She had a reputation and he, like everyone else, was familiar with it. She’s something special, they all said. She’s smart—book smart, you know—but down to earth. Good head on her shoulders. She’s got class—you’ll never see her at a dive bar. But she’s not exactly a snob either—she stays away from the fancy hotels with the dim lighting and polished grand pianos. Great sense of style and a lot of spunk. In fact, that’s what people murmured about the most: Her personality was a bit unpredictable, but usually a lot of fun. Usually.
He had met her in the past and, truthfully, he was taken with her at their first meeting. Though not exactly warm, she was at least approachable and courteous. He was shy; she was preoccupied. He never made his intentions known and, eventually, was distracted by other things.
A few years later, he sought her out. He heard that she was still single and looking. They also speculated that she was still the high class dame that she once was, though his friends couldn’t say that with much confidence—they hardly knew her.
“You might want to look her up—go out for a few drinks, catch up. You’ve grown, my friend, and she may now realize what she missed in the past.”
So he made some inquiries.
She ignored him.
He tried again, and she still ignored him.
All of this, he knew, was information. Although he knew first impressions were just that—impressions—he was disappointed with her reaction (or lack thereof, really).
His third attempt, though, was somewhat productive.
“Yeah, uh huh, gimme your number—yeah, yeah, don’t call me, I’ll call you. Thanks.”
The entire affair was curious: She wasn’t the least impressed with his courtship—and he didn’t think she was feigning ennui, either. She still seemed preoccupied, though he was particularly struck with her apathy.
The other six women he was courting—it was, after all, a numbers’ game—were remarkably more enthusiastic about his overtures. He had already obtained all of their phone numbers, shared some stimulating conversations, and even met their friends. Admittedly, some of them were more coy than the others—you know how women are—but, in his estimation, things were progressing well.
In fact, one of the women had unwittingly captured his attention. He hadn’t ever heard of her; he could have easily overlooked her. One of his friends, though, was dating one of her friends, and suggested that they chat.
“She’s really nice,” his friend had commented. “She’s got a lot to offer. Give her a call.”
And she was notable. Sure, she didn’t have the glitz and glam of the other girl, but there was something sweet about her. She was demure, unassuming—it was unexpectedly endearing. Her charm lay in her quiet wit, something that most people overlooked if they didn’t pause to actually talk with her. She didn’t mind—it kept the peacocks away from her.
He was intrigued. Who was this girl? That she wanted to spend time with him made him feel even more optimistic—he always did much better in person than he did on the phone.
When the other girl finally called him—”Hey, you there?”—he shook his head, politely said good-bye, and hung up the phone. If that was the way she was treating him now, how would she treat him if they actually got together?
This could be a story about a boy and girl. Or it could be a story about a girl and a fellowship program.
30 Jul 2007 | 5 comments.
Link-o-Rama (IV).
No substantial offerings tonight.
>> Seattle Lindy Exchange. Lindy exchanges are dancing events that occur around the world so people who lindy hop can (1) have a ready excuse to travel and (2) dance with people with whom they do not routinely dance. The Seattle Lindy Exchange is occurring this upcoming weekend and will feature a free dance in downtown Seattle. Last year, the outdoor dance was held at the Seattle Center with minimal shade; though fun (I danced with people from two different countries and about eight to ten different American states), it was uncomfortably warm. If you’re in the Seattle area and would like to witness an organized “lindy bomb”, visit Westlake Park (4th and Pine) next Sunday.
>> Yehoodi. This is the lindy hop message board for New York City. It appears that their primary weekly dance is called “Frim Fram”. I hope I will have the opportunity to attend that dance when (not if! but when! hooray!) I visit New York City.
>> Farecast. I still don’t understand why flying along the Pacific coastline is more expensive than flying across the country. For the first time since I moved to Seattle, I got plane tickets to fly to Southern California for less than $200. I suppose that I bought these tickets four months in advance might have something to do with the decreased cost.
>> Busted tees. There is a guy who dances regularly who usually wears tee shirts from this company. He, like many of the other male dancers, works at Microsoft. I used to think that the significant number of computer programmers who lindy hop was a function of location—Boeing, Amazon, and Microsoft are all based in Seattle. However, after speaking with dancers from other cities and from perusing the Yehoodi message board, it seems that lindy hop attracts these computer/engineering/techy types. I wonder if the same pattern holds true for salsa and tango.
>> Barbecue and mood. I had thought about writing about all the anti-depressing activities I had pursued today (particularly in contrast to the initially depressing weather we had this morning—it was grey and drizzling), including a barbecue I had attended this afternoon. In a whimsical moment, I asked, in jest, Pubmed to return articles that addressed “barbecue AND mood”. One article came up.
