I’ve had patients ask my advice on what to do about visiting grandparents and great-grandparents for Thanksgiving over the past few weeks. I hear their anguish, their indecision, their desire to celebrate with family fighting against their fear of spreading the virus to someone they love, and the deeper fear and guilt that they are making the wrong decision by choosing to miss out on those beautiful moments together. My recommendation? If you think that, barring some tragedy, the person you love has some good years of holiday celebrations left, it seems wise to sacrifice this one in order to safeguard all of the others. This pandemic won’t last forever. … Continue reading Nobody wants to ruin your Holidays
In the context she is using it, ‘doing your own research’ at minimum means using the amazing, abundant resources of the internet to learn more about the concepts being discussed, and then using that new knowledge to get yourself over that first hump in the Dunning-Kruger effect and figure out 1. what you need to learn next and 2. what the limits are on how much you can actually learn about this on your own. The good news is, as long as you are humble in your assessment of your own understanding, you can also use that knowledge to 3. verify the reliability of whomever you go to to learn more. … Continue reading COVID-19 Vaccine Misinformation (minute-by-minute analysis)
As doctors, we carry our dead with us no more or less than anyone else; it is only that we generally have many more to carry. For every tragedy where a family and friends are left to wonder “what could anyone have done?” there is a physician who is left to question, earnestly drawing on all their clinical reasoning and accumulated knowledge, “What could I have done?”… Continue reading 30 Days on Doctoring: Reflections on Death and Eternity
Please keep yourself and others safe. Don’t be afraid of the virus, but please act in charity to those around you by taking reasonable and proven precautions like wearing a mask, maintaining physical distancing, and engaging in sound epidemiological principles like getting tested if you are ill, self-quarantining if you are exposed, and honestly and proactively participating in contact tracing if you are diagnosed.… Continue reading Don’t Be Afraid of COVID-19.
There’s a lot to unpack here. In an ideal world, the most important factor in what an insurance company would pay for would be the doctor’s determination, after carefully evaluating the patient and engaging in shared decision making about a treatment plan. Cost should be a consideration, but if a patient needs a certain medication or is stable on a certain medication, that should be the medication they end up with.… Continue reading 30 Days on Doctoring: I don’t get to pick which medicines your insurance company will pay for.
A 2 year old little girl fell and broke her arm. It happened while playing outside in the evening, and when she wasn’t able to move it without excruciating pain, her family went to the Emergency Room at their local hospital. They chose that hospital, out of all the hospitals in town, because it was owned and operated by the same company through which they have their medical insurance (this is important). … Continue reading 30 Days on Doctoring: Medical Roadblocks and Barriers to Care, A Story.
I have a friend, a hospice doctor, who has completed over 500 death certificates since finishing residency a few years ago. He has included a sole diagnostic code maybe twice. What Dr. Hesse sees as the ‘real’ COVID-19 deaths, these 9,210 death certificates without any other documented diagnoses, are actually an anomaly; I am forced to ask myself how that many death certificates were complete in such an incomplete and insufficient manner.… Continue reading 6%
On some level this math is incredibly simple; more people in close quarters means more cases, and more cases means more deaths. The real question is how much worse will reopening schools make the pandemic, and as we discuss below, whether that risk is justified right now. This question is going to answer itself in a few months, maybe even within a few weeks; but right now the best we can do is guess. … Continue reading Back to School
Last year myself and one of my clinic partners trained hundreds of physicians, nurses, and medical students to use their calling in medicine to recognize the signs of human trafficking and help address the unique medical and support needs of survivors. Last week, that partner and I both spent a significant amount of time in full PPE, in the 90-100 degree heat, evaluating, testing, and counseling patients for COVID-19. There is not a competition of awareness, focus, advocacy, or effort between those fighting these two assaults on our fellow Image-Bearers of God. The people who are fighting human trafficking are often the very same people fighting COVID-19.… Continue reading Please keep comparing COVID-19 to Human Trafficking (Part 2).
COVID-19 has already surpassed stroke, drug overdose, and the very deadly Seasonal Flu of 2017-2018, and there is zero chance that it won’t also surpass accidents and chronic respiratory diseases soon. But unlike the flu, COVID-19 did not begin to disappear in the late Spring and early Summer, and we are once again seeing a surge in deaths from the virus as we enter August.… Continue reading Stop comparing COVID-19 to Car Accidents (Part 1).
No Dr. Immanuel, it is not unethical to refrain from using a medication in a clinical scenario where it has no proven efficacy. This is the philosophy that led to the opioid epidemic and every day leads to polypharmacy, another very real killer of the elderly. We took oaths to first do no harm, and sometimes that means sitting in the tension and anxiety of an unknown future with our patients and admitting, regardless of our own hubris, that we don’t have anything special or prescribable to offer other than our sound advice, sincere compassion, and reliable information. In fact, this is actually a pretty big part of our jobs already.… Continue reading America’s Frontline Doctors (I guess I don’t count?)
