Medical Black Humor, that is Neither Funny nor Appropriate.

19 09 2011

Last week, I happened to see this Facebook post of the The Medical Registrar where she offends a GP, Anne Marie Cunningham*, who wrote a critical post about black medical humor at her blog “Wishful Thinking in Medical Education”. I couldn’t resist placing a likewise “funny” comment in this hostile environment where everyone seemed to agree (till then) and try to beat each other in levels of wittiness (“most naive child like GP ever” – “literally the most boring blog I have ever read”,  “someone hasn’t met many midwives in that ivory tower there.”, ~ insulting for a trout etc.):

“Makes no comment, other than anyone who uses terms like “humourless old trout” for a GP who raises a relevant point at her blog is an arrogant jerk and an unempathetic bastard, until proven otherwise…  No, seriously, from a patient’s viewpoint terms like “labia ward” are indeed derogatory and should be avoided on open social media platforms.”

I was angered, because it is so easy to attack someone personally instead of discussing the issues raised.

Perhaps you first want to read the post of Anne Marie yourself (and please pay attention to the comments too).

Social media, black humour and professionals…

Anne Marie mainly discusses her feelings after she came across a discussion between several male doctors on Twitter using slang like ‘labia ward’ and ‘birthing sheds’ for birth wards, “cabbage patch” to refer to the intensive care and madwives for midwives (midwitches is another one). She discussed it with the doctors in question, but only one of them admitted he had perhaps misjudged sending the tweet. After consulting other professionals privately, she writes a post on her blog without revealing the identity of the doctors involved. She also puts it in a wider context by referring to  the medical literature on professionalism and black humour quoting Berk (and others):

“Simply put, derogatory and cynical humour as displayed by medical personnel are forms of verbal abuse, disrespect and the dehumanisation of their patients and themselves. Those individuals who are the most vulnerable and powerless in the clinical environment – students, patients and patients’ families – have become the targets of the abuse. Such humour is indefensible, whether the target is within hearing range or not; it cannot be justified as a socially acceptable release valve or as a coping mechanism for stress and exhaustion.”

The doctors involved do not make any effort to explain what motivated them. But two female anesthetic registrars frankly comment to the post of Anne Marie (one of them having created the term “labia ward”, thereby disproving that this term is misogynic per se). Both explain that using such slang terms isn’t about insulting anyone and that they are still professionals caring for patients:

 It is about coping, and still caring, without either going insane or crying at work (try to avoid that – wait until I’m at home). Because we can’t fall apart. We have to be able to come out of resus, where we’ve just been unable to save a baby from cotdeath, and cope with being shouted and sworn at be someone cross at being kept waiting to be seen about a cut finger. To our patients we must be cool, calm professionals. But to our friends, and colleagues, we will joke about things that others would recoil from in horror. Because it beats rocking backwards and forwards in the country.

[Just a detail, but “Labia ward” is a simple play on words to portray that not all women in the "Labor Ward" are involved in labor. However, this too is misnomer.  Labia have little to do with severe pre-eclampsia, intra-uterine death or a late termination of pregnancy]

To a certain extent medical slang is understandable, but it should stay behind the doors of the ward or at least not be said in a context that could offend colleagues and patients or their carers. And that is the entire issue. The discussion here was on Twitter, which is an open platform. Tweets are not private and can be read by other doctors, midwives, the NHS and patients. Or as e-Patient Dave expresses so eloquently:

I say, one is responsible for one’s public statements. Cussing to one’s buddies on a tram is not the same as cussing in a corner booth at the pub. If you want to use venting vocabulary in a circle, use email with CC’s, or a Google+ Circle.
One may claim – ONCE – ignorance, as in, “Oh, others could see that??” It must, I say, then be accompanied by an earnest “Oh crap!!” Beyond that, it’s as rude as cussing in a streetcorner crowd.

Furthermore, it seemed the tweet served no other goal as to be satirical, sardonic, sarcastic and subversive (words in the bio of the anesthetist concerned). And sarcasm isn’t limited to this one or two tweets. Just the other day he was insulting to a medical student saying among other things:“I haven’t got anything against you. I don’t even know you. I can’t decide whether it’s paranoia, or narcissism, you have”. 

We are not talking about restriction of “free speech” here. Doctors just have to think twice before they say something, anything on Twitter and Facebook, especially when they are presenting themselves as MD.  Not only because it can be offensive to colleagues and patients, but also because they have a role model function for younger doctors and medical students.

Isolated tweets of one or two doctors using slang is not the biggest problem, in my opinion. What I found far more worrying, was the arrogant and insulting comment at Facebook and the massive support it got from other doctors and medical students. Apparently there are many “I-like-to-exhibit-my-dark-humor-skills-and-don’t-give-a-shit-what-you think-doctors” at Facebook (and Twitter) and they have a large like-minded medical audience: the “medical registrar page alone has 19,000 (!) “fans”.

