In the December 2010 issue of JAMA, Robert Brook writes an essay titled "A Physician = Emotion + Passion + Science." In it, he makes the argument that we should use language that more engages the "right brain" in our discussions of science today.
He might be right about that to a certain extent. To be honest, I am a little conflicted on the point. Certainly, it can be hard to communicate exciting ideas in the dry passive voice of modern scientific writing. Perhaps a little panache would help, (although I might stop before putting a cartoon in the middle of a research article in NEJM.) At the same time, I think that there is a purpose to the detached voice of scientific writing. After all, when we publish our findings we are basically putting them out there to face the scrutiny of our colleagues and our community. There is something to be said for a world in which we mostly "let the facts speak for themselves" in this initial presentation, and save our more passionate debates for other venues. A not-so-small part of me that believes that using precise, if dry, language and a specified format in the publication of research results is more than a necessary evil, but a strength of the scientific process. Perhaps we need not to change the presentation of research findings, but create a new venue to allow for the discussion of the work and the debates that an exciting paper can so often precipitate to take place in a more clearly defined public forum. That is, preserve the integrity of the presentation of results, but also provide a venue and a broader audience for the passion and excitement (and disappointment) that those results can provoke. It's certainly something to think about.
But regardless of his point, some of Dr. Brook's reasons for making it are both depressing and downright wrong.
The article contains the following paragraph: "Not very long ago… Each patient was an individual with a family and a community. Each physician was an individual with a small amount of technology at his or her disposal. Every patient required a different art of care, whether it was the way the patient was touched by the physician or the manner in which experiences were shared or questions were asked. Without available or sufficient health insurance, physicians and patients had to work together to produce treatment plans that were consistent with the patients' culture and socioeconomic status and that reflected the patients values about the kind of care that they wanted and did not want."
Anybody out there want to tell me why on Earth that paragraph is in the past tense? Brook's argument is that as technology has improved, care has become increasingly standardized, and that this standardization has led scientific communication becoming "standardized, emotionless and dispassionate." But I think (hope, pray) that this past tense idea of even remotely personalized medicine is downright false. Admittedly, I'm a long way away from being a practicing physician, but I hope that every treatment plan I come up with, for my entire career, is consistent with the patient's culture and reflects the patient's values about the kind of care they want or do not want. Nobody, physician or patient, should find anything less even remotely acceptable. And while it is nice to imagine that in the beautiful modern world of insurance, we no longer have to consider the patient's socioeconomic status, or the cost of treatment options, in reality, not doing so is beyond irresponsible and will only cause both the patient and the system further harm. Dr. Brook's putting a personal doctor-patient relationship into the past tense, dismissing the modern need for custom designed personal care, and awareness of the cost, is something of a tragedy, but I don't think it has anything to do with the dry language of scientific papers. Thankfully, I can't think of a single one of my colleagues that plans to practice this "standardized, emotionless and dispassionate" form of medicine that he seems to think is all we have left.
Dr. Brook goes on to say, "It is difficult to imagine a young physician growing up in this communication environment, trying to focus his or her brain on science studies that seem to be written in a language as foreign as medieval English would be to modern inhabitants of the British Isles." Now, I am currently struggling with the writing of a scientific paper, and I will be the first to admit that the language doesn't always come easily, and that I am writing for a specific audience. I've often told my husband and my mother that they don't have to prove they love me by reading my scientific articles. Still, if they did make an attempt, I assure you that they, all of you, and all of the other "young physicians" I know, would have a far easier time reading "Disrupted reinforcement signaling in the orbitofrontal cortex and caudate in youths with conduct disorder or oppositional defiant disorder and a high level of psychopathic traits" than The Canterbury Tales in the original. I would like to believe that those of us that have chosen the field of medicine don't need a gimmick to focus on the science for a little while, and I hope that most of those that have preceded me into the field will give us a little more credit than Dr. Brook seems willing to.
So yes, perhaps we could enliven medical research with a little more emotion. I'm all for putting the debate and discussion that is the most exciting part of science into a public forum and letting the people that care passionately about a topic teach us all.
I'm even more for making the time in the medical school curriculum to have emotions and passions outside of the raw science that we all must learn, and it seems like that may be where Brook is hurting. It's not the flaws of the dry language of the modern scientific paper that he is telling us about in this essay, but perhaps a deeper feeling of being unable to express his emotions in the modern dialogue of medicine. To be honest, I feel a little sorry for him. At the same time, I'm pretty sure that the answer isn't more emotional imagery in my next paper.
