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Health And The Value Of Open-Mindedness

Three recent sto­ries lead me to my open­ing topic for the year: The value of open-mindedness. This char­ac­ter­is­tic — a state of recep­tive­ness to new ideas — affects how we per­ceive and process infor­ma­tion. It’s a qual­ity I look for in my doc­tors, and which I admire espe­cially in older people.

Piece #1 — On the brain’s matu­rity, flex­i­bil­ity and “cog­ni­tive fitness”

For the first piece, I’ll note a Dec 31 op-ed piece that appeared in the New York Times: This Year, Change Your Mind, by Dr. Oliver Sacks, the neu­rol­o­gist and author. In this thought­ful essay, he con­sid­ers the adult brain’s “mys­te­ri­ous and extra­or­di­nary” power to adapt and grow: “I have seen hun­dreds of patients with var­i­ous deficits — strokes, Parkinson’s and even demen­tia — learn to do things in new ways, whether con­sciously or uncon­sciously, to work around those deficits.”

With appro­pri­ate and very-real respect, I ques­tion Sacks’ objec­tiv­ity on this sub­ject — he’s referred some of the most out­stand­ing (i.e. excep­tional) neu­ro­log­i­cal cases in the world. And so it may be that his care­ful reports are per­fectly valid but not rep­re­sen­ta­tive; for most of us, the adult brain’s capac­ity to estab­lish new cir­cuitry for lan­guage learn­ing or music appre­ci­a­tion may be lim­ited. What his sto­ries do show is that unimag­in­ably strange things hap­pen in our brains, at least occa­sion­ally. And maybe we should just accept that and take notes (as he does so care­fully), and keep an open mind. Read more »

*This blog post was originally published at Medical Lessons*

Measuring GNH (“Gross National Happiness”)

This evening, when I fin­ished clean­ing up the kitchen after our fam­ily din­ner, I glanced at the cur­rent issue of the Econ­o­mist. The cover fea­tures this head­line: the Joy of Grow­ing Old (or why life begins at 46). It’s a light read, as this so-influential mag­a­zine goes, but nice to con­tem­plate if you’re, say, 50 years old and won­der­ing about the future.

The article’s the­sis is this: Although as peo­ple move towards old age they lose things they treasure — vitality, men­tal sharp­ness and looks — they also gain what peo­ple spend their lives pur­su­ing: Happiness.

Fig. 1 (above): “A snap­shot of the age dis­tri­b­u­tion of psy­cho­log­i­cal well-being in the United States,” Stone, et al: PNAS, May 2010 (y-axis: “WB” stands for well-being.)

Young adults are gen­er­ally cheer­ful, accord­ing to the Econ­o­mist’s mys­te­ri­ous author or authors. Things go down­hill until midlife, and then they pick up again. There’s a long dis­cus­sion in the arti­cle on pos­si­ble rea­sons for the U-shaped curve of self-reported well-being. Most plau­si­ble among the expla­na­tions offered, which might be kind of sad except that in real­ity (as opposed to ideals) I think it’s gen­er­ally a good thing, is the “death of ambi­tion, birth of accep­tance.” The con­cept is explained: “Maybe peo­ple come to accept their strengths and weak­nesses, give up hop­ing to become chief exec­u­tive or have a pic­ture shown in the royal Acad­emy…” And this yields contentedness. Read more »

*This blog post was originally published at Medical Lessons*

Concierge Medicine: The Cost Of Healthcare “Room Service” And Other Hospital Amenities

A per­spec­tive in [a recent] NEJM con­sid­ers the Emerg­ing Impor­tance of Patient Ameni­ties in Patient Care. The trend is that more hos­pi­tals lure patients with hotel-like ameni­ties: Room ser­vice, mag­nif­i­cent views, mas­sage ther­apy, fam­ily rooms and more. These ser­vices sound great, and by some mea­sures can serve an institution’s bot­tom line more effec­tively than spend­ing funds on top-notch spe­cial­ists or state-of-the-art equipment.

