Cell 2 Soul: The Humane Health Care Blog

Opportunities Missed

All patients deserve to be treated as family
July 30, 2007
Special to The Times,By James Channing Shaw
...diagnosis is not yet established. Too often, the real cause of the problem is recognized only in retrospect. James Channing Shaw, a dermatologist at the University of Toronto, is a writer of medicine-related essays and the author of "The Quotable Robertson...  Download J.Shaw.pdf

Canna Lillies -- Nature's Miracles

Okay, so I'm obsessed with these amazing canna lilies at every stage of their growth and development.  Another twisted leaf bud, set in a perfectly arrayed nest of leaves with its shadow observing its growth.  The other, a flower bud, no twists on this part of the plant, growing 6 inches a day, hiding the colorful contents of its huge and showy bloom that will one day unfurl and reveal itself.  One of Nature's miracles.  Awesome, isn't it?  -- Elaine Adler (Lexington, MA)

Our friend, the master gardener, Wayne Winterrowd of Readesboro, Vermont wrote:
"Are you really sure you want to ask me about cannas?  That would be something similar to asking a dermatologist to tell everything he knows about acne or photodermatitis or something like that, whatever that something may be.  Well, then, here goes.  You did ask for it!  To read Wayne's comments click  Download Canna.pdf

Tacit knowledge in Medicine

Author: Rakesh Biswas

Following an article presented in NEJM:

Oscar the Cat Predicts Patients' Deaths

http://www.sun-sentinel.com/features/health/sns-ap-death-cat,0,713126.story

http://content.nejm.org/cgi/reprint/357/4/328.pdf

It demonstrates the usage of tacit knowledge in medicine, in this particular instance in a cat.

It reminded me of tales of physicians/seers of yore who were said to have predicted not only their patient deaths but also their own deaths right down to the last minute and would generally choose to depart in style surrounded by their initially disbelieving relations.

Off course this may not be generalized to all physicians and this particular cat too needed to have been gifted to have found its place in nejm (unless he was as success theorists like to believe just being at the right place at the right time).

In recent times another mention of tacit knowledge in physicians (Greenhalgh T, British Journal of General Practice, May 2002 395) particularly with reference to predicting patient death has been made by a well known author physician and the paper also raises issues on EBM as EBM is definitely a way of reducing over-reliance on tacit knowledge in physicians:

That night, I went home and told my husband that I had
seen a man who was going to die. He did indeed die, four
days later, despite normal bloods and observation chart
throughout. Postmortem showed a strangulated volvulus.
This story raises a number of questions about the appropriate
clinical management of the patient in hospital, but I
include it here to show that intuitive insights are commonplace
in general practice, and they may or may not save
lives. They are rarely as impressive as the one I first heard
quoted by Professor Nigel Stott (and which I subsequently
analysed in detail1) from a GP in Cardiff: 'I got a call from a
lady saying her three-year-old daughter had had diarrhoea
and was behaving strangely. I knew the family well, and was
sufficiently concerned to break off my morning surgery and
visit immediately.'
This GP's hunch led him to diagnose correctly, and treat
successfully, a case of meningococcal meningitis on the
basis of two non-specific symptoms reported over the
phone — an estimated 'hit rate' for that particular GP of one
in 96 000 consultations, and a veritable tour de force for clinical
intuition. The intuitive judgements we make on a daily
basis in clinical practice are generally less dramatic but no
easier to explain on a rational level.

I wonder if EBMers would like to comment on this parallel movement and is there a possibility of developing an experimental design to study these phenomena in medicine?

On Cats

In the past week  both Newsweek and the New England Journal of Medicine have published interesting pieces on cats (see below).  This got us to thinking.  If you have some spare moments, please follow the links.

