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The Best Doctors Are Constantly Learning

Monday’s New Yorker has a story, Personal Best, by Atul Gawande. It’s about coaching, and the seemingly novel idea that doctors might engage coaches – individuals with relevant expertise and experience — to help them improve their usual work, i.e. how they practice medicine.

Dr. Gawande is a surgeon, now of eight years according to his article. His specialty is endocrine surgery – when he operates it’s most often on problematic glands like the thyroid, parathyroid or appendix. Results, and complications, are tracked. For a while after he completed his training he got better and better, in comparison to nation stats, by his accounting. And then things leveled off.

The surgeon-writer considered how coaches can help individuals get better at whatever they do, like playing a sport or singing. He writes:

The coaching model is different from the traditional conception of pedagogy, where there’s a presumption that, after a certain point, the student no longer needs instruction. You graduate. You’re done. You can go the rest of the way yourself…

He wonders about how this might apply in medicine: Read more »

*This blog post was originally published at Medical Lessons*

Canadian C-Spine Rule: How To Know If A Neck Is Likely To Be Broken

Christian Vaillancourt, MD and his colleagues recently published an article in the journal Annals of Emergency Medicine (2009;54:663-671) entitled “The Out-of-Hospital Validation of the Canadian C-Spine Rule by Paramedics.” This rule was originally developed for “clinical clearance” (e.g., without the use of x-rays) of persons with possible cervical spine fracture (broken neck) in alert and stable trauma patients by qualified persons (generally, emergency physicians) in a health care setting (such as an emergency department). This particular study found that paramedics can apply the Canadian C-Spine Rule reliably, without missing important cervical spine injuries.

The Rule, properly applied to an awake and alert injured person for which there is a concern for a cervical spine injury, provides the following direction:

1. If a person has a high-risk factor (age greater than or equal to 65 years; a dangerous mechanism of injury [a fall from an elevation greater than or equal to 3 feet; fall down 5 or more stairs; direct blow to top of head, such as a diving board accident; motor vehicle accident characterized by high speed, rollover or passenger ejection; motorized recreational vehicle accident; bicycle collision]; or numbness/tingling in an arm or leg), then neck immobilization and x-rays are indicated. Read more »

This post, Canadian C-Spine Rule: How To Know If A Neck Is Likely To Be Broken, was originally published on by Paul Auerbach, M.D..

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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