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Covid-19 — A Reminder to Reason Faced with the Covid-19 pandemic, clinicians feel compelled to do something for their patients. But we need to retain a healthy skepticism and remember the principle...

Medical schools have been moving away from lecture-based courses. Questions remain, however, regarding what content students must learn, how that learning is best done, and what else is required for trainees to become lifelong learners and adaptable practitioners.

When we become obsessed with finding the right answer, at the risk of oversimplifying the richly iterative and evolutionary nature of clinical reasoning, the result is the very antithesis of humanistic, individualized patient-centered care.

A 24-year-old sailor presented to the emergency department with a seven-day history of shortness of breath, occasional substernal chest pain, increasing abdominal girth, and nausea and vomiting. He reported leg swelling and a weight gain of 14 kg during the preceding three weeks.

Presentation of Case A 61-year-old man was admitted to the hospital because of increasing exertional dyspnea. The patient had been in excellent health until three months earlier, when he began to experience mild exertional dyspnea, with an occasional cough productive of clear sputum. Radiographic studies of the chest performed on two occasions showed abnormalities, and different antibiotics were administered on each occasion without improvement. The dyspnea worsened, and anorexia developed, with a weight loss of 7 kg. Three weeks before admission, pulmonary-function studies were performed at another hospital (Table 1). The patient was referred to this hospital. The patient worked . . .

Dyspnea may be defined as an uncomfortable sensation of breathing. The sense of respiratory effort, chemoreceptor stimulation, mechanical stimuli arising in lung and chest wall receptors, and neuroventilatory dissociation may all contribute to the sensation of dyspnea. Different mechanisms likely give rise to qualitatively different sensations of dyspnea. In most patients, dyspnea is probably due to a combination of mechanisms. For example, in asthma, a heightened sense of effort, neuroventilatory dissociation, and vagal stimuli arising from bronchoconstriction and airway inflammation may all play a role. Patients with different disorders and different mechanisms of dyspnea use different phrases to describe their breathing discomfort. Hence, the language patients use to describe their dyspnea may provide clues to the etiology of their symptoms.