Lungspan Newsletter by Taj Rahman MD: Dead Space

What Is the DISC Framework? Why Medicine Needs It

Taj Rahman MD — Mon, 02 Mar 2026 02:05:02 GMT

Last week I told you about a deteriorating post-CABG patient trending toward intubation, a conversation with the surgeon that felt like a negotiation rather than a shared decision, and a plan that fractured quietly between two sets of attending notes. Nobody Dropped the Ball. So Why Did the Plan Almost Fall Apart?

If you missed Part 1, read it first for context.

This week we’ll talk about the DISC assessment as a framework to understand the miscommunication that was happening, what the research says, and what you can practically do with it starting today.

What Is the DISC Framework? The Origin of the Model

DISC is a behavioral style model built on research from a 1928 book called Emotions of Normal People by psychologist William Marston. His observation was that you could understand how someone communicates by watching how they respond to four things: problems, pace, people, and procedures.¹

The framework describes four behavioral tendencies — not fixed personality types, not a diagnostic label. Tendencies. How people prefer to process and deliver information, shaped partly by who they are and partly by what their environment has reinforced over years.

D — Dominance. Direct, decisive, results-oriented, action-biased. D-style communicators want the bottom line fast. They form positions quickly and push toward resolution. Ambiguity is uncomfortable — not because they’re impatient by nature, but because in their professional world, delay has real consequences.

I — Influence. Enthusiastic, relational, optimistic, energized by people. I-style communicators lead with connection. They read rooms well. Their vulnerability is follow-through on detail.

S — Steadiness. Patient, consistent, process-oriented, attuned to the people around them. S-style communicators notice things others miss — the small change in a patient’s work of breathing at hour three, the quiet signal that gets charted three times before anyone acts on it. Their vulnerability is that their concern often travels through channels that require others to be paying close attention.

C — Conscientiousness. Analytical, precise, evidence-driven. C-style communicators want to understand the full picture before committing to a recommendation. They build toward conclusions. Their vulnerability is that this process can read as indecision to someone who has already formed a position.

Most people are a blend. I run S/C — methodical, relationship-aware, deeply uncomfortable with being pushed to compress a complex situation into a forced timeline. Which explained, among other things, that phone call with the D-style surgeon in Part 1.

Does DISC Work in Healthcare? What the Evidence Shows

Before I go further, I want to be honest about something.

DISC is not a validated clinical diagnostic tool in the same way that an EKG is. The evidence base is not homogeneous, and some researchers have raised legitimate questions about its predictive validity.²

However, DISC remains a widely-used behavioral framework across a variety of industries — corporate HR, talent management, sales, real estate, financial services, law firms. The Wiley Everything DiSC brand alone reports over a million people take the assessment every year. A frequently cited statistic is that roughly 70% of Fortune 500 companies use some version of DISC.⁸ It's also used in over 90 countries.⁸ Given that there are dozens of competing versions beyond the Wiley brand, total annual usage is likely several million assessments globally.

Now there is a growing body of practice-based evidence in healthcare settings. It is used most heavily in two contexts- leadership development programs (CMOs, department chiefs, section heads) and hospital HR/onboarding. The American Association for Physician Leadership (AAPL) actively promotes DISC for physician leaders. There is enough signal that medical educators are starting to take it seriously.

A 2019 publication in the Journal of Surgical Education integrated DISC into general surgery residency leadership training at Rutgers RWJ Medical School. After a year, 96% of residents agreed the tool was useful.³ More telling: before the curriculum, only 22% of those same residents felt they had received adequate communication training³ — despite the fact that interpersonal and communication skills is one of the six core competencies required by the ACGME.⁴

A 2025 paper (also from Rutgers) in the Journal of Surgical Education mapped a full DISC curriculum to the Kern six-step framework for curriculum development in surgical residency, finding it provided a practical structure for communication training across multiple clinical settings — OR, emergency consults, multidisciplinary rounds.⁵

