Ed Walker is 102 years old. I met him by chance on a steep hill in Lunenburg, Nova Scotia – not long after my husband blurted, “I hope you’ve got good brakes on that scooter!” Ed pulled up next to us (to demonstrate his brakes) and jubilantly announced his age, along with his suspected reason for it: “I have prostate cancer but chose to leave it alone.”
I chuckled to myself, thinking that he was probably right about his longevity-hospital avoidance connection.
Of course, the diagnosis and treatment of prostate cancer is being hotly debated these days. While no one likes the idea of leaving cancer untreated, slow-growing prostate cancer may be less of a threat to men at a certain age than the treatment required to cure it. And that’s a difficult truth to accept – especially for Americans.
My fellow blog contributors have noted the disconnect between scientific evidence and clinical practice in regards to prostate cancer. According to a recent study in the New England Journal of Medicine, PSA (a screening test for prostate cancer) testing has not made a difference in overall longevity. Urologists still favor testing (the American Urological Association guidelines recommend initiating PSA testing for all men starting at age 40) while family medicine physicians don’t usually recommend it. Is there a conflict of interest driving this difference in recommendation? Perhaps – though I suspect it has more to do with a surgical mentality (to cut is to cure!) than a conscious decision to protect one’s income. If you think there’s a shortage of urologic procedures to go around, then I’d recommend you simply consider the increasing age of the US population. It’s not as if the prostate gland is the only thing that needs work “down there.”
Perhaps Americans can take some cues from their elderly neighbors to the north – and try to accept that doing something is not always better than “doing nothing.” In the case of some prostate cancers, it’s cheaper, safer, and a lot less painful.
I’ll never forget the day when I argued for protecting parents against misleading and false information about the treatment of autism. I was working at a large consumer health organization whose mission was to “empower patients with accurate information” so that they could take control of their health. My opposition was himself a physician who requested that our organization publish an article that advised parents of children with autism to seek out DAN! practitioners and chelation therapy.
I prepared my remarks with the utmost care and delivered them to a committee of our lay executives. I cited examples of children who had died during chelation treatments, explained exactly why there was no evidence that chelation therapy could improve the symptoms of autism and in fact was based on the false premise that “heavy metals” in vaccines were implicated in the etiology of the disease. I concluded that it would be irresponsible for the company to publish such misleading advice/information for parents, and would in fact be counter to our entire mission.
My physician opponent suggested that it was our company’s duty to inform parents of all their options, that we should not be judgmental about treatments, and that I was part of a paternalistic medical establishment that tried to silence creative thinking.
The committee ended up siding with my opponent. I was flabbergasted and asked one of the committee members what on earth they were thinking. She simply shrugged and said that my opponent was more likable than I was.
This experience marked the beginning of my journey towards fighting fire with fire – understanding that being right is not the same as being influential, and that “winning” an argument (where lives are on the line) requires a different skill set than I learned in my scientific training.
Book Review
And so it was with great interest that I picked up Randy Olson’s book, Don’t Be Such A Scientist: Talking Substance In An Age Of Style. I was pleased to see that other scientists had experienced the same revelation – that we need to be more communication-savvy to become more societally-influential.
Olson’s book outline is simple: four “don’ts” and one “do.” Don’t be so cerebral, literal-minded, poor at telling stories, or unlikeable. Do be the voice of science. He begins his book with a captivating story: a marine biologist goes to Hollywood and is shredded by an acting teacher for being incapable of raw emotion. Most scientists will get a good chuckle out of this narrative and will relate to Olson’s culture shock.
As the book winds along, the reader is introduced to a series of the author’s former girlfriends. He reminisces:
She would listen to me talk and talk and talk to the old folks and finally, by the end of the day, she would have had enough. So her favorite thing to do in the evening was, when I was done talking, to look deeply, romantically, lovingly into my eyes and say in a soft and seductive Germanic voice… “You bore me.”… p.82
Another girlfriend developed an affectionate nickname for me, “Chief Longwind,” which she would abbreviate when I’d get going on something and just say, “That’s enough for tonight, Chief.” p.83
Unfortunately, as these ladies noted, Olson’s strong suit is not compelling dialog – a tragic irony for a book written to inspire more effective science communication. Nonetheless, since scientists are rarely deterred by boredom, I think that there are some conceptual gems worth unearthing.
