via other things amanzi: ct scans.
i’m usually quite good at reading ct scans, but this one just left me with one big question mark.
…and like most questions from surgeons to radiologists, this one is half full of it 
*This blog post was originally published at scan man's notes*
Between what is said and what is not, the truth lies in waiting. Palpate the silence. Hear the double meaning. Smell the hesitation. See the nostrils flare. Watch the direction of the gaze. Feel the tension.
The truth vibrates in myriad ways. It is deep, below the surface. Frank Herbert’s novel Dune illustrates the concept with fascinating fiction. Imagine a people –the Bene Gesserit — genetically bred and trained as seers into the unconsciousness, sensors of the truth, like breathing lie detectors. Little did I know that such truth seers are not just a part of fiction, and although a rarity, live and walk amongst us.
I have met such a seer. Towards the end of my residency training, a gifted psychologist was assigned to follow me as a routine part of our training. I’d become competent and efficient in administering my craft. “My doctoring will impress her,” I thought with some pomp.
Right before the first person we saw, she told me, “Pretend I’m not in the room.” Then, for the duration of the morning, she silently observed the patients I saw and my interaction all while in the back of the room.
After seeing a few patients, we’d break and talk. The patients I saw, I felt, were representative of standard primary care issues: Joe forgets to take his medication. Susan can’t quit smoking. Elaine has unexplained abdominal pain. My medical paradigm explained that Joe, like most people, can’t comply taking continuous medications. Susan is addicted, not interested in quitting smoking until she’s good and ready. Elaine’s pelvic pain is mysterious but not worrisome.
I’m stunned when, after my medical analysis, the psychologist paused, emitting a rueful smile. She sighed knowingly and responded, “Actually, Joe is angry at his wife and defies her by refusing to comply. Susan has unresolved issues with her father who’s probably an alcoholic. Elaine’s pain suggests sexual molestation.”
“Give me a break!” cried a voice from inside of me. And as the days rolled along there were other voices too. “I am a family doctor. This is not medicine! I don’t have time for this! Just what you’d expect from a psychologist; too much Freud!”
As the weeks turned, I reluctantly see her hit nail after nail on the head. She saw complex patterns in people’s behaviors and complaints that I’m too blind, and too unwilling, to see.
With this new, almost astonishing, dimension to medicine, I see, for the first time, art, compassion, insight, and intuition as equal partners to the formulas of science. I slowly wonder what it truly means to be called “a doctor,” when so much is missed in the science of “performance.” I am captivated, begging to know: How does she see? Can I learn? Is she gifted or crazy?
We are in the final days of my tutelage when we meet an enraged Sharon, in follow-up from the emergency room after a miscarriage. She didn’t know she was pregnant, began to bleed, and ended-up in the ER. She was pushed into a back room, left alone for a long time, bleeding heavily. She felt abandoned, angry, and humiliated. The ER attending staff, she insists to me, made her feel like a “slut.” I listen and then promise to investigate and call her back.
In the post-patient meeting I explained to the Bene Gesserit (as I now secretly called my psychologist mentor), “Delays occurred in the ER’s treatment of Sharon and she was over reacting but never in danger.”
“Right about the danger,” the Bene Gesserit concedes, “Wrong about what happened. Sharon had an affair her husband found out about it through the miscarriage.”
Having been humbled too many times, my resistance drops. “What did I miss can you show me?” I beg.
“You sense her over-reaction, her anger, yet dismissed it. Something else fuels her rage. Close your eyes. Pretend to be having a miscarriage right now. I’ll coach you through it.”
“This will be tough.” I think, “I am a man and can’t really miscarry and am sitting in the doctor’s lounge with plenty of colleagues enjoying this play acting.” I close my eyes and settle into a foreign reality. It doesn’t take long to be guided to bells ringing in my head. “I don’t feel like a slut.”
The Bene ignores me and continues, “The vibrations are always there if you tune your antenna to the right frequency. People are pools of water with surface and depth. Illness arises within a context. Ripples on the surface are the symptoms caused from objects thrown-in or vibrations from the past arising to the surface. To reveal this union between the physical and emotional bodies is a unique potential of a healer. “
Sharon’s husband visited my office three days later, chief complaint chest pain. The betrayal was written all through him and verified as forecasted by my mentor. Unnerved I began in earnest to train my own antenna as to reach my fullest possible potential as a healer, a potential only realized by committing the time to listen comprehensively, intuitively, respectfully needed to do so.
Medical care today is all about the quantitative: 10-minute office visits, performance-based measurements, and only the facts. Medical problems are often not simple algebra formulas where the sum equals its parts. Many times healing requires the art of listening, intuition, trust, insight, empathy, grace and even spirituality. It’s not neat, nor quantifiable, but many have journeyed through life enough to know it’s true. Even after all the science has spoken, the art hides itself in myriad ways, patiently waiting.
Until next week, I remain yours in primary care,
Alan Dappen, MD
I don’t have to tell you that in this economy everyone is looking for ways to cut costs. One place many people are choosing to save pennies is by choosing generic, or store brands, instead of name brands at the supermarket.
The Food Marketing Institute reports these stats:
The average family spends $98.40 weekly on groceries. If you have children, you will spend well over $100. So saving even a few dollars each shopping trip can add up.