I may be spending a lot of my time with the dry language of science at the moment, but I hope that the emotion and passion that brought me to medicine will help keep my experience from being what Dr. Brook seems to see. This upcoming week will be spent drafting a paper (and reading dozens of others), but I'm confident that I will be able to focus on the task at hand, cartoons or no, even if I do have to sign of facebook and focus on the "foreign language" of Chaucer, I mean Neuropsychopharmacology, for just a little while.
This essay refers to: Brook RH. A Physician = Emotion +Passion +Science. JAMA. 2010. 304; 2528-2529.
Sunday, March 13, 2011
Monday, January 3, 2011
Grace
The first book that I've read in 2011 has gotten the year off to a beautiful start. Some background: I'm going to be reading an absurd number of short stories this year, because I am trying to work on my own craft in that (manageable while in medical school) genre. In order to make that possible, I've been amassing volumes to keep me busy, and I've picked up several collections over the last couple of weeks and months. One of these is Sherman Alexie's War Dances. I found this collection of poetry, short fiction, and difficult to classify but nonetheless stunning prose as a bargain book at the FABULOUS Tattered Cover in Denver, where I got to spend several very happy hours reading and browsing on New Years Eve while my husband took care of some of his groomsman duties. (We were in Denver for a wedding.)
Alexie won the 2010 PEN/Faulkner Award for this book, but I had literally never seen it on a shelf before. That's a tragedy, it's a fantastic collection, and people should be reading it. You should be reading it. I'm sure that your local library has a copy handy. It's moving and powerful writing, and more than once while I was reading it, I found myself having to look up and take a moment to collect myself. I almost cried on the bus this morning. It's been a long time since I've been moved to tears in a public place by a piece of fiction. If you're a reader, pick this up and give it a go, and let me know what you think.
Of course, pretty much everything that I have said so far sounds like it belongs in my reading blog. So why am I talking about it here, in my writing and medicine blog?
I'll tell you, in the final story in the collection, "Salt" a senile and lonely widow tells our narrator the story of burying her cat, and praying by his graveside. As she scatters salt over his body to speed his trip to heaven, he seems to come back to life. When she calls her doctor (not her veterinarian, but her physician) to report the miracle, he calls her vet, and they both make a house call. She is thrilled by this, "Imagine! Two doctors on a house call. That doesn't happen anymore, does it?" In response, the narrator thinks:
"It happens when two graceful men want to help a fragile and finite woman."
And that, my friends, might be the most beautiful sentence on humanism in medicine that I have ever read. It's what I hope to be. Graceful. What a beautiful word to describe the art of knowing what a fellow human needs, to tell us about the gift of going to great lengths to bring comfort beyond physical healing. The elegance of that sentence stopped me in my tracks. It simultaneously brought me near to tears and gave me hope. I imagine that I will remember reading this story for the rest of my career. I hope that I will, and that I will be able to use it as a touchstone, as a reminder. We are all fragile and finite, and grace is a beautiful thing to strive for.
Even if you don't want to read the rest of War Dances, read "Salt." It's only 17 pages, but it lays bare in that tiny span the fragility of humans, young and old. It's a powerful piece of writing, it will make you think. But maybe don't read it on the bus, because I think that it will likely also make you cry.
Alexie won the 2010 PEN/Faulkner Award for this book, but I had literally never seen it on a shelf before. That's a tragedy, it's a fantastic collection, and people should be reading it. You should be reading it. I'm sure that your local library has a copy handy. It's moving and powerful writing, and more than once while I was reading it, I found myself having to look up and take a moment to collect myself. I almost cried on the bus this morning. It's been a long time since I've been moved to tears in a public place by a piece of fiction. If you're a reader, pick this up and give it a go, and let me know what you think.
Of course, pretty much everything that I have said so far sounds like it belongs in my reading blog. So why am I talking about it here, in my writing and medicine blog?
I'll tell you, in the final story in the collection, "Salt" a senile and lonely widow tells our narrator the story of burying her cat, and praying by his graveside. As she scatters salt over his body to speed his trip to heaven, he seems to come back to life. When she calls her doctor (not her veterinarian, but her physician) to report the miracle, he calls her vet, and they both make a house call. She is thrilled by this, "Imagine! Two doctors on a house call. That doesn't happen anymore, does it?" In response, the narrator thinks:
"It happens when two graceful men want to help a fragile and finite woman."
