Spiraling empiricism

I did my residency training at the University of Virginia just before ward-based wet labs were eliminated from hospitals....so I fondly (and sometimes, not-so-fondly) recall gathering samples from newly admitted patients and carrying them around the corner to perform a Gram stain, KOH prep, wet prep, or India Ink exam. One patient in particular was very influential in my choosing infectious diseases as a career--a septic patient admitted in the middle of the night to our medical intensive care unit, for whom we made the diagnosis immediately by performing a cerebrospinal fluid Gram stain in a small lab just a few steps away from the unit. Something about the entire experience of caring for that patient, who made a complete recovery, was extremely compelling....but there were a lot of things about my training at Virginia that drew me to infectious diseases. Not least of which the fact that half my medicine ward attendings were ID faculty, beginning with Dr. Ed Hook, who was my first general medicine ward attending.

Anyway, I'm digressing terribly. This post is meant simply to direct you to this piece by Dr. Abraham Verghese, infectious diseases physician and bestselling author. The piece needed no introduction--it's great, just go read it!


  1. I agree that that Dr. Verghese is an excellent writer, however a quick Google and PubMed search reveals that the first or at least much early use of the phrase "spiraling empiricism" in this context seems to have been by Kim and Gallis in 1989 and not Victor Yu's 2009 article. Reference below.

    Observations on spiraling empiricism: its causes, allure, and perils, with particular reference to antibiotic therapy. Kim JH, Gallis HA. Am J Med. 1989 Aug;87(2):201-6. Review.


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