Something of utility

As the new year looms, I'm pondering how exactly to best approach this blog, and whether to continue with attempts to post things (this past year having been something of a posting desert). I do think it may be of some benefit, inasmuch as I need to be pushed to try and write things on a regular basis. We shall see.

In the interim, this site has a list of Gmail tips from Google that provide some excellent approaches to making your labors more efficient. Really good stuff for those who use gmail.

On the patient as person

Intern year staggers to an end, and perhaps with the constant rainfall outside, my ideas will blossom with words well-suited to harvest and display here upon the internet. We shall see.

One thought this morning relates to our relations with patients. As many are aware already, the health care system spends a significant amount of time dealing with people as patients, as complex amalgamations of disease, physical exam findings, and medications rather than as people proper. As any who have experienced this as a patient know, this is not how people wish to be viewed.

This trend is not because of health care providers, but rather in spite of our best efforts, and often is something we can and do forestall with our actions. Yet the system is set up to keep us from relating to people as people-in part because it is admittedly easier to deliver medical care (in the driest sense of the term) when this is your approach.

More thoughts on how to fight this in the months to come, I'm sure-throughout this year I've found that talking to patients about their social history, i.e., themselves, is a great way to round out their picture, as well as to make me genuinely invest in them. Another just thought of this morning-why do we invariably refer to people in our write-ups as "77 yo male" or the like? I do not know or claim that this will make a crushing difference...but I am going to try to remember from here on out to start the "history of present illness" and "assessment and plan" sections of my notes with " is a year old..."

A small step, undoubtedly. But perhaps a useful one.

On birthdays

The best gift for this birthday is having it during my vacation. Which allows me time to sleep and think and ponder. I have been on the wards for 6 months, with 3 2-day weekends and one 5-day holiday at New Year's. The length of time without time has begun to sink in somewhat.

I wrote to my grandmother early today that I'm spending it (in part) thinking upon and thanking those who've helped shape me into my present self. They are legion in number, a fact that is both intimidating and pleasing, to think of the infinite mosaic of self to which so many have given a piece.

I'm pleased to have already seen many of my STL friends this trip; I look forward to catching some further folks in LA and SF before I go back to the people awaiting me in Boston. Friends, teachers, and patients alike.

thoughts post-code in the early AM

I feel my experience over the year best comes out in my confidence, in the tone I can adapt with my patients and in my presentations while comfortable in their diagnoses and my knowledge of management. The beginning of internship was marked with stuttering thoughts and intermittent withdrawals of diagnosis and prognosis, with lesson quickly learned that I should not make to bold a claim without carefully checking first.

Now, I can muster up "the doctor" in compelling and convincing form, slipping into the role with the certainty of someone much better at the job that my self of 9 months past.

It is nice to see some progress.

Neat idea

http://googleblog.blogspot.com/2009/03/google-health-helping-you-better.html

Sort of a Facebook for health information. If well protected, an excellent notion...

Reminder of Burning Man

http://www.vimeo.com/3430164

An example of talented people at work. Amazing to see, and a good reminder of the other uses of time people have...

Words

Bouncing from Italo Calvino to "8 Mile," I'm struck by the similarity between the two wildly different projects. It's the appeal of the smoothly executed step crossed with the mystique of painter's eye, both a product of the self as well as part of it, a section of the extended phenotype. Too, the mastery of the thing to hear the flow or read the well-wound suspense.

Both excellent works, brimming with excellent words.