At Mount Sinai Beth Israel, a DISC workshop for 79 internal medicine residents across the 2022–23 academic year found that months after a single half-day session, all respondents reported feeling prepared and confident to apply what they'd learned.⁶

An older 2011 study found associations between DISC profiles and OB/GYN resident performance: residents who performed well on high-stakes examinations tended toward high D and C — decisive and precise — while those who struggled often had profiles mismatched to the demands of the specialty.⁷

None of this is definitive. But it’s enough to take seriously — particularly when the alternative is what we currently do, which is give people no framework at all and expect them to figure out cross-specialty communication through trial and error with patient care hanging in the balance.

Why Surgeons and Intensivists Communicate Differently

There is some evidence that suggests different medical specialties attract — and then further reinforce through training and practice — different behavioral tendencies.¹⁰ In my experience, surgeons cluster heavily toward D: a field where a moment’s hesitation in the OR has direct consequences selects for action-orientation and trains it over years. Pulmonologists like myself tend toward S/C — our work is chronic disease, iterative reasoning, long patient relationships. Primary care shows strong S representation. Radiology and pathology usually cluster towards C.

This means every cross-specialty interaction is also a cross-cultural communication event.

The CT surgeon on that phone call in Part 1 wasn’t being obstructionist. He was operating in his native communication language — direct, decision-forcing, oriented toward resolution. I wasn’t being indecisive. I was building toward a recommendation in mine — process-first, shared understanding before commitment.

Neither of us was wrong. Neither of us had a vocabulary for what was happening.

How to Adjust Your Communication Style by Specialty

If I know I’m calling a D-style surgeon, I restructure the conversation entirely.

I don’t build toward my recommendation — I lead with it: “He needs gentle diuresis tonight. Here’s the reason why, here’s the specific ask, here’s what we’re monitoring for. If any of these numbers move, I call you directly.” The D-style brain can work with that. It has a defined ask, a monitoring plan, and a decision point.

Flip it: if the surgeon knows he’s talking to an S/C intensivist, he reframes his opening. Instead of “what exactly are you proposing” — which an S/C hears as pressure to skip steps — he might try: “Walk me through what you’re seeing and what you need from me to feel confident about the plan.” That framing gets to the same place faster, counterintuitively, because the S/C no longer needs to spend half the conversation establishing that the full picture matters.

This extends to the consult note too — one of the most important communication artifacts in medicine, and one nobody teaches you to write for your audience.

A good consult for a D-style surgeon is not the same document as a good consult for a C-style neurologist.

The surgeon wants the diagnosis, the specific ask, and the one critical action in the first two lines. The neurologist wants the differential, the data trail, the reasoning chain.

Most of us write consult notes in our own style and then feel confused when the response doesn’t match what we expected.

My default is to build the picture before I land on the recommendation. I’ve actively pushed myself to write the conclusion first. It doesn’t feel natural. But it gets the information where it actually needs to go.

How to Use DISC in Clinical Practice: A Starting Point

Take a free DISC assessment such as this one, takes about 10 to 15 minutes. Maybe ask two colleagues from different specialties to do the same. Have one honest conversation about what came up.

At its most useful, DISC is a prompt. It gets you thinking about how you communicate, how the people around you communicate, and why those two things don't always line up the way you'd expect.

A word on the criticisms of DISC, because they matter: the evidence that DISC predicts clinical performance or competence is weak, and I wouldn't use it that way.² What it does reliably is something more modest — it opens conversations that wouldn't otherwise happen, and it gives people a vocabulary for friction they've felt their entire career but never had words for. That's the use case I'm endorsing here.

None of what DISC describes will be new to you — the experiences are familiar. What's new is having a framework for them. The patient hand-off that unraveled quietly. The consult call that ended in tension rather than alignment. The family meeting where everyone was physically present and nobody was actually on the same page. These aren’t failures of character or competence. They are different communication styles operating in the same room without a shared language.

