Friday, April 8, 2016

Quiz Apr12

Doubling up today, don't overlook the April 7 quiz below.

1. (T/F) Atul Gawande says mortality, or the human experience of aging, frailty, & dying, was covered in Med School.

2. What did Gawande and his cohort "pay [their] medical tuition to learn about"?

3. Where did most deaths occur in the mid-20th century? Where now?

4. Is the ability to travel one of the Independent Activities of Daily Living?

5. How have communications technologies impacted the way the elderly are regarded?

6. What does AG say we now venerate more than maturity?

What books most influenced your decision to become a doctor, and your approach to medicine? Who are your favorite physician-writers?

I have so many: Anton Chekhov, Sir Arthur Conan Doyle, John Keats, Walker Percy. Mikhail Bulgakov was famous for “The Master and Margarita,” but his “Country Doctor’s Notebook” is fascinating, too. So is William Carlos Williams’s “Doctor Stories.” When I was in medical school, a trio of doctors who’d come out with nonfiction books around that time awoke me to the concrete, practical idea that one could be both a physician and attempt to write seriously: Oliver Sacks, Sherwin Nuland and Abraham Verghese. I reread Lewis Thomas constantly. Richard Selzer’s essays on his life as a surgeon — for instance, “Mortal Lessons,” “Confessions of a Knife” and “Letters to a Young Doctor” — can seem overwritten, but they have stayed with me for years now. These writers all transcend the term “physician-writers.” They’re just writers, telling us about the experience of being human.

What book would you most recommend to an aspiring doctor today?

Tolstoy’s “The Death of Ivan Ilyich.” It’s the best portrayal of sickness and suffering I have ever read — minutely observed, difficult and still true a century and a quarter later. Continue reading the main story

...His new book, “Being Mortal,” is a personal meditation on how we can better live with age-related frailty, serious illness and approaching death.
It is also a call for a change in the philosophy of health care. Gawande writes that members of the medical profession, himself included, have been wrong about what their job is. Rather than ensuring health and survival, it is “to enable well-being.” (continues)

DQ

  • Should socioeconomics and race be included in the medical curriculum? Should medical faculty include ethicists, sociologists etc.? Or can it be presumed that interpersonal skill and sensitivity will be adequately addressed at the undergraduate level, so long as entry-level exams address them?
  •  Do you agree with AG's self-assessment regarding his and his colleagues' care of Mr. Lazaroff? 5
  • Where do you expect to die? Where do want to die? To what extent is it a proper concern of medical professionals to accommodate patients' wishes in this regard?
  • What's your view of elderly people undertaking dangerous daily activities (like riding a horse) "because it's important to them"? Where would you draw the line?  (What if it's important to grandpa to drive?) Has this been an issue in your extended family?
  • Are you nostalgic or envious towards the kind of old age AG's grandfather had? 20
  • What would you recommend, if Alice were your patient? 24


Ken Burns/Siddhartha Mukherjee, Cancer: The Emperor of all Maladies
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Health/nyt
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"Being Mortal" on Frontline

ABC's "Frontline" program featured Atul Gawande's Being Mortal. Watch it here.

THE LATEST

What Matters Most to You in the End?


We want to hear from you: What would you do if your time became short?

A Link Across Generations


The prolonged dying process of his own father was one of the catalysts for Dr. Atul Gawande to better understand end-of-life care.

Why Is It So Hard for Doctors to Talk to Patients About Death?


When a young mother was terminally ill, Dr. Atul Gawande offered advice to give her family hope. In “Being Mortal,” he says he now regrets it.

How Should Doctors Help Terminally Ill Patients Prepare for Death?


“You don’t have to spend much time with the elderly or those with terminal illness to see, over and over and over again, how medicine fails the people it is supposed to help,” says renowned surgeon and author Dr. Atul Gawande.