29 Jul 2007 | 6 comments.
UpToDate, Joe’s Goals, and Fortunes.
>> UpToDate. UpToDate is essentially a concise online textbook for medical conditions. Medical students learn quickly to consult UpToDate for information on topics as varied as causes of hyponatremia (low sodium), manifestations of sickle cell crisis, or criteria for the MELD (model end-stage liver disease) score so that they (1) learn, (2) minimize the chances of looking like complete dolts during rounds, and (3) can expound at length in the “impression” and “plan” portions of their verbose notes. Interns and residents (and presumably attendings, too), continue to consult this useful resource on the fly for information as they evaluate and manage patients.
UpToDate is not a free resource. Word on the street is that within the past year, the company that manages UpToDate has increased their prices by 500%! Thus, any institution that would like to make UpToDate available to staff now must pay a fee that is over half a million dollars.
The folks at UpToDate know how much housestaff rely upon this program. Darn it.
A potential competitor is Dynamed, which prides itself on “superior evidence-based results”. I must confess that I’m impressed with the abundance of (very recent) citations Dynamed provides for different subjects [for things that are relatively uncommon, such as the efficacy of selective serotonin reuptake inhibitors (also known as SSRIs) in contrast to tricyclic antidepressants (TCAs)…]. Information is presented in a concise format, but allows the reader to consult the original articles with ease.
This is particularly striking because the other word on the street is that only 10% of UpToDate is evidence-based. I have no data to support that assertion; that’s just what the (reliable) rumor mill mutters. UpToDate could theoretically brainwash us all with heretical information that would absolutely impact patient care. (Not to say that some of us don’t already do that….)
A disadvantage of Dynamed is that one must already know something about the topic to make sense of the information. UpToDate is a textbook; thus, you can read general background information about progressive multifocal leukoencephalopathy (PML) before learning about appropriate management and treatment of this condition. On Dynamed, you better know what PML is or otherwise, the information doesn’t really make much sense.
>> Joe’s Goals. This is a great application to use for motivation. Joe’s Goals is a Web 2.0 tool that allows you to track your habits; in psychological literature, this behavior is known as “self-monitoring”. The very act of monitoring what you do (or do not do) can change behavior. For example, people who track how many cigarettes they smoke a day often suddenly realize just how often they are smoking, how many cigarettes they are smoking, and how much they are spending on that habit. This information, when blatantly recorded, forces people to become more aware of what they are doing and thus, may foster more rapid behavior change. Maybe. Benjamin Franklin was a proponent of self-monitoring. You could be just like him.
Amongst other things, I am currently tracking my academic reading. I like putting those green checks into the boxes to mark my progress. (And, for what it’s worth, learning theory posits that positive reinforcement—using the green check marks—is more effective in eliciting change than punishment—using the red stop signs. Empirical evidence suggests that the theory is accurate.)
>> Fortune cookies. A few weeks ago, a good friend purchased a magnet for me. The magnet reads
Some dream of fortunes
Others dream of cookies
She knows me well.
Today, the fortune inside my fortune cookie read
Your ideas will be totally acceptable.
What kind of fortune is that?
26 Jul 2007 | 12 comments.
Teaching Observations.
My friend, a newly minted PhD, and I taught a behavioral medicine seminar this morning for a group of internal medicine residents. Our (over-) attention to semantic detail led us to title the seminar as “The Role of the Provider in Challenging Interactions with Patients”. Usually, these types of interactions are referred to as “difficult patient interactions”, which are then further abbreviated to “those difficult patients”. Approaching patients—or people, for that matter—as “difficult” doesn’t help anyone; it merely girds the physician to enter a battle that may not actually exist. Last I checked, medicine is a collaborative endeavor, not a blood-drawing sport.
My friend and I had given this seminar to a different group of internal medicine residents earlier this year, when the interns had about eight months of experience under their white coats and the more senior residents were slogging through a drab winter of discontent. When we solicited the group for challenging interactions, they easily rattled off many, many specific instances of professional frustration. When we prompted them for obstacles that interfere with their goals in patient care, they provided a litany of complaints. Most of them involved “environmental” issues (the endless paperwork, the incessant pages, the unending requests and clarifications from ancillary and other medical services, etc.), but many of them focused on issues that they attributed to patients:
- “Sometimes they are so demanding and they’re asking for things that aren’t reasonable.”
- “When they’re homeless, they often can’t make their appointments or get their meds filled.”
- “They want to talk about things that aren’t directly related to their health.”
