Mold Remediation in Boring, MD

DISCLOSURES

April 01, 2025

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Details of a fascinating case circulated widely this month on X, shared by an emergency physician in the United States. It involved an elderly patient in refractory ventricular fibrillation, resistant to five defibrillation attempts, epinephrine, and amiodarone. As the emergency department team debated the use of dual-sequential defibrillation — a technique employing two defibrillators simultaneously — the patient achieved return of spontaneous circulation. The patient subsequently arrested again, underwent five additional shocks, further pharmacological interventions, and ultimately a stellate ganglion block using bedside point of care ultrasonography, which restored stability.

From a UK perspective, the discourse surrounding this case was not one of awe but of critical analysis. Beyond considerations of do-not-attempt-cardiopulmonary-resuscitation orders and a patient’s escalation status, a more profound question emerges: Does contemporary medicine risk becoming performative? Is the pursuit of ‘exciting’ interventions always aligned with the pursuit of optimal patient outcomes?

The contrast between US and UK medical culture is perhaps illuminated in cases such as these. In the United States, the prevailing ethos of medicine often leans towards high-stakes interventions and a willingness to employ novel or experimental measures in critical situations. This approach is, at times, almost cinematic and adrenaline-inducing. Structural incentives, including the fee-for-service model and litigation concerns, may further drive this inclination toward interventionism.

In contrast, the UK medical framework prioritises adherence to protocol and resource allocation. This distinction is not merely procedural but reflects deeply ingrained philosophical attitudes towards medical practice.

Which approach ultimately serves the patient better? The inclination toward aggressive escalation is often underpinned by the assumption that more intervention equates to better care. However, this assumption is not always true. Medicine is not merely about action but about the selection of the right action at the right time. There is an inherent trade-off between intervention and prudence, between immediate response and long-term outcomes.

Every additional intervention carries risks — whether in the form of procedural complications, drug side effects, or the downstream consequences of too much medicalisation.

The notion of ‘heroic’ medicine permeates popular TV programmes like House MD or Grey’s Anatomy. In these medical dramas, asingle doctor might float seamlessly between performing a craniotomy in one scene and a hip replacement in the next. But does this archetype align with the reality of optimal medical practice?

The evolution of medical sub-specialisation is predicated on an empirical truth: Expertise enhances patient outcomes. The more refined a skill set, the lower the margin for error, and the greater the likelihood of success. Consider the question: Whom would you prefer operating on a loved one? A surgeon electrified by the high-stakes nature of the procedure, pulse racing and hands trembling from adrenaline? Or a clinician so experienced that the act is second nature, performed with a level of precision bordering on the mechanical and the mundane?

Mastery in any domain — whether in surgery or the performing arts — is not characterised by emotional passion and intensity but by a state of effortless execution. A concert pianist does not actively deliberate on each keystroke; they simply play. Likewise, the best medical decisions stem from repetition, experience, and an absence of anxiety. The ideal doctor is not a dramatist but a technician — one whose expertise is so refined that their decisions are based on evidence and pattern recognition rather than impulse.

Experience fosters composure, and within that composure lies the capacity to perceive important details — the subtly bleeding vessel, the nearly undetectable shift in cardiac rhythm, the critical but easily overlooked clinical sign. Medicine, particularly in acute care, will always entail moments of urgency, but the romanticisation of medicine as a spectacle is a misdirection.

The most effective medicine is not sensational — it is systematic, data-driven, and, if we may say, unremarkable. Because, in the end, it is the unremarkable that saves lives.

Arya Anthony Kamyab is a foundation year 1 doctor working in the Northeast of England. You can follow him on Instagram @aryak.writes.

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Cite this: Should Medicine Be Boring? The Case for Methodical, Evidence-Based, and Unremarkable Care - Medscape - April 01, 2025.

Two undergraduate students from Independent University, Bangladesh (IUB) have secured a place in the finals of the 2025 Not-A-Boring Competition, an annual engineering contest organised by The Boring Company, the tunnel-digging venture of billionaire Elon Musk.

According to a recent blog by IUB, Shah Asif Hafiz, from the Department of Accounting, and Dewan Md Alif, from the Department of Finance, are part of Bored Tunnelers, a 19-member multidisciplinary team made up of students and researchers from various universities across Bangladesh. The team will compete in the final round of the competition, which is set to take place from March 27 to 29, 2025, at The Boring Company's R&D headquarters in Bastrop, Texas, USA.

Bored Tunnelers, formed in 2023, has developed a micro tunnel boring machine (MTBM) using an interdisciplinary approach that integrates robotics, mechanical, electrical, civil, and computer engineering. The team previously competed in the 2024 edition of the competition, and earned the 'Rookie Award' for their innovative concept. The team was also invited to trial their MTBM at The Boring Company headquarters in Texas.

The Not-A-Boring Competition challenges teams to construct a 30-metre-long, 500mm-wide tunnel as efficiently as possible, with the objective of advancing tunnelling speed and reducing costs. The event serves as a testing ground for future tunnelling technology with applications in urban planning, high-speed transportation, utilities, defence, and space colonisation. Teams compete across three categories—Innovation, Accuracy, and Speed—with the overall winner determined by tunnel completion time.

Despite their achievements, the team faces financial challenges in funding the local testing phase, manufacturing, shipment, and travel costs for the final round in Texas. However, they remain committed to advancing tunnel boring machine (TBM) technology in Bangladesh.

According to the IUB website, Bored Tunnelers is working closely with manufacturing partner Bangladesh Industrial Technical Assistance Centre (BITAC) and has secured sponsorship from Grameenphone, GIGABYTE AORUS, Super Star Group (SSG), and the Ministry of Public Administration.

The team has also expressed their gratitude for receiving guidance from Salman Khan Promon, Graduate Teaching and Research Fellow at the University of Houston, USA; Md Mamunur Rashid, Executive Engineer at BITAC; and Md Ashrafuzzaman, Additional Secretary to the Ministry of Public Administration in Bangladesh.

The 2025 Not-A-Boring Competition will bring together teams for safety inspections, technical presentations, and networking opportunities before the main event. Final presentations and inspections will take place from March 24 to 26, leading up to the competition including tunnel drilling and performance evaluations from March 27 to 29. The event will conclude with post-competition cleanup on March 30 and final packing on April 1.