With so many pieces of misinformation floating around out there and so little time to write 3,000-5,000 word blog posts, today’s post is just an attempt to debulk the malignant tumor of COVID-19 misinformation. The rules are simple:
1. Memes only.
2. Each meme gets one paragraph only (I completely failed at this part).
3. The crazier or less sincere the meme, the snarkier the response.
… Continue reading Medical Misinformation Meme Monday
It’s clear that there are some people who are not comfortable with the majority of physicians drawing one conclusion while a small minority draw the opposite conclusion unless one of those groups is lying. If that’s you, please consider which doctors have the greater financial motivation to build a false narrative- and stand to actually gain from the narrative they are building- and which are willing to tell the truth even if it hurts them financially.… Continue reading A rare moment of cynicism: Why are the doctors lying?
When lone wolf doctors promote unproven therapies and set themselves up as experts with miracle cures, without having actually done the clinical research to validate their claims, it erodes the fragile trust that we work so hard to build with our patients when we are unwilling to engage in that same type of speculative treatment. This unearned mistrust has the potential to breakdown the patient-physician relationship and affect our patients’ health for years to come. … Continue reading Texas doctors trying novel treatments (the trap of anecdotal evidence).
COVID-19 Questions and (attempts at) Answers, Part 3: Isn’t a surge a good thing? Herd Immunity and the RECOVERY Trial.
The longer we can work together to flatten the curve, the more time we create to discover new therapies, improve our understanding of the virus, and collect high quality data about transmission and vulnerability that can help us develop novel, strategic mitigation approaches; and we are already seeing the benefits of the work of this kind that we have done so far as a society. … Continue reading COVID-19 Questions and (attempts at) Answers, Part 3: Isn’t a surge a good thing? Herd Immunity and the RECOVERY Trial.
COVID-19 Questions and (attempts at) Answers, Part 2: What about antibody testing and asymptomatic cases?
When that antibody test you got comes back positive and the manufacturer says their test is “95% accurate,” you may be tricked into thinking it means there’s a 95% chance you really have already had the virus and now have antibodies against it. But they are only telling you half the story.… Continue reading COVID-19 Questions and (attempts at) Answers, Part 2: What about antibody testing and asymptomatic cases?
COVID-19 Questions and (attempts at) Answers, Part 1: Is the rise in cases just due to more testing?
Many of those hospitalized patients are fighting for their lives in the ICU right now, as the hospitals are starting to fill up around them and their nurses and doctors are becoming fatigued. As we’ve seen elsewhere, the ratio of those who don’t recover will only increase if resources and the margin for careful attention and heroic efforts on their behalf begin to run short. … Continue reading COVID-19 Questions and (attempts at) Answers, Part 1: Is the rise in cases just due to more testing?
Whether it is surgeons or industrial workers, cultures in which many women wear face coverings as part of their public clothing, or my 5 year old spending three weeks straight in his Spider-Man costume and refusing to wear anything else, the wearing of masks is something we all have some degree of experience with and have never really been concerned about until now, when we are suddenly being told they are extremely dangerous by the same people who have been spreading various types of COVID-19 misinformation since mid-March. … Continue reading On Masking
‘Less lethal’ still means potentially lethal, and many of the weapons and techniques being used still possess the potential to kill. They are not crowd control devices or nuisance stimuli, but weapons. The question we need to be asking ourselves is whether the use of weapons, including weapons with potential to maim and kill, has been justified.… Continue reading “Non-Lethal” Weapons: A Doctor’s Perspective.
Apparent medical misinformation from an unlikely source: Asymptomatic, Presymptomatic, and Minimally Symptomatic.
The idea of asymptomatic transmission, the virus actually being transmitted from a person who does not feel ill, who may not even know they have been exposed, is pretty terrifying. It means that you could, without ever knowing it, be the agent of delivering a deadly pathogen to a loved one; and that you may not ever know you were the one that gave it to them even after the fact. But asymptomatic transmission does in fact occur.… Continue reading Apparent medical misinformation from an unlikely source: Asymptomatic, Presymptomatic, and Minimally Symptomatic.
The physicians who wrote this letter are advocating that life return to normal. But just as in every mass casualty, their call to shift our standard of care and abandon transmission reduction strategies necessitates allowing some to die who might otherwise have lived. This group that should be forsaken, who in the letter’s own words “require too many resources to save”, are the excess dead from COVID-19, who might have been spared by “reopening” with more caution, more national sacrifice, more people-centered policies, and more patience.… Continue reading COVID-19 as a Mass Casualty Event; my response to a letter signed by 600 doctors.
