September Round-Up (Medical Student gems)

Youtube Channel: Vsauce

It has to be the most interesting video channel on the internet. Michael Stevens the main host has become an internet personality and star as a result of his fascinating channel, in fact Vsauce now is spread over four channels on Youtube; Vsauce1 (linked above), Vsauce2 (hosted by Kevin Lieber), Vsauce3 (dedicated to virtual worlds and Wesauce. There are often videos about medical themes or ancient medical practises for those looking for most medically related content. I absolutely love this channel and it never fails to leave me in a completely pensive state about the universe or nature of things. 

Book: Doctors Dissected

Doctors dissected is an incredibly honest insight into the lives of Doctors. Jane Haynes (a psychotherapist) asks various British doctors (a few of them London based GP's) about the reasons they chose medicine and how they feel about the profession today. The answers are often incredibly heartfelt and you feel you really are experiencing a side of these doctors that very few people would get to see. I finished this book with a feeling that Medicine has changed dramatically over the last forty years both for the better and for the worse (its often mentioned the loss of continuity of care has been the worst loss to current medical practice). 

Twitter accounts: @NEJM @Qikipedia

The New England Journal of Medicine and The QI elves, the Kings/Queens of interesting facts (Not strictly medical account but very entertaining nonetheless). 

Webpage: Sporcle

This website, although its full of games, is a fantastic site for educational time killers. I found myself addicted to trying to name all the countries in Europe, Africa and eventually the world. So again not strictly medical, however, if you want something medical there are some medically related quizzes. For example try naming all the eponymous syndromes..

Film: The Doctor

Ok the choice is obvious and it may seem like a boring movie but this movie was the centre of my course on professionalism and there are some lessons to learn. The main character, an arrogant heart surgeon, gets laryngeal cancer and the movie follows his journey through the patient experience. 

For more round ups click here. 

So you want to learn a new language...

Today is the United nations world English Language Day So I've decided to share the many methods I used to learn italian, that should apply to learning any language (even English).

First of all before even considering the list below, hands down the best way to learn any language is to live in a country and with the people that speak that language.

Here a list of what I use to learn languages:

• Babbel: costs a little but offers a comprehensive course for many languages at all levels, i got a super cheap membership with so random GroupOn deal, anyway moving on.
• Duolingo: its completely free! this app is great to practise the basics, you can even compete with friends. 
• Grammar books: the back bone of learning grammar is practise, find a textbook like this just full of simple exercises.
• Dual language books: in my opinion utterly useless, but I didn't stop me using them for many years. 
• Skype language exchanges: Tandem is particularly good, also heard about Hellotalk.
• Blogs: there are absolutely millions of language blogs, you have to sift through them to find a good one like this and this, best of all they are completely free!
• Podcasts: this coffeebreak series by radiolingua is incredible and again freeeee!

You dont have to spend any money to learn a language it only requires dedication and of course hours of practise practise practise.

I found this book really helped, Fluent Forever by Gabriel Wyner.

Creativity, it's more than practise

Summary and interpretation of this interesting article by Scientific American on creativity.

Creativity doesn't fit the old adage of 'practise makes perfect' or deliberate practise. It needs to be original, meaningful and surprising (as defined by the US patent office). Here are some tips and realities about creativity:

• Creativity is blind: often luck plays a role
• Creative people often have messy processes: your most creative work may come before your worst piece of work, it can be random.
• Creators rarely receive helpful feedback: standards are constantly changing, so you cant rely on feedback.
• The 'ten year rule' doesn't apply to creativity: you don't need ten years to become an expert as in many trainable skills, but time does help.
• Talent isn't relevant: talent is simply 'the rate that someone gains expertise', since expertise isn't always required it isn't necessary. talent will help a creator learn what already exists. 
• Personality is relevant: creators tend to have a more independent, unconformity, risk taking and unconventionality based personality. They also tend to be more open to new experiences.
• Genes are relevant: genes determine personality and behaviour 
• Environment also plays a role: perhaps the biggest conrtibutor to creativity, look for a new environment and a great mentor. 
• Creative people have broader interests and more versatility: cross hobbies, dont focus on one occupation/topic/pasttime. 
• Too much expertise can be detrimental to creativity: for example learning everything there is to know about creative writing will limit your creative writing ability in terms of creativity (counter-intiutive I know)
• Outsiders often have the creative advantage

"I hope I have convinced you that creators are not mere experts. Creativity does draw on a deep knowledge base, and delibrate practice can certainly contribute to many aspects of creativity, but ultimately creativity involves much more than just deliberate practice. Creators are not necessarily the most efficient, but their messy minds and messy processes often allow them to see things others have never seen, and to create new paths that future generations will deliberately practice."

-Scott Barry Kaufman

The not so funny truth about creativity 

Medice Cura Te Ipsum

Today I attended a really interesting talk by sociologist Dr Jonathan Imber and his good friend Dr Lorenzo Berra, a professor of Anaesthesia at Harvard medical school. The talk was titled 'medice cura te ipsum', a latin phrase taken from the bible which is best translated as 'Physician, Heal thyself'. The phrase is best understood as 'counsel to your defects before you counsel the defects of others', an important message in complicated field of medicine.  

Jonathan Imber specializes in the sociology of medicine and its historical and religious dimensions, while Dr Berra works in the intensive care unit at Massachusetts general hospital. Imber published in 2008 the book Trusting Doctors: the decline of moral authority in american medicine, a topic I'm sure many doctors particularly older ones can relate to. 

