What does it mean when a computer can make better medical decisions than a human? The progress in large language models, and in particular the popularity of ChatGPT, has brought these questions to the forefront in 2023, but we’ve been discussing this for over 50 years. In this episode, Dr. Shani Herzig and I are going all the way back to the early 1970s with the invention of AAPHELP, the first real clinical decision support system, and the first time doctors had to contemplate working with –...

What happens when a patient far from surgical care – say, at the bottom of the Pacific ocean on a submarine, or at a research base in Antarctica in the middle of the winter – develops a surgical abdomen? This dilemma was the impetus to build the first truly effective clinical decision support system – and to grapple with what it means when a computer can make better medical decisions than a doctor. In this episode, part one of three, we discuss the dramatic stories of appendectomies at...

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...

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...

How do doctors actually think? And if we can answer that, can we train a computer to do a better job? In the post-WW2 period, a group of iconoclastic physicians set about to redefine the nature and structure of clinical reasoning and tried to build a diagnostic machine. Though they would ultimately fail, their failure set the stage for the birth of the electronic health records, formalized the review of systems, and set up a metacognitive conflict that remains unresolved to this day. This...

Internal medicine physicians like to pride ourselves on our clinical reasoning – the ability to talk to any patient, pluck out seemingly random bits of information, and make a mystery diagnosis. But how does this actually work? In this episode, called The History, I’ll be joined by Gurpreet Dhaliwal as we explore the beginnings of our understanding on how clinical reasoning works – starting in the middle of the 19th century with polar tensions between two ways of approaching our patients that...

Modern plastic surgery was born out of the horrors of trench warfare in World War I. In this episode, Adam interviews historian Lindsey Fitzharris about her new book The Facemaker, about the life of surgeon Harold Gillies and his quest to rebuild his patients' faces. 

In the early 19th century, a strange new illness, seemingly unknown to medicine, ravaged settler communities in the American Middle West. As fierce debates about this new disease, now called milk sickness, raged – was it from toxic swamp gasses? arsenic in the soil? infectious microorganisms? from the poor constitutions of the settlers – an irregular medicine woman named Dr. Anna and an indigenous Shawnee healer discovered the cause of the disease and successfully prevented it in their...

Burnout seems to stalk healthcare workers; between a third and a half of doctors and nurses had symptoms of burnout BEFORE the COVID-19 pandemic. Major medical associations have recognized burnout as a serious problem and the condition is being added to ICD-11 as an “occupational phenomenon.” How did we get ourselves into this situation? How has burnout gotten so bad? In this episode, the first #HistMedConsultService, I’m joined by historians of healthcare and emotions Agnes Arnold-Forster...

How can we medically tell whether or not someone is alive or dead? The answer is much more complicated than you'd think. In this episode, which is a live podcast I gave with Tony Breu at the Massachusetts Chapter of the ACP annual meeting on October 16, 2021, we track the evolution and controversies of the death exam, from a trans-Atlantic scandal surrounding a possible vivisection, a 19th century “X-prize” to determine a technology that could diagnose death, and the mysterious Lazarus...

During World War II, the US Army launched a seemingly routine experiment to find the ideal way to screen soldiers for tuberculosis. Jacob Yerushalmy, the statistician in charge of this project, would succeed at this task -- and end up fundamentally changing our conception of medical diagnosis in the process. This episode features Dr. Shani Herzig, as well as a new segment featuring Dr. Umme H. Faisal on Yellapragada Subbarow and his discovery of ATP.

What does it mean when different physicians disagree about a diagnosis? I am joined by Dr. Shani Herzig as we explore this issue in the second part of my series on the development of diagnosis. We’re going to discuss the advent of signal detection theory in the middle of the 20th century as new diagnostics such as laboratory testing and x-rays started to challenge classical views of diagnosis. If you want to purchase any Bedside Rounds swag, the store is at...

