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Medical Education, Medicine and Literature

Thoughts on the arts and humanities in shaping a medical career

We’ve written before about art’s intersections with medicine. For example, Audry Shafer, MD, director of Stanford’s Program on Arts, Humanities, and Medicine, explains how art in the medical setting can help patients and caregivers communicate an experience. A multidisciplinary undergraduate course helps students understand the structures of human viruses through sculptural renderings. And physician-author Abraham Verghese, MD, professor of medicine, advocates for attention to bedside manner through literature as well as policy.

Over on The Arnold P. Gold Foundation’s blog, Johanna Shapiro, PhD, a professor at UC Irvine School of Medicine, makes another case for letting your pre-med son or daughter major in philosophy (or sociology or art history). She writes:

To me, the most important meta-questions a future physician can engage with (preferably every day of her life) are fundamentally moral ones:

  • What kind of doctor do I want to be?
  • Who am I and who can I become within the practice of medicine?
  • How do dominant discourses in medicine and society influence me, my patients, and our community in negative or positive ways?
  • What is my commitment/responsibility/ to my patients and my community and how can I best serve them?

Arts and the humanities serve not to make you a better person, Shapiro writes, but to encourage you to continually examine and evaluate your actions – a useful course of study in any profession.

Previously: Stanford humanities course helps counteract the “powerlessness and shame” of addictionMore than medicine: Stanford medical students embrace their artistic passions through unique program and Live tweeting journalist Sheri Fink at Medicine and the Muse Symposium 

Medicine and Literature, Stanford News

Stanford Medicine magazine’s big reads of 2013

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The 10 most-read Stanford Medicine magazine stories published this year (as determined by pageviews on our website):

Almost without hope – Seeking a path to health on the Rosebud Indian Reservation: Tracie White’s report on life in one of the hardest places in America to stay healthy — the Rosebud reservation in South Dakota.

Labor day – The C-section comes under review: An article by Julie Greicius explaining the rise of C-sections and why a decrease in how often the procedure is performed should be around the corner.

Microbe computers – Built from the stuff of life: A feature by Andrew Myers on the creation of a computer made of biological molecules that can run inside our cells.

Blood, sweat and fears – A common phobia’s odd pathophysiology: John Sanford’s story about conquering blood phobia.

Against the flow – What’s behind the decline in blood transfusions?: Sara Williams explains the drop in transfusions — and why it’s good news for health.

Leo and Frida – The doctor and the artist: A feature by Catherine Reef on the friendship between artist Frida Kahlo and Stanford surgeon Leo Eloesser, MD.

Too deeply attached – The rise of placenta accreta: Erin Digitale describes the epidemic of placenta accreta and how this potentially fatal condition affected one family.

Roll up your sleeve – There’s still no substitute for blood: Jessica Shugart on why blood donation remains crucial.

In his blood – A doctor driven by hemophilia: Krista Conger profiles Holbrook Kohrt, MD, a physician who grew up with hemophilia and is dedicating his life to finding cures for life-threatening disease.

Priming the pumps – Debugging Dhaka’s water: Ruthann Richter tells how a trip to the slums of Dhaka, Bangladesh led to a radical solution for contaminated drinking water.

Previously: Stanford Medicine magazine’s big reads of 2012 and Stanford Medicine magazine’s big reads of 2011
Illustration (the cover of our special report “Blood at work”) by Renphoto

Media, Medicine and Literature, Technology

More reasons for doctors and researchers to take the social-media plunge

More reasons for doctors and researchers to take the social-media plunge

I’ve come across so many helpful and insightful articles on medical and science professionals’ use of social media lately that I’m compelled to share a few. Last week on Wing of Zock, Cynthia Floyd Manley, associate director of public affairs and marketing at Vanderbilt University, shared nuggets from a recent conference on digital professionalism and reminded readers why maintaining a digital presence is so important for doctors. (She quoted Bryan Vartabedian, MD: “Physicians have two choices, really. They can participate in the discussion that is happening online and frame the story, or they can let someone else frame the story for them.”)

Earlier in the month, the PLOS blog Mind The Brain published a Q&A with a young scientist who uses Twitter to connect with other researchers and learn more about what’s happening in her field. She provided concrete tips for those scientists who want to dip their toes in the Twitter waters and also shared how the platform connects her with other academics:

I feel that with Twitter, my academic world expanded to include many colleagues I wouldn’t otherwise meet. I am now able to keep my finger on the academic pulse better. The information shared on Twitter is so much more current than you would find on journals or conferences. For instance, academics I follow post their latest articles on Twitter that would otherwise probably take me months to learn about. I can then ask questions of the authors themselves and chat with them. I think we all love to talk about our work!