Sadly there is a total lack of reflection and reason in many of the comments. What to think of:

“wow, really. The quasi-academic language and touchy-feely social social science bullshit aside, this woman makes very few points, valid or otherwise. Much like these pages, if you’re offended, fuck off and don’t follow them on Twitter, and cabbage patch to refer to ITU is probably one of the kinder phrases I’ve heard…”

and

“Oh my god. Didnt realise there were so many easily offended, left winging, fun sponging, life sucking, anti- fun, humourless people out there. Get a grip people. Are you telling me you never laughed at the revue’s at your medical schools?”

and

“It may be my view and my view alone but the people who complain about such exchanges, on the whole, tend to be the most insincere, narcissistic and odious little fuckers around with almost NO genuine empathy for the patient and the sole desire to make themselves look like the good guy rather than to serve anyone else.”

It seems these doctors and their fans don’t seem to possess the communicative and emphatic skills one would hope them to have.

One might object that it is *just* Facebook or that “#twitter is supposed to be fun, people!” (dr Fiona) 

I wouldn’t agree for 3 reasons:

  • Doctors are not teenagers anymore and need to act as grown-ups (or better: as professionals)
  • There is no reason to believe that people who make it their habit to offend others online behave very differently IRL
  • Seeing Twitter as “just for fun” is an underestimation of the real power of Twitter

Note: *It is purely coincidental that the previous post also involved Anne Marie.





How a Valentine’s Editorial about Chocolate & Semen Lead to the Resignation of Top Surgeon Greenfield

27 04 2011
Children's Valentine in somewhat questionable ...

Image via Wikipedia

Dr. Lazar Greenfield, recently won the election as the new President of  ACS (American College of Surgeons). This position would crown his achievements. For Greenfield was a truly pre-eminent surgeon. He is best known for his development of an intracaval filter bearing his name. This device probably has saved many lives by preventing blood clots from going into the lungs. He has been highly productive having authored more than 360 scientific articles in peer-reviewed journals, 128 book chapters as well as 2 textbooks.

Greenfield also happened to have a minor side job as the editor-in-chief of Elsevier’s Surgery News. Surgery News is not a peer-reviewed journal, but what Greenfield later defines as a monthly throw-away newspaper (of the kind Elsevier produces a lot).

As an-editor-in chief Greenfield wrote open editorials (opinion pieces) for Surgery News. He found a very suitable theme for the February issue: Valentine’s day.

Valentine’s Day is about love, and the editorial was about romantic gut feeling possibly having a physiological basis. In other words, the world of  sexual chemical signals that give you butterflies-feelings. The editorial jumps from mating preferences of fruit flies, stressed female rotifers turning into males and synchronization of menstrual cycles of women who live together, to a study suggesting that “exposure” to semen makes female college students less depressed. All 4 topics are based on scientific research, published in peer review papers.

Valentines Day asks for giving this “scientific” story a twist, so he concludes the editorial as follows:

“So there’s a deeper bond between men and women than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates.”

Now, everybody knows that that conclusion ain’t supported by the data.
This would have required at least a double-blind randomized trial, comparing the mood-enhancing effects of chocolate compared to …….  (yikes!).

Just joking, of course…., similar as dear Lazar was trying to be funny….

No, the editorial wasn’t particularly funny.

And somehow it isn’t pleasant to think of a man’s love fluid wrapped in a ribbon and a box with hearts, while you expect some chocolates. Furthermore it suggests that sperm is something a man just gives/donates/injects, not a resultant of mutual love.

However this was the opposite of what Greenfield had in mind:

The biochemical properties of semen that were reviewed have been documented in peer-reviewed journals and represent the remarkable way that Nature promotes bonding between men and women, not something demeaning.”

Thus the man just tried to “Amuse his readers” and highlight research on “some fascinating new findings related to semen.”

I would have appreciated a more subtle ending of the editorial, but I would take no offense.

….Unlike many of his fellow female surgeons.  The Women in Surgery Committee and the Association of Women Surgeons considered his editorial as “demeaning to women” (NY-Times).

He offered his sincere apologies and resigned as Editor-in-Chief of the paper. The publication was retracted. As a matter of fact the entire February issue of Surgery News was taken off the ACS-website. Luckily, Retraction Watch published the editorial in its entirety.

Greenfield’s apologies weren’t enough, women surgeons brought the issue to the Board of Regents, who asked him to resign, which he eventually did.

A few weeks later he wrote a resentful letter. This is not a smart thing to do, but is understandable for several reasons. First, he didn’t he mean to be offensive and made his apologies. Second, he has an exemplary career as a longtime mentor and advocate of women in surgery. Third, true reason for his resign wasn’t the implicit plead for unprotected sex, but rather that the editorial reflected “a macho culture in surgery that needed to change.” Fourth, his life is ruined over something trivial.

Why can’t one write a lighthearted opinion-piece at Valentine’s day without getting resigned? Is it because admitting that “the “bond between men and women” is natural and runs deep” is one of those truths you cannot utter (Paul Rahe).

Is this perhaps typically American?

Elmar Veerman (Dutch Journalist, science editor at VPRO) comments at at Retraction Watch:

(…) Frankly, I don’t see the problem. I find it rather funny and harmless. Perhaps because I’m from Europe, where most people have a more relaxed attitude towards sex. Something like ‘nipplegate’ could never happen here (a nipple on tv, so what).  (…) I have been wondering for years why so many Americans seem to think violence is fine and sex is scary.