DISC won't solve medicine's communication problems. But naming what's happening in the room is the first step toward changing it — and this gives you a way to do that in real time, with the people you're already working with.

Why Do Hospital Handoffs Fail? A Case Study in Physician Communication

Taj Rahman MD — Thu, 26 Feb 2026 22:50:01 GMT

A post-CABG respiratory failure case with no villain, no clinical error, but a communication breakdown that DISC diagnoses better than any root cause analysis.

Link to Part 2 for a deeper dive into DISC framework

It was post-op day one after a four-vessel CABG (coronary artery bypass surgery), and something was going wrong in the way that things go wrong before anyone is ready to call it an emergency.

Mike was a 64-year-old, former smoker with moderate COPD, had been somewhat underweighted in the pre-surgical risk conversation. He went through the complicated six hour long surgery without incident. Cardiothoracic surgery was satisfied. In their framing, the operation was the main event and a success. What comes after in the ICU is maintenance.

For the next three hours, the ICU nurse was noticing slow changes in Mike’s vitals which she didn’t like.

His oxygen requirements were slowly creeping up. Not dramatically, not in a way to trigger major alarms, but steadily worse. He came to the unit on 2 liters. In two hours, he was needing 4 liters, and then in four hours up to 6 liters. She documented his work of breathing as “increased effort, but not in distress.” She flagged it twice in the EMR. Mentioned it to the CT surgery resident on afternoon rounds. The resident reviewed the chest X-ray, noted expected post-operative atelectasis, and charted “no acute concerns.”

She charted a third time. And then she waited.

That’s what S-style communicators do — and I’ll explain what that means later on. For now- she was thorough, methodical, non-catastrophizing, deeply attuned to small changes over time. She trusted the system to respond. But that trust was not rewarded with the attention the situation required.

As the ICU doctor on call, I got called for a consult at 7:30 p.m, right after shift change.

By then Mike was on high-flow nasal cannula oxygen, visibly short of breath, with bilateral infiltrates on repeat imaging. Not the asymmetric basilar atelectasis you expect after a sternotomy, but a diffuse, fluffy picture that, in the context of a significantly positive intraoperative fluid balance and multiple units of blood products given on bypass, pointed toward transfusion-associated circulatory overload or TACO. Volume-driven pulmonary edema in a post-bypass left ventricle that hadn’t fully recovered from cardioplegic arrest. Mike’s P/F ratio was trending down and his high-flow oxygen needs going up.

He was heading toward intubation if we didn’t get ahead of this carefully.

I called the CT surgery attending directly.

What happened next wasn’t a fight

That’s important to understand. The version of this story that ends with two doctors arguing in the hallway would be a simpler story than what I’m trying to tell you.

This was quieter. Professionally courteous throughout. And in some ways more dangerous because of it.

He picked up on the second ring. I could hear the end of a long OR day in his voice — clipped, efficient, biased toward closing out the evening. I introduced myself, led with the clinical picture- bilateral infiltrates, worsening hypoxia, TACO in the setting of significant positive fluid balance and blood product exposure, I wanted to implement a conservative fluid strategy, hold further volume, trial gentle diuresis, and agree on an intubation threshold now — before the overnight team inherited an ambiguous situation at 2 a.m.

There was a pause.

“His cardiac output looked fine on the last Swan numbers. Pressures have been stable. He just came off bypass — some fluid redistribution is expected.”

He wasn’t wrong.

That’s what made the conversation hard.

Two physicians. Same patient. Both clinically correct.

I agreed with all of it. Then I said the pulmonary picture was telling a different story than the hemodynamics — not a contradiction, because in early TACO you can have significant pulmonary volume overload before the systemic numbers declare themselves. The lungs were the canary.

“What exactly are you proposing?”

Not a question. A prompt for a specific, actionable decision.