Atul Gawande has joined distinguished company - Bertrand Russell, Arnold Toynbee, Robert Oppenheimer, and J.K. Galbreath et al - with his Reith Lectures, commencing with "Why Do Doctors Fail?"

Surgeon and writer Atul Gawande explores the nature of fallibility and suggests that preventing avoidable mistakes is a key challenge for the future of medicine.
Through the story of a life-threatening condition which affected his own baby son, Dr. Gawande suggests that the medical profession needs to understand how best to deploy the enormous arsenal of knowledge which it has acquired. And his challenge for global health is to address the inequalities in access to resources and expertise both within and between countries.
This first of four lectures was recorded before an audience at the John F Kennedy Presidential Library and Museum in Dr. Gawande's home town of Boston in Massachusetts. The other lectures are recorded in London, Edinburgh and Delhi.
Previous Reith Lectures

NY Review of Books (@nybooks)
Marcia Angell on getting old, and on choosing when to die j.mp/1wbDL6v


Our bodies age. As members of the kingdom of animals, we inherit a biology that grows less efficient with time. Glitches and injuries accumulate. Our youthful form is lost, and our aged one is gained.
By dint of fear of change, the innate sexual attractiveness of younger bodies, and massive exploitation of both by marketing forces, we feel embarrassed and deprived as our bodies slowly deteriorate.
Not all cultures view aging so negatively. So the bias could be overcome. But how?
  1. Don’t take aging personally. After all, aging happens to everyone, from the beginning of life until its end. And like they say, Growing old beats the alternative! Every person who has ever lived beyond early adulthood has grappled with the changes the years impose. Granted, some people age more slowly than others, but every one of us looks and feels older as time passes. You are not alone.
  2. See aging as Natural. We live in an era when ‘organic,’ ‘all-natural,’ ‘non-GMO,’ ‘cage-free,’ and other eco-marketing catchphrases are used to sell products. Moderns want the growth and harvesting of foodstuffs to proceed naturally. Well, aging is no less aligned with Nature than vegetables cultivated without pesticides; why not embrace growing older the way we embrace organic foods?
  3. Appreciate the gifts of aging. As we grow older, we grow wiser. This isn’t folk mythology; it’s fact. We learn from experience. We find more acceptance in our hearts. We assess our strengths and weakness with more humility and self-compassion. We begin to view circumstances in shades of gray rather than black-and-white. Youthful hunger wanes until we find ourselves valuing what matters over the long run above what feels pleasant in the short run. We care less about personal goals and more about collective ones. To my mind, at least, the gain of gentleness, nuance, and altruism more than compensate for the lessening of passion and militance.
  4. Embrace the big picture. If you listed the names of all 108 billion people who have ever lived, at the rate of one per second, it would take 3,400 years. And the entire human saga has unfolded over just the last 0.005% of the time since life began on this planet. Does it make sense to feel affronted by a body’s aging when so many people (and countless other lifeforms) have endured the same fate, and when the span of even the longest human life barely measures as a single tick on the cosmic clock? Each of us is a unique product of history, but we delude ourselves if we believe our own lives more important than those of all the others. If we identify with Life as it has grown on this planet for billions of years, rather than our personal speck of biology, we gain freedom from the constrictions of daily concerns. We feel opened to a larger world, a larger sense of Self, and the great, beautiful mystery that is Living.
  5. Nurture a sense of humor. It helps to take aging less seriously. Early in 2014 I underwent major surgery. Postoperatively, I was horrified to see how the abdominal muscles I’d been strengthening for years ended up looking scarred and distorted. It helped lessen the sense of grief when I joked about losing my ‘last bastion of sexiness.’ The use of humor has a long history of helping the aged feel less burdened by wrinkles, sags, dribbles, creaks, and farts. Join the fun!
http://blogs.psychcentral.com/childhood-adversity/2014/12/4-ways-to-embrace-aging/
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Being Mortal, which was published in October, is ostensibly about the struggle to cope with the constraints imposed by flesh-and-bone biology—and the failure of medical science to acknowledge that any ability to push back is finite. Gawande's ultimate message, that death in America is not often enough discussed, and that patients suffer at the hands of well-meaning doctors because of it, has been generally celebrated, though not for breaking particularly new ground. His is the basic message for which the late surgeon Sherwin Nuland's How We Diewon a National Book Award 20 years ago; and it's the message of another book released last week, The Conversation, by another Harvard physician, Angelo Volandes. It's a message that has grown extremely loud inside of the health-professional echo chamber, but is somehow still only faintly reverberating into broader culture. 
"I think too many people don't know what's going on behind those closed doors in hospitals," Volandes told me. "But if they did, they'd be outraged. So many people are getting—not costly care—I'm talking about unwanted care..." (continues) 
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New York, New York - Atul!

