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 YorkTimes: 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*
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*
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*
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*
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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