Donald Kushner, MD
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Physicians
Early in my career, I saved a man's life, and he was not pleased. Mr. H came to see me for knee pain. With my training still fresh, I moved through a standard review of systems. When I asked about…
Early in my career, I saved a man’s life, and he was not pleased. Mr. H came to see me for knee pain. With my training still fresh, I moved through a standard review of systems. When I asked about cardiac symptoms, he mentioned that for several weeks, walking more than a block caused chest pain that resolved with rest. The knee was forgotten. I explained the cardiac risk, ordered …
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Bridging the gap between a chronic disease diagnosis and treatment
Physicians
Every clinician has encountered this moment. A patient leans forward and says, "But doctor, I was fine yesterday." The statement carries confusion, frustration, and sometimes quiet alarm. It also reveals an assumption deeply embedded in both medical culture and human…
Every clinician has encountered this moment. A patient leans forward and says, “But doctor, I was fine yesterday.” The statement carries confusion, frustration, and sometimes quiet alarm. It also reveals an assumption deeply embedded in both medical culture and human cognition, that stability should look like consistency.
In clinical medicine, predictability is often mistaken for stability. We feel reassured when symptoms follow familiar patterns. Patients feel encouraged when treatments produce repeatable …
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Why symptom variability in chronic illness is not failure
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