Juvenile Hall

Today i visited the juvenile facility in Ventura county. They house a few hundred deliquent kids there at one time. Most stay a few month, some stay 2 years. Kids who ended up there for many reasons, from skipping school, to drug possession, to stealing cars, to murder. Kids who visit there quite often pretty much get 'institutionalized'. They get everything done for them as long as they can obey the rules. They