These are my top 5 take-home messages:
1. Communicate in a human way – be humorous, tell stories, don’t feel as if you have to present all the details. The goal is to get people curious enough to ask more questions.
2. Broad audiences prefer style over substance – learn to be bilingual (to speak with academics versus a general audience).
3. Marketing is critical for influence. The creators of Napoleon Dynamite spent a few hundred thousand dollars on production and $10 million on advertising/marketing. The movie grossed $50 million. Scientists who wish to be influential (or get their message across broadly) must bow the knee to the marketing gods.
4. Some people are naturally good communicators, others are not. Find the good ones and make them spokespeople. “The strongest voice is that of a single individual.” p. 166
5. Likability trumps everything. People make snap judgments about whether or not they like you, and your message’s impact is dependent upon your likability factor. Likability is related to humor, emotion, and passion. p. 148
And so, Don’t Be Such A Scientist offers some great food for thought – and I suppose if it hadn’t been written by a scientist it might also have been a more engaging read! But who am I to say, I’m still trying to bend my mind around the idea that Americans don’t care about facts.
Today an elderly physician friend of mine woke up with some very mild abdominal pain. He is a stoic man, and never complains about anything – not even the pain associated with a dislocated/shattered hip and multiple bone fractures from a car accident (he was very nonchalant about that event 2 years ago).
So when I heard that he was going to see a doctor about his belly pain – I knew that something serious was afoot. His doctor ordered an abdominal x-ray series, noted a tumor, and sent him to the O.R. within the hour.
In the O.R. the surgeons found a perforated colon (it must have ruptured minutes to an hour or two prior) without signs of peritonitis. There was a cancerous mass (without metastases) that they were able to remove completely. They washed his peritoneal cavity extensively to remove all fecal matter and potential cancer cells and transferred him to the ICU for observation overnight and IV antibiotics.
So far it seems that my friend will make a full recovery – and there is no evidence of remaining cancer, though we’ll need to be vigilant with follow up.
I can’t get over how lucky he was to have discovered the perforated colon within hours of it occurring, that the surgeons took care of him immediately, and that the cancer seems to have been contained and removed. I don’t know if his “luck” was partially due to his physician’s intuition about his own body, professional courtesy extended to him by peers, or that the Canadian healthcare system is not as burdened in his part of the country (Nova Scotia) as it is in others where there may be longer wait times.
All I can say is that my friend is one lucky Canadian!
This post is a “Dr. Val classic” – first published in early 2007.
***
Internship, for those of you who may not know, is the first year of residency training. It is the first time
that a doctor, fresh out of medical school, has responsibility for patient care. The intern prescribes medications, performs procedures, writes notes that are part of the medical record, and generally learns the art of medicine under the careful watch of more senior physicians.
Internship is a frightening time for all of us. We’ve studied medicine for 4 years, memorized ungodly amounts of largely irrelevant material, played “doctor” in third and fourth year clerkships, but never before have lives actually been put in our hands. We know the expression, “never get sick in July” because that’s when all the well-intentioned, but generally incompetent new interns start caring for patients. And so, we tremble as we begin the new stage in our careers – applying our medical knowledge to real life situations, and praying that we don’t kill anybody.
I’ll never forget my first day of internship. I must have drawn the short straw, because not only was I assigned to the busiest, sickest ward in my hospital (the HIV and infectious disease unit), but I was on call that day (so I’d be working for 24 hours straight) with the most hated resident in the program (he had a reputation for treating interns poorly and being arrogant to the nurses). As I reviewed my patient list, I noticed that the sign out sheet (the paper “baton” of information handed to you by the last intern who cared for the patients – meant to give you a synopsis of what they needed) was supremely unhelpful. Chicken scratch with diagnoses and little check boxes of “to do’s” for me. I was really nervous.
