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January 2010
Patient Care and Science
Spiraling Empiricism: When in Doubt, Put on Blindfold and Shoot

The following is a brief excerpt from a recent online article written by Abraham Verghese, MD, FIDSA, a regular contributor to

There are so many instances in infectious diseases where a rapid and precise diagnosis can be made by directly examining sputum, wound drainage, blood smears, skin lesions, and the like. Over two decades I can still remember those “eureka” moments; it made all the difference in the care of the patient by finding precisely what was causing the problem, short circuiting what was otherwise blind therapy with many drugs, hoping one was treating the cause of the infection. Diagnosis matters—surely that’s something we can all agree on.

Perhaps not. Some years ago, OSHA closed down our wet labs. These historic rooms—where interns and residents in the night or at any time could look at urine, use a Gram stain to look for bacteria in various specimens, and do other simple tests—were gone. Admittedly, they were messy rooms, and I suppose there was some potential for exposure to unsafe pathogens. But it was also the place where a generation of interns and residents learned bread and butter tricks that made them better diagnosticians. We lost that battle.

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