And that, my friends, might be the most beautiful sentence on humanism in medicine that I have ever read. It's what I hope to be. Graceful. What a beautiful word to describe the art of knowing what a fellow human needs, to tell us about the gift of going to great lengths to bring comfort beyond physical healing. The elegance of that sentence stopped me in my tracks. It simultaneously brought me near to tears and gave me hope. I imagine that I will remember reading this story for the rest of my career. I hope that I will, and that I will be able to use it as a touchstone, as a reminder. We are all fragile and finite, and grace is a beautiful thing to strive for.
Even if you don't want to read the rest of War Dances, read "Salt." It's only 17 pages, but it lays bare in that tiny span the fragility of humans, young and old. It's a powerful piece of writing, it will make you think. But maybe don't read it on the bus, because I think that it will likely also make you cry.
Wednesday, September 15, 2010
My Story To Tell
So I've been reading Richard Selzer's Letters to a Young Physician. One of the essays spoke to me. It got me thinking about a particular challenge in my life and my career, and I started writing about it last night.
That piece isn't finished yet, but that's not why it's not making an appearance in this blog. I won't post that piece here because it deals with aspects of my personal history that I don't want to put into the ether of the internet, from which, I must assume, everyone that I ever meet could discover them. I'm not talking about secrets per say. Nobody that knows me well would be surprised by the foundations of my essay. The challenge here is surrounding the personal details of our lives that our friends know but that that we don't necessarily want potential future employers to discover at the speed of google.
But I'm also proud of this piece, even just in the first draft. This makes me want to put it somewhere that will allow readers to get their hands on it. Otherwise all the effort seems a little wasted. Second draft? Third? Instead of sleep? Studying? Writing something else?
I've been a journal writer all my life, and I am certainly not claiming that writing without an audience other than yourself serves no purpose. Writing for myself and the page that I write on has been essential to my sanity for long periods of my life. But that writing has not had the polish of the things that I've been working on lately. That writing was about processing emotions as opposed to being a writer. As a journaler I want to be left to myself, but as I writer, I am not satisfied with this audience of one.
And perhaps that long history of journal-writing is why I am struggling with this issue now... not just in this case, but more broadly. I turn to words when I am emotionally raw and ethically challenged. The ideas and events that have moved me to actually put pen to paper or fingers to keyboard in the last couple months have been powerful ones, but ones that I'm either not free or not willing to give to the world. The intimate challenging moments involving my friends and family, personal ethical questions, and stories of patients that would make no sense without details that blow HIPPA to oblivion can't pass freely from my hands.
And so I've been asking myself the question: which of these things are my stories to tell? It's obvious (I hope) that I would never post or publish something that violated the privacy and confidentiality of my relationship with a patient or research subject. But what about the privacy and confidentiality of one of my siblings? My husband? My friends? I am not alone in the emotional moments of my life, there are other players. Is it for me to paint the saddest moments in the history of my family and then give them to the world? They are part of my story, but they are not mine alone, and they can't be separated in narrative or emotion from the people I love. When I write a poem about my life, do I give everyone involved veto power before I try to publish? Do I even ask? Surely there needs to be a line.
Because the writing is mine. The work is mine. The moments and the emotions are mine as well. But not just mine. These things are shared, and belong as much to my loved ones as to me. Who am I that I can give away another person's story for the sake of telling my own?
So lately I find myself unsure about what to do with that second draft. Whether to push through a third one at all. How do you tell your story when so little of your story is yours alone to tell?
That piece isn't finished yet, but that's not why it's not making an appearance in this blog. I won't post that piece here because it deals with aspects of my personal history that I don't want to put into the ether of the internet, from which, I must assume, everyone that I ever meet could discover them. I'm not talking about secrets per say. Nobody that knows me well would be surprised by the foundations of my essay. The challenge here is surrounding the personal details of our lives that our friends know but that that we don't necessarily want potential future employers to discover at the speed of google.
But I'm also proud of this piece, even just in the first draft. This makes me want to put it somewhere that will allow readers to get their hands on it. Otherwise all the effort seems a little wasted. Second draft? Third? Instead of sleep? Studying? Writing something else?
I've been a journal writer all my life, and I am certainly not claiming that writing without an audience other than yourself serves no purpose. Writing for myself and the page that I write on has been essential to my sanity for long periods of my life. But that writing has not had the polish of the things that I've been working on lately. That writing was about processing emotions as opposed to being a writer. As a journaler I want to be left to myself, but as I writer, I am not satisfied with this audience of one.