http://www.newyorker.com/contributors/atul-gawande

Bioethics Centre (@BioethicsCentre)
As hospitals go digital, human stories get left behind [via @ColinGavaghanstatnews.com/2016/04/06/ele…

Bioethics Centre (@BioethicsCentre)
Sexting for your health: patients send genitalia photos, raising legal concerns [via @ColinGavaghantheguardian.com/society/2016/a…

39 comments:

  1. DQ: Should socioeconomics and race be included in the medical curriculum? Should medical faculty include ethicists, sociologists etc.? Or can it be presumed that interpersonal skill and sensitivity will be adequately addressed at the undergraduate level, so long as entry-level exams address them?

    Answer: While I agree that the topics of socioeconomics and race should be offered as undergraduate courses separately, I do not feel that it should be included in the medical curriculum. However, I feel like the option of taking both should be made available to students who would like to take them. Personally, I feel like taking these courses would strengthen my understanding of each and reassure me of issues that I could expect to face in future situations—both in and out of the hospital setting. In regards to the backgrounds of medical faculty, I feel that their inclusion would allow for assistance and teachings from various viewpoints. This would allow for more in-depth understandings of solutions and treatments in both the faculty-student relationship and the student-patient relationship. Also, I do not feel that it is a safe to presume that all undergrad institutions allow equal or some degree of interpersonal and sensitivity—even if entry-level exams address them. While this is more of an individual issue, I feeling that all first time matriculates should be trained in both skills. It was one this to read and understand, but another to read and perform. The latter would allow each student the opportunity to become more aware of their necessities.

    ReplyDelete
  2. Quiz Question: When speaking on the shift between the young and the old, what does Atul Gawande claim to be the most important?

    ReplyDelete
  3. How Do We Heal Medicine? Find out what Atul Gawande has to say about it:

    https://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine?language=en

    ReplyDelete
  4. Watching Out for the Elderlies When Times Call for It

    *Atul Gawande’s book on Being Immortal, touches upon many issues including the ethics of engaging in dangerous acts. In the following report, I will express my views on this issue as it pertains to elderly involvement. These issues have not been directly presented within my family, but that doesn’t make this issue any easier for me to discuss due to the level of ethicality that is involved.