When we asked them how they themselves might be obstructing their goals, they paused—
—and soon were able to realize that their own behaviors could adversely affect the interactions. (Hence “the role of the provider”.) After further discussion, the group, as a whole, conceded that one of the main points it learned from the exercise was that physicians themselves do play an active role in the interaction and that their own behaviors can shape the eventual outcome. Many residents do not have opportunities to reflect upon what they do and why they do it.
This is why my friend and I wanted to hold this seminar.
Today, the group consisted primarily of interns, who have been doctors for about one month. Four weeks. When we prompted them for their experiences and thoughts, we often heard silence.
There were two clocks in the room, both with loud and unsynchronized second hands. The passing time was noisy.
I was particularly struck with vast experience we all obtain during our intern years. It’s not that these interns had romanticized patient interactions—they hadn’t. They were merely extraordinarily anxious about their own performance and potential incompetence—which is completely developmentally appropriate. In fact, that itself caught my attention: These interns were so focused on themselves and their perceived inabilities that they could not focus outwards. Thus, when asked what patient characteristics may obstruct health objectives, they merely stared back at us. Maybe shame prevented them from sharing what was on their minds. I’m not sure.
The senior resident and the attending in the room, however, easily piped up with responses for patients and for physicians. In fact, it was the more experienced physicians (no doubt by seniority) who engaged in the discussion and, at least overtly, reflected on their awareness.
To say that this “saddens” me is inaccurate. I’m pleased that, when given the opportunity to do so, physicians are able to step back and reflect upon how they interact with patients. I’m “sad” that physicians do not regularly engage in this self-awareness. This is not to suggest that physicians should routinely sit around a campfire, hold hands, and sing “Kumbaya” while mulling over suboptimal interactions with patients. I just wonder if physicians and patients would share more useful experiences and effective communication if people were more mindful of what and how they contribute to an interaction.
I’ve been invited to give the talk again—solo, as my friend is going to New York City for his post-doctoral work—after the new year. I already wonder how that will go.
I also taught medical students today. This is the first time I’ve had a formal opportunity to teach a group of medical students in a more “lecture” style; I’m more accustomed to teaching individual medical students. There was the “Futon of Knowledge”, where I taught three medical students at one time, but that experience was limited to the room with the futon in it. (There are many ways to distort the idea of the “Futon of Knowledge”—it wasn’t like that.)
The medical students are also four weeks into their medical careers, so, for the most part, they are bright-eyed and eager. Teaching, for me, is tons of fun as it is, but teaching medical students is especially rewarding. It’s neat to see the lightbulbs over their heads flicker with curiosity before illuminating with understanding. And—shall we be honest?—it’s neat to think that I may (positively) influence the way they think about and interact with patients in the future. Truthfully, I can’t take credit for this stuff, though; medical students will incorporate what they like into their repertoires and toss the rest.
I saw one of my former medical students today. He is one of those double doctors—you know, he’s got an MD and a PhD. When we met, he had already earned his PhD. He arguably knows all there is to know about vitamin K. And he was my medical student—a good one at that, too. Curious, thoughtful, kind, and intelligent. Gentle with patients.
Except, now, he’s an intern. He was wearing the requisite long white coat. It was still starchy and thus, didn’t sit quite right on his tall, lanky frame. His hair was unkempt and his posture was slouchy.
“Hey, look at you!” I enthusiastically greeted, tugging on his coat to emphasize it’s “real doctor” length.
He smiled at me—he looked tired and much older than I remembered. “Hi,” he greeted, rubbing his head. “I’m post-call—I was falling asleep on the shuttle—”
I patted him on the shoulder. “Go,” I directed, hustling him into the hospital. The more time he spent talking with me, the more time he’d be in the hospital, and the less time he would have to sleep.
In his fatigue, he tried to continue our conversation, though I made it difficult for him. In retrospect, I probably should have allowed him to ask me how I was doing.
25 Jul 2007 | 6 comments.
A Story About Socks.
Once upon a time in a land not so far away, there was a sock manufacturer called Jansun. Jansun was one of several major sock manufacturers and the factory was tucked away in the high hills where the horizon kissed the sky. Like the other sock manufacturers, the seamstresses focused on producing one, specialized type of sock. This particular sock came in a variety of sizes and was composed of two types of thread: A cotton-like material that cushioned the foot and a polyester-like material that kept the foot dry and ventilated. This sock had a name: Speridone.
Not everyone in the land wore socks. People generally didn’t purchase socks for themselves; sometimes they visited the town podiatrist due to concerns about their feet. Other times, friends or family members brought people to the podiatrist because they were highly concerned about the condition of the feet of their loved ones. And, sometimes, police officers brought people to the podiatrist because some people had frightening, unpredictable feet. The podiatrist dutifully inspected feet and made recommendations about socks to prevent further feet deterioration.
