Illustration of Teaching Cognitive Processes

robert bell rmsbell200 at YAHOO.COM
Thu Sep 15 05:02:28 UTC 2016


Do we know which commonly used drugs have the most worrying side effects?  Steroids would rank high I think. Would a list be helpful?

Robert Bell
> On Sep 14, 2016, at 11:05 AM, Edward Winslow <edbjwinslow at GMAIL.COM> wrote:
> 
> Thanks for the articles, David. 
> As Detsky says, most often students are "too confident" and have difficulty incorporating uncertainty into their thought processes, and always look at the bottom of the lake. If we tell this story too many times on rounds, we'll become branded as "The snakes on the dock, Doc."  
> 
> Maybe we could challenge ourselves to teach our teachers some aspects of story telling. We all might need a series of anecdotes about how things like unanticipated consequences of things that we do should change our approach to patient care. 
> Maybe we could collect a series of anecdotes/stories that will help us explain why things like constructing a differential diagnosis could be useful. 
> 
> I heard a story yesterday:
> A fairly prominent citizen of Chicago got care from 3 different sources (an AMC, a prominent Orthopaedic group, and another well known hospital in the area). At the first two, he had surgery on his foot and ankle. About 10 days later he was evaluated at the third hospital for back pain with sciatica. The neurosurgeon gave him Dexamethasone and was horrified when the patient developed an infection at the site of the prior surgery, complicated by sepsis. When I asked the citizen, whether anyone did a "complete" exam, including looking at the feet and legs, he didn't remember that happening. This wasn't a failure of the three different EMRs that didn't talk to each other (would an HIE have helped - maybe), but it WAS a failure of doing enough to ensure that a diagnosis wasn't missed. Maybe a medical student having to do a "complete H&P" might have helped this citizen. 
> 
> Detsky does tell us several stories about not looking one place only, but trying to keep our minds open to other possibilities. Can we find more?
> 
> On Wed, Sep 14, 2016 at 10:29 AM, David Katz <d.katz at mail.utoronto.ca <mailto:d.katz at mail.utoronto.ca>> wrote:
> Hi all,
> 
> One of my mentors, Allan Detsky, has written a really nice illustrative piece in JAMA about teaching cognitive processes. 
> 
> http://jama.jamanetwork.com/mobile/article.aspx?articleid=2552213 <http://jama.jamanetwork.com/mobile/article.aspx?articleid=2552213>
> 
> Enjoy,
> David Katz
> 
> 
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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