    It is no surprise that the undertaking of risky activities is one that can be thrilling when overcome, but often fatal when human actions do not match up with the level of intensity involved. News reports continually broadcast breaking news coverages of countess cases of individuals who succumb to such chancy activities. These cases do not have to be, and indeed the numbers would decrease if proper precautions were enforced. Whether knowingly or unknowingly, what these individuals fail to realize ahead of time is that, “You only live once”, does not have to apply to engaging in deadly activities.
    When it comes to applying these scenarios to the elderly, many people would agree that their actions are their own—and that removing such opportunities from these individuals is unjust and a sign of ageism. I beg to differ on those who follow this ideal. I feel that if given the opportunity to prevent possible injury or death of these people, proper precautions should be taken in order to wisely avoid worsened predicaments. The notion of letting these deaths potentially occur is rather inhumane. In the case of horse-riding, society—as a whole—understands the risks that are associated with it. Many may argue that this is the case with all activities, just to a varying degree. While I do not dispute this fact, activities such as the aforementioned activity, are among the more dangerous ones if individuals are not carefully trained. Despite how important such actions are to the elderly, I feel that is even more vital that people delve into the potential threats that come at engaging in such activities at a certain ages.
    When driving and rollercoaster riding becomes more important to elderly individuals than their safety, then I feel that intervention is required. Although some individuals, whether young or old, are more qualified drivers than others, I feel that there comes a time when the keys should be restricted from elderlies, even if solely for the greater good of society. However, what makes addressing this issue difficult is the fact that there are a myriad of additional factors that should be examined further, aside from age, to determine if certain elderlies still qualify to drive.
    For one to argue against my views of intervening on the behalf of elder individuals in prevention of risky behaviors means that they support the idea that “regardless of age factors, everyone deserves an equal chance at an opportunity”. But I can’t say that I agree with this idea especially when there are more dangers associated with the activity than rewards. Is it fair to say that an elder should be granted their wish of skydiving or bungee jumping? I do not think so because of all the health complications that could ensue as a result. At the end of the day, the answer to these decisions lie on the elders themselves and those directly involved with offering them risky services. However, I still stand on the notion that society should do its best to prevent the injuries and deaths of these individuals if at all possible.

    ReplyDelete
  5. Quiz Question:

    The French philosopher ________ stated that: "To die of age is a rare, singular, and extraordinary death, and so much less natural than others; it is the last and extremest kind of dying."

    (pg. 32 -- Chapter 2)

    ReplyDelete
  6. What's your view of elderly people undertaking dangerous daily activities (like riding a horse) "because it's important to them"? Where would you draw the line? (What if it's important to grandpa to drive?) Has this been an issue in your extended family?

    I think that it is fine for elderly individuals to partake in exciting daily activities such as riding a horse or jogging through the state park if it is important to them; however, if it is an activity that interferes with or possibly harms the individuals around the elderly person, then, I believe that a line should be drawn and the elderly person should either be prevented in performing their dangerous activity (I.E: Driving while visually impaired) or regulated to the point in which no "accidental" harm can be caused upon other people (even if it is important to grandpa...). Anyways, those are just my thoughts on the topic!

    ReplyDelete
  7. Quiz Question:
    How has modern scientific capability has profoundly altered the course of human life? (pp. 6)

    ReplyDelete
    Replies
    1. “People live longer and better than at any other time in history. ”

      Delete
  8. Discussion Question: Why do you think multiple societies all over the world expect the family members of elders to care for them?

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  9. Here is a link I found from Stanford University in connections with AG discussing what has become of the end of life process in America and how problems of 'medicalized' mortality only continues to rise.

    https://med.stanford.edu/news/all-news/2015/03/gawande-discusses-problems-of-medicalized-mortality-in-the-us.html

    ReplyDelete
  10. I got to thinking about where most people die and started thinking about why most people die. So, I headed over to the WHO website and found this page.

    http://www.who.int/mediacentre/factsheets/fs310/en/

    This page offers charts and statistics on the top ten reasons people died in 2012 and a comparison of leading causes of death over the last decade. It's an interesting read! Heart disease is of course number one.

    ReplyDelete

  11. Where do you expect to die? Where do want to die? To what extent is it a proper concern of medical professionals to accommodate patients' wishes in this regard?

    I expect to die in a hospital, as that is likely where they will take me if I'm not dead once found. Where I would like to die? Well, I'd like to die in a place that will be very difficult to get to. I want everyone to have to go through extreme measures to get to my body and once there, I want it to be extremely difficult to collect my poor corpse. I want it to be an epic adventure for those who must collect me, one they will always remember. I also want my death to be near unexplainable, a great mystery that only the greatest minds can solve. I want my death to vex everyone, so that they really have to work for it. I think they would appreciate my kindness in this matter, giving them such an amazing experience in their chosen career.