So I began to round on my patients – introducing myself to each of them, letting them know that I was their new doctor. I figured that even if I couldn’t completely understand the sign out notes, at least by eye-balling them I’d have an idea of whether or not they were in imminent danger of coding or some other awful thing that I figured they’d be trying to do.
My third patient (of 15) was a thin, elderly Hispanic man, Mr. Santos. He smiled at me when I came
in the door – the kind of lecherous smile that a certain type of man gives to all women of child bearing age. I ignored it and introduced myself in a professional manner and began to check his vital signs. I was listening to his heart, and I honestly couldn’t hear much of anything. There was a weird, very distant beat – something I wouldn’t expect for such a thin chest. The man himself looked awful, but I really wasn’t sure why – he just seemed really, really ill.
My pager was going off mercilessly all night. I wondered if this was how the nurses got to know the characters of their new interns – to test them by paging them for anything under the sun, tempting us to tip our hand if we had tendencies to be impatient or disrespectful. But in the midst of all the “we need you to sign this Tylenol order” pages, there came a concerning one: “Hey, Mr. Santos doesn’t look good. Better get up here.”
My heart raced as I rushed to his bedside. Yup, he sure didn’t look too good. He was breathing heavily, and had some kind of fearful expression on his face. I didn’t really know what to do, so I decided to call the resident in charge (much as I was loathe to do so, since I knew he would humiliate me for bothering
him).
The resident appeared in a froth – “Why are you paging me? What’s wrong with the patient? Why do you need me here? This better be good!”
“Um… Mr. Santos doesn’t look too good.” I said, frightened to death.
“What do you mean ‘he doesn’t look too good?’ Can you be a little bit more specific” he said, sarcasm dripping from his tongue.
“Well, I can’t hear his heart and he’s breathing hard.”
“I see,” said the resident, rolling his eyes. He marched off towards the patient’s room, certain to make an example of me and this case.
I trotted along behind him, hoping I hadn’t been wrong in paging him – trying to remember the ACLS
protocol from 2 weeks prior.
The resident drew back the curtain around the man’s bed with one grand sweep of the arm. “Mr. Santos,
how are you doing?” he shouted, as if the man were deaf.
The man was staring at the wall, taking in deep, labored breaths of air. I saw that the resident immediately realized that this was serious, and he placed his stethoscope on the man’s chest.
I approached on the other side of the bed and held his hand. “Mr. Santos, I’m back, remember me?” He smiled and looked me straight in the eye.
He replied, “Angel.” (in Spanish) Then he let out a deep breath and all was silent.
The resident shook the man, “Mr. Santos? Mr. Santos?!” There was no response.
“Should I call a code?” I asked sheepishly.
“Nope, he’s DNR,” said the resident.
I was flabbergasted.
“Yep, you just killed your first patient. Welcome to intern year.”
As I thought about his cruel accusation, I was comforted by the fact that at least, as Mr. Santos released his final breath, he thought he had seen an angel. Maybe my presence with him that night did something good… even though I was only a lowly intern.
I was glad to see that my recent interview with Tommy Thompson was referenced by Larry King in his opening remarks on healthcare reform with Elizabeth Edwards. My friend Eric Kuhn at CNN kindly offered me the video to embed here on my blog… The Better Health reference is at minute 1:08. I was also asked to submit a blog post to Larry King’s blog, so stay tuned for that! As I have always maintained – medblogs are upstream of mainstream!
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Ed Walker is 102 years old. I met him by chance on a steep hill in Lunenburg, Nova Scotia – not long after my husband blurted, “I hope you’ve got good brakes on that scooter!” Ed pulled up next to us (to demonstrate his brakes) and jubilantly announced his age, along with his suspected reason for it: “I have prostate cancer but chose to leave it alone.”
