Situation, Background, Assessment, Recommendation. A four-part script for handing a patient from one American clinician to another, taught in nursing schools and used in hospitals nationwide. Borrowed from the US Navy, where it standardized reporting to a commanding officer, and adopted in medicine because unstructured handoffs were losing information at every shift change.
health
Informed consent
An American physician must disclose the risks, benefits and alternatives of a procedure before it takes place, and document that the disclosure occurred. The standard in many states is what a reasonable patient would want to know, not what the patient thought to ask about.
Nutrition Facts
Federal regulation requires a panel on packaged food giving serving size, calories, and specified nutrients, in a set order and a set format. Every manufacturer must publish the same categories, including the unflattering ones, on the package itself.
Ask your doctor
The United States and New Zealand are the only high-income countries that permit direct-to-consumer advertising of prescription drugs. American pharmaceutical companies spent $6.58 billion on it in 2020, up more than tenfold from 1996.
The standard closing line of every one of those advertisements is an instruction to the patient: ask your doctor about it. The system is built on the assumption that the patient will raise the subject, not that the physician will.
The second opinion
American patients are actively encouraged to seek one, by insurers, by patient advocacy groups, and often by physicians themselves. Doing so is not treated as a discourtesy to the first doctor. The patient is understood to be the one deciding.
Good Samaritan laws
Every US state has legislation protecting a bystander who intervenes in an emergency from being sued for the consequences. The legal system identified hesitation as the problem and removed the reason for it.
The golden hour
American trauma medicine is built around the idea that the first hour after serious injury determines survival. R Adams Cowley in Baltimore made it doctrine, and the US trauma system — helicopters, designated trauma centres, rapid transport — was designed around it.
Researchers have since questioned whether sixty minutes is a meaningful threshold. The system it produced is real regardless, and it was built on the premise that speed is the treatment.
Bystander CPR
American public health has spent decades training ordinary people to start chest compressions immediately rather than wait for professionals, and has simplified the instruction repeatedly to lower the barrier to starting. The campaign is not about doing it well. It is about doing it now.
Robert Koch
Koch established a formal procedure for proving that a particular microorganism causes a particular disease. The organism must be found in every case, isolated and grown in culture, produce the disease when introduced into a healthy host, and be recovered again from that host.
Before Koch, causation in medicine was asserted. After Koch, it had to be demonstrated, in four steps, in order.
Rudolf Virchow
In 1858, at the Pathological Institute in Berlin, Virchow published Die Cellularpathologie. His argument was that disease does not reside in organs or tissues in general, but originates in individual cells, and that the nature of a disease can be understood by looking at those cells under a microscope.
He also developed the first systematic method of autopsy, and the modern autopsy still uses his technique.
He is called the father of modern pathology. Pathology is diagnosis pushed as far down as it will go.