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“Dr. Watson” And The 7 (Human) Qualities Of An Ideal Physician

After the computer known as Watson easily dispatched of the best two human Jeopardy! contestants in history, IBM announced that one of the first applications of their artificial intelligence technology would be in the medical field. We should soon expect virtual physician assistants in the exam room. At least one of my friends even speculated that the days of human doctors are numbered.

Is it possible that machines will replace humans in the doctor-patient relationship? I doubt it. According to a study done by the Mayo Clinic in 2006, the most important characteristics patients feel a good doctor must possess are entirely human. According to the study, the ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Watson may have proved his cognitive superiority, but can a computer ever be taught these human attributes needed to negotiate through patient fear, anxiety, and confusion? Could such a computer ever come across as sincere?

I’m afraid some major calibrations might be needed to substitute artificial intelligence for an “ideal” physician. What do you think? Here’s an artist’s conception (read: farce) of how such an application in the examining room might play out. Click HERE to watch the medical cartoon.

*This blog post was originally published at The Examining Room of Dr. Charles*

Stress In Life: Respond Differently And Live Longer?

“This job is killing me” is not a statement of jest. It is a desperate plea of outright sincerity.

Stress, anxiety, depression — all have been associated with an increased risk of cardiovascular disease and mortality. But can interventions to help people cope with stress positively affect longevity and decrease risk of dying? The results of a new study in the Archives of Internal Medicine would imply the answer is an encouraging “yes.”

Constructively dealing with stress is easier said than done, but it would seem logical that if we can reduce our psychological and social stressors we might live longer and delay the inevitable wear and tear on our vessels. This study proved that one such intervention, cognitive behavioral therapy (CBT) for patients who suffered a first heart attack, lowered the risk of fatal and nonfatal recurrent cardiovascular disease events by 41 percent over eight years. Nonfatal heart attacks were almost cut in half. Excitement may be dampened by the fact that all-cause mortality did not statistically differ between the intervention and control groups, but did trend towards an improvement in the eight years of follow up.

Definitely less suffering. Maybe less deaths.

The authors state that psychosocial stressors have been shown to account for an astounding 30 percent of the attributable risk of having a heart attack. Chronic stressors include low socioeconomic status, low social support, marital problems, and work distress. Emotional factors also correlated with cardiovascular disease include major depression, hostility, anger, and anxiety. Read more »

*This blog post was originally published at The Examining Room of Dr. Charles*

7 + 3 = 10 Foods To Avoid In 2011

A patient reading a copy of Prevention in the waiting room brought to my attention an interesting article entitled “7 Foods That Should Never Cross Your Plate.” I would have to agree that these seven commonly eaten foods should be avoided, so I’ll rehash them here, along with three more of my own choosing to flesh out a New Year’s 7 + 3 = Top 10 list.

The lead into the article implores the reader to recognize that “clean eating means choosing fruits, vegetables, and meats that are raised, grown, and sold with minimal processing.” Michael Pollan, the regarded author of The Omnivores Dilemma and In Defense of Food, puts it even more simply: “Eat food. Not too much. Mostly plants.”

So here are the food items to avoid, in no particular order:

1) Canned Tomatoes – The resin that lines the corners of tin cans usually contains bisphenol-A, a compound found to produce estrogenic effects in the body, linked to heart disease, diabetes, obesity, and possibly neuro-developmental problems like ADHD. Tomatoes get picked on because their acidity increases the leaching of BPA into the food. Perhaps citrus foods and other acidic canned goods would have the same concerns.

2) Corn-Fed Beef – If you’ve ever watched the documentary Food Inc., you’ve probably been disgusted and appalled by the supply chain that brings meat to our tables and fast food restaurants. Bloated cows are being fed corn and soybeans, heavily subsidized crops controlled by Monsanto, to the detriment of their health. Eating their meat passes on the lower nutritional value to us, and perpetuates an immoral system of CAFO’s and cow concentration camps. Grass-fed beef, especially free range, is higher in vitamins, minerals, and has a healthier fat profile (better omega-3 to omega-6 fatty acid ratios). Bison tends to be grass fed, free-range, and of a superior nutritional quality. Eat Wild can help you find local farms that raise animals properly and often need your support. Think of the higher cost returning dividends on your health and as a charitable support of a good cause. Read more »

*This blog post was originally published at The Examining Room of Dr. Charles*

Blood Print: “Am I, The Doctor, Bleeding?”

I’m diligently writing a detailed note in the patient’s chart as he speaks of his multiple concerns — severe depression, headaches, and dizziness. I’m not making good eye contact. Often this is effective because I can resist the allure of passively following his narrative to its own diagnostic suspicions. Instead I can record his intuitive guesses without persuasion, formulating my own independent ideas even as I value his. Except that as I write in his chart I notice streaks of red blood appearing among the black script. Am I hallucinating? Am I capable of making paper bleed? Am I, the doctor, bleeding?

With closer inspection I notice three small cuts on my chapped knuckles and fingers, products of the incessant and obsessive handwashing compelled by modern medicine. We are obliged to wash our hands before and after each patient contact, which leads to about 60 hand washings per day. In the dry winter air this can become punishing to the integrity of the skin barrier.

I apologize to the patient for marring his chart, yet it almost seems symbolic — physician blood spilled upon a script of human affliction. I know I should tear the page out of his chart and write a clean new one, yet the scrawls of black ink and stripes of red blood look like art. It is a poem, punctuated with living iron and crimson flourish. Despite having made poor eye contact in an attempt to distance and strengthen my consideration of his symptoms, ironically I see the commonality of our bleeding.

*This blog post was originally published at The Examining Room of Dr. Charles*

Depression: Is It A “Character Issue” And A Disqualifier For Leadership?

When the Republicans took back the House of Representatives [recently], John Boehner, the presumptive new Speaker and current Senator from Ohio, unleashed a “sob heard round the world.” As The New York Times quotes:

“I’ve spent my whole life chasing the American dream,” (Boehner) said, beginning to cry. He swallowed and tried again. But describing all the bad jobs he had once led to near sobbing when he got to the line, “I poured my heart and soul into running a small business.”

Boehner has cried in public many other times, the recent election night being only the largest stage to date. The tears also flow at his annual golf tournament, or while watching a child pledge allegiance to the flag, listening to a Republican colleague speak about his Vietnam War experiences, the unveiling of a statue of Ronald Reagan, while accepting various awards, during a rendition of “America the Beautiful,” etc. Could these tears be signs of major depression? Should melancholy be a disqualification for leadership? Were Clinton’s tears any better? Read more »

*This blog post was originally published at The Examining Room of Dr. Charles*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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