    I believe that if a person is dying and cannot be saved, if the doctor can do nothing, they should say do and let the patient do whatever they choose for their last days. After all, they are dying, a doctor should therefore let them live before they die.

    ReplyDelete
  12. Quiz question:

    What have we allowed our fates to be controlled by?

    ReplyDelete
    Replies
    1. “by the imperatives of medicine, technology, and strangers”

      Delete
  13. Here's a little funny quote by Gawande regarding our oppression of the elderly because of our concern for them.
    http://www.macleans.ca/wp-content/uploads/2014/10/mac40_10-theinterview.jpg

    ReplyDelete
  14. DQ:
    How do you expect to deal with patients if/when you become a doctor?

    ReplyDelete
  15. Comment DQ:
    Where do you expect to die? Where do want to die? To what extent is it a proper concern of medical professionals to accommodate patients' wishes in this regard?

    I expect to die either in a hospital after a rush to get there or at home. I want to die at my property in the country that I aquired from my hard work. I expect most likely to die from cancer due to my family history but not until I am at least in my 80's unless something crazy caused my death unexpectedly (air plane jump accident, etc.). I want to live life to the fullest in my own way with my family and friends.
    Doctors should allow patients to die as they wish as long as the results do not physically harm anyone else. They should not be regarded as a science experiment unless that is their true wish and decision.

    ReplyDelete
  16. DQ: Are you nostalgic or envious towards the kind of old age AG's grandfather had?

    I think it would be ideal to live long with lots of family around you and meeting all your needs, but as Gawande argues, this is not reasonable in our modern society. On the other hand, other forms of living while free and assisted, as discussed later in the book, are a nice alternative too.

    ReplyDelete
  17. Quiz question: Who popularized the term "retirement community"?

    ReplyDelete
  18. Weird Deaths:
    These are ways that I do not expect to die.
    http://www.oddee.com/item_98556.aspx

    ReplyDelete
  19. DQ:What's your view of elderly people undertaking dangerous daily activities (like riding a horse) "because it's important to them"? Where would you draw the line? (What if it's important to grandpa to drive?) Has this been an issue in your extended family?
    I am currently dealing with this issue somewhat. My grandmother is 76 years old and lives alone, she still drives herself around but not often, which we are thankful for, but it still worries me. The reason I'm worried is because she is not as sharp as she once was, this is evident when we play cards, and a drop in mental acuity could cause her to potentially wreck, we all know what horrible drivers are on the roads. As the youngest in the family I don't want to tell her to stop driving all together but I don't see how much safer she can get.

    ReplyDelete
  20. DQ: What's your view of elderly people undertaking dangerous daily activities (like riding a horse) "because it's important to them"? Where would you draw the line? (What if it's important to grandpa to drive?) Has this been an issue in your extended family?

    Answer: I do not agree with elderly people undertaking dangerous daily activities. It is important for anyone, not only the elderly, to protect themselves to the best of their ability. If the risk is small, then I believe that person should be able to continue to do what they enjoy; however I do not agree with a 90 year old man riding a horse because if he were to fall, he may not be able to recover. I encountered a situation related to this in my own family. My grandmother is 67 years old and she loves to ride bikes. A few years ago we saw no real risk, so we allowed her to ride her bike in peace. However, after two knee replacements, the thought of my grandmother on a bike in the woods worried my family. So, as an alternative, we suggested that she invest in a indoor bike. She loved the idea and all of our minds are at ease.

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  21. Here is a blog post by Daryn Eller on embracing aging that I enjoyed.

    http://www.oprah.com/style/Crows-Feet-and-Wrinkles-How-to-Embrace-Aging

    ReplyDelete
  22. Discussion Question

    Is it important to you to be pitied "as [you] wish to be pitied"? Is that something you seek to do for others?

