Origin Stories
Tony BreuAn exploration of why we do what we do in medicine. I identify and review the history of common practices, how culture and habit make us resistant to change, and more.
| Platform |  | Pricing | Only free issues | Publishes | Weekly |
|---|---|---|---|---|---|
| Issues | 12 | Founded | 3 years ago | Last Issue | a year ago |
| Active | |||||
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tonybreu.substack.comLatest Issues
How >100,000 CFU became synonymous with UTI
Readers of Origin Stories know that I love writing about numerical thresholds (e.g., >250 PMNs for spontaneous bacterial peritonitis or <7 g/dL to prompt a red blood cell transfusion). I also recently wrote about a surrogate end-point (asym...
DVT Prophylaxis in Hospitalized Medical Patients - Questioning the Evidence
Venous thromboembolism (VTE) chemoprophylaxis (aka “DVT prophylaxis”) for hospitalized medical patients is standard practice. Guidelines (ASH, ACCP, Thrombosis Canada) and common point-of-care resources (UpToDate) recommend its use, and the...
Calcium versus Sodium Chloride
Clinicians can recite some treatments with a Pavlovian response. If I were to walk past an intern and say, “Stabilize the cardiac membrane!” they’re likely to shout, without even thinking, “Calcium!” Given the speed required to appropriatel...
β-blockers in heart failure. From No! to Maybe? to Yes!
Early in medical school, I memorized that β-blockers (e.g., propranolol, metoprolol, carvedilol) are “negative inotropes” and therefore decrease the force of heart contractions. Later, in residency, I was indoctrinated that they were part o...
[Behavioral] Alert!
We have all experienced alert fatigue. Most alerts are generated as one interacts with the medical record (e.g., when entering a new order). But one type of alert pops up as a patient’s electronic medical record is entered: the behavioral a...
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Authors
The writers behind this newsletter.
Hospitalist at the VA Boston Healthcare System, co-host of The Curious Clinicians Podcast, co-Deputy Editor of the Things We Do For No Reason series in the Journal of Hospital Medicine, and incessant asker of 'why'?
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