“Good” Patients and “Difficult” Patients — Rethinking Our Definitions. Four weeks after his quadruple bypass and valve repair, 3 weeks after the bladder infection, pharyngeal trauma, heart failure, nightly agitated confusion, and pacemaker and feeding-tube insertions, and 2 weeks after his return home, I was helping my 75-year-old father off the toilet when his blood pressure dropped out from under him. As did his legs. I held him up. I shouted for my mother. As any doctor would, I kept a hand on my father's pulse, which was regular: no pauses, no accelerations or decelerations. My mother was 71 years old and, fortunately, quite fit. She had been making dinner and said she dropped the salad bowl when I yelled for her.
Together, we lowered my father to the bathroom floor. In the emergency department, after some fluids, my father felt better. My mother waited with my father. After weeks of illness and caregiving, it can be a relief to be a daughter and leave the doctoring to others. We doctors do many things that are otherwise unacceptable. Using Time-In To Support Childrens Social & Emotional Needs. Your Thoughts Can Release Abilities Beyond Normal Limits. There seems to be a simple way to instantly increase a person’s level of general knowledge. Psychologists Ulrich Weger and Stephen Loughnan recently asked two groups of people to answer questions. People in one group were told that before each question, the answer would be briefly flashed on their screens — too quickly to consciously perceive, but slow enough for their unconscious to take it in. The other group was told that the flashes simply signaled the next question. In fact, for both groups, a random string of letters, not the answers, was flashed.
But, remarkably, the people who thought the answers were flashed did better on the test. Our cognitive and physical abilities are in general limited, but our conceptions of the nature and extent of those limits may need revising. Can our thoughts improve our vision? To rule out the possible effect of motivation, the researchers brought another group of people into the cockpit and asked them to read a brief essay on motivation.
George Saunders's Advice to Graduates. It’s long past graduation season, but we recently learned that George Saunders delivered the convocation speech at Syracuse University for the class of 2013, and George was kind enough to send it our way and allow us to reprint it here. The speech touches on some of the moments in his life and larger themes (in his life and work) that George spoke about in the profile we ran back in January — the need for kindness and all the things working against our actually achieving it, the risk in focusing too much on “success,” the trouble with swimming in a river full of monkey feces. The entire speech, graduation season or not, is well worth reading, and is included below.
In Lieu of Money, Toyota Donates Efficiency to New York Charity. How a secretive panel uses data that distorts doctors’ pay. “I have experience,” the Yale-trained, Orlando-based doctor said. “I’m not that slow; I’m not fast. I’m thorough.” This seemingly miraculous proficiency, which yields good pay for doctors who perform colonoscopies, reveals one of the fundamental flaws in the pricing of U.S. health care, a Washington Post investigation has found. Unknown to most, a single committee of the AMA, the chief lobbying group for physicians, meets confidentially every year to come up with values for most of the services a doctor performs. Those values are required under federal law to be based on the time and intensity of the procedures. The values, in turn, determine what Medicare and most private insurers pay doctors. But the AMA’s estimates of the time involved in many procedures are exaggerated, sometimes by as much as 100 percent, according to an analysis of doctors’ time, as well as interviews and reviews of medical journals.
In fact, in comparison with some doctors, Sheela’s pace is moderate. “Of my time?” Atul Gawande: How Do Good Ideas Spread? Why do some innovations spread so swiftly and others so slowly? Consider the very different trajectories of surgical anesthesia and antiseptics, both of which were discovered in the nineteenth century. The first public demonstration of anesthesia was in 1846. The Boston surgeon Henry Jacob Bigelow was approached by a local dentist named William Morton, who insisted that he had found a gas that could render patients insensible to the pain of surgery.
That was a dramatic claim. On October 16, 1846, at Massachusetts General Hospital, Morton administered his gas through an inhaler in the mouth of a young man undergoing the excision of a tumor in his jaw. Four weeks later, on November 18th, Bigelow published his report on the discovery of “insensibility produced by inhalation” in the Boston Medical and Surgical Journal. There were forces of resistance, to be sure. Sepsis—infection—was the other great scourge of surgery.