Not only female surgeons  object to the editorial. Well-known male (US) surgeons “fillet” the editorial at their blogs: Jeffrey Parks at Buckeye Surgeon ( 1 and 2), Orac Knows at Respectful Insolence (1 and 2) and Skeptical Scalpel (the latter quite mildly).

Jeffrey and Orac do not only think the man is humorless and a sexist, but also that the science behind the mood-enhancing aspects of semen is crap.

Although Jeffrey only regards “The “science” a little suspect as per Orac.”…. Because of course: “Orac knows.”

Orac exaggerates what Greenfield has said in the “breathtakingly inappropriate and embarrassing article  for Surgery News”, as he calls it. [1]:  “Mood-enhancing effects of semen” becomes in Orac’s words  the cure for female depression and  “a woman needs a man to inject his seed into her in order to be truly happy“.
Of course, it is not fair to twist words this way.

The criticism of Orac against the science that supports Dr. Greenfield’s joke is as follows: The first two studies are not related to human biology and the semen study” is “about as lame a study as can be imagined. Not only is it a study in which causation is implied by correlation, but to me the evidence of correlation is not even that compelling.”  

Orac is right about that. In his second post Orac continues (in response to the authors of the semen paper, who defend Greenfield and suggest they had obtained “more evidence”):

(..)so I was curious about where they had published their “replication.” PubMed has a wonderful feature in which it pops up “related citations” in the right sidebar of any citation you look up. I didn’t recall seeing any related citations presenting confirmatory data for Gallup et al’s study. I searched PubMed using the names of all three authors of the original “semen” study and found no publications regarding the antidepressant properties of semen since the original 2002 study cited by Dr. Greenfield. I found a lot of publications about yawning and mental states, but no followup study or replication of the infamous “semen” study. color me unimpressed” [2](..)

Again, I agree with Orac: the authors didn’t publish any confirmatory data.
But looking at related articles is not a good way to check if related articles have been published: PubMed creates this set by comparing words from the title, abstract, and MeSH terms using a word-weighted algorithm. It is goal is mainly to increase serendipity.

I didn’t have time to do a proper Pubmed search, which should include all kinds of synonyms for sperm and mood/depression. I just checked the papers citing Gallups original article in Google Scholar and found 29 hits (no Gallop papers indeed), including various articles by Costa & Brody i.e. the freely available letter (discussing their research): Greater Frequency of Penile–Vaginal Intercourse Without Condoms is Associated with Better Mental Health. This letter was a response to an opposite finding by the way.

I didn’t look at the original articles and I don’t really expect much of it. However, it just shows the Gallop study is not the only study, linking semen to positive health effects.

Assuming Greenfield had more than a joke in mind, and wanted to reflect on the state of art of health aspects of semen, it surprises me that he didn’t dig any further than this article from 2002.

Is it because he really based his editorial on a review in Scientific American from 2010, called “An ode to the many evolved virtues of human semen” [3,4], which describes Gallup’s study and, strikingly, also starts with discussing menstrual synchrony.

Greenfield could have discussed other, better documented, properties of semen, like its putative protection from pre-eclampsia (see references in Wikipedia)[5]

Or even better, he could have cited other sexual chemical signals that give you butterflies-feelings, like smell!

In stead of “Gut Feelings” the title could have been “In the nose of the beholder” or “The Smell of Love” [6].

And Greenfield could have concluded:

“So there’s more in the air than St. Valentine would have suspected, and now we know there’s a better gift for that day than chocolates: perfume.

And no one would have bothered and would have done with the paper as one usually does with throwaways.

Notes

  1. Coincidentally, while reading Orac’s post I saw a Research Blogging post mentioned in the side bar: masturbation-and-restless-leg-syndrome. …Admittedly, this was a friday-weird-science post and a thorough review of a case study.
  2. It would probably have been easier to check their website with an overview of publications
  3. Mentioned in a comment somewhere, but I can’t track it down.
  4. If Greenfield used Scientific American as a source he should have read it all to the end, where the author states: I bid adieu, please accept, in all sincerity, my humblest apologies for what is likely to be a flood of bad, off-color jokes—men saying, “I’m not a medical doctor, but my testicles are licensed pharmaceutical suppliers” and so on—tracing its origins back to this innocent little article. Ladies, forgive me for what I have done.”
  5. Elmar Veerman has written a review on this topic in 2000 at Kennislink: http://www.kennislink.nl/publicaties/sperma-als-natuurlijke-bescherming (Dutch)
  6. As a matter of fact these are actual titles of scientific papers.




An Educator by Chance

13 10 2010

The topic of the oncoming edition of the blog carnivalMedical Information Matters“, hosted by Daniel Hooker, is close to my heart.

Daniel at his call for submissions post:

I’d love to see posts on new things you’re trying out this year: new projects, teaching sessions, innovative services. Maybe it’s something tried and true that you’d like to reflect on. And this goes for anyone starting out fresh this term, not just librarians!

When I started as a clinical librarian 5 years ago, I mainly did search requests. Soon I also gave workshops as part of evidence based practice courses.

Our library gave the normal library courses PubMed, Reference Manager etc. We did little extra for medical students. There was a library introduction at the beginning and a PubMed training at the end of the curriculum.

