74 - R2D2
Bedside Rounds
What does it mean when a computer can make better medical decisions than a human? The progress in large language models, and in particular the popularity of ChatGPT, has brought these questions to the forefront in 2023, but we’ve been discussing this for over 50 years. In this episode, Dr. Shani Herzig and I are going all the way back to the early 1970s with the invention of AAPHELP, the first real clinical decision support system, and the first time doctors had to contemplate working with – or competing against – computer systems.
info_outline
73 - Seadragon
Bedside Rounds
What happens when a patient far from surgical care – say, at the bottom of the Pacific ocean on a submarine, or at a research base in Antarctica in the middle of the winter – develops a surgical abdomen? This dilemma was the impetus to build the first truly effective clinical decision support system – and to grapple with what it means when a computer can make better medical decisions than a doctor. In this episode, part one of three, we discuss the dramatic stories of appendectomies at Novolazarevskaya and aboard the submarine Seadragon. Also, there’s a brand new #AdamAnswers about the...
info_outline
72 - Problems
Bedside Rounds
American doctors spend the majority of their time during the day on the computer, either writing or reading notes about their patients; only a small fraction is spent with the human beings in their care. Technology itself – especially the electronic medical record – has often been blamed for this. But in this episode – a recorded grand rounds that I gave at the San Francisco VA in 2022 – I argue that this alienation has its roots in the way we’ve decided to organize clinical data, and the assumptions that we’ve made about the nature of medical care. In particular, I’m going to...
info_outline
71 - A Doctor's Work, part 2
Bedside Rounds
In the past episode, cultural and medical historians Lakshmi Krishnan and Mike Neuss discussed the history of the actual work of the doctor – Holmesian detective, data entry clerk, or something else altogether. In this episode, we conclude our discussion by talking about what type of metaphors are best suited for clinical work. Plus a brand new #AdamAnswers about the reason that American doctors are so obsessed with using, well, the # symbol in our notes.
info_outline
70 - A Doctor's Work
Bedside Rounds
What do doctors actually do? Are they Sherlockian detectives, hunting down obscure clues to solve intractable cases? Are they virtuosic experts, training for half a lifetime to bring the latest science to bear to cure disease? Or are they clerks, whose main job is to collect and enter data into the electronic health record? In this episode, Adam is joined by medical and cultural historians Lakshmi Krishnan and Mike Neuss to discuss the stories we tell about our own work – and how this often conflicts with the realities of clinical practice.
info_outline
69 - The Database
Bedside Rounds
How do doctors actually think? And if we can answer that, can we train a computer to do a better job? In the post-WW2 period, a group of iconoclastic physicians set about to redefine the nature and structure of clinical reasoning and tried to build a diagnostic machine. Though they would ultimately fail, their failure set the stage for the birth of the electronic health records, formalized the review of systems, and set up a metacognitive conflict that remains unresolved to this day. This episode, entitled “The Database,” is the second part of this on the history of diagnosis with Gurpreet...
info_outline
68 - The History
Bedside Rounds
Internal medicine physicians like to pride ourselves on our clinical reasoning – the ability to talk to any patient, pluck out seemingly random bits of information, and make a mystery diagnosis. But how does this actually work? In this episode, called The History, I’ll be joined by Gurpreet Dhaliwal as we explore the beginnings of our understanding on how clinical reasoning works – starting in the middle of the 19th century with polar tensions between two ways of approaching our patients that are still felt today. Along the way, we’ll talk about the American Civil War, Car Talk,...
info_outline
The Facemaker with Dr. Lindsey Fitzharris (#histmedconsultservice)
Bedside Rounds
Modern plastic surgery was born out of the horrors of trench warfare in World War I. In this episode, Adam interviews historian Lindsey Fitzharris about her new book The Facemaker, about the life of surgeon Harold Gillies and his quest to rebuild his patients' faces.
