign fired by stereotype and hatred — of women, of disabled people, of POWs, of Muslims, of Mexicans, of African Americans. (Remember that time he saw a black man at the town hall debate and immediately chanted “inner cities” about 25 times?)

Trump voters, you gave two thumbs up to a man who promised to recreate the Berlin Wall. You said sure no prob to calls for Muslim registries. You condoned talk of repealing marriage equality; you were fine with a return to the illegal abortion era when hundreds of thousands of women died of butchery. You were so short-sighted about your health insurance premium that you sold the country to a man who wants to dismantle the only protection you had against skyrocketing medical bills, not to mention flat-out denying coverage to your friends and neighbors who might have had a stroke, or multiple sclerosis, or any one of a number of “pre-existing conditions.” Perhaps most disturbingly, you voted into highest office a man who has called women pigs, who has felt up his own child, who has gloated about sexual assault, who has been accused of rape by a dozen women, one of whom was 13 years old at the time. If none of that was enough to make you vote for anyone else — Hillary, Gary Johnson, Jill Stein, Egg McMuffin, a god-damned yellow dog — you ARE racist and misogynist.

So Trump voters, I am sorry that your feelings have been hurt. I hope that at least some of you will participate in some good old-fashioned consciousness raising to learn some empathy for those who have been and will be directly harmed by your racist, sexist, selfish decision.

But I will NOT apologize for calling out hatred, and the effects of hatred, when I see it. And if that’s condescension, I’m the Queen of England.