Thus, when the interns had to do a CAT (Critically Appraised Topic), they had to start from SCRATCH ;) : learn the PICO, domains, study types, searching the various databases.  After I gave  a dozen or so 1-hour long introductions to consecutive interns, repeating the same things over and over, I realized this was an ineffective use of time. So I organized a monthly CAT-introduction with a computer workshop. After this introduction I helped interns with their specific CAT, if necessary.

This course is appreciated very much and  interns usually sigh: “why didn’t we learn this before?! If we had known this…”, etcetera.

Thus we, librarians, were very enthusiastic when we got more time in the newly organized curriculum.

We made e-learning modules for the first year, two for the second year, a Pubmed-tutorial, and a computer workshop (150 min!). In the 4th year we grade the CATs.

The e-learning modules costed me tons of time. If you read the post “How to become a big e-learning nerd by mistake” at Finite Attention Span you understand why.

We used a system that was designed for exams. On my request the educational department embed the system in a website, so students could go back and forth. Lacking any good books on the topic, students should also be able to reread the text and print whatever they liked.

I was told that variation was important. Thus I used each and every of the 10 available question types. Drop down menus, clickable menus, making right pairs of terms etc. Ooh and I loved the one I used for PICO’s, where you could drag words in a sentence to the P, I, C or O. Wonderful.

Another e-learning module consisted largely of Adobe Captivate movies. As  described in the above mentioned post:

Recognise that you are on a learning curve. First of all, it is vital that your software does not always remind you to save individual files before closing the program. It is especially helpful if you can demonstrate this three times inside a week, so that you end up losing the equivalent of about two days’ work: this will provide you with a learning experience that is pretty much optimised.

Swear. Vigorously.

Become a virtuoso of the panic-save, performing Ctrl+S reflexively in your sleep, every three minutes (…)

Correcting the callouts and highlight boxes and animation timings so they don’t look like they were put together by committee is complicated. Also, writing really clear, unambiguous copy takes time.

It sounds familiar. It also regularly happened to me that I started with the wrong resolution. Then I heard afterwards: “Sorry, we can only use 800×600.”

But workshops are also time-consuming. Largely because the entire librarian staff is needed to run 30 workshops within a month (we have 350 students per year). Of course it didn’t end with those workshops. I had to make the lesson plan materials, had to instruct the tutors, make the time tables, the attendance lists and then put the data into an excel sheet again. I love it!

The knowledge is tested by exams. This year I had to make the questions myself -and score them too (luckily with help of one or two colleagues). Another time buster. The CATs had to be scored as well.

But it is worth all the pain and effort, isn’t it?

Students are sooo glad they learned all about EBM, CATS, scientific literature and searching…

Well, duh, not really.

Some things I learned in the meantime

  1. Medical students don’t give a da do not care much about searching and information literacy.
  2. Medical students don’t choose that study for nothing. They want to become doctors, not librarians.
  3. At the time we give the courses, the students not really need it. Unlike the interns, they do not need to present a CAT, shortly.
  4. Most of our work is undone by the influence of peers or tutors that learn the students all kind of “tricks” that aren’t.
  5. It is hard to make good exams. If the reasoning isn’t watertight, students will find it. And protest against it.
  6. …. Because even more important than becoming a doctor is their desire to pass the exams
  7. If the e-learning isn’t compulsory, it won’t be done.
  8. You can’t  test information literacy by multiple choice questions. It is “soft” knowledge, more a kind of approach or reasoning. Similarly PICO’s are seldom 100% wrong or right. The value of PICO-workshops lies in the discussions.
  9. The students just started their study. They’re mostly teens. These kids will have a completely other attitude after 4 years (no longer yelling, joking, mailing, Facebook-ing, or at least they are likely to stop after you ask).
  10. Education is something I did by chance. I just do it “in addition to my normal work”, i.e. in the same time.
  11. Even more important, I’m a beginner and have had no specific training. So I have to learn it the hard way.

Let me give some examples.

This year I wanted to update one of my modules. I had to, because practically all interfaces have changed the last two years (Think about PubMed for instance).

I made an appointment with the education department, because they had helped me enormously before.

Firstly I noticed that my name had been replaced by those of 3 people who hadn’t done anything (at least with regard to this particular e-learning course). Perhaps not so relevant here. But the first red flag…

The module was moved to another system. It looked much nicer, but apparently only allowed a few of those 10 types of questions. The drag and drop questions, I was so fond of, were replaced by irritating drop down menus. With the questions I made, it didn’t make sense.

The movies couldn’t be plaid fast forward, back or be stopped.

And the girl who I spoke to, a medical student herself, couldn’t disguise her dislike of the movies. First she didn’t like the call-outs and highlight boxes, she rather liked a voice (me speaking, deleting the laborious call-outs ?!). Then she said the videos were endless and it was nicer when the students could try it themselves (which was in fact the assignment). She ignored my suggestion that Adobe is suitable for virtual online training.

Then someone next to her said: Do you know “Snag-it”, you can make movies with that too!?

Do I know Snag-it? Yes I do. I even bought it for my home computer. But Snag-it is nowhere near Adobe Captivate, at least regarding call-outs and assembly. I almost mentioned Camtasia, which is from the same company as Snag-it, but more suitable for this job.

