Show Notes
What was behind the mysterious increase in lung cancer deaths at the turn of the 20th century? The first of a three-parter investigating the cigarette-smoking link and causality, this episode looks at that early debate, which largely focused on environmental pollution. Along the way, we're going to talk about toxic vapors -- and not Miasma theory, but the actual literal Great Smog of London in 1952 that killed over 10,000 people -- as well as the birth of the case-control study, Nazi attempts at tobacco control programs, and the rather prosaic beginnings of a debate that rages to this day. Plus a new #AdamAnswers about the medical cause of Game of Thrones greyscale featuring Dr. Jules Lipoff!
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More from Bedside Rounds
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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 discuss one of the most influential medical thinkers of the second half of the 20th century, Larry Weed, his invention of the problem-oriented medical record and the SOAP note, and how his insight – that medical documentation fundamentally influences how we think about our patients – changed the way we think about our patients.
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.
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.