While I’m still learning about Bayesian analysis in the interpretation of clinical trial evidence, it is fundamental to the bedside practice of medicine, where much depends on your pre-test, and how any test result affects your post test. This is an excellent illustration of the concept. Your patients will be well served by your experience.
During 36 years of pediatric practice I learned children don’t play fair in presentation. A second history is often worth its weight in gold. A detail that had skipped the patients mind initially or a question phrased differently yields complete changes in the course. I have had horses masquerading as zebras and zebras masquerading as horses.
You and your future patients will benefit from your early realization that judgement is one of the key elements of successful medical practice. And judgement cannot be baked into AI and other "modern" tools.
One of my mentors once said,”Your puzzling patient’s diagnosis will often have appeared in an article you read in The New England Journal last Tuesday.” That was not infrequently the case then,but the NEJM isn’t what it used to be…
My husband, after passing a stress test and being called a "poster boy for the management of CAD," wrote his cardiologist a lengthy letter describing his symptoms and when they occurred. This, the cardiologist said, "caused him to think," and quickly resulted in two stents in his widowmaker. Time and attention, sadly, are often luxuries, for all of us; not just professionals.
As I see it, you were the perfect person for Mr. A. Coincidence of biases? Maybe. I always say that coincidence is our higher power’s way of working anonymously in our lives. I’m glad he had you!
While I’m still learning about Bayesian analysis in the interpretation of clinical trial evidence, it is fundamental to the bedside practice of medicine, where much depends on your pre-test, and how any test result affects your post test. This is an excellent illustration of the concept. Your patients will be well served by your experience.
During 36 years of pediatric practice I learned children don’t play fair in presentation. A second history is often worth its weight in gold. A detail that had skipped the patients mind initially or a question phrased differently yields complete changes in the course. I have had horses masquerading as zebras and zebras masquerading as horses.
You and your future patients will benefit from your early realization that judgement is one of the key elements of successful medical practice. And judgement cannot be baked into AI and other "modern" tools.
One of my mentors once said,”Your puzzling patient’s diagnosis will often have appeared in an article you read in The New England Journal last Tuesday.” That was not infrequently the case then,but the NEJM isn’t what it used to be…
Today you would just order a VEXAScan
There’s no question that at times the gut is smarter than the brain.
Nice diagnosis and a feather in your cap. I suspect that at the end of your career you’ll have a cap full of feathers. 👍
Ben Hourani MD, MBA
Never heard of VEXAS before. Thanks for the article.
Great essay! Step #1: Worry.
My husband, after passing a stress test and being called a "poster boy for the management of CAD," wrote his cardiologist a lengthy letter describing his symptoms and when they occurred. This, the cardiologist said, "caused him to think," and quickly resulted in two stents in his widowmaker. Time and attention, sadly, are often luxuries, for all of us; not just professionals.
Posts like this help to restore belief in the medical profession.
COVID, due to the lies we were told, crushed it completely. There is zero trust.
But reading this post reminds me there are some who study the profession to heal patients- not profit and kill. Thank you.
As I see it, you were the perfect person for Mr. A. Coincidence of biases? Maybe. I always say that coincidence is our higher power’s way of working anonymously in our lives. I’m glad he had you!