I love researching, reading, and learning about common practices in medicine. Like many others, I did this for years without an outlet for sharing or teaching others. Then, in 2018 I began to write tweetorials aimed at answering questions about mechanisms, physiology, and pathophysiology. I had discovered an outlet.

At the same time, I have had a long fascination with what Lenny Feldman coined as Things We Do For No Reason (TWDFNR). These are practices in medicine that we (including me) continue to do despite a lack of evidence of benefit or even evidence of harm. This interest was forged during my residency. I would be asked to order “anemia labs” (i.e., iron studies, B12, folate) each time I encountered a low hemoglobin, only to find I never diagnosed folate deficiency. This observation led me to study the rate of folate deficiency in my hospital (spoiler: it is low). Later, I was invited to give talks on other TWDFNR and join Lenny as co-Deputy Editor of a series in the Journal of Hospital Medicine of the same name. I had discovered another outlet.

One of my favorite parts of researching tweetorials and TWDFNR is uncovering that first paper describing a practice or finding. A 2023 review might reference a 2018 study. That 2018 study might then cite an older one, maybe from the ‘70s. And back I go, looking for the Origin Story of what we do.

In this substack, I aim to discuss not only those Origin Stories but also why we continue to do what we do. Why do some practices persist despite plentiful evidence that they don’t work or cause harm? Why are others adopted quickly and easily? If knowing why you do what you do is of interest, subscribe and learn along with me.