How good are doctors at diagnosis?

This is the most relevant paper I have written. Not perfect but addresses a huge issue I think could change medicine if acknowledged
…it has changed how I think about diagnosis

ja.ma/3rQNtjv
@JAMAInternalMed
@drjohnm
1/n

The con argument for bio markers from @DrEmilyMcD
At IDWeek2026
She says we need to stop to zombie tests!

At IDweek Anna Sick-Samuels getting us started on bio markers pro/con @ValerieVaughnMD @SHEA_Epi

Kicking off the diagnostic stewardship course at #IDweek2026 is Valerie Vaughn!

"a woman who thanked me for listening to the story of the son she claimed was paralyzed shortly after receiving a vaccine. I don’t know the full details of her son’s experience — my gut reaction was that his misfortune was not related to a vaccine — but that doesn’t mean I should dismiss that woman, the pain she clearly felt, and her reasons for losing trust in science. For far too long, we in the media have stayed away from stories like these for fear of stoking unnecessary fear. I’m mindful of that challenge, but I believe we must tell those stories in a responsible way."

We need more of this!

statnews.com/2026/09/21/tru… via @statnews

This will be a great #IDWeek workshop. Hope to see people there!

Diagnostic stewardship from the basics to advanced topics like new inflammatory markers and AI.

@DrEmilyMcD @ValerieVaughnMD @SHEA_Epi @mhayde2

This just came in the mail!

People who care about public health need to imagine how it can be built to be stronger and more relevant. Sandro Galea has done a lot of thinking around this.
He describes post-covid as a post war time of rebuilding.
The current rollback of federal AHRQ etc. also gives a post war reality.
We shouldn’t go back to the same but use the opportunity.
If we can’t imagine / describe a compelling new future we won’t make one.
Focusing health on advancing our wellbeing, humanity, autonomy and ability for all to achieve their potential as Sandro Galea seems like a great starting point.

Un "complicado" artículo que habla de un tema común y básico. La diferencia entre validez de una prueba (sensibilidad y especificidad) y rendimiento (valores predicitvos). Y alguna cosilla más. Un poco complicado eso de la "transición de las métricas"
jamanetwork.com/journals/jamai…

This piece took a few years to write but captures something critical to diagnosis—especially in infectious disease. w/ great colleagues Debbie Korenstein & Dan Diekema
jamanetwork.com/journals/jamai…

Remap cap influenza has been submitted to lancet and is preprinted

papers.ssrn.com/sol3/papers.cf…

@ABsteward @BradSpellberg

Too often I see the practice of “shotgun testing”. Especially in ID, rheum, and hepatology. I still see this approach “to be thorough” “to provide a complete evaluation” or “to be safe”

It’s none of the above

Our local expert in firearms! Go @JonBaghdadi

Nice to start the day w/ thoughtful writing of @adamcifu for @Sensible__Med
A formative patient in my training also had bad PCP--(and a CD4 of 0). We still exchanged letters after I had moved away from NYC.
Advice for a Student Entering Medical School open.substack.com/pub/sensibleme…

"This huge expense of energy to purify language reveals a weakened belief in more material forms of progress. If we don’t know how to end racism, we can at least call it structural. The guides want to make the ugliness of our society disappear by linguistic fiat. Even by their own lights, they do more ill than good—not because of their absurd bans on ordinary words like congresswoman and expat, or the self-torture they require of conscientious users, but because they make it impossible to face squarely the wrongs they want to right, which is the starting point for any change."
theatlantic.com/magazine/archi…

"Equity language doesn’t fool anyone who lives with real afflictions. It’s meant to spare only the feelings of those who use it."

Smoky days remind me of Covid, the ease of groupthink
The sacrificing of daily routines and activities for “safety”, while not being able to know if it is any safer. (and finding models, and assumptions, from limited observational data and public health researchers who are focused on validating their worldview over rigorously analyzing data)
The lack of valuation for daily life
The extra effort for all except those who work from home & don’t exercise
The impact on parents, kids, those who need help, those who rely on structure of activities to handle life
I don’t think we’re past the patterns that made us wrong with Covid…

Stopping doctors from ordering unnecessary diagnostic tests requires a structural fix

In this piece I tried to make diagnostic stewardship more understandable. It feels like a big advance if it can be built into systems. The WHO has a workgroup doing this and @SHEA_Epi has a special interest group.

Here are some exerpts from this piece (but read for more)

statnews.com/2026/07/06/unn… via @statnews
@PaulSaxMD @ValerieVaughnMD

Patients need “a smarter system. We have the science to improve testing and diagnosis. Now we need the will to use it.”