Kevin, MD posted an entry today entitled, “Black Wednesday: A dark day for the medical blogosphere“, in which he reports of several medical bloggers closing their blogs—some with explanations, some without. He also argues that because “medicine is one of the last adopters of technology”, they are “slow to adapt to the openness that defines the heart of the blogosphere”. He also touches upon recent major media coverage of medical blogs and concerns of patient privacy.
I don’t entirely agree that the reaction towards blogs is primarily due to resistance towards technology. This may certainly contribute to the general dearth of physician bloggers, but there are more significant factors that contribute to our small population, such as
- Time. In the midst of call schedules, variable work hours, and maintenance of general life (eating, sleeping, exercising, attending to relationships, etc.—ideally this is part of a physician’s routine), doctors (presuming that they have the desire to write) may not view blogging as a high enough priority to pursue. There are only so many hours in the day and the last thing extroverted physicians may want to do is spend time on the computer, sharing their experiences and opinions to a faceless and nameless audience.
- Fatigue. Often, the last thing doctors want to think or talk about is work when off duty. To write about medicine requires that one thinks about medicine.
- Maintaining the Order. And by “order”, I mean “secrets of the trade”. That phrase sounds more pretentious than I intend, but I believe there is an element of truth to it. Like any other profession, physicians may hold opinions about their work and the people they encounter that may undermine the image they want to project. Despite reports of unscrupulous physicians, disturbing malpractice lawsuits, and personal anecdotes that induce wincing, physicians are generally held in high esteem. (Ask your male friend who is a doctor if he’s ever used the line “I’m a medical student” or “I’m a doctor” to pick up women!) Is it okay to share ideas, thoughts, or opinions that may mar our sparkling image? What harm will we cause if we actually show our humanity? What are the consequences if we reveal that we are indeed fallible?
- Lack of interest. Doctors are people. Some people don’t like to write. Hence, some doctors don’t like to write. (There’s the transitive property in action.)
Fear, however, may be the most potent factor: What if someone construes what I write as medical advice? What if one of my patients reads this? What will my patients think of me? What will my colleagues think of me? Will the medical center view me as a liability rather than an asset? And on and on and on.
As an odd coincidence, the New York Times recently printed a piece, “Doctors Who Wield the Pen to Heal the Profession“, that describes the increasing number of publications by physicians in the general press (for example, articles in the New York Times—I personally envy Elissa Ely!—or pieces in The New Yorker, etc.). From what I can tell, the content of these “major media” pieces is not dissimilar to that on medical blogs—these authors critique the profession, provide commentary about the practice of medicine, and share patient stories. So what is it about writing online in independent blogs that differs from writing in major media? Have hospital administrators frowned upon Jerome Groopman for criticizing the thought processes of physicians? Did the chair of the neurosurgery department chide Sanjay Gupta for the opinions he provides on television? I imagine that the medical centers that employ these published physicians are rather proud that they are affiliated with these writers. However, no-name—nay, anonymous!—physicians who write online are somehow more threatening to institutions.
Maybe it’s because we just don’t write as well?
Graham recently wrote about a conversation he had with Atul Gawande. He expressed disappointment upon realizing
everything he writes he writes because he wants to understand it, and writing is his way of thinking his way through things. He doesn’t write to make change, more because he has found an interesting paradox that he wants to understand.
I confess that instead of feeling disheartened, I felt surprised because that’s the exact same reason why I write. It was a feeling of (imagined) kinship. When I first started blogging near seven years ago (!), I read something from Evan Williams (one of the founders of Blogger) that said something along the lines of “if I write better, I think better”. I absolutely agree.
The beauty of blogging is the near-immediate feedback, both from myself and from others. Many of my more “literary” pieces stem from clinical situations that left me feeling perplexed or distressed. Writing about them helps me understand how I perceived what happened, how other parties may have perceived what happened, how things could have gone differently, and what details I may have missed at the time of the situation. Different ideas may blossom in my brain that may help me view the issue from different perspectives, allowing me to perhaps be more empathic in the future. All of this—and usually more—happens as a result of retelling the story.
And then there are the comments that readers leave. Though I have abandoned my previous practice of responding to each comment, I (like other physician bloggers, I presume) read each one and often learn from the perspectives of others. It’s easy for us all to get caught up within our own frame of references and forget how our thoughts and behaviors may be (adversely) influencing a situation.
So, I agree: It is sad and unfortunate that members of our cohort have had to abandon their weblogs due to unelaborated forces. The diversity of information and opinions available on the internet is what makes it astonishing, educational, and stimulating. The muting of these distinctive voices in this arena is a loss not only to our peers, but also to the general online community.
16 May 2007 | 11 comments.
Link-O-Rama (II).
>> This American Life: 81 Words. “The story of how the American Psychiatric Association decided in 1973 that homosexuality was no longer a mental illness.” I’ll be listening to this tomorrow morning as I walk to work.