Far from it. But anesthesia was no easier. Why You Never Truly Leave High School. Throughout high school, my friend Kenji had never once spoken to the Glassmans. They were a popular, football-playing, preposterously handsome set of identical twins (every high school must have its Winklevii). Kenji was a closeted, half-Japanese orchestra nerd who kept mainly to himself and graduated first in our class.
Yet last fall, as our 25th high-school reunion was winding down, Kenji grabbed Josh Glassman by his triceps—still Popeye spinach cans, and the subject of much Facebook discussion afterward—and asked where the after-party was. He was only half-joking. Psychologically speaking, Kenji carries a passport to pretty much anywhere now. The party was fine. You’d think Kenji’s underwhelmed reaction would have been reassuring. “Well, right,” said Kenji.
“And maybe the way life is, still, sometimes,” said Larry. Not everyone feels the sustained, melancholic presence of a high-school shadow self. To most human beings, the significance of the adolescent years is pretty intuitive. Three Studies That Changed the Way We Think About Productivity. Going Under. In December 2003, Brent Cambron gave himself his first injection of morphine. Save for the fact that he was sticking the needle into his own skin, the motion was familiar--almost rote. Over the course of the previous 17 months, as an anesthesia resident at Boston's Beth Israel Deaconess Medical Center, Cambron had given hundreds of injections. He would stick a syringe into a glass ampule of fentanyl or morphine or Dilaudid, pulling up the plunger to draw his dose. Then he'd inject the dose into his patient. The way in which Cambron handled his own injection reflected that intense curiosity--but also a degree of caution.
Cambron initially told no one of his decision to use morphine--not his colleagues, not even his live-in girlfriend, from whom he hid his syringes. That first injection of morphine, however, would quite possibly be the last time Cambron actually chose to do drugs. Today, anesthesiology has obviously come a long way from Wells's animal bladder of laughing gas. Clueing in Customers - Why Docs Don't Wear White Coats or Polo Shirts at the Mayo Clinic. The Mayo Clinic works hard to build relationships with patients and their families.
In this excerpt from Harvard Business Review, the authors explain how Mayo uses visual and experiential clues to tell a compelling story to customers. by Leonard L. Berry and Neeli Bendapudi In health care, the visual clues about an institution's core values and the quality of care are particularly difficult to separate from the actual service because people spend significant time in the facility—some stay for days or even weeks. The physical environment is also connected to medical outcomes: The potential of design to promote healing through stress reduction has been documented in dozens of studies. For these reasons, more medical institutions are making an effort to create open, welcoming spaces with soft, natural light. Mayo doesn't limit its facilities' clue management to public spaces. Environmental clues in the outpatient setting are orchestrated just as carefully. Clueing In Customers.
Nobody likes going to the hospital. The experience is at best unnerving, often frightening, and, for most of us, a potent symbol of mortality. What’s more, it’s very hard for the average patient to judge the quality of the “product” on the basis of direct evidence. You can’t try it on, you can’t return it if you don’t like it, and you need an advanced degree to understand it—yet it’s vitally important.
And so, when we’re considering a doctor or a medical facility, most of us unconsciously turn detective, looking for evidence of competence, caring, and integrity—processing what we can see and understand to decipher what we cannot. The Mayo Clinic doesn’t leave the nature of that evidence to chance. It’s called “evidence management”: an organized, explicit approach to presenting customers with coherent, honest evidence of your abilities. Evidence management is a lot like advertising, except that it turns a company into a living, breathing advertisement for itself.
Clues in People. Jack Andraka, the Teen Prodigy of Pancreatic Cancer. What the Research on Habit Formation Reveals About Willpower (And How You Can Apply it to Your Life) Each time they did the test they did it without expending willpower, then they did it after expending willpower. This adjusts for familiarity, since the baseline was the same each time they took the test, even after being familiar with it.
Even if the baseline had changed, they could use that change to normalize the values of the second portion of each test. So, to directly answer your question, no that doesn't account for changes in the data. The experiment is designed to adjust for that. Also, in at least some of the studies described here (and I imagine all of the work of these researchers, as you wouldn't likely get your results published without this), the researchers have a control group who they measure doing all the same things as the treatment group *except* they don't assign them the treatment activity (in this case, developing a habit by exercising regularly).