And just today, MedCrunch featured a piece singing the praises of Twitter (which prolific blogger and social-media expert Kevin Pho, MD, calls here “the most powerful application for listening and for keeping informed about what’s happening in the science and medical communities”) and encouraging physicians to – at a minimum – create and maintain professional profiles on LinkedIn. As Susan Williams writes in her post, “defining your reputation by illustrating your credentials and your authority in your field affects two of the most important patient-doctor relationship traits: respect and trust.”

Previously: How should doctors respond to negative reviews?, A reminder to young physicians that when it comes to social media, “it’s no longer about you”, How using Twitter can benefit researchers, Advice for physicians when interacting with patients online and How can physicians manage their online persona? KevinMD offers guidance

Medicine and Literature

When death comes rapping at the chamber door: Writers inspired by crises and medical emergencies

looking to heavenHave you ever had a near-death experience? I haven’t, so I can only imagine how much more creative I could be right now. At least that’s the leap I chose to make after reading a blog post on The Airship that featured eight famous writers who experienced medical emergencies or sidestepped an untimely death and went on to produce now-canonical works of literature. These are suffering artists not in the heartbroken sense, but on a physiological level.

Russian novelist Fyodor Dostoyevsky, the piece notes, endured seizures all his life. When he was arrested at age 28 and sentenced to death, and then unexpectedly freed by order of the Tsar and sentenced to hard labor in Siberia instead, things started looking up. From the piece:

This incident is said to have increased the frequency and severity of Dostoevsky’s epileptic fits, but the young writer also channeled the experience into his work, evident from this passage in The Idiot:

He said that those five minutes seemed to him to be a most interminable period, an enormous wealth of time; he seemed to be living, in these minutes, so many lives that there was no need as yet to think of that last moment, so that he made several arrangements, dividing up the time into portions — one for saying farewell to his companions, two minutes for that; then a couple more for thinking over his own life and career and all about himself; and another minute for a last look around…

Then there’s Stephen King, who, during an uncharacteristic bout of writer’s block, took a walk to clear his head when working on “On Writing”:

A passing driver, distracted by his dog moving around, plowed into the unsuspecting writer. King flew into a ditch, where he suffered a collapsed lung, severe fractures to his leg that nearly required amputation and a broken hip.

Despite undergoing several subsequent surgeries, King kept working on the book, for which this new experience formed an integral part. In addition, upon his return home from the hospital, King was able to see his studio as it would have been had he died in the accident. That image provided the inspiration for his subsequent novel, Lisey’s Story.

The other authors’ stories include similar cliffhangers and injury recoveries.

Via @randomhouse
Photo by kevin dooley

History, Humor, Medicine and Literature, Science, Technology

Half-century climb in computer’s competence colloquially captured by Nobelist Michael Levitt

Half-century climb in computer's competence colloquially captured by Nobelist Michael Levitt

ancient computerOn October 9, the day Stanford macromolecule-modeling maven Michael Levitt, PhD, won his Nobel Prize, I wrote him a note of congratulations.

He wrote back six days later: “Thanks so much. It has been one wild ride! It will be good for the field, though, and I will learn to disappear and still have time for myself.” It’s a wonder he got back to me as soon as he did, crushed as he must feel by the cheering throngs dogging him at every turn since Nobel day. But he has made a point of replying quickly and gracefully to not only well-wishers but deadline-driven reporters.

Although his Nobel was for chemistry, the lab Levitt operates in is stocked with shelves full of ones and zeroes. His expertise lies in the field of computer science, a field of which Alfred Nobel had no inkling when he created the awards in his final will, written in 1895.

As we all know, Nobel made his millions in the explosives field. No explosion he could have imagined in 1895 has been more profound, in recent decades, than the explosion in computing power pithily encapsulated in Moore’s law. In the late 1960s, Levitt began constructing his increasingly detailed simulations of the giant biomolecules that animate our cells and, in a sense, our souls as well, by pumping punchcards into what was then among the world’s most potent computers (dubbed Golem in memory of a powerful, soulless giant of medieval Jewish folklore) at Israel’s Weizmann Institute.