Then the girl said the movies were only meant to show “where to press the buttons”, which I repeatedly denied: those movies were meant to highlight the value of the various sources. She also suggested that I should do some usability testing, not on my colleagues, but on the students.

Funny how insights can change over times. The one who helped me considered it one of the best tutorials.

While talking to her, it stroke me that the movies were taking very long and I wondered whether each single call-out saying “press this” was functional. Perhaps she was right in a way. Perhaps some movies should be changed into plain screenshots (which I had tried to avoid, because they were so annoying Powerpoint like). If my aim wasn’t that students learned which button to press, why show it all the time?? (perhaps because Adobe shows every mouse click, it is so easy to keep it in..)

It is a long way to develop something that is educative, effective and not boring….

But little by little we can make things better.

Last year one of the coordinators proposed not to take an exam the first year but give an assignment. The students had to search for an original study on a topic in PubMed (2nd semester) and write a summary about it (3rd semester). The PubMed tutorial became compulsory, but the two Q & A sessions (with computers) were voluntary. Half of the students came to those sessions. And the atmosphere was very good. Most students really wanted to find a good study (you could only claim an article once). Some fished whether the answers were worth the full 4 points and what they had to do to get it. The quality of the searches and the general approach were quite good.

In good spirits I will start with updating the other modules. The first should be finished in a few days. That is… if they didn’t move this module to the next semester, as the catalog indicates.

That would be a shame, because then I have to change all the cardiology examples into pulmonology examples.

Gosh!…. No!!

Credits

The title is inspired by the  post “How to become a big e-learning nerd by mistake”.
Thanks to Annemarie Cunningham (@amcunningham on Twitter) for alerting me to it.

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Stories [8] How Not to Reassure (or Treat) a Patient

23 08 2010

The host of the next edition of the Grand Rounds is Fizzziatrist at A Cartoon Guide to Becoming a Doctor. Thus it is no surprise that the theme of this edition is “Humor in Medicine”. The Fizzziatrist:

When I host Grand Rounds, I will post the links in order of how many times each one made me go “ha!” (…) It’s all quite scientific.

Well that’s a tough job. First both as a medical librarian and  a patient, I’m not in the situation to experience a lot of the humorous aspects of a doctors job. Furthermore I’m not the HA-HA-HA LOL-REAL SCREAM type. I’m more of the smile and the grin.

So what to do? I hope you find the following enjoyable. And perhaps many little ha’s do make one big HA.

——————–

How not to reassure (or treat) your patients (own experience)

My GP (the leading character in this story; he resembles a bull in a china shop, sometimes, but other than that, he is o.k.)

  • At one of my first visits he was trying to (manually) find the card of my husband. 
    When he thought he found it, he muttered:
    “that old guy?”
    Apparently he had mistaken my father (I still had my maiden name) for my partner.
    Lucky (both for me and my gp)  he was wrong. But how embarrassing if he
    had been right.

    wikipedia (CC)

  • Once I phoned him for I don’t know what and he said:
    “I’m not seeing  you often”
    “Why, is that bad?”
    “Well, it is exceptional”
    “Exceptional?”
    “Yes, I see women of your age regularly”

    “For what kind of disease, if I may ask”.
    “Well, the flu .. and for pill or IUD-controls”
    [sneering] “Sure, but I’m never seriously ill and I have a gynecologist for the latter”.
  • When I was pregnant of my second child, I phoned him for a prescription for anti-Rh antibodies, which I needed for prenatal testing. Since I hadn’t visited my gynecologist after my first child, and the hospital nurses had assured me that gp’s and midwives normally prescribed, this should not be a problem.
    I began: “I’m a few weeks pregnant and ….”
    He interrupted me, confused: “but that..….. but ….. you were pregnant a few months ago“.
    He was half right. I had had a miscarriage then. (Dang! A heavy blow)
    After a curt explanation, I hung up.
  • Later he phoned me back (with a thin excuse) and I asked him for the anti-Rh antibodies, but he just didn’t get it.
    Ask your  midwife”.
    “But I don’t have a midwife”
    “Everyone has got a midwife, nowadays”
    “No, I got a gynecologist”
    “Then  ask your gynecologist”
    “But  I’m not his patient anymore”
    “Then ask him to be your doctor again”
    “But I need the prescription right now“.

    I tried to convince him in vain. He finally mumbled something like: That is of my beat, I don’t do pregnancies and deliveries anymore.
    [luckily one phone call to the gynecologists' wife was enough to get the prescription. She passed the message immediately, and said that if I liked him to take care of me again, it was best to make an appointment soon after the test.]
  • My gp had the same attitude another time.  I had signs of a Addison crisis. I tried to explain to him what might be wrong. He asked one or two things, shrugged and then said: “You better make an appointment with your specialists. This disease is beyond my practice.”
    At the time it seemed ok to me, but my endocrinologist said it was irresponsible: “Suppose he wouldn’t immediately refer someone with an acute crisis: that could be fatal. [I was hospitalized in this case, but it was not that urgent] See also “the Doctor and the Patient”
The Doctor, by Sir Luke Fildes (1891)

Image via Wikipedia

My gynecologist/obstetrician [a friend of mine recommended him, because he was kind and puts you at ease. It really is a wonderful doctor, and after all those deliveries he still considered birth a miracle. However, his way of reassuring was not always effective]. 