My instinct at that moment was to walk him through the reasoning first. Build the picture together. Make sure we were operating from shared understanding before I asked him to change a management plan on a patient he’d spent six hours operating on. That’s how I land on recommendations — through process, not declaration.

To a surgeon at the end of a twelve-hour OR day, this read as hedging.

He interrupted, not unkindly, about 30 seconds in.

“So you want to diurese him.”

“Gently. One modest dose of furosemide, watch the urine output and oxygen needs over two hours, draw a BMP at the two-hour mark. If his creatinine moves or his pressures soften, we stop.”

“I don’t want to tank the preload on a fresh bypass. His kidneys just came off pump.”

This was not defensiveness. This was legitimate clinical reasoning said quickly and directly. Post-CABG patients on day one are genuinely vulnerable — aggressive diuresis can impair coronary filling pressure, compromise graft perfusion, and precipitate acute kidney injury in post-bypass kidneys already under physiologic stress. He had watched those complications happen. His concern deserved a real answer.

I gave him one. He agreed to a single low dose of lasix with close monitoring. We hung up.

And then the plan quietly fell apart.

The handoff

The surgeon documented his priorities: conservative management, close hemodynamic monitoring. I documented a trial of diuresis with specific parameters and a two-hour reassessment window.

The overnight resident inherited both notes. She read them as roughly consistent — both sounded cautious, both emphasized monitoring — and didn’t register the operational gap between “conservative management” and “trial of diuresis with defined endpoints.”

The nurse asked a clarifying question at 9 p.m. about whether the furosemide order was active. The resident, unsure which attending’s framing was the directive, gave a hedged answer.

The furosemide got delayed another two hours while everyone waited for someone else to make the call.

By 11 p.m. I was called back to the bedside. Mike’s oxygenation was worse and he was placed on Bipap, heading towards intubation. We gave the lasix. Got 800 cc off over three hours. By 2 a.m. he was back on 4 liters nasal cannula, comfortable, trending the right direction.

He didn’t get intubated. Eventually, he went home on day six.

The outcome was good.

But I’ve thought about situation similar to those hours between 7:30 and 11 p.m. more times than I can count. The nurse who had flagged a deteriorating patient multiple times and received no clear directive. The resident caught between two sets of notes trying to infer what was actually sanctioned. A patient on high-flow in a room where the plan existed but hadn’t fully transferred to the people responsible for executing it.

The Joint Commission estimates that up to 70 percent of serious unplanned medical events trace back to communication failures — not diagnostic errors, not technical mistakes. Communication failures.

Here's what I didn't know that night that I eventually understood after learning about the DISC assessment framework a few months later.

Every person in that case was operating from a behavioral style that was entirely predictable, and entirely invisible to everyone else. The surgeon was D: direct, decisive, built for fast resolution, uncomfortable with process that looks like delay. The ICU nurse was S: steady, observant, communicating through documentation, trusting that careful charting would move the right people. I'm S/C: I don't declare recommendations — I construct them, brick by brick, until the picture is complete. And the overnight resident who inherited two divergent notes at shift change had no framework to understand that what looked like clinical alignment was actually two physicians sort of talking past each other in their native languages. There is emerging literature on DISC assessment model in healthcare (beyond the c-suite). And it has practical implications for every cross-specialty interaction in medicine.

Link to Part 2 where we dive deeper into the DISC assessment framework.

Why Do People Believe False Health Claims? Plato Had the Answer.

Taj Rahman MD — Sun, 30 Nov 2025 02:30:29 GMT

I saw a post last week claiming you could cure diabetes with cinnamon water. 47,000 shares.

Meanwhile, the family medicine doctor I follow who actually treats diabetes? Her careful explanation of glycemic control got maybe 200 likes.

The miracle cure videos rack up millions of views. The vaccine conspiracy theories have spread like wildfire. And the actual experts—people who spent years studying and practicing medicine—get drowned out by algorithmic noise.

As the saying goes, history doesn’t always repeat, but it often rhymes.

