Biomedical subjects
J D Sapira
Publications and source records attributed to J D Sapira.
Contemporary use of the disease concept: III. A pedantic failure to change behavior regarding the problem of anemia.
The frequency with which house staff noticed their patients to be anemic, the frequency with which they tried to find out why the patients were anemic, and the diagnostic accuracy of such endeavors were measured. Next, an intervention was conducted in which the teams were lectured on the subject of anemia, given reading materials on the subject, and given social encouragement to solve the problem. At follow-up no improvement was found in any of the outcome variables.
Earlobe creases and macrophage receptors.
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On violating Occam's razor.
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Panic disorder and depression in patients with chest pain not due to coronary artery disease.
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Why teach basic sciences in medical school?
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A personal history of the ectopic brain.
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Usefulness of physical examination in detecting the presence or absence of anemia.
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Why perform a routine history and physical examination?
Science uses two types of data--one for generating hypotheses and a second for testing hypotheses. In clinical medicine the history and physical examination generate the data used for making hypotheses about what could possibly be wrong with the patient; but the various laboratory and imaging procedures are used for hypothesis-testing, ie, deciding which of the possible problems is actually the one bothering the patient. Although comparisons between physical examination maneuvers and imaging procedures may tell something about the precision of the former, in general such comparisons can tell little about the intrinsic worth of one versus the other, because these two different types of procedures generate data with two completely different types of usage.
Why medicine residencies?
Over the last several decades the context of the medicine residency has changed. These changes are described and attributed in considerable degree to bureaucratic impositions. I consider it paradoxic that there is finally a move afoot to reverse the changing nature of medicine residencies, yet this effort appears in the form of yet another bureaucratic imposition.
Which will be the best medical school in ten years?
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Contemporary use of the disease concept: II. The question of anemia.
Of 105 admissions to a medical service, 64 involved anemia (defined as a hematocrit value of less than 38%) at some time during the admission. Chart review revealed that the disease concept was not being used, as most of the anemias were unnoticed or undiagnosed, and most of the diagnoses that were made were incorrect.
Mayne's sign is not pathognomonic of aortic insufficiency.
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The Moloch of the quick fix.
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A modest proposal: board certification for medical educators (or quis custodiet ipsos custodes?).
So that medical educators themselves will not be deprived of the benefits of certification, a brief written examination is offered as a first step. While the examination questions initially appear to be as obscure as those found on other certifying examinations, on further consideration they are found to be illustrative of certain basic concepts of medical education that are thought to be enduring, though not currently popular.
Study design: two standards?
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Why is medical school difficult? Or, if it isn't difficult, why it should be.
Given the intellect and motivation of the idealized contemporary medical student and the structure of contemporary medical education, one might not expect medical school to be difficult; experience dictates otherwise. Since medical school prepares one to become a physician, the inherent difficulty of medical school is expected to lie in the areas of the physician's attitudes, skills, and knowledge. This expectation is not supported; instead it is suggested that the difficulty may actually reside in the fact that the student must negotiate three different learning styles in the course of only two years.