Think­ing back on the last time I vis­ited some­one at Sloan Kettering’s inpa­tient unit, and I mean­dered into the bright lounge on the 15th floor, stocked with books, games, videos and other signs of life, I thought how good it is for patients and their fam­i­lies to have a non-clinical area like this. The “extra” facil­ity is privately-funded, although it does take up a rel­a­tively small bit of valu­able New York City hos­pi­tal space (what might oth­er­wise be a research lab or a group of nice offices for physi­cians or, dare I say, social work­ers) seems wonderful.

If real healthcare isn’t an even-sum expense prob­lem, I see no issue with this kind of hos­pi­tal accou­trement. As for room ser­vice and order­ing oat­meal for break­fast instead of insti­tu­tional pan­cakes with a side of thaw­ing orange “juice,” chicken salad sand­wiches, fresh sal­ads or broiled salmon instead of receiv­ing glop on a tray, that’s poten­tially less waste­ful and, depend­ing on what you choose, health­ier. As for yoga and med­i­ta­tion ses­sions, there’s rarely harm and, maybe occa­sion­ally, good (i.e. value).

But what if those resources draw funds away from nec­es­sary med­i­cines, bet­ter soft­ware for safer CT scans and phar­ma­cies, and hir­ing more doc­tors, nurses or aides? (I’ve never been in a hos­pi­tal where the nurses weren’t short-staffed.) Read more »

*This blog post was originally published at Medical Lessons*

Video: “The Too-Informed Patient”

This video, “The Too-Informed Patient,” came my way lately. It’s featured on NPR’s Mar­ket­place website:

The Too Informed Patient from Marketplace on Vimeo.

—–

The pup­peteer skit fea­tures the inter­ac­tion between a young man with a rash and his older physi­cian. The patient is an informed kind of guy: He’s checked his own med­ical record on the doctor’s web­site, read up on rashes in the Boston Globe, checked pix on WebMD, seen an episode of “Gray’s Anatomy” about a rash and, most inven­tively, checked iDiagnose, a hypo­thet­i­cal app (I hope) that led him to the con­clu­sion that he might have epi­der­mal necro­sis.

“Not to worry,” the patient informs Dr. Matthews, who mean­while has been try­ing to exam­ine him (“Say aaahhh” and more): He’s eli­gi­ble for an exper­i­men­tal pro­to­col. After some back-and-forth in which the doc­tor — who’s been quite cour­te­ous until this point, call­ing the patient “Mr. Horcher,” for exam­ple, and not admon­ish­ing the patient who’s got so many ideas of his own — the doc­tor says that the patient may be exac­er­bat­ing the con­di­tion by scratch­ing it, and ques­tions the wis­dom of tak­ing an exper­i­men­tal treat­ment for a rash. Read more »

*This blog post was originally published at Medical Lessons*

5 Reasons Why Patients Don’t Mention Symptoms To Their Doctors

To com­plain or “be good” is an appar­ent dilemma for some patients with seri­ous illness.

Yes­ter­day I received an email from a close friend with advanced breast can­cer. She’s got a lot of symp­toms: Her fatigue is so over­whelm­ing she can’t do more than one activ­ity each day. Yes­ter­day, for exam­ple, she stayed home all day and did noth­ing because she was sup­posed to watch a hockey game in the evening with her teenage son and other fam­ily mem­bers. Her voice is weak, so much it’s hard to talk on the phone. She has dif­fi­culty writ­ing, in the man­ual sense — mean­ing she can’t quite use her right arm and hand properly.

“It’s some­thing I would never men­tion to the doc­tor because it is very sub­tle,” she wrote. “But it has not improved and if any­thing has wors­ened over time.”

There are more than a few pos­si­ble med­ical expla­na­tions for why a per­son who’s receiv­ing breast can­cer ther­apy might not be able to use her right arm. But that’s not the point of today’s les­son. What’s note­wor­thy here is that the patient — an edu­cated, thought­ful woman who’s in what should be the mid­dle of her life and is try­ing as best she can to sur­vive — doesn’t think these symp­toms are worth mentioning. Read more »

*This blog post was originally published at Medical Lessons*

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IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

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

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Latest Book Reviews

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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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