The talk started as simple discussion about the origins of their friendship, in the shadowing experience of Imber's son who had some doubts about pursing a career in medicine. Dr Imber went on to highlight the importance of experience with people being a key factor in deciding whether to pursue a career in medicine. Medicine after all is about dealing with people, people who are in fact often suffering and at their most vunerable. Medical education itself is lacking in this aspect of teaching students about real suffering. Dr Berra described how he didn't actually learn about suffering until well after graduation when dealing with one of his own family members suffering with a terminal cancer. 

Dr Berra was very personable and delved into great detail about the personal experiences that shaped his medical career. He really pushed the importance of a good mentor, someone to share the experience of becoming a doctor, not someone who just teaches things now and there but someone who you can develop a real friendship with and can relate to your own experiences.

Two of Dr Berra's stories stood out (I have changed many of the facts, but the idea is the same). When he was just an intern only on his second rotation he was on a late shift and a young guy came in with gastroenteritis, flu-like symtoms, unable to walk. The patient became hypotensive and the decision was made with the team to give fluids, but the patients BP kept falling. Eventually the patient crashed and they had to give CPR for over an hour, and unfortunately the patient passed away. Later they found out that the chap had a viral myocarditis and perhaps fluids wasnt the best shout. 

The second story, a young guy came in after a horrendous crash after a snowmobile jump. the guy had landed flat on his back with the snowmobile on top of him. Almost every bone was broken, contusions everywhere and the spine was severed at C7. While looking at the CT with the radiologist and the team, the radiologist openly said theres no hope, what can we do, such a young guy paralysed for life. Dr Berra stood up and said lets at least try, come on. Later the father of the young guy thanked Dr Berra, he had infact been their with the team as they looked at the CT with the radiologist. The patient is now ok, many years on and able to move his hands despite the lack of sensation and mobility in his legs. 

The entire hospital was sued for the first case, many doctors became very defensive with their medicine after that. Medicine now is all about performance. People forget doctors are human and can make mistakes, and sometimes that mistake is just an inability to predict some outcomes in the future. Defensive medicine is an expensive way to deal with patients, both economically and in terms of suffering. Doctors need to also trust their own patients. A good doctor needs to do decision making without fear and in the best interests of the patients.

Dr Imber told a great story about how the editor of the NEJM (New England Journal of Medicine) became really quite ill once, needing to spend many days stuck in a hospital bed. The editor having been a doctor for many many years, only then realised how important nurses were to the patient experience. There is more to the patients experience than just the doctor-patient relationship. The patient deals with nurses, other healthcare staff, his/her own suffering and of course family and friends. 

I guess I've ranted on a bit now. In summary:

• If you are considering medicine, be around people. Try to gain experience in the human experience of suffering. Care homes for example are an ideal place to start.
• A good mentor is important
• Trust yourself and your decisions
• Never stop studying, even when you are well qualified
• There is much more happening outside the doctor-patient relationship in hospital for the patient
• Take your time with patient to take a full history and gain a complete understanding of their illness experience (10-15 minutes assigned time is a ridiculous concept). 

(Dr Joanthan Imber and Dr Lorenzo Berra, Humanitas Hospital Rozzano 2016)

Random lifehacks episode 1

When I was much younger I used to love reading Men's health magazine, it was full of random workout routines and lifehacks, great for killing time on the bus to university. I used to write down some of the little facts and lifehacks that I learnt, here are a few:

• Blue light is linked to arousal and as effective as drinking a coffee for an energy boost (Try and install a blue light filter for any screen-work on your computer/tablet/pc before bed, it will help you sleep better)

• Avoid drinking lots of fluids with mealtimes, it can dilute the effect of your gastric juices affecting digestion. It's the small things that make a difference to how you look and feel. (Drinking a glass of water just after you wake up will help you wake up and feel better)

• 7AM is the best time to do aerobic exercise for reducing nocturnal systolic blood pressure – and increasing duration of deep sleep. 7PM is the best time to do aerobic exercise for reducing nocturnal diastolic blood pressure

• The BMI on average is lower in gardeners, Gardeners also self report higher rates of self esteem and positive mood. (Plant a snake plant for 100% oxygen production, it's the plant NASA want to take to Mars, it's produces oxygen day and night). 

New year resolutions

People who explicitly make resolutions are 10 times more likely to attain their goals than people who don't explicitly make resolutions

That is even if only 8% actually achieve their goals

This site has all the facts: http://www.statisticbrain.com/new-years-resolution-statistics/

                         Prof Wiseman's top 10 tips to achieving your New Year's resolution:

1. Make only one resolution. Your chances of success are greater when you channel energy into changing just one aspect of your behaviour.

2. Don’t wait until New Year’s Eve to think about your resolution and instead take some time out a few days before and reflect upon what you really want to achieve.

3. Avoid previous resolutions. Deciding to revisit a past resolution sets you up for frustration and disappointment.

4. Don’t run with the crowd and go with the usual resolutions. Instead think about what you really want out of life.

5. Break your goal into a series of steps, focusing on creating sub-goals that are concrete, measurable and time-based.

6. Tell your friends and family about your goals. You're more likely to get support and want to avoid failure.

7. Regularly remind yourself of the benefits associated with achieving your goals by creating a checklist of how life would be better once you obtain your aim.

8. Give yourself a small reward whenever you achieve a sub-goal, thus maintaining motivation and a sense of progress.

9. Make your plans and progress concrete by keeping a handwritten journal, completing a computer spreadsheet or covering a notice board with graphs or pictures.

10. Expect to revert to your old habits from time to time. Treat any failure as a temporary setback rather than a reason to give up altogether.