Some podiatrists recommended the Speridone socks from Jansun. Some of these podiatrists had mistresses who were seamstresses at the Jansun factory. Other podiatrists believed that Speridone socks were useful. A few of these podiatrists primarily served people who couldn’t afford socks—or much else, for that matter. Men in suits from Jansun handed out free pairs of Speridone socks to these podiatrists so they could distribute them to people who could use socks. Most people agreed that Speridone socks didn’t protect feet from everything and anything, but they frequently prevented cuts, scratches, and some of the other minor annoyances that stumble across bare feet.
It was a tenuous relationship that some podiatrists had with Jansun—they wanted to help sockless people, but since they didn’t make socks themselves, they had to rely on the big factory on the hill.
Years passed and soon, Speridone socks were no longer as fashionable or protective as they could be. New fiber technology had arrived and the time had come to improve socks. The seamstresses at Jansun began to experiment with Speridone socks with hopes that they could increase the cushioning, improve its wicking qualities, or lengthen the sock’s drawer life. Upgrades in the sock would allow the seamstresses to earn more money so they could purchase prettier dresses, more glittery garters, and more elegant shoes (with podiatrist approval, of course).
Within a few months, messengers scurried down the hill and announced that the Jansun factory had created a better sock for the people in the town. The new sock was called Vega.
Podiatrists and common people alike asked, “What’s the difference between Speridone and Vega? How much better is the sock now?”
“Vega,” the messengers proudly declared, “will be the most comfortable sock you will ever have on your feet. Instead of two types of thread, the Vega sock only has one type of thread. This allows for greater wicking power and outstanding feet comfort.”
Some podiatrists viewed the socks with skepticism. A few of them obtained a pair from the factory and, within the quiet confines of their offices, compared the two sock types. Indeed, it was true: The cotton-like material was essentially gone and, now, the polyester-like material predominated. The sock, in theory, would conform better to the foot, increase ventilation, and provide better protection from the elements—the ultimate purpose of socks.
“We should test the socks, though, just to be sure,” they agreed.
Jansun wouldn’t allow a head-to-head (foot-to-foot?) comparison of Speridone socks to Vega socks—after all, they were too similar and what if the older sock performed better than the newer sock? All the efforts of the seamstresses would go to waste and the seamstresses at the other sock factories would end up getting more money to buy lacy bras and patterned stockings.
Thus, the podiatrists settled with comparing the new Vega socks to another accepted sock, the Prexa sock (produced by Elly, a gigantic factory that loomed on a snow-capped mountain). Some people wore the Vega sock on a daily basis for about six weeks; other people wore the Prexa sock for about six weeks. All the people had feet problems. At the end of the six weeks, the podiatrists compared the feet of the two populations to see whose feet looked (and smelled) better.
The results were not particularly notable; regardless of which pair of socks people wore, their feet improved (no cure, though) and looked about the same.
“Eh,” the podiatrists said.
“That was only six weeks!” the Head Seamstress at Jansun proclaimed. “With the concentration of wicking fiber, the results will be better in the long-term! We want to improve the health of everyone’s feet and believe that this sock will soothe the sole!”
What the Head Seamstress did not mention from the hill, though, was that the cost of Speridone socks was about to drop—soon, everyone could afford Speridone socks if they wanted a pair—but not everyone needed a pair of socks. A cut in the price of Speridone socks would mean a cut in the amount of money the Jansun factory would receive—and that would mean that the seamstresses could not purchase new, satin panties.
Vega socks, though, were new! novel! different! And thus, Jansun could mark up the prices of these socks and continue to collect a profit from the sock-wearers—and satin panties would abound! It didn’t matter that the Vega socks, on testing, weren’t superior to socks that were already available—as long as people believed that Vega socks were better, that was all that mattered.
“Feh,” the podiatrists said.
The podiatrists who provided socks to the poor, though, were horrified to learn that Jansun would no longer provide Speridone socks to them.
“We want to provide the best socks available to the sockless,” the Head Seamstress said. “Vega socks are on the cutting edge of fiber technology. Speridone socks are not. We’ll start delivering Vega socks only next week.”
The podiatrists grumbled. They understood that the sock industry was, indeed, an industry.
“Speridone socks haven’t even been marked down yet,” they said. “They want us to start handing out Vega socks now so that when the Speridone socks finally are cheaper, no one will be wearing Speridone socks. Everyone will be used to Vega socks on their feet and if they ever have the money to purchase their own socks, they’ll ask for Vega socks instead… even though they’re basically the same sock!”
I anticipate that I will be posting at a noticeably lower frequency for the next few weeks… I blame anxiety, not otherwise specified.
22 Jul 2007 | 4 comments.