And perhaps that long history of journal-writing is why I am struggling with this issue now... not just in this case, but more broadly. I turn to words when I am emotionally raw and ethically challenged. The ideas and events that have moved me to actually put pen to paper or fingers to keyboard in the last couple months have been powerful ones, but ones that I'm either not free or not willing to give to the world. The intimate challenging moments involving my friends and family, personal ethical questions, and stories of patients that would make no sense without details that blow HIPPA to oblivion can't pass freely from my hands.
And so I've been asking myself the question: which of these things are my stories to tell? It's obvious (I hope) that I would never post or publish something that violated the privacy and confidentiality of my relationship with a patient or research subject. But what about the privacy and confidentiality of one of my siblings? My husband? My friends? I am not alone in the emotional moments of my life, there are other players. Is it for me to paint the saddest moments in the history of my family and then give them to the world? They are part of my story, but they are not mine alone, and they can't be separated in narrative or emotion from the people I love. When I write a poem about my life, do I give everyone involved veto power before I try to publish? Do I even ask? Surely there needs to be a line.
Because the writing is mine. The work is mine. The moments and the emotions are mine as well. But not just mine. These things are shared, and belong as much to my loved ones as to me. Who am I that I can give away another person's story for the sake of telling my own?
So lately I find myself unsure about what to do with that second draft. Whether to push through a third one at all. How do you tell your story when so little of your story is yours alone to tell?
Sunday, August 1, 2010
The Most Prestigious Disease
Kevin MD, a blogger for medpagetoday.com pointed out an interesting, troubling study earlier this week. The study, performed in Norway, attempts to rank the prestige of both medical specialties, and less conventionally, of diseases themselves. If you want to read more about it, here’s an article and the abstract. Basically, they mailed a survey to a bunch of physicians and medical students that had a list of diseases and asked them to rank how prestigious each one was.
Now, there are a number of things about this that are appalling. I am totally fine with the fact that there are differing levels of perceived prestige for different medical specialties. I am also aware that I am planning to select one, psychiatry, that is not often near the top. However, I think that attempting to rank diseases themselves is disgusting. It’s more prestigious to have leukemia than thyroid cancer?! Where does that even come from? It just doesn't make sense conceptually to me.
The study only ranks 38 diseases, so obviously a lot of the biggies are left out. There's probably something to criticize in the methodology of a survey that includes ankylosing spondylitis (very rare) and not diabetes (very common)… but what I really want to talk about are the diseases that come in last on the prestige scale. Because it is not the top of this list, but the bottom that tells me what this survey was all about.
Of the four psychiatric diagnoses included in the survey, none are above the bottom six. The only two diseases that rank lower than any psychiatric condition are cirrhosis of the liver and fibromyalgia. Despite this outcome, the study authors make the claim that diseases located in vital organs in the upper parts of the body have high prestige. Really?
Come on folks. Name the highest up and most vital of all the organs.
The brain perhaps?
Are we really still so deep in the stone age that we can’t admit that someone with schizophrenia, depression or chronic anxiety has a brain problem? How about someone with cerebral palsy, which is only 8th from last?
My reading of these results points to a rather different conclusion. What we have here is the reverse social stigma scale. Diseases that nobody holds against you are near the top. No one tells you to buck up and get back to work if you have a heart attack or a brain tumor. Most of the things in the middle are kind of neutral: not as serious, but no way to assign any blame to the patient either. (It is notable that testicular cancer #5, while ovarian cancer is #12 and breast and cervical cancers are not even important enough for inclusion on the list. Men's reproductive organs are far more prestigious than women's.)
And down at the bottom of the list we find exactly those people that likely don’t need to be told that they’re not at the top of the social status scale. Patients with diseases that are psychiatric (anorexia, depression, anxiety and schizophrenia), poorly understood (fibromyalgia), or associated with culturally unaccepted behaviors or groups (cirrhosis, AIDS).
So I have to ask, what was the point? How could a scientist convince themselves that they had learned something about prestige as opposed to something about prejudice? Does this work really need to be done? Resources were used to conduct this study. Resources that could have been used to try to better understand some of those chronic and terrible diseases at the bottom. Resources that could have paid for antiretrovirals for someone with AIDS or some of the long term care that is so often needed by a patient with cerebral palsy.
The journal Social Sciences and Medicine decided to publish this study. I challenge any self-respecting social scientist to tell me that these rankings don’t have more to do with prejudice against people with the diseases near the bottom than the prestige of the diseases near the top.