Dogs have masters.  Cats have staff.  Anonymous  and more quotes:

Christopher Smart "on his cat Jeoffrey" from Jubilate Agno (1762)  Download christopher_smart.pdf

Here's another fine poem, this one harkening back to C. Smart and Jeoffrey:  Wild Gratitude by
by Edward Hirsch about his cat, Zooey.  Hirsch finally understands that
It is Jeoffrey—and every creature like him—
Who can teach us how to praise—purring
In their own language,
Wreathing themselves in the living fire.  Download wild_gratitude.pdf


Saving my cat:  why no price was too high by Frederick R. Lynch
Newsweek July 30, 2007 issue - I recently paid $11,000 in veterinary bills for my cat, Fritz. I've been hesitant to tell friends about this expenditure, which I know seems extravagant. But after hearing a radio financial guru answer questions from two callers about tapping their 401(k) accounts for veterinary bills, I realized I am not alone.  Download newsweek_cat.pdf

A Day in the Life of Oscar the Cat by David Dosa, New England Journal of Medicine
Oscar the Cat has had an uncanny ability to predict when [nursing home] residents are about to die. Dr. David Dosa describes a day in the life of Oscar. Download cat_nejm.pdf

Before we away from home, our Cat, "Chi," lies on an article of clothing or in an open suitcase.  She knows we are leaving and it seems to center her to be in contact with clothing.  Go figure?

A Doctor's Prayer

If I can stop one Heart from breaking
I shall not live in vain
If I can ease one Life the Aching
Or cool one Pain

Or help one fainting Robin
Unto his Nest again
I shall not live in Vain.

                           Emily Dickinson

A little learning...

A little learning is a dangerous thing;
Drink deep, or taste not the Pierian spring:
There shallow draughts intoxicate the brain,
And drinking largely sobers us again.

                                       Alexander Pope

80 yo Man/750 m. bike race

This August, 80 year-old LeRoy Varga, a retired engineer from New Jersey, will take a bike ride. It’s known as the Paris-Brest-Paris Randonneur, and it begins outside Versailles, then winds through the French countryside to the port city of Brest and back to Paris. It covers 750 miles. It has to be completed in 90 hours.

To read the article in the NY Times, please click on Download varga_bike_ride.pdf .

After the Shock

Jane Brody of the NY Times features Jessie Gruman's new book, "Aftershock: What to do when the doctor gives you -- or someone you love -- a devastating diagnosis" in her July 3, 2007 column. She writes: "I consider this book so valuable I plan to keep it on my bedside table should I need it later on. Its recommendations are based not just on the author’s experiences with illness, but also on interviews with more than 250 others: patients, family members, nurses, doctors, health plan administrators, managers of busy practices and nonprofit leaders."  To read Brody's article click on Permalink.

The following was taken from the Amazon site:  "With her first book, social psychologist Gruman (founder and and president, Center. for the Advancement of Health ) aims to empower patients, and those close to them, with practical and well-organized information about how to use the first few days after a serious medical diagnosis to help those involved make the right decisions for themselves. This is a very sensitively written book, with patient concerns always central and information arranged to avoid overwhelming the reader. Gruman uses various interesting points of view expressed by experts in the field, as well as her own personal experiences, to illustrate key issues and ideas, which helps to confirm that there is no one right way to react to a diagnosis. The mix of topics covered in the ten chapters and eight appendixes includes the factual "Finding the Right Doctor and Hospitals" and a chapter called "Involve Others," which covers interpersonal issues. Highly recommended for all public library and consumer health collections." -Elizabeth J. Eastwood, Mesa P.L., Los Alamos, NM, Library Journal

Schweitzer on Service

Almost 20 years ago, Dr. Art Brownstein passed this inspiring Schweitzer quote along to me.  I transcribed it and printed it out.  It sits on a window sill above my office desk.  Every few days, a patient reads it and remarks how much it means to them.  I wish I remembered to read it every day, since it heps one to be a better and more caring physician.

Thomas Wolfe

Which of us is not forever a stranger and alone?

For more quotes from Thomas Wolfe's "Look Homeward Angel" please click: Download look_homeward_angel.pdf