docdocgoose

3 ปีที่แล้วdiscuss

As a physician who is neither young nor old, I can appreciate the timelessness of this sort of professional grousing: The young who know but cannot do; the old who do but are no longer in the know. Discerning when to utilize technologies (eg devices, drugs, protocols) plays a key mediating role in this dynamic.

docdocgoose

4 ปีที่แล้วdiscuss

Receiving VIP care sounds like an unalloyed good, but it’s more complicated.

Mortality for some conditions is higher on VIP floors because nursing is geared towards hospitality over clinical specialization/acting without deference to patient convenience.

VIPs often want to access new/off-label treatments, which can go quite poorly. VIP get all sorts of inadvisable care (“the best”; “access to experimental treatments”).

I’ve always thought about quality of care as an upside down U shaped curve: if you’re poor it’s bad, but if you’re a VIP it can also be bad. To be clear, the U isn’t symmetric, but weird things happen at the high end.

The ideal state is building a human bond with your caregiver, and in general, it will be returned with appropriate attentiveness. This is just harder when you’re poor or have complex stressors, but it also seems hard for many VIPs.

docdocgoose

4 ปีที่แล้วdiscuss

Principles of Neural Science by Kandel et al

Molecular Biology of The Cell by Alberts et al

Janeway’s Immunobiology

Robbin’s Pathologic Basis of Disease

All of these books are extraordinary in their sheer ability to organize thousands of small details into thematic narratives of how life operates.

They also reveal how hard we humans try to narrate life into tidy, comprehensible themes.

These books are all of an era (2005-2015), and there are probably newer ones. That said, they are a great guide for non biologists into how experts think things work.

docdocgoose

5 ปีที่แล้วdiscuss

I appreciate that some Nobel selections, like this one, are for core biological discoveries rather than hot topics.

How our bodies perceive / interface with the world is fundamental to our human experience: Pain, temperature, positioning. And that these perceptions can be significantly modulated by how our bodies process them (eg pain).

Not only is their actual body of work impressive, as it cuts across so many methodologies to get a glimpse at “how things work,” their discoveries opened up fields for others.

docdocgoose

5 ปีที่แล้วdiscuss

An important 2012 study found that higher patient satisfaction is correlated with higher costs and death. This is not counter intuitive if one has practiced medicine. Point being that healthcare isn’t a classic consumer product and social experiments like patient/provider concordance have complex effects.

https://jamanetwork.com/journals/jamainternalmedicine/fullar...

docdocgoose

6 ปีที่แล้วdiscuss

Reduced power and cost requirements are critical for this technology to be viable for low middle income country (LMIC) settings, particularly in rural areas. In many sub-Saharan countries, there are A handful in the country and use is complicated by unstable grids. High impact tech if use cases for these settings are sharpened.

docdocgoose

6 ปีที่แล้วdiscuss

Bruce chaired my PhD committee- he was a gentle and thoughtful person.

An observation about his approach to science, which I thought was distinctive: he was interested in a big, fuzzy relationship- health and stress. Over the course of his career, his lab wrote hundreds of small, credible papers to fill out and explore this relationship. Few were in the big journals, but over time, a sort of broadly understood relationship emerged and many other labs also participated in developing this concept. Now it’s just sort of something we understand- it’s a robust concept.

His approach always struck as significantly different from the one or two big nature/science papers that claims to discover or demonstrate a fundamental relationship. These tour de force papers can be vital, and they can also mislead an entire field.

I appreciated Bruce’s approach, especially because the incentive structure that permeated my graduate experience was “go big or go home”. There are entire classes of Scientific insight that won’t be revealed if this is this approach dominates.

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