About 2,400 years ago, Plato watched a similar theme unfold in ancient Athens. Different platform, similar problem. Back then, instead of social media influencers, they had a group called the Sophists. Instead of TikTok algorithms, they had public assemblies and jury trials. But the core issue was identical—the people who were best at sounding right were drowning out the people who were actually right.

And Plato was pissed.

Who Were the Sophists? The Original Influencers

So who were these Sophists? Think of them as the original viral content creators. They were professional debaters and speech coaches in ancient Athens who made serious money teaching politicians and rich families how to be persuasive speakers. They knew how to work a crowd, make their opponents look stupid, and win arguments.

But—and this is what made Plato lose his mind—they didn’t actually care about being right.

The Sophists mastered what Plato called “eristic,” which is basically the art of winning arguments by whatever means necessary. False dilemmas? Sure. Exploiting confusion about terms? Absolutely. Going off on random tangents when it helps your case? Why not. The goal wasn’t truth. The goal was applause.

Plato made this distinction between pistis (which is just belief or opinion) and episteme (actual knowledge). The Sophists dealt exclusively in pistis. They said whatever would make people cheer. Their principles mysteriously shifted depending on who was in the audience.

Sound familiar?

The Algorithm Is Basically a Sophist

Social media has turned us all into that ancient Athenian crowd. And the algorithm? It’s running the same playbook the Sophists used—give people exactly what makes them click, share, and react. Not what’s true. Not what’s useful. What feels right.

This is why health misinformation thrives online.

Think about what actually performs well:

Simple answers to complicated problems
Clear villains (Big Pharma! Insurance companies! Greedy doctors who don’t listen! The medical establishment!)
Personal stories that “prove” the experts wrong
Urgent warnings that make you feel smart for knowing them
Stuff that confirms what you already believed anyway

You know what’s missing? Actual medical evidence. Peer-reviewed research. The boring truth is that many health conditions are messy, have multiple causes, and don’t have quick fixes.

It’s not just that bad information exists—it’s that the persuasive stuff beats the accurate stuff almost every single time.

Why False Health Claims Are More Persuasive Than True Ones

Plato didn’t sugarcoat things. He compared rhetoric (the Sophists’ whole deal) to cooking.

His point: A skilled cook can make unhealthy food taste delicious. Similarly, a good Sophist makes arguments sound convincing whether or not they’re actually correct.

Medicine, on the other hand, might give you something unpleasant—medications or procedures with side effects, changing diets, quitting smoking—because it actually works. Real medical knowledge doesn’t always go down easy.

Now think about health content on social media. What gets more engagement: me explaining that weight loss is complicated and requires sustained lifestyle changes? Or some influencer promising you can “melt belly fat in 7 days” with one weird trick?

A doctor carefully walking through vaccine data with all the nuance and statistics? Or a charismatic skeptic with a story about someone who had a bad reaction?

Why Experts Refuse to Debate Health Misinformation

In 2023, Joe Rogan offered vaccine scientist Peter Hotez $100,000 to debate Robert F. Kennedy Jr. on his podcast. Hotez said no. The internet lost its mind. People called him a coward, said he must not be confident in his science, accused him of being afraid to defend his positions.

But Hotez understood something crucial: debates aren’t about finding the truth. They’re about winning. And Kennedy—trained lawyer, experienced public speaker—knows every trick in the book. He can dodge questions, make scientific concepts sound sketchy with the right tone of voice, turn a serious discussion into soundbites that could make the scientist look arrogant and elitist.

This is exactly why Plato hated debates. When you turn truth-seeking into a performance with winners and losers, you’re not figuring out who’s right—you’re judging who did better in the moment. And being good at performing has nothing to do with being correct.

The format itself is the problem.

Why Health Influencers Outrank Actual Doctors Online

Plato noticed something darkly funny: the Sophists got rich and famous, while spreading misinformation. The real philosophers who cared about truth? Often ignored or mocked.

