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On Being a Doctor |2 June 2015

Dr. Afshar's Grid

Bennett W. Clark, MD

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Author, Article, and Disclosure Information
  • From Johns Hopkins University School of Medicine, Baltimore, Maryland.

    Requests for Single Reprints: Bennett W. Clark, MD, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD 21287; e-mail, bclark12@jhmi.edu.

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It was the morning after my first overnight call as an intern. I was nervous and reeked of sweat. Dr. Kia Afshar, youthful and rested, with buzzcut hair, leaned on a folding shelf outside a hospital room. Inside was the patient I had admitted for hypotension and decompensated heart failure. A ring of white coats—interns, residents, medical students—formed around Dr. Afshar. He took my H&P and turned it over to use as scratch paper. The white coats leaned in for a closer look.
Dr. Afshar drew four vertical lines. He hatched them with horizontal lines. He labeled the columns: Mechanism of Circulatory Shock, Right Atrial Pressure, Cardiac Output, and Systemic Vascular Resistance. He labeled the rows: Hypovolemic, Distributive, and Cardiogenic.
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Clark BW. Dr. Afshar's Grid. Ann Intern Med. ;162:799–800. doi: 10.7326/M14-2719

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Published: Ann Intern Med. 2015;162(11):799-800.

DOI: 10.7326/M14-2719

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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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