The Corona virus crisis has gripped, perhaps strangled our society. Is this event the unprecedented medical apocalypse that the evening news and our political leaders are portraying?  It is a big deal but some historical perspective is necessary to balance our understanding of this pandemic. I present observations from the trenches we are preparing as we face this unknown .

I have argued that high blood pressure is not a disease but a sign - so a sign of what , exactly?  In this entry I explain why it is difficult to convince my colleagues to abandon the idea that high blood pressure is an imminent threat and how I reshape my patient's thinking regarding this vital sign .

It widely acceppted that high blood pressure is bad and causes heart attacks, strokes and and host of other maladies. Although this idea has intuitive appeal and is so widely held as to have become "common knowledge", the problem is that this belief is wrong.  In this podcast I discuss how this fallacious idea distorts our understanding and ultimately harms our patients. 

To understand the mysteries of medicine we are taught basic concepts we then use construct cognitive frameworks that allows us to interpret information, make predictions and formulate interventions.  But what if the original concepts are wrong? Experience has proven to me that many dogmatically held beliefs in medicine are flawed and negatively impact patient care.  In this episode I begin an analysis of this important problem.

Can  a non critically ill patient's physical exam yield information that is not more precisely derived from laboratory testing, imaging, or other technology?  Certainly.  In this episode, I discuss aspects of the physical exam that remain not only clinically relevant, but essential to understanding a patients pathology.

If we are being honest, most emergency physicians will admit that our physical exams have become subservient to technology as we evaluate our patients.  Does this mean that the physical exam is now just an archaic ritual?  Not so fast, my friends.  In this episode I describe those aspects of my physical examination I still fine crucial as I care for critically ill patents.

The big reveal! The top two negative changes to befall the practice of emergency medicine are finally unveiled.  How these have evolved and why they constitute a powerful malignant influence is examined.  

I move on to discussion of the "big ticket item" changes that have impacted the practice of emergency medicine one the last four decades. I outline what drives these changes and how they errode the quality of care provided in our emergency departments .

Forty years of experience have allowed me to develop skills and acquire knowledge that make the practice of Emergency Medicine a bit easier.  Thank goodness for that, since many other factors have appeared through the years that have had the opposite effect.  So with this episode, let the bitchin' begin!

During four decades of emergency medicine practice much has changed. In this podcast I describe what my experience has taught are some of the most beneficial changes that have improved the day-to-day practice of emergency medicine.