Elizabeth Blackwell -- the first woman to earn a medical degree in the United States -- and her sister Emily Blackwell are some of the most important physicians of the 19th century, firmly establishing the role of women as physicians, starting an infirmary and hospital for poor women and children, and founding a women’s medical college that was decades ahead of its time. In this episode, Dr. Nora Taranto joins me to explore the legacy of the Blackwells along with Janice Nimura,

Words matter. Etymology gives us insight not only into the origins of words, but why they remain so important today, especially in medicine. In this episode, we’re delving into four specific words -- doctor, cerebrovascular accident, rounds, and zebras.  And along the way, we’re going to discuss pre-historical pastoralists on the Eurasian steppes, medieval universities, Octagonal air-ventilated chambers in 19th century Baltimore, and of course, early 21st century sitcoms.

For a special holiday treat, we’re going to explore two tales of salmonella disease detectives -- the first about Mary Mallon (“Typhoid Mary”) and the birth of the genre; and the second about a mysterious salmonella outbreak at Massachusetts General Hospital solved with the assistance of a very jolly patient. Along the way, we’ll talk about clinical epidemiology, the long-lasting influence of Berton Roueché, and the joys of being an internist! Conference:...

Diagnosis is arguably the most important job of a physician. But what does it actually mean to make a diagnosis? In this episode, we’ll explore this question by tracking the development of the “classical” model of diagnosis and pathological anatomy and discussing three cases over three hundred years. Along the way, we’ll ponder the concept of the lesion, iatromechanistic theories of the human machine, the birth of the International Classification of Diseases, and the rise and decline of the...

In this episode, I talk about my podcasting journey -- how I started Bedside Rounds for inspiration during a low period in residency, how it changed me as a physician, and how it has changed my views about digital education and the future of medical education in general. We are hosting the first annual iMED conference in January (virtual this year, of course) -- the link is cmeregistration.hms.harvard.edu/digitaleducation to sign up!

The COVID-19 pandemic laid bare the racial health disparities in the United States, with markedly increased mortality especially among Blacks and Native Americans. In this episode, Tony Breu and I discuss the conception of race, racism, and the social determinants of health through three historic plagues in the United States -- from yellow fever in New Orleans, to poliomyelitis, and finally the early days of HIV/AIDS -- and what lessons we can draw for COVID-19.

In August of 1918, a horrific second wave of the Spanish Flu crashed across the world. In this episode, the third of a four-part series exploring hydroxychloroquine and COVID-19, I’ll explore this single moment in time, through the mysterious origins of the Spanish Flu and historiographical controversies, scientific missions to mass burial sites in remote Alaskan villages, the ill-fated journey of the HMS Mantua, debates about how to count victims of a pandemic, and the mystery behind...

The 1889 Russian Flu was the first influenza pandemic in an increasingly globalized world. In this episode, the second of a two-parter on how hydroxychloroquine became a great hope in COVID-19, we’ll talk about how quinine became the standard of care for influenza. Along the way, we’ll discuss the astrological origins of the flu, conspiracy theories about previous global coronavirus outbreaks, the media panic over the Russian Flu, and first year law school cases about Carbolic Smoke Balls.

This bonus episode introduces episode four of the Curious Clinicians, about Vincent Van Gogh and digitalis. The Curious Clinicians is a new medical podcast produced by Hannah Abrams, Avi Cooper, and Tony Breu; you can download them all at curiousclinicians.com.

Before CT scans, EKGs, and even the humble x-ray, there was the stethoscope, arguably the first diagnostic test in the history of medicine. In this episode, we revisit Rene Laennec and the invention of the stethoscope -- a potent new way to localize, for the first time, disease inside the still-living human body. Plus a new #AdamAnswers on medical eponyms!

Where did cinchona, the first medication to cure malaria, come from? This episode explores the murky history of the bark of the fever tree and its derivative chloroquine with mysterious pre-Columbian Pacific crossings of the plasmodium parasite, Jesuit priests and Inca healers, a Chinese Emperor performing a clinical trial to treat his fever, chemistry leading to the first modern pharmaceuticals, and imperialism on a global scale.