    ReplyDelete
  23. Quiz Question

    What tormented Ivan Ilyich most?

    ReplyDelete
    Replies
    1. “was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and he only need keep quiet and undergo a treatment and then something very good would result”

      Delete
  24. Where do you expect to die? Where do want to die? To what extent is it a proper concern of medical professionals to accommodate patients' wishes in this regard?

    I don't know about the locale, but I expect to die in action, even if it's just reading a book. The prospect of waiting for death does not suit me. Either I will be able to continue doing the things I love or it is time to let go. I suppose the same goes for the second question. This is how I want to do. If I could choose the place, though, I would probably pick home in my reading chair or on the beach. A hospital is simply not an option.
    I am not a medical professional nor do I have any desire to be one. However, I think some responsibility for the patient's wishes must be acknowledged. If the person doesn't want to die in the hospital, this is a simple and deserved right. Doctors shouldn't get to make that decision for them. Occasionally, of course, people get grandiose ideas and believe they are exempt from rule due to their terminal status. The doctor should not have to endanger his/her medical license or provide services beyond basic necessary care. Respecting wishes is one thing, taking on the responsibility of making them come true is entirely another.

    ReplyDelete
  25. DQ: What's your view of elderly people undertaking dangerous daily activities (like riding a horse) "because it's important to them"? Where would you draw the line? (What if it's important to grandpa to drive?) Has this been an issue in your extended family?

    I believe that this should be allowed on certain conditions. I think that those who are considered chronologically "elderly" should be not held back physically or socially simply due to this fact as I know some people in their 60's that are more active and able bodied than their younger peers. However, if the individual clearly is not healthy enough to safely complete or participate in the particular task or could potentially endanger others then I think the answer is clear. With that being said, I think we would say this about any individual not just the elderly. My mother had had an experience with late grandfather on her side of the family concerning driving which was a due to his inability to drive without the potential endangerment of other drivers.

    ReplyDelete
  26. This is a game i recently came to know about called the knockout game where kids will randomly try to knockout a random person with a single punch. This video is of a 72 year old victim which reminded me of the disregard for elderly wisdom pointed out in the reading. link below

    https://www.youtube.com/watch?v=TNASEz19feA&nohtml5=False

    ReplyDelete
  27. Quiz Question:
    Who was Sitaram and about how old was he when he died?

    ReplyDelete
  28. Quiz Question: Who wrote illness as metaphor?

    Article Zika Virus: http://www.bbc.com/news/world-us-canada-36020165

    ReplyDelete
  29. Lee Gish and Phillip Shackelford
    Discussed different ways to die and weird ways death is observed.

    ReplyDelete
  30. Heather Deal, Sarah Bratcher, Addison Riverbank
    We discussed hospice at home vs. in the hospital. We decided that it would be more intimate and easier on the family to let go if it was done at home

    ReplyDelete
  31. Group Report with Jocelyn

    We discussed the question about where we expected to die and linked that with Gawanda's perspective on Ivan Ilyich. We both want our opinions to be respected as his were not. And neither of us want to die in a hospital.

    ReplyDelete
  32. Where do you expect to die? Where do want to die? To what extent is it a proper concern of medical professionals to accommodate patients' wishes in this regard?

    I personally want to die in a peaceful area around those I love. I would prefer not to be a burden to those I love while still staying comfortable and void of all pain as much as possible.

    ReplyDelete
  33. Should socioeconomics and race be included in the medical curriculum? Should medical faculty include ethicists, sociologists etc.? Or can it be presumed that interpersonal skill and sensitivity will be adequately addressed at the undergraduate level, so long as entry-level exams address them?

    I think it is important that all medical professionals be aware of the troubles od different socioeconomic classes. It is the same reason so many schools are pushing the need for psychology and sociology, so that professionals better understand the needs of different types of people.

    ReplyDelete
  34. Our (large) discussion group discussed the various ways in which we may want to die.

    ReplyDelete