Now, there are a number of things about this that are appalling. I am totally fine with the fact that there are differing levels of perceived prestige for different medical specialties. I am also aware that I am planning to select one, psychiatry, that is not often near the top. However, I think that attempting to rank diseases themselves is disgusting. It’s more prestigious to have leukemia than thyroid cancer?! Where does that even come from? It just doesn't make sense conceptually to me.
The study only ranks 38 diseases, so obviously a lot of the biggies are left out. There's probably something to criticize in the methodology of a survey that includes ankylosing spondylitis (very rare) and not diabetes (very common)… but what I really want to talk about are the diseases that come in last on the prestige scale. Because it is not the top of this list, but the bottom that tells me what this survey was all about.
Of the four psychiatric diagnoses included in the survey, none are above the bottom six. The only two diseases that rank lower than any psychiatric condition are cirrhosis of the liver and fibromyalgia. Despite this outcome, the study authors make the claim that diseases located in vital organs in the upper parts of the body have high prestige. Really?
Come on folks. Name the highest up and most vital of all the organs.
The brain perhaps?
Are we really still so deep in the stone age that we can’t admit that someone with schizophrenia, depression or chronic anxiety has a brain problem? How about someone with cerebral palsy, which is only 8th from last?
My reading of these results points to a rather different conclusion. What we have here is the reverse social stigma scale. Diseases that nobody holds against you are near the top. No one tells you to buck up and get back to work if you have a heart attack or a brain tumor. Most of the things in the middle are kind of neutral: not as serious, but no way to assign any blame to the patient either. (It is notable that testicular cancer #5, while ovarian cancer is #12 and breast and cervical cancers are not even important enough for inclusion on the list. Men's reproductive organs are far more prestigious than women's.)
And down at the bottom of the list we find exactly those people that likely don’t need to be told that they’re not at the top of the social status scale. Patients with diseases that are psychiatric (anorexia, depression, anxiety and schizophrenia), poorly understood (fibromyalgia), or associated with culturally unaccepted behaviors or groups (cirrhosis, AIDS).
So I have to ask, what was the point? How could a scientist convince themselves that they had learned something about prestige as opposed to something about prejudice? Does this work really need to be done? Resources were used to conduct this study. Resources that could have been used to try to better understand some of those chronic and terrible diseases at the bottom. Resources that could have paid for antiretrovirals for someone with AIDS or some of the long term care that is so often needed by a patient with cerebral palsy.
The journal Social Sciences and Medicine decided to publish this study. I challenge any self-respecting social scientist to tell me that these rankings don’t have more to do with prejudice against people with the diseases near the bottom than the prestige of the diseases near the top.
Wednesday, July 28, 2010
On Being A Writer
About 18 months ago, I wrote a piece for bookworming (my other, occasionally updated, blog) after I attended a reading by Lauren Groff. During that reading, Groff asked the crowd if anyone was a writer, and I noticed that the majority of the people in the audience had raised their hands, although I had not. That got me started on what it would take for me to feel as if I could raise my hand in response to that question, and you can find some of my thoughts, if you’re interested, in the original post.
If you choose not to read it (and that’s fine by me) here’s the summary: I did not feel like a writer, but I was sure that I wanted to become one. I thought of myself in some limbo of becoming, but I was optimistic about that, planning to commit some time to the process, and reading Stephen’s King’s On Writing to help me get started.
I’m not all that ashamed to say that I didn’t find as much time as I had hoped. The pressures of medical school can be overwhelming, and Andrew moved here. I did write a couple of pieces last year, but I didn’t commit to it the way that I had intended to when I was writing that blog entry. Such is life. There’s nothing to do but move forward.
This past weekend, I did a whole bunch of moving forward. At the AMSA Writer’s Institute, I had that fire lit under my ass again. It’s a much more powerful flame this time because it came stoked by a community of other talented and inspired people who, like me, want to find a way to fit writing into a medical career. I was ready, once again, to commit to figuring it out, to think about becoming a writer. I wrote the beginnings of a couple pieces that I think might come to something. I had great conversations with a couple of physician writers about how they have made it work in their lives and how to develop my craft. I met some amazing colleagues whose writing I’m sure we’ll all be reading for years into the future. By the third full day, I was totally sold. I was inspired and excited and motivated as I have never been before. This was it, I thought, I am really going to become a writer.
Then there was a moment when Dr. Sayantani DasGupta challenged that idea of becoming. She stood in front of the room, beautiful and passionate, and told us all that we were already writers. I’m paraphrasing here, but she assured us that we were not baby writers, nor apprentice writers, not people that wanted to become writers at some point in the future, but writers. Certainly we could and should develop in the craft, but that development was the development of a writer, not the development into a writer. She told us that we had to claim the title, all the better to be able to use it.