>> Weather Underground. My trusted source for weather for almost eight years now. The Seattle forecast for tomorrow features a high of 75 degrees F (that’s 24 degrees for you Celsius folk) and clear! Spring is lovely here.
>> One Bag. “The art and science of travelling [sic] light.” This was wonderfully helpful when I was traveling for medical school and residency interviews. The one bag thing is sweet. Except the liquid restrictions detract from the elegance of The Single Carry-on.
>> Daddy-O’s. Cute, vintage clothing for guys and gals. I wore this dress to recent gala. Petticoats are fun. (… though I shan’t ever admit that in person.)
>> Calendars That Work. This is part of my GTD package. I use the two-month calendar to help me stay on top of my call schedule, dinner plans, blood donations, workshops, supervision sessions, meetings… oh! And those sporadic vacations.
>> Mark Poulin jewelry. The website doesn’t do justice for the variety and cuteness of his art. His trinkets were for sale in a store on Piedmont Avenue in Oakland; it was one of the rare occasions that I actually found myself wanting to purchase jewelry.
14 May 2007 | 3 comments.
Running.
I have elected to take up running.
I do not have any fondness for it. Like the running clothes I have worn in the past, my memories of running are tired, faded, and mildly malodorous.
In junior high and high school, it was with resignation that I donned my gym clothes (green shorts and tee in junior high; heather grey shorts and navy blue shirt in high school) to run laps. Sweat collected within the mat of my thick hair before pouring forth in steady rivulets down the slope of my forehead, eventually ungracefully splattering on my flushed cheeks. My glasses slipped down my nose and the occasional errant sweat droplet flung itself onto my spectacles, obstructing my view. Though my breaths were synchronized with my footfalls, they did not flow with quiet ease into my lungs; it sounded and felt artificial, mechanical. I envisioned my respiratory system functioning like a soundless accordion generating quarters notes at a clipped allegro. The saliva within my mouth thickened into the consistency of ketchup, my lips dried into the texture of toast, and my tongue felt like a piece of jerky.
Upon crossing the finish line, the sweat dribbled off of my head in earnest as the silent accordion played on, huffing out breathless notes as I felt the blood rush to my skin. It was a warm, uncomfortable radiance; now that the wind resistance had disappeared, heat convection was stymied. I wanted to peel everything off: my moist gym clothes, damp underwear, sticky socks, and heavy shoes. Was there a way to shed my flushed, warm skin?
I didn’t look forward to running. I didn’t enjoy it while I was doing it. And the very, very brief effects of endorphins following the run were simply not rewarding enough for me.
So I decided to give running another try in college.
One of my roommates, an agile, sinewy young man who admired Lenny Kravitz and Jessica Alba, ate dinner off of the cardboard box that once held the futon (before we acquired a real table), and didn’t have enough facial hair to shave even on a weekly basis, was an avid runner.
“Come running with me,” he suggested, probably between guffaws (because if we weren’t laughing at each other, we were laughing at something else equally silly). “It’ll be fun.”
And when he said “Come running with me,” he actually meant, “Let’s go running within the same time period” because there was no way I could keep up with him. He dashed around the outer loops of Drake Stadium as I plodded my way along the middle track, wondering why the heck I was hastening the erosion of the cartilage cushioning my knees. As the sun set behind the West bleachers of the stadium, sending an orange-purple glow over Westwood, we each faithfully completed our revolutions, week after week.
There even came a time when I went running alone—because, really, that’s what we were doing all along: running together, separately.
So I have elected to take up running again. Although I support cardiovascular health, I am in greater support of losing the weight I gained during my intern year. Walking and lindy hop can only burn so many calories. I’m armed with a running schedule from this book, a pair of solid running shoes from the attentive folks from this store, a fresh, unmarked running journal, a public commitment made on this here blog (in following the example of the serial deviant), and a determination that makes steel look as flimsy as silk!
Tomorrow is Day 1.
13 May 2007 | 21 comments.
Sex, Size, and Society.
We’ve both done the same things:
- evaluated patients intoxicated with or withdrawing from alcohol, cocaine, heroin, and methamphetamine
- managed belligerent patients who were psychotic (please note that this does not mean that all patients who are psychotic are belligerent)
- refused to prescribe medications to patients
- managed patients who became angry and frustrated because they did not receive Xanax, Vicodin, or Adderall from us
- refused to admit patients into the hospital
- managed patients who became livid upon learning that we would not provide them with a bed for the night
He, however, has been nearly physically assaulted, threatened with bodily harm, and warned to watch over the safety of his family. From what I can tell, angry, male patients also expend much more energy yelling at him than at me.