info_outline
67 - Fever on the Frontier
Bedside Rounds
In the early 19th century, a strange new illness, seemingly unknown to medicine, ravaged settler communities in the American Middle West. As fierce debates about this new disease, now called milk sickness, raged – was it from toxic swamp gasses? arsenic in the soil? infectious microorganisms? from the poor constitutions of the settlers – an irregular medicine woman named Dr. Anna and an indigenous Shawnee healer discovered the cause of the disease and successfully prevented it in their community. But their discovery went unheeded for over a half century. This is a live podcast that I gave...
info_outline
66 - Burnout
Bedside Rounds
Burnout seems to stalk healthcare workers; between a third and a half of doctors and nurses had symptoms of burnout BEFORE the COVID-19 pandemic. Major medical associations have recognized burnout as a serious problem and the condition is being added to ICD-11 as an “occupational phenomenon.” How has burnout gotten so bad? In this episode, the first #HistMedConsultService, I’m joined by historians of healthcare and emotions Agnes Arnold-Forster and Sam Schotland to historicize burnout.
info_outlineFor thousands of years, bloodletting was the standard of care for any number of medical conditions, but at the turn of the nineteenth century, often acrimonious debates about the practice would lead to a new method of medical knowledge. The first of a multi-part series on the birth of population medicine, this episode visits the controversies surrounding the death of George Washington and Benjamin Rush’s bleeding of Philadelphia during the 1793 yellow fever epidemic and asks the big question -- how do doctors truly “know” what actually helps their patients? Plus, a brand new #AdamAnswers about military metaphors in medicine. All this and more on Episode 37 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!
Sources:
- Brickell J, Observations on the Medical Treatment of General Washington in His Illness, retrieved from https://books.google.com/books?id=YXA3AQAAMAAJ&pg=PA90&lpg=PA90&dq=craik+dick+washington+medical+repository&source=bl&ots=IZB72sSdaS&sig=kUY0JZHft1HbRrarR9RE4r-2w_A&hl=en&sa=X&ved=2ahUKEwju3PT439TcAhVOxVkKHZPHBVQQ6AEwA3oECAcQAQ#v=onepage&q&f=false
- Cohen B, The death of George Washington (1732-99) and the history of cynanche. J Med Biogr. 2005 Nov;13(4):225-31.
- Craik J and Dick E, The Medical Repository and Review of American Publications on
Surgery, Third Quarter, 1805. - Fuks A, “The Miliary Metaphors of Modern Medicine,” 2009.
- Harington J, Regimen Sanitatis Salernitanum (ca. 11th c.), retrieved from https://faculty.humanities.uci.edu/bjbecker/PlaguesandPeople/week3f.html
- Kopperman P, "Venerate the Lancet": Benjamin Rush's Yellow Fever Therapy
in Context. Bulletin of the History of Medicine, Volume 78, Number 3, Fall 2004, pp.
539-574 - Lane HP et al, “The war against dementia: are we battle weary yet?” Age and Ageing, Volume 42, Issue 3, 1 May 2013, Pages 281–283.
- Moed et al, “Cantharidin Revisited: A Blistering Defense of an Ancient Medicine,” JAMA Dermatology, October 2001.
- Morens DM, Death of a President, NEJM Dec 9, 1999
- Niehyl PH. The English bloodletting revolution, or modem medicine before 1950. Bull Hist Med 1977; 51, pp. 464-483.
- North RL, “Benjamin Rush, MD: assassin or beloved healer?” Proc (Bayl Univ Med Cent). 2000 Jan; 13(1): 45–49.
- Parapia LA, History of bloodletting by phlebotomy. British Journal of Haematology Volume 143, Issue 4
- Rush, Benjamin. Observations Upon the Origin of the Malignant Bilious, or Yellow Fever in Philadelphia, and Upon the Means of Preventing It: Addressed to the Citizens of Philadelphia. Philadelphia: Printed by Budd and Bartram, for Thomas Dobson, at the Stone House, No. 41, South Second Street., 1799, retrieved from: https://iiif.lib.harvard.edu/manifests/view/drs:6483213$1i
- Wallenborn WM, George Washington’s Terminal Illness: A Modern Medical Analysis of the Last Illness and Death of George Washington, retrieved from: http://gwpapers.virginia.edu/history/articles/illness/