I’d love to tell you that I don’t care what insurance you have. I’d love to say it just doesn’t matter to me, that every patient gets an equal share of my time, energy, and attention. I’d love to tell you that I treat your CHF and shoulder pain exactly the same if you have Medicare, or Blue Cross and Blue Shield, or our local state grant funded coverage program, or are paying out of your own pocket. But it isn’t true.… Continue reading I absolutely do look at your insurance (repost).
Anecdotal evidence is important in medicine, but the principles of evidence based medicine also dictate that, as scientists, we rely on stronger forms of evidence when they are available. If that evidence seems to contradict what we ourselves have experienced, that is reason to both examine the evidence more carefully, and to reflect on our own clinical experiences with a greater degree of scrutiny and honesty. … Continue reading Dallas Doctor Speaks at Set Texas Free Rally
Last night a friend sent me the latest viral COVID-19 misinformation video. You can view it below, though once it is inevitably removed from YouTube I won’t bother to re-link to it; I am sure it will be popping up on your Facebook feed soon enough (if it isn’t already). Having recently spent considerable time… Continue reading Debunking the Latest “Truth the Government Doesn’t Want You to Know” Video.
This is a false narrative and, frankly, on the grossly cynical side even for the conspiracy theory people. When you intubate a severely hypoxic patient, having tried everything else you know of to keep them off the ventilator, your decision is to use a ventilator or watch them slowly die gasping for air. Unless you’ve been in that situation, your theories on doctors putting patients on ventilators because they were told to or are thinking about their next paycheck don’t carry much weight with me. … Continue reading The Paradoxes of PlanDemic
The major failure here is to distinguish between microbes and pathogens. Dr. Erickson wouldn’t tell you to touch your face and not wash your hands if you had been around Ebola. He wouldn’t tell you not to wash the surface of your kitchen counter if you had been cutting up raw chicken. He wouldn’t tell you that exposure to viruses is important to building a healthy immune system if you were about to pet a rabid dog.… Continue reading Lies, Damned Lies, and a Few More Statistics – Dr. Erickson and COVID-19, Part 2
I really believe that this could be me, were the circumstances different, going on youtube and sharing these false statistics. Yes, Dr. Erickson has financial interests at stake here, but so far I’ve been inclined to think that he really believes his numbers. When you are pouring over data like this for hours or days and you think you’ve hit on some vital statistic that nobody else is picking up on, and it confirms what you already really, really want to believe, it can be so easy to get tunnel vision and not check your math against the backdrop of reality.… Continue reading Dr. Erickson and the 3rd Kind of Lie (Statistics)
Will these conspiracy theorists finally abandon the ‘it’s just like another flu’ argument, or would they like to hold on to until COVID-19 has actually surpassed the numbers set by the Spanish Flu pandemic in 1918?… Continue reading Data Analyst Declines to Analyze Data, Part 1: Home Isolation, Medicare Fraud, and The Flu.
OK, let’s just rip this band-aid off right at the beginning; you don’t get to be the Rebel Alliance. I know that might be hard emotionally for some of you that grew up watching Star Wars eight times per week like I did, but if you are the Rebel Alliance then this analogy is going to fall apart even more quickly than it’s destined to anyway. … Continue reading Treat Your Immune System Like The Death Star (A Slideshow)
We are living in an era of human history when reliable, true information is really capable of saving lives and when false information endangers our friends, loved ones, and neighbors. As we seek to obey the command of our Savior, let us reflect that we may never again in our lifetimes see such a moment as this, when these two concepts are so closely linked and refusal to be as wise as serpents can lead so directly to a failure to be as harmless as doves.… Continue reading The Church and Medical Misinformation During COVID-19
Wearing masks every day of our lives, not hugging each other, and avoiding dirt and trees are not practices that have ever been espoused by Physicians or public health experts. Taking precautions as a society right now because a particular, new, deadly virus is currently spreading in our communities and threatening to overwhelm our ability to care for those affected, is something we espouse. I believe that, regardless of what some people might want us to believe, most of us have the common sense to see the difference.… Continue reading Handsome Chiropractor is more concerned about masks and gloves than about COVID-19
I had hoped at some point this week to write a rebuttal to the incredibly deceitful and frankly quite silly “Dr. SHIVA Ayyadurai, MIT PhD Crushes…” youtube video that has been shared so widely by my facebook friends. I haven’t had the chance to write about it yet… but I did make some memes.… Continue reading Memes for Dr. Shiva Ayyadurai
We carry our dead around with us for years, and very, very often there wasn’t anything that anyone could have done differently. When there was, hopefully we have learned from it; but the pain may last nearly as long as the lesson. The idea of doctors across the nation suddenly embellishing death certificates and medical records to make a virus we HATE seem even more dangerous than it already is seems pretty ridiculous, aside from being just blatantly not true.… Continue reading What happened to all the deaths that AREN’T from COVID-19?