Same thing today. Health influencers with zero medical training get millions of followers. They write bestsellers. They launch supplement lines. They go on the most viewed podcasts. The algorithm loves them because they generate engagement.

Meanwhile, actual expert consensus—thousands of scientists doing rigorous research over decades—gets dismissed as “what Big Pharma wants you to believe.”

Years of medical training get treated the same as someone who spent an afternoon Googling and found some blogs that confirmed what they already believed.

This isn’t democratization of information. It’s just sophistry winning again.

How to Spot Health Misinformation: The Tricks Haven't Changed

If Plato scrolled through social media today, he’d spot the same tricks immediately:

The false choices: “Natural vs. Chemical.” “Western Medicine vs. Holistic Healing.” “Trust Your Body vs. Trust Doctors.” These force you to pick sides when reality is usually more complicated.

Playing with definitions: Throwing around medical terms that sound scientific but actually mean nothing specific in a medical context. “Toxins.” “Boost your immune system.” “Reduce inflammation.” Most people don’t know enough to question it.

Changing the subject: When someone challenges their claims, watch how they pivot to personal stories, or start attacking motives, or bring up some unrelated controversy.

Looking credible without being credible: Lab coats in videos. Impressive-sounding credentials that have nothing to do with the topic. Scientific-looking graphs with cherry-picked data.

Every trick from ancient Athens, updated for the algorithm.

Why I Started This Newsletter

Look, I’m a lung doctor. In a typical clinic visit, I get maybe 10-15 minutes with you, a few times a year. In that time, I need to check your symptoms, adjust medications, order tests, address whatever’s urgent.

There’s no time for the bigger picture. I can’t walk you through all the nuances of your condition. I can’t address every misconception you’ve seen online. I can’t give you the framework to evaluate health information on your own.

The system doesn’t allow for it. The time literally isn’t there.

But that gap gets filled anyway. And it gets filled by content designed to go viral, not content designed to be accurate. By sophistry, not medicine.

I don’t think this newsletter is going to blow up. Real health education doesn’t work that way. Understanding how your lungs actually work, or how to think about screening tests, or why certain symptoms are connected—that takes time. It builds slowly. It’s not going to give you the rush of a shocking revelation.

But it’s true. And I think you deserve the truth, even when it’s complicated and less exciting than the viral stuff.

The Algorithm Isn’t Changing

Let me be realistic: we’re not fixing this problem. Social media companies make money from engagement, and sophistry is more engaging than expertise. Strong emotions drive shares. Controversy drives comments. Simple explanations drive clicks.

But you can learn to spot it when it’s happening.

When health content promises easy answers—be suspicious. When it gives you clear villains to blame—be skeptical. When it makes you feel special for knowing something “they” don’t want you to know—recognize the manipulation.

When complicated medical questions get treated like debates with obvious winners instead of ongoing scientific investigations—you’re watching sophistry in action.

And when a real expert won’t “debate” a charismatic skeptic? They’re not being cowardly. They’re refusing to play a game designed to reward performance over truth.

Where Plato Got It Right (And Where He Didn’t)

Plato nailed the core problem: mistaking persuasiveness for truth is dangerous. Debates often hide truth instead of revealing it. People who care more about winning than being correct can do real damage—especially when lives are at stake.

But Plato was also kind of an elitist. He didn’t trust democracy at all. He thought most people couldn’t handle the truth and needed philosopher-kings running things.

I don’t buy that. I think you’re perfectly capable of understanding complex health stuff if someone explains it clearly, without jargon or condescension. I think you can learn to recognize sophistry. But you need to understand the game being played.

The algorithm isn’t on your side. Going viral doesn’t mean something is true. The most-liked health content is often the most misinformed, if not frankly dangerous.

Have you noticed the gap between what goes viral and what’s actually helpful when it comes to health information? I’d genuinely love to hear about your experience in the comments.

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