And this is not a testament to his lack of clinical acumen as a psychiatrist: He is skilled. His peers and superiors uniformly hold high regard for him; “his” patients (versus patients we see in the emergency rooms or in consultation) compliment him and appreciate his work; he’s a genuinely nice guy. Fellow residents have described him as a “sweet Boy Scout”.
He’s also physically intimidating. He could be a football player—a defensive lineman. Or a bouncer for an exclusive club. Or a Secret Service Agent.
And I believe the sole reason why he receives so much more negative energy than I do in our clinical work is because he is a large, stocky man.
This totally sucks for him because it makes the job significantly more stressful. No one likes or wants immersion in the churning waters of anger; we all run from the tides of conflict when given the opportunity.
I’m not sure if angry men do not threaten me because I am a woman or they threaten him because he is a man. When men become angry with me, do they refrain from threatening me because of something like chivalry? (Perhaps, though I am not inclined to believe so—a man did once threaten to bite into his gaping arm wound and spit blood at me if I got any closer to him; that’s not chivalrous.) Is it because they can already sense my fear? (Which, admittedly, I readily advertise and use to further secure my personal safety.) Is it because, on some level, they realize that although I may be freaked out, I still expect them to behave appropriately? Is it because they know they can injure me, but I am simply not worth the effort?
When confronted with my large male peer, do angry male patients succumb entirely to testosterone and prepare to fight? Is there a greater thrill in assaulting my colleague, The Man, than in taking down me, who clearly does not resemble The Man (or The Woman or any other traditional authority)? Do they sense my peer’s simmering anger and frustration and build upon that energy? Is it merely a cultural effect—you know, it’s okay to get into a fight with a large man, but not with a woman?
I make a point of avoiding the term “angry patient” and focus particularly on “angry men” because angry, psychotic women specifically have the same risk of engaging in violent behavior as angry, psychotic men (which is higher than non-psychotic men and women). (I do not have a citation for this right now.) Several angry, psychotic women have threatened to pummel me. I do not take their threats lightly.
Regardless of how we proceed in our lives, we bring so much more than just our personalities to our interactions with others. (Stating the obvious is part of my charm.) My good friend, though gentle and delightfully diplomatic, can’t “turn off” his male brawn. I wonder not only how he feels when these episodes unfold, but also how much frustration he feels afterwards when he reviews the situation to learn how he can minimize conflict in the future. His physical appearance may unfortunately serve as a biological cue that activates other men to actions they would never consider if they interacted with me.
And what assumptions do I trigger in patients during our interactions? I absolutely modulate both my appearance and behaviors to maximize rapport with and engage patients—but what about those things I can’t control? Would patients react to me differently if I were shorter? what if I wore skirts, showed some leg? what if I had blonde hair, blue eyes, and freckles? Could I possibly be a “better” psychiatrist? (Whatever “better” means?) a better dancer? a better writer? a better blogger? a better human being?
11 May 2007 | 4 comments.
The Women are Dangerous.
“You’re really pretty,” he said, winking at her.
She tested her penlight twice against the screen of her gloved palm before replying, “Open your mouth and say ‘ah’, please.”
He raised a single eyebrow and ran his fingers through his dark hair. She did not return his smile.
“Oh, come on,” he playfully whined before opening his mouth. His light eyes watched her face as she scrutinized his palatal arches, uvula, tonsils, tongue, teeth, and buccal mucosa.
“Everything look okay in there?” the 22 year-old man lightly asked when she completed her examination.
“Yes,” the medical student curtly answered, averting her eyes while she peeled the gloves off of her slender hands.
“Good,” the patient answered. “You’re a great medical student, you know? Thorough, good manners, attractive—I appreciate your attention.”
Turning her back towards him to wash her hands, she rolled her eyes.
“Can I have a cup of water? My sore throat is dry,” he said as she was drying her hands.
Saying nothing, she plucked one cup from the tower of cups on the counter, filled it with tap water, and handed it to him.
“Thank you,” he answered, again winking at her.
She turned to leave the room and, feeling his eyes on her body, tugged at her short white coat in a lame effort to lengthen the hem.
Suddenly, she felt his hands on her shoulders, stopping her. She didn’t realize what happened to her until she had completely spun herself around to face him, that young face grinning mischievously at her:
He had kissed the top of her head.
He didn’t realize what happened to him until he was on the floor: She punched him in the left cheek and when his hands flew to his face in surprise, she kicked him in the groin. While rocking back and forth on the tiles and uttering high-pitched noises of discomfort, he looked up at the medical student through squinting eyes. She was holding the small cup of water…
… and then proceeded to pour the liquid onto his crotch of his pants. It splashed over his fingers, seeped into and darkened the canvas cloth, and dribbled onto the cold tiles.
“Don’t ever touch me,” she said before stepping out of the room.
He rolled back onto his other side, wincing and groaning in pain.
10 May 2007 | 7 comments.