  • March 31, late afternoon: “It is time to get your baby ( 2,5 weeks post-term), but we better postpone it for two days. It is not such a nice day to celebrate the child’s birthday, don’t you think” (meaning April Fools day)
  • When I had my first check-up he warmed the speculum, trying to break the ice with some humor: “they do warm the cutlery for each course at the Chinese”, don’t they?
    (I found it rather tasteless, but remained silent: he meant it well)
  • When we discussed where I would deliver, he said that that would be in his hospital. I sighed with relief. As any new mother I was nervous about it.
    But he didn’t want me to have false expectations:
    Of course I hope I can personally deliver your baby. However, the chances are real that someone else will be around at that time. But believe me, if the moment is there, you don’t care who stands at the foot of your bed. Even if it is a gorilla..”

My Dentist (the best, most skillful, pleasant dentist there is, but still ….  a dentist)

  • Once, just finished drilling, she said carefully: “Don’t be scared when you look into the mirror….. I just touched your tongue”.

This concludes my experiences.  If you would like to read more serious stuff about “how (not) to reassure”, then you can read this old article The Art Of Reassurance (PDF) or this recent blog post at « HealthSkills WeblogIs reassurance reassuring?

One main advise (from the latter blog):

Never reassure a patient about something they are not already worried about. It would be a mistake, for example, to earnestly reassure patients that they do not have cancer when the thought had never entered their minds!”

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#Friday Foolery 19: #Funnydoctornames

12 03 2010

Last Tuesday I went to my dentist named Joy and I tweeted:

  1. Laika (Jacqueline)
    laikas Although my dentist’s name is Joy and although she is the best dentist in the world, going to the dentist is still not my favorite thing!

Within no time other people (doctors, healthcare workers as well as librarians) responded to this tweet with their own funny Doctor-names.
Doc_rob even
created the hashtag #funnydoctornames. Searching for this hashtag, I found tweets I had missed, because they were directed to doc_rob and not to me.

Below some of the tweets, oldest ones first:

  1. Laika (Jacqueline)
    laikas Although my dentist’s name is Joy and although she is the best dentist in the world, going to the dentist is still not my favorite thing!
  2. martha
  3. doc_rob
    doc_rob @laikas We had a cardiologist named Dr. Killam.
  4. Claire Hayward
    EnableOT @doc_rob @laikas – my husband works with Dr Evill!
  5. Claire Hayward
    EnableOT @laikas @doc_rob at school I was taught by german teacher Herr Cutts!
  6. Jenny Reiswig
    bmljenny @laikas I worked at a place where there was a Dr. Medline. I thought that was pretty hilarious.
  7. doc_rob
    doc_rob I heard of a proctologist named Ben Dover, but that may have been fictitious. #FunnyDoctorNames
  8. Matthew Bowdish MD
    MatthewBowdish @doc_rob I know a gastroenterologist named Dr Bowlus #funnydoctornames
  9. kevin johnson
    dockj @doc_rob #FunnyDoctorNames We had a resident, Dr. Merlo rotating with Dr. Pino. Fortunately not many Pediatric patients needed Detox.
  10. Sarah Vogel
    sevinfo @laikas A friend goes to a dentist called Dr. Jolly

this quote was brought to you by quoteurl

Doc_rob (although mentioning Bend-Over as proctologist) warned: “Just not the obvious urologist names… #FunnyDoctorNames!
But of course these are the most hilarious. Symtym for instance points at a funny story regarding vasatomy featuring Dr. Donald Snyder, an urologist and dr Dick Chopper, a surgeon. Medpiano immediately mentioned Dr Seaman, the urologist, while  Doc_Rob himself linked to a whole page with funny medical names, listed per discipline. Like:

  • OB/GYN: Dr. Wiwi, Dr Ono; , Dr Fillerup (as in fill-her-up), Dr Dildy; Dr Cherry, Dr Love, Dr Semen, Dr In Hur, Dr Bunn, Dr Hooker, Dr Finger, Dr Cocks, Dr Nippel, Dr Beaver (3), Dr Biggerstaf
  • GI: Dr. Puppala, Dr Butt
  • Surgeons: Dr Cutts, Dr Slaughter (3), Dr Kutteroff, Dr Butcher
  • Urology: Dr Peter Poor , Dr Waterhouse and Dr Dick Finder
  • Psychs: Dr Alter, Dr Brain, Dr Strange, Dr Moodie, Dr Nutt, Dr Crabb, Dr Dement
  • Pediatricians:  Dr Jelley; Dr Small,  Dr Tickles,  Dr Sno White, Dr Toy, Dr Kidd (4 )

Of course there are many other lists on the Internet like this one. But the above list is very thorough and is preceded by a list of references pertaining to “Research into nominative determinism”. This may not be surprising as the list was started by Kathy Tacke, a Library Manager, on the MEDLIB-List.

Know any other funny medical/doctor names? Please tell me!