It took me right back to that blog entry from so long ago, and it blew all those ideas about the process of becoming right out of my mind. And for the best I think, because now I have no more excuses. I have, as one of the other participants wrote in his blog on MedScape this week, crossed from “should” to “will.” There is no more, “If I want to be a writer I should find more time to work.” That sentence doesn’t make sense anymore. There is a new imperative.
I am a writer. There is nothing left to do but write.
And damn, doesn’t that feel good?
If you choose not to read it (and that’s fine by me) here’s the summary: I did not feel like a writer, but I was sure that I wanted to become one. I thought of myself in some limbo of becoming, but I was optimistic about that, planning to commit some time to the process, and reading Stephen’s King’s On Writing to help me get started.
I’m not all that ashamed to say that I didn’t find as much time as I had hoped. The pressures of medical school can be overwhelming, and Andrew moved here. I did write a couple of pieces last year, but I didn’t commit to it the way that I had intended to when I was writing that blog entry. Such is life. There’s nothing to do but move forward.
This past weekend, I did a whole bunch of moving forward. At the AMSA Writer’s Institute, I had that fire lit under my ass again. It’s a much more powerful flame this time because it came stoked by a community of other talented and inspired people who, like me, want to find a way to fit writing into a medical career. I was ready, once again, to commit to figuring it out, to think about becoming a writer. I wrote the beginnings of a couple pieces that I think might come to something. I had great conversations with a couple of physician writers about how they have made it work in their lives and how to develop my craft. I met some amazing colleagues whose writing I’m sure we’ll all be reading for years into the future. By the third full day, I was totally sold. I was inspired and excited and motivated as I have never been before. This was it, I thought, I am really going to become a writer.
Then there was a moment when Dr. Sayantani DasGupta challenged that idea of becoming. She stood in front of the room, beautiful and passionate, and told us all that we were already writers. I’m paraphrasing here, but she assured us that we were not baby writers, nor apprentice writers, not people that wanted to become writers at some point in the future, but writers. Certainly we could and should develop in the craft, but that development was the development of a writer, not the development into a writer. She told us that we had to claim the title, all the better to be able to use it.
It took me right back to that blog entry from so long ago, and it blew all those ideas about the process of becoming right out of my mind. And for the best I think, because now I have no more excuses. I have, as one of the other participants wrote in his blog on MedScape this week, crossed from “should” to “will.” There is no more, “If I want to be a writer I should find more time to work.” That sentence doesn’t make sense anymore. There is a new imperative.
I am a writer. There is nothing left to do but write.
And damn, doesn’t that feel good?
On Blogging Anew
Well, here it goes.
I was thinking about it before this weekend, which was spent in DC at the AMSA Writer's Institute, and now there is nothing to do but jump in, I am actually going to be updating this blog.
In the spirit of keeping myself honest... I'll tell you all right now, I'm committing to writing three posts every two weeks. You should expect something new every five days or so. You should not expect me to blog the week of the wedding, because I am trying to be ambitious, but I am not dilusional. It would make me excited to have followers, so feel free to link up.
It's going to be about medicine, and research, medical school and writing, and who knows what else. I'll try to make everything readable to a general audience. I'll probably double post some book review type things here and in bookworming. I am always open to questions, comments, and ideas for things that you think I should be writing about or responding to. The email link works if you don't want to post it for the world to see. Let's make this interactive. Sweet.
I've taken down just about everything that I had posted here before when this was a more personal and experimental space, except for the post below on "The Neverending Reading Train" because, while we're being honest, I just plain like that one.
And with that, we're off.
I was thinking about it before this weekend, which was spent in DC at the AMSA Writer's Institute, and now there is nothing to do but jump in, I am actually going to be updating this blog.
In the spirit of keeping myself honest... I'll tell you all right now, I'm committing to writing three posts every two weeks. You should expect something new every five days or so. You should not expect me to blog the week of the wedding, because I am trying to be ambitious, but I am not dilusional. It would make me excited to have followers, so feel free to link up.
It's going to be about medicine, and research, medical school and writing, and who knows what else. I'll try to make everything readable to a general audience. I'll probably double post some book review type things here and in bookworming. I am always open to questions, comments, and ideas for things that you think I should be writing about or responding to. The email link works if you don't want to post it for the world to see. Let's make this interactive. Sweet.