Can you tell a difference in the store brand vs the manufactured brand? I personally will purchase store brand for many things like milk, bread, cheese, butter, etc. I have tried some of the store brand cereals and not found them to be as good as the manufactured brand. It all depends, though, on the product and the price. If a manufactured brand is on sale or if I have a coupon, it is much cheaper to go with that than the store brand.
Did you know that many of the store brands are actually made by national brands and relabeled for the store? This varies by store and product, but often those paper towels that are store brand are the same as the manufactured brand.
What do you think? What do you purchase in the generic, or store brand? Do you notice a difference?
This post, Going Generic, was originally published on Healthine.com by Brian Westphal.
I attended the 29th annual Management of Change (MOC) Conference with Dr. Val. The conference is sponsored by the American Council for Technology and the Industry Advisory Council. MOC brings together government and industry leaders to share knowledge, collaborate, and develop actionable technology management strategies. As a physician, attending this conference for the first time, I assumed a great deal of the conference topics would be over my head and in very “techie” terms. My hope was to get a glimpse of some of the technology solutions the government was considering as they relate to health care IT.
Vivek Kundra, first Chief Information Officer of the United States, addressed the audience early in the day in language that even a doc could understand. He spoke about the need to simplify government, and connect people to solutions, instead of “endless bureaucracies.” The same of course goes for medicine. How great would it be to connect our patients to systems that actually had interoperable medical data?
I was able to catch up with Mr. Kundra after his talk for a few minutes and ask him how technological simplification would apply to physicians such as myself, operating in a haphazard infrastructure with varying PAC systems, EMR’s and paper charts. He said the key would not only be investing in technology, but investing in training healthcare personnel to master new technologies. He acknowledged that different generations of physicians would embrace technology differently, but ultimately, if a physician says he “can do a better job on paper” then we have a problem.
I was very impressed by Mr. Kundra’s answer namely because it was so insightful for a man who’s expertise lies primarily in the technology field. He does not come from a healthcare background, and yet had hit the nail on the head. There has been so much talk about HIT being the “key” to cost savings and the next “breakthrough” in medicine. With very little discussion on how physicians feel about it. For some docs – particularly those that come from an older generation – the thought is quite terrifying. They are happy with their paper charts and manual dictations. Health technology is almost viewed as an impediment to those set in their ways, and accustomed to a system that has worked for them and their patients for years. This upheaval will not come without it’s challenges even after we find the best technologies for the tasks at hand. It will be imperative for government leaders to understand that the mission of HIT implementation may be just as difficult as finding the technology solutions they are currently seeking.
As Mr. Kundra and his team embark on this huge task, it will be important for physicians and health care personnel to engage with the government and serve as a guide for what docs need from technology, and what will and will not work for our patients. I hope next year’s conference is attended by more physicians such as myself and Dr. Val.
New Media guru Clay Shirky was the keynote speaker at the Management of Change conference in Norfolk, Virginia. His recent book, Here Comes Everybody, is considered a must-read by most web 2.0 enthusiasts. Clay and I escaped the conference for a tête-á-tête at a local Starbucks where we wrestled with the thorny issues of healthcare and crowd sourcing.
Dr. Val: I’ve noticed that there is a difference between being right and being influential. Doctors are having a hard time adjusting their tone to be more compelling in a social media culture. What do you think physicians can do to be more influential online?
Shirky: The problem is that, since we all die eventually, everyone will be unhappy with their healthcare at some point. This creates a social dilemma that’s neither transitory nor small. First, there will always be snake oil salesmen peddling “eternal life,” and second, there will always be an unhappy faction who rail against the medical establishment. You should not try to stamp out that faction, but referee it. Federalist Papers No. 10 states that faction is the normal case of government – the trick is not to allow factions to gain disproportionate power. Physicians need to realize that patients have different priorities than they do, and speak to those as much as possible.
Dr. Val: What do you mean that we have different priorities?
Shirky: Take Medpedia for example – physicians are eager to write about rare types of liver cancer, but they don’t want to write about the basics of biopsy technique. For the physician, it’s perfectly obvious what a liver biopsy entails, so he/she doesn’t think to write about it. But the patient is probably more interested in learning about biopsy procedure than the scientific details of a rare liver cancer. The entries in Medpedia strongly reflect physician interests and priorities, though the resource is ultimately supposed to serve the educational needs of patients.
Dr. Val: What’s the best way to close that gap in priorities?
Shirky: We need to fuse the conversation between physicians and patients. The more they work together, the more valuable the content will be.
Dr. Val: What do you think about the trend towards “user-generated healthcare?”
Shirky: It’s important to have checks and balances. When lay people discuss medicine, their unguided conversation can degenerate into vitamin hucksterism. I think that whole movement was initiated when the FDA decided not to regulate the supplement industry – people have been used to getting input from others who aren’t scientifically qualified. Now everyone gives medical advice, and people listen.
Social media is a very new phenomenon. We have not figured out how to apply good checks and balances yet – amateurs’ opinions and voices can drown out the experts. We want to believe that everyone’s opinion is equally valid – but that’s just not the case. In the end, quality and clarity of messaging is a source of power.
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