Recent article From the Sunday New York Times: "Doctor, shut up and listen!"

David Lawrance david.lawrance at GMAIL.COM
Tue Jan 13 00:24:14 UTC 2015


Let it not go unsaid that Dr. Centor is the creator of the Centor Rule
which has revolutionized the treatment of pharyngitis, and that he is
a hero of mine. I devour all of his articles and I have tremendous
respect for his ability to so thoughtfully challenge the prevailing
common sense with data-driven enlightenment and reflection.

The practice of clinical medicine is neither art nor science. Those
things are both experimental. Whatever I do is not so much that. I
think I'm more of a skilled technician. My skills were largely
learned, but not taught. I have a lot left to master even after 35
years of practice. I wish what I did was experimental so that I could
twist the knobs and measure the effect and characterize the linkages.

I am also sure that nothing that I do is supernatural except for that
wonderful thing that happens when animals assist each other through
empathy. Since it seems to be possible to design self-driving cars, I
have greater hope for what machines will be capable of doing in
medicine. I don't know how much insight that engineered intelligence
will do toward teaching me to perform better, though, as machine
intelligence is unencumbered of my human failings. The kinds of
mistakes that I make are strengths in other spheres, heuristics that
usually work in making hasty decisions that are often good enough. I
can't rid myself of that hard-wiring, I can merely hope to dampen its
effect in certain situations. (Perhaps diagnosis will be best
conducted from outside the human realm.)

The Centor Rule scores a sore throat from 0-4. In the original
version, 0-1 is treated as a cold without diagnostics, without
antibiotics, 2-3 as needing a rapid strep or throat culture for
determining whether an antibiotic is necessary, and 4 was treated
empirically with an antibiotic. Dr. Centor revised his algorithm after
a decade or so to considering an antibiotic when the score was 3. Not
all that causes morbidity or mortality is strep, and not all of it is
easily culturable, or not simply culturable in an appropriate
timeframe. To look at the patient for those signs of toxicity that are
not so easy to always describe.

David

On Mon, Jan 12, 2015 at 11:29 AM, Ross Koppel <rkoppel at sas.upenn.edu> wrote:
> Yes! of course... and several things included that are wrong or
> misunderstood.
>
> Ross Koppel, Ph.D. FACMI
> Sociology Dept and Sch. of Medicine
> Senior Fellow, LDI, Wharton
> University of Pennsylvania, Phila, PA 19104-6299
> 215 576 8221 C: 215 518 0134
>
> On 1/12/2015 12:41 PM, Robert L Wears, MD, MS, PhD wrote:
>>
>> I have to strongly agree here.  A history is not a collection of facts,
>> but a narrative
>> co-constructed by doctor and patient (and often, family).  It's much more
>> akin to interpreting
>> literature than it is to following an algorithm.
>>
>> And it's never 'complete'.  In any communication, there are always more
>> possibilities than
>> can be realized; something is always left out, something else also could
>> have been said.
>>
>> bob
>>
>>
>
>
>
>
>
>
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> Medicine
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