———————

Voor Nederlanders: wij hebben natuurlijk ook heel grappige doktersnamen. Mijn vorige tandarts heette bijv. Dr Snijders (en als marinier deed hij zijn naam eer aan). Mijn ex-collega heette dr. Quack. En Beenhakker is ook een naam die veelvuldig voorkomt onder orthopeden & chirurgen. Hier is een NL-lijst met wat namen, zoals

  • Dr. I.L. Boor, Dr. Snoep, Dr. Vulinghs (Tandarts)
  • Dr. Knipscheer, Dr. Lips, Mevr. Ooievaar (Gyneacoloog, vroedvrouw)
  • Dr. Kortleve
  • Dr. Plasmans, van den Fonteyne, Daisy Dratatie (uroloog)
  • Dr. Zuur (Scheikundige)
  • Drs. Pillen (apotheker)

Kent u meer grappige namen van mensen uit de gezondheidszorg, zeg het mij!

Dr Wiwi; Dr Blessing (FP with OB sideline), Dr Ono; Dr Risk, Dr Fear, Dr Yell, Dr Lecher, Dr Dibble, Dr Fillerup (as in fill-her-up), Dr Hyman, Dr C. Surgeon, Dr Risk, Dr Beavers, Dr Polke, Dr Jamm, Dr Boddy (pronounced body, “bawdy”); Dr Dildy; Dr Cherry, Dr Love (many Loves, especially the partnership Drs. Love and Nerness), Dr B. Savage, Dr Dickman, Dr Pillow, Dr Fear; Dr Fingerhut.; Dr Popp, Dr Spoon, Dr Hyman, Dr Bush, Dr Kuntz, Dr Pap, Dr Storck, Dr Kum, Dr Semen, Dr In Hur, Dr Hatch.; Dr Heinie.; Dr Bunn, Dr Wiwi, Dr Dick, Dr Grab, Dr Catching, Dr Gass, Dr Handwerker, Dr Born, Dr Angel, Dr Sunshine, Dr Fagnant, Dr Hatcher, Dr Hooker, Dr Finger, Dr Cocks, Dr Nippel, Dr Lipps, Dr Payne, Dr Beaver (3), Dr Biggerstaf




LOCA Congress for Interns – LOCA co-assistenten congres

14 05 2009

movir
Last Sunday I was an invited speaker at a national congress for interns, the LOCA congress. LOCA stands for “Landelijk Overleg Co-Assistenten”.

This congress has been initiated to facilitate the contact between interns of all Dutch universities and to cover in depth subjects that usually don’t get much attention.

The LOCA congress offered a diverse program, varying from “minimal invasive and maximal effective surgery”, “memory training” and “a dirty mind is a joy forever”. You can see the program here (Saturday; Sunday).

The previous event I gave a Search Workshop, this time the subject was “Medicine 2.0″.

I didn’t realize in advance that this wasn’t a convenient day. First it was Mother’s day. My children weren’t pleased that I wouldn’t be around. Furthermore I had to prepare an Evidence Based Searching day the following Monday and several other workshops that week. Still, Sunday morning we spent together in the garden eating home made smoothies and muffins that my eldest daughter L made, with on them in colors: “Mama blog”, “L X M”, “Laika twitter”, “Success”,  etcetera, which illustrates how they see me now.

Despite  that I had 40 min. instead of the expected 60 min., and just about half of the workshop subscribers (it was a very sunny day) showed up, I found it a pleasant workshop. Mostly because the audience was very interested and interactive. Within those 40 minutes, however, I could only touch upon some aspects, giving most emphasis to the web 2.0 tools which can be used in daily practice by medical professionals to find information (social networking sites, RSS also in Pubmed, personalized home pages, blogs and wiki’s)

40 minutes is short and I promised the interns to provide them with some information afterwards.

I’m too busy at the moment with my regular job, but I expect that the promised information will be available within 1-2 weeks at:

But I won’t withhold a series of tweets (Twitter messages)  specifically directed to the interns of this workshop. You can view the tweets labeled with #MOVIR, here at Visibletweets. They have been tweeted by doctors, a patient, a nurse and a physiotherapist. Please see them all, the first tweets are shown last.





Appropriate bedside manners

14 05 2008

Do you prefer a doctor that is crying at the bedside or rather one that stays calm and keeps at a professional distance???

My previous post on Etiquette Based Medicine also dealt with ‘correct’ attitudes of doctors towards their patients. Here I quoted Dr. Khan who believes that “patients may care less about whether their doctors are reflective and empathic than whether they are respectful and attentive”. His opinion is shared by many, but certainly not by all. I allready cited a British Journal of General Practice issue on doctor-patient communication, where different viewes were presented. Well, the debate is still ongoing. In the NY Times of 22nd April was a interesting piece about physicians crying at the bedside: At Bedside, Stay Stoic or Display Emotions? [*requires registration].

Some excerpts:

“A young doctor sat down with a terminal lung cancer patient and her husband to discuss the woman’s gloomy prognosis. The patient began to cry. Then the doctor did, too.

At a recent meeting of the Society of General Internal Medicine, Dr. Anthony D. Sung of Harvard Medical School and colleagues reported that 69 percent of medical students and 74 percent of interns said they had cried at least once.