Since those seminal days, the ones-and-zeroes game has picked up speed. Responding to an e-mailed query from science writer Lisa Krieger of the San Jose Mercury News, Levitt put it this way:

The computer that I used in 1968 allowed me 300 [kilobytes] of memory, or about 1/10,000th of the memory on a smart phone. [An extremely complex,  fifty-step computation] took 18 minutes on the Golem computer… for a cost of about five million 1965 U.S. dollars ($35 million today). The same calculation takes 0.18 seconds on an Apple MacMook PRO laptop costing $3,500. This means that the calculation is… 6,000 times faster on a computer costing… 10,000 times less.

If cars had changed in the same way, Levitt drolly noted, “a 1965 Cadillac that cost $6,000 in 1965 dollars ($40,000 today) would actually cost just four dollars. More amazingly, it would have a top speed of 600,000 miles an hour and be able to carry 50,000 people.”

Makes me wonder: Just how long will it be before we can no longer tell our computers from ourselves?

Previously: But is it news? How the Nobel Prize transformed noteworthy into newsworthy, Nobel winner Michael Levitt’s work animates biological processes, No average morning for Nobel winner Michael Levitt and Stanford’s Michael Levitt wins 2013 Nobel Prize in Chemistry
Photo by kalleboo

Health Policy, Medicine and Literature, Patient Care, Stanford News

Abraham Verghese on health-law battle: “We’ve worried so much about the process, not the patient”

Abraham Verghese on health-law battle: "We’ve worried so much about the process, not the patient”

In the ongoing political struggle over the implementation of the Affordable Care Act, a key component - the patient - remains under-discussed, argues Abraham Verghese, MD, a professor of medicine at Stanford. Verghese recently gave a talk at the University of Denver, and his thoughts on the new law, and his call for judicious use of medical tests and procedures, and attention to bedside manner, were among the topics of discussion. Barbara Ellis of the Denver Post reported in a blog piece earlier this week:

“We’ve worried so much about the process, not the patient,” Verghese said. “If the purpose of Obamacare is to help people get health insurance; if its purpose is to not punish people with pre-existing conditions; if its purpose is to promote quality health care … then what’s so bad about it?”

“Whatever Obamacare does, it will put a premium on not ordering medical tests willy-nilly,” he said. “It will force physicians to come up with a rational idea of what to do next.”

Verghese also talked about technology and how it can improve the quality of care, so long as physicians address the patient first. “A physical exam is a ritual. Someone is telling me their intimate details, allowing themselves to be touched,” he said, according to the Post. “That’s a ritual that’s important to patient care.”

Previously: Abraham Verghese’s Cutting for Stone: Two years as a New York Times best sellerA call for extended bedside-manner training and Can the use of devices among physicians lead to “distracted doctoring?”

Aging, Chronic Disease, Health Costs, Medicine and Literature

Examining end-of-life practices and Katy Butler’s “Knocking on Heaven’s Door”

How long is too long to hang on when the end of life calls? Abraham Verghese, MD, Stanford physician and best-selling author, discusses the emotional and financial costs of extended end-of-life care in a New York Times book review of Katy Butler’s “Knocking on Heaven’s Door.” In the book, Butler details the drawn-out descent of her father after a stroke and sheds light on the unseen hardships of caring for the slowly dying, both for families of the ill and hired home workers.

From the review:

Butler finds that the health care system — and society — seem quite unprepared for a patient like her father. Had he received a diagnosis of a terminal illness, the family would have been supported by a Medicare-funded hospice team.

“But there is no public ceremony to commemorate a stroke that blasts your brain utterly, and no common word to describe the ambiguous state of a wife who has lost her husband and become his nurse.”

The review compares the sometimes six-figure cost of an end-of-life ICU stay to a home health-care worker’s salary, which Butler describes as typically “immorally low.”

Verghese writes:

My hope is that this book might goad the public into pressuring their elected representatives to further transform health care from its present crisis-driven, reimbursement-driven model, to one that truly cares for the patient and the family.

Previously: A conversation guide for doctors to help facilitate discussions about end-of-life careHow a Stanford physician became a leading advocate for palliative care, Honoring an exploration of the “cost of dying”, Exploring the psychological trauma facing some caregivers and Is $618,616 too much to (try to) save a life?

Autism, In the News, Media, Medicine and Literature, Mental Health

The Reason I Jump: Insights on autism and communication

As I write this, I’m keenly aware that communication is one of the most common, and perhaps most difficult, things we do. That’s why I was both humbled and heartened when I read about Naoki Higashida’s book The Reason I Jump on Biographile today.

The book is described as a “stunningly clear-eyed look into the experiences of a boy with autism.” But, as explained in the review, many of the themes Higashida addresses in his book, “reveal truths about communication and connection that all humans should contemplate.”

