Clinical medicine

This page collects every article by Dr. Damon Tojjar in this topic. For all topics see browse by topic, and for the source-anchored record see damontojjar.com/record.

Articles in this topic (18)

Clinical reasoning (4)

• Are Clinicians Well Calibrated? Reading the Evidence on Diagnostic Confidence3 min read

  Calibration is the match between how confident a clinician feels and how often they are actually right. Studies show the mismatch is real: confidence barely changes...

• How Clinicians Reason: Dual-Process Thinking and Illness Scripts4 min read

  Clinicians reason in two overlapping modes: a fast, intuitive pattern recognition that experts lean on most of the time, and a slower, deliberate analysis they call...

• The Diagnostic Timeout: A Structured Pause Against Premature Closure4 min read

  A diagnostic timeout is a short, deliberate pause in which a clinician stops before committing to a diagnosis and asks what else the picture could be and what does...

• What the History and Physical Examination Still Contribute to a Diagnosis4 min read

  Careful studies of how diagnoses are actually reached find that the patient's history points to the final answer far more often than the examination or the...

Evidence-based primary care (6)

• Do Routine General Health Checks Make People Healthier?4 min read

  A general health check is a routine invitation to screen for several diseases and risk factors at once in people who feel well. Pooled randomized trials covering...

• Lag Time to Benefit: Why Some Preventive Treatments Only Pay Off Later4 min read

  Lag time to benefit is how long a preventive treatment has to be continued before it prevents one bad outcome across a group of people. Screening for breast and...

• Paying for Quality: What Pay for Performance in Primary Care Actually Changed4 min read

  Pay for performance ties part of a practice's income to hitting measured quality targets, such as recording a blood pressure or offering a vaccination. Large...

• Prescribing Cascades: When a Side Effect Is Treated as a New Disease4 min read

  A prescribing cascade happens when the side effect of one medicine is misread as a new medical problem, so a second medicine is prescribed to treat it. A common...

• The Three-Talk Model of Shared Decision Making3 min read

  The three-talk model describes shared decision making as three linked conversations. Team talk is where the clinician signals that real choices exist and offers...

• Treatment Burden and Minimally Disruptive Medicine4 min read

  Treatment burden is the work of being a patient: taking medicines, attending appointments, monitoring numbers, and coordinating between clinicians. Minimally...

Diagnostic error (1)

• How Common Is Diagnostic Error, and How Do We Even Count It?4 min read

  Diagnostic error is genuinely hard to count because there is no single denominator and each measurement method sees a different slice. National estimates rely on...

Diabetes diagnostics (2)

• How Diabetes Is Actually Diagnosed, and Why One Test Is Rarely Enough3 min read

  Diabetes can be diagnosed by any of four laboratory findings: a high fasting glucose, a high glucose two hours into an oral glucose tolerance test, a high HbA1c, or...

• When HbA1c Misleads: Reading the Test's Blind Spots3 min read

  HbA1c estimates average glucose by measuring the fraction of hemoglobin that has been glycated, and it quietly assumes a normal red blood cell lifespan and normal...

Diabetes therapeutics (1)

• How Type 2 Diabetes Treatment Is Escalated: Reading the Guideline Logic3 min read

  For years, type 2 diabetes treatment escalated in a straight line: start metformin, then stack drugs until the HbA1c target was met. The current consensus from the...

Adrenal diagnostics (1)

• Reading the Workup for Adrenal Insufficiency3 min read

  Adrenal insufficiency means the body cannot make enough cortisol, and the workup has to answer two questions: is cortisol truly deficient, and is the problem in the...

Thyroid diagnostics (1)

• Reading the Workup of an Overactive Thyroid3 min read

  An overactive thyroid shows up first as a suppressed TSH with elevated thyroid hormones, but that pattern only says the hormone level is high, not why. The decisive...

Diagnosis and screening (1)

• Red Flags and Reassurance: What a Warning Sign Actually Predicts4 min read

  A red flag is a feature meant to raise suspicion of serious disease hiding behind a common symptom. But a single red flag usually shifts the probability only a...

Diabetes trial appraisal (1)

• Why Every New Diabetes Drug Must Run a Cardiovascular Outcomes Trial3 min read

  A cardiovascular outcomes trial, or CVOT, is a large study that tests whether a diabetes drug raises or lowers the risk of heart attack, stroke, and cardiovascular...