In the 1988 PBS documentary “Can We Make a Better Doctor?” a Harvard medical student, Jane Liebschutz, sees her patient unexpectedly die during a cardiac bypass operation. She suddenly bursts into tears and wanders away from her colleagues until the chief surgeon, who has witnessed what happened, assures her that her response was natural.

Dr. Benita Burke, skipped lunch to spend extra time with her cancer patients. They dubbed this time “mental health rounds,” during which they could address issues that were not strictly medical. Many times, Dr. Burke would wind up in tears or giving an embrace.

The comments in the NY Times and at two blogs (DB’s Medical Rants and Clinical Cases and Images) are also worth reading. These responses illustrate that there is not one truth. Whether strong emotions like crying are appropriate depends on the doctor, the patient, the situation and where and how emotions are expressed. Most patients do not seem to appreciate outright crying at their bedside as it makes them insecure. A crying doctor might also feel like a final verdict: no hope is left. But nobody would blame an intern for crying with his or her mates. And a doctor who cries in front of the patient’s family when sharing information about a serious medical error might help to accept what happened.

So, what kind of doctor would you prefer?

I agree with Dr Hiram Cody, cited in the NY Times, who cautions against excess emotions. Although Dr. Cody emphasizes the need for doctors “to understand, to sympathize, to empathize and to reassure,” he says his job “is not to be emotional and/or cry with his patients for two reasons: It is not therapeutic for the patient, and it will cause “emotional burnout”. (although I’m not sure about the latter)

Personally I prefer a doctor with great knowledge, but openminded to other ideas, attentive and empathic, but without loosing a certain distance, a good listener, explaining disease and treatment options, ….. but no crying, please, never! Never when I’m around. Not when I’m the patient.

****************************************************

NL flagToevallig kwam ik in mijn Feed-Reader een bericht tegen uit de New York Times van 22 april, dat perfect aansluit op mijn vorige post over Etiquette Based Medicine: At Bedside, Stay Stoic or Display Emotions? [*registratie vereist].

Dit stuk bespreekt de voor en tegens van een dokter die zich “laat gaan”.

Enkele citaten:

A young doctor sat down with a terminal lung cancer patient and her husband to discuss the woman’s gloomy prognosis. The patient began to cry. Then the doctor did, too.

At a recent meeting of the Society of General Internal Medicine, Dr. Anthony D. Sung of Harvard Medical School and colleagues reported that 69 percent of medical students and 74 percent of interns said they had cried at least once.

In the 1988 PBS documentary “Can We Make a Better Doctor?” a Harvard medical student, Jane Liebschutz, sees her patient unexpectedly die during a cardiac bypass operation. She suddenly bursts into tears and wanders away from her colleagues until the chief surgeon, who has witnessed what happened, assures her that her response was natural.

Dr. Benita Burke, skipped lunch to spend extra time with her cancer patients. They dubbed this time “mental health rounds,” during which they could address issues that were not strictly medical. Many times, Dr. Burke would wind up in tears or giving an embrace.

Behalve dit stuk zijn ook de commentaren in de NY-times zelf en op 2 blogs (DB’s Medical Rants en Clinical Cases and Images) de moeite van het lezen waard. Diverse meningen passeren de revue, zowel die van dokters als patiënten of familie. Hieruit blijkt dat er niet één waarheid is. Of het uiten van heel sterke emoties kàn, hangt erg af van de dokter, de patient, hun relatie en de situatie. De meeste patienten vinden het uiten van emoties wél belangrijk (“een dokter moet geen robot zijn”), maar velen vinden te sterke emoties zoals het in huilen uitbarsten waar de patient bijstaat niet prettig, omdat ze juist willen dat ze op hun arts kunnen steunen. Gaat het om een heel slechte boodschap (kanker bijvoorbeeld) dan kan de patient het ook ervaren dat hij opgegeven is: de arts neemt alle hoop dan in een keer weg. Maar als een co-assistent bij het overlijden van zijn/haar “eerste” patient bij haar vrienden uithuilt kan iedereen dat begrijpen. Als een dokter huilt wanneer hij slecht nieuws brengt over een dierbare ten gevolge van een medische fout, dan kan dat bij de verwerking helpen.

Maar welke dokter zou jij verkiezen?

Ik ben het in grote lijnen met Dr Hiram Cody eens. In de NY Times waarschuwt hij tegen overmatige emoties. Hij benadrukt weliswaar dat artsen begripvol moeten zijn, moeten meeleven, empathisch moeten zijn en gerust moeten stellen, maar echt emotioneel zijn en huilen raadt hij af omdat het noch de patient noch de arts goed doet.

Persoonlijk verkies ik een arts met een goede kennis van zaken, maar die wel openstaat voor andere opvattingen, die meeleeft en empathisch is wanneer nodig. Hij moet goed kunnen luisteren, mij serieus nemen, goed kunnen uitleggen waarom ik iets heb en welke behandelingsmogelijkheden er zijn (met hun voor-en nadelen). Hij moet eerlijk zijn en als ik het nodig zou hebben is een beetje emotie en een beetje warmte prettig. Maar huilen, nee. Geen huilen waar ik bij ben. Niet wanneer ik de patient ben.








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