The Quiet Ones. Not long ago a couple across the aisle from me in a Quiet Car talked all the way from New York City to Boston, after two people had asked them to stop. After each reproach they would lower their voices for a while, but like a grade-school cafeteria after the lunch monitor has yelled for silence, the volume crept inexorably up again. It was soft but incessant, and against the background silence, as maddening as a dripping faucet at 3 a.m. All the way to Boston I debated whether it was bothering me enough to say something. As we approached our destination a professorial-looking man who’d spoken to them twice got up, walked back and stood over them. “Sir,” the girl said, “I really don’t think we were bothering anyone else.” “No,” I said, “you were really annoying.” “Yes,” said the woman behind them. “See,” the man explained gently, “this is how it works. In a 2006 interview David Foster Wallace said, “it seems significant that we don’t want things to be quiet, ever, anymore.”
Older Dads Pass On More Genetic Mutations. How Long Does Food Last? Shelf LIfe Expiration DateEat By Date | Shelf Life, Food Storage & Expiration Date Guide. Simplied. What's In a Face? Several years ago, a woman named Brook White appeared on the reality TV competition show . White was 24 years old, blond, and strikingly pretty.
When she sang her song, "Like a Star," she struck a familiar chord among some viewers. White said nothing about her religion , but Mormons, members of the Church of Jesus Christ of Latter Day Saints, were certain that she was one of their own. "She has the Mormon Glow," one blogger wrote, referring to the belief that the faithful radiate the Holy Spirit.
White mentioned that she never drank a cup of coffee or watched an R-rated movie—signs of a Mormon-like squeaky-clean lifestyle. Soon after, psychologists Nalini Ambady, then at Tufts University, and Nicholas Rule, at the University of Toronto, set out to test the Mormon glow. They certainly could—and in just a glance. To determine what exactly triggers Mordar, Ambady and Rule cropped photos beyond recognition. Mormons don't drink or smoke. BEYOND THE HALO EFFECT: Attractiveness and Personality. Lessons Learned From Aurora Colorado. As I continue to read about the terrible tragedy in Aurora, Colorado, I can’t help but think there’s some lessons from my time as a Navy SEAL that I can pass on to the average citizen. I want to make sure that the victims of the Aurora do not suffer or die in vain. As a country, we need to learn from this tragedy, raise awareness, and save lives in the future. So here goes… When at sporting events, concerts, and the movies, choose seats that give you a tactical advantage always.
Or Log In About the Author Brandon Webb is a former U.S. Viewpoint: A Letter to the Country from an Emergency Physici... : Emergency Medicine News. I am an emergency physician with an apolitical message in this rather politically charged, polarized time in our country. I have worked for some time in this profession, and have noticed a disturbing trend about which I must speak out — the growing number of emergency department scenarios in which the selfishness and entitlement of those without real emergencies drown out the quiet suffering of those in real need.
This morning a middle-aged woman came into the emergency room in cardiac arrest. ACLS was performed to keep her alive. Other patients were in the ED before she even arrived, certainly with what they felt were emergencies, but treatments for these individuals were placed on hold as this event took precedence. This was no movie, no reality TV show. I walked to my office, emotionally drained and exhausted, and from across the emergency department another patient, upset that she had to wait, spoke out brashly in tones that carried to every room in the department.
Sincerely, Born To Run | Human Evolution. "I didn't buy it at all," Bramble says. Like most of his peers, Bramble's first reaction to Carrier's hypothesis was that "humans are pitifully slow. " From the perspective of a vertebrate morphologist, humans lack one of the most obvious features of animals adapted for serious speed: a tail. In creatures that cover ground bipedally, such as kangaroos, kangaroo rats, and roadrunners, "the tail is the major balance organ," Bramble says. "In the whole history of vertebrates on Earth—the whole history—humans are the only striding biped that's a runner that's tailless. " Still, Bramble eventually came to realize that people turn in remarkable performances. He once filmed a horse cantering, with Carrier running alongside at the same pace. Although Carrier moved on to other research, Bramble grew convinced that his student had discovered something.
"Once the idea is in your head, then you start thinking about things differently," Lieberman says. When Did Americans Lose Their British Accents?
Bad career advice: Do what you love. Losing the War - by Lee Sandlin. The man who turned his home into a public library. John Bartlett's Game Changers in Infectious Disease: 2011: New Mechanisms of Antibiotic Resistance. Smart people SLEEP LATE.