In the Biographile interview, Higashida, who was 13 when he wrote the book, describes hard-to-grasp, prickly concepts such as communicating with compassion, and why good communication is hard work but worth the effort, with bell-like clarity. I cannot wait to get my hands on the book.

From the review:

Some people tend to assume that individuals with all kinds of disabilities have a less than mature understanding of language. But in many cases, even when speech and language production are impaired, understanding is not. Higashida explains to readers that baby talk is disheartening for him to hear as a young man. He encourages people not to talk down to people with autism, or anyone. “True compassion is about not bruising the other person’s self respect,” he writes, revealing not only an expert command of language but also wisdom beyond his years.

To share his experiences and his fiction with the world, and even to communicate basic needs to his family and caretakers, he painstakingly spells out the words on alphabet grids while others transcribe. He admits learning to communicate independently was hard work and at times, he felt “utterly beaten” by the process. But, Higashida reminds us, “to live my life as a human being, nothing is more important than being able to express myself […] it’s about getting across to other people what I need and what I need them to understand.”

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: More Stanford findings on the autistic brainA mother’s story on what she learned from her autistic sonUsing music to improve communication skills in children with neurodevelopmental disorders and Stanford study reveals why human voices are less rewarding for kids with autism

Medical Education, Medicine and Literature, Podcasts, Stanford News

Starting a new career in academic medicine? Here’s a bible for the bedside: The Academic Medicine Handbook

Starting a new career in academic medicine? Here's a bible for the bedside: The Academic Medicine Handbook

Roberts_book_coverWhen I spoke with Laura Roberts, MD, chair of psychiatry at Stanford, for a 1:2:1 podcast about the new book she edited, The Academic Medicine Handbook, I told her I thought every profession needs what she’s created, a hands-on guide on how to achieve success. Think about it. How much of our professional success is determined by skills we were never taught in college or grad school? In Chapter One, she writes, “…my sense is that nearly all early-career faculty members experience, as I did, an unsettling combination of feeling overly schooled and yet, still unprepared. Decades of formal education, as it turns out, are insufficient for some of the unexpected and labor-intensive everyday duties of the instructor/assistant professor…”

So here it is, a soup-to-nuts manual that gives academics in medicine a road map for how to excel.  It covers the basics, with chapters on how to manage time, how to give a lecture and how to prepare the best curriculum vitae. And it gets even more sophisticated, with how to evaluate an offer letter, how to understand flaws in clinical research and how to prepare an IRB application. The bottom line: If you’re a young professional just beginning a career in academic medicine, here’s a bible to have along your bedside.

Medicine and Literature, Science

Medical journalist talks about history of – and problem with – embargos

Having not come from a science background, I admit to not knowing much (okay, anything) about embargos before coming to work here. I quickly learned the drill, though: Scientific journals set a designated time/date in which the media can run stories on a particular study - in an effort (in the words of my wise colleague Krista Conger) “to give media professionals enough time to prepare a thoughtful, well-researched story about the research without giving any media outlet a competitive advantage over another.”

Things have changed in the decade-plus since I first learned about this system (some journals are now embargo-free), but embargos are still very much in use – and breaking them is serious business. So I took great interest in a recent Communication Breakdown Q&A on the topic with journalist/Embargo Watch founder Ivan Oransky, MD, who says he’s been “obsessed with embargos” for years. In the Q&A, Oransky provides more background on the embargo system and discusses why he’s in favor of changing it:

The Ingelfinger Rule, which I’m now convinced is the real problem with the embargo system, was a policy then-New England Journal of Medicine editor-in-chief Franz Ingelfinger came up with in 1969. He didn’t call it that at the time, and it has evolved since, but the basic idea was that some researchers were going straight to the media with their “breakthroughs,” bypassing peer review and causing a lot of confusion and false hope. So he decreed that NEJM wouldn’t consider any papers whose results had already been publicized, whether in the mass media or other journals.

It’s important to remember that history because the fact is that Ingelfinger had a legitimate concern, and came up with a reasonable way to address it. The problem in the time since then is that the Ingelfinger Rule has become a gag order. Scientists are deathly afraid of talking to reporters, because it might jeopardize their publication in a prestigious journal. That fear is actually out of proportion to policies at major journals. But until it changes, it makes it very difficult for journalists to tell the real stories of science – which focusing on the study of the week, as the Ingelfinger Rule, aided and abetted by embargoes, encourages…

Previously: Stanford scientist sets sail on new publishing model with launch of open-access, embargo-free journal and Count down to stem cell news in 3, 2, 1

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