I've taken down just about everything that I had posted here before when this was a more personal and experimental space, except for the post below on "The Neverending Reading Train" because, while we're being honest, I just plain like that one.
And with that, we're off.
Tuesday, July 14, 2009
The Never Ending Reading Train
The AMSA Book Discussion group is scheduled to read The House of Hope and Fear: Life in a Big City Hospital for discussion on July 24. This is mostly amusing because the book is not scheduled to be released until August 1. I admit, those of us that read in medical school are an efficient bunch, but even we can't read things before we get them. If I was determined to have Dr. Young, the author as one of the speakers in this series, I might have suggested waiting until the book actually came out, or using her earlier book, What Patient's Taught Me: A Medical Student's Journey but who am I to judge. (In all fairness, that book could be awful, I haven't read it yet, but it's coming to me with love from the Cincinnati Public Library, so I'll let you know.)
Instead, it seems like the discussion is going to focus on writing in general (apparently including a writing exercise) and a JAMA article she wrote a couple of years ago "The Hospitalist's Story" JAMA, Nov 1, 2006, vol 296, pp 2067-68. That article, thankfully, is available now (at least to those of us who have easy access to JAMA).
I can't actually attend this webinar, because when it takes place I will be in Colorado for the MD/PhD conference. I'm a little bummed about this, because I feel like the discussion that involves a writing exercise might be the one that I would most enjoy, but I don't think that there's anything that I can do about it except hope that I can access it online after the fact. Such is the life of a busy person.
I did download the article though, it's interesting enough, about working with patients with chronic illness who seem to use the emergency room and the hospital as their primary (and in many cases, only) healthcare, and the frustrations that come with treating indigent patients, and with people dying from things that should be treatable or preventable with good primary care that they seem unwilling or unable to access. Nothing revolutionary, but generally interesting.
What I really want to talk about though is not the article. Instead I would like to take you inside my head for a moment and talk about a little problem that I like to call "The Never-Ending Reading Train."
My interaction with this article provides an excellent example of this particular issue that I have with life. Here's how it happens:
1.) I get the email about this book discussion webinar, glance at it, realize that I can't attend, but because I am thinking about taking the reins on getting groups together to talk about medical humanities at school, I decide to see if I can get the book from the library.
2.) I run a search for the book on the library webpage, don't find it, but do find another by the same author, which I place on hold before I go back to the email to see how recently the actual discussion book came out. I notice that it's not out yet, and that instead they'll be discussing the article.
3.) I go to PubMed find the article, download it and take a look. The pdfs of articles from JAMA have an extra title page, and this one has a feature which I have never noticed, under the topics listing, there is a link which reads "Contact Me when new articles are published on this topic" which in this case happens to be "Humanities."
4.) I click on this link, thinking that it will be glorious if JAMA emails me when they are going to print interesting things. I am taken to a page where I am able to select from a LONG list all the topics that I would like automatic emails about. Reading down the list, I choose all the topics that seem particularly likely to produce blog or discussion/debate worthy articles (ethics, policy, humanities), as well as my particular areas of medical interest, psychiatry and neurology. The resulting list is not a short one. Subscrbe.
5.) I go back to the article, read it, and then realize that it is a part of a recurring series "A Piece of My Mind" which seems to be short essay type articles about a number of issues in medicine, just the sort of thing that I like.
6.)I run a PubMed Search for the article series, and begin looking through the past options to see if any are particularly interesting.
7.)I read the first paragraphs of six or seven, all the way through 5 others, and download three that I think I might want to come back to in blogging or reflection.
So what's happened here? I got an email, and that email has led me to two books, five or six articles read, four actually downloaded articles, three blog entry ideas and a subscription to email lists that will inevitably lead to hundreds more articles and emails just like the one that started all this.
This is not an isolated incident. I think that if I stopped what I was doing right now, and committed to reading, full time, for the next five years, I still wouldn't get through my current, "To Read" pile. Maybe not ten years, maybe not for the rest of my life. And for someone that wants to write, I find the writing portion of the deal sometimes doesn't happen, gets lost in my idea that I need to read EVERYTHING on a topic before I can write ANYTHING. I don't think that it's a good way to go, but it has it's advantages. I found wonderful books and very interesting articles on the third or fourth cars of one of these trains of thought. And I would be lying if I claimed not to enjoy the process… but where's the limit? Or where should it be?
Or course, if I knew the answer to that question, my browser window might not be complicated by two New York Times articles in tabs kept open for possible future blogging. My list of library books might be much shorter, but I also might be missing things that have really spoken to me.
I'm not sure how to balance it, because there's not enough time in the world, and this really is the prime example of how my particular road to my particular hell (the ring of always, always feeling like I am behind) is paved with the very best of intentions.
I am reminded of Italo Calvino's If On a Winter's Night a Traveler (one of my favorite books of all time) and a quotation that I will have to hunt down later that pretty much sums it up.
Which reminds me, I'd like to read the rest of Calvino...
Instead, it seems like the discussion is going to focus on writing in general (apparently including a writing exercise) and a JAMA article she wrote a couple of years ago "The Hospitalist's Story" JAMA, Nov 1, 2006, vol 296, pp 2067-68. That article, thankfully, is available now (at least to those of us who have easy access to JAMA).
I can't actually attend this webinar, because when it takes place I will be in Colorado for the MD/PhD conference. I'm a little bummed about this, because I feel like the discussion that involves a writing exercise might be the one that I would most enjoy, but I don't think that there's anything that I can do about it except hope that I can access it online after the fact. Such is the life of a busy person.
I did download the article though, it's interesting enough, about working with patients with chronic illness who seem to use the emergency room and the hospital as their primary (and in many cases, only) healthcare, and the frustrations that come with treating indigent patients, and with people dying from things that should be treatable or preventable with good primary care that they seem unwilling or unable to access. Nothing revolutionary, but generally interesting.
What I really want to talk about though is not the article. Instead I would like to take you inside my head for a moment and talk about a little problem that I like to call "The Never-Ending Reading Train."
My interaction with this article provides an excellent example of this particular issue that I have with life. Here's how it happens:
1.) I get the email about this book discussion webinar, glance at it, realize that I can't attend, but because I am thinking about taking the reins on getting groups together to talk about medical humanities at school, I decide to see if I can get the book from the library.
2.) I run a search for the book on the library webpage, don't find it, but do find another by the same author, which I place on hold before I go back to the email to see how recently the actual discussion book came out. I notice that it's not out yet, and that instead they'll be discussing the article.
3.) I go to PubMed find the article, download it and take a look. The pdfs of articles from JAMA have an extra title page, and this one has a feature which I have never noticed, under the topics listing, there is a link which reads "Contact Me when new articles are published on this topic" which in this case happens to be "Humanities."
4.) I click on this link, thinking that it will be glorious if JAMA emails me when they are going to print interesting things. I am taken to a page where I am able to select from a LONG list all the topics that I would like automatic emails about. Reading down the list, I choose all the topics that seem particularly likely to produce blog or discussion/debate worthy articles (ethics, policy, humanities), as well as my particular areas of medical interest, psychiatry and neurology. The resulting list is not a short one. Subscrbe.
5.) I go back to the article, read it, and then realize that it is a part of a recurring series "A Piece of My Mind" which seems to be short essay type articles about a number of issues in medicine, just the sort of thing that I like.
6.)I run a PubMed Search for the article series, and begin looking through the past options to see if any are particularly interesting.
7.)I read the first paragraphs of six or seven, all the way through 5 others, and download three that I think I might want to come back to in blogging or reflection.
So what's happened here? I got an email, and that email has led me to two books, five or six articles read, four actually downloaded articles, three blog entry ideas and a subscription to email lists that will inevitably lead to hundreds more articles and emails just like the one that started all this.
This is not an isolated incident. I think that if I stopped what I was doing right now, and committed to reading, full time, for the next five years, I still wouldn't get through my current, "To Read" pile. Maybe not ten years, maybe not for the rest of my life. And for someone that wants to write, I find the writing portion of the deal sometimes doesn't happen, gets lost in my idea that I need to read EVERYTHING on a topic before I can write ANYTHING. I don't think that it's a good way to go, but it has it's advantages. I found wonderful books and very interesting articles on the third or fourth cars of one of these trains of thought. And I would be lying if I claimed not to enjoy the process… but where's the limit? Or where should it be?
Or course, if I knew the answer to that question, my browser window might not be complicated by two New York Times articles in tabs kept open for possible future blogging. My list of library books might be much shorter, but I also might be missing things that have really spoken to me.
I'm not sure how to balance it, because there's not enough time in the world, and this really is the prime example of how my particular road to my particular hell (the ring of always, always feeling like I am behind) is paved with the very best of intentions.
I am reminded of Italo Calvino's If On a Winter's Night a Traveler (one of my favorite books of all time) and a quotation that I will have to hunt down later that pretty much sums it up.
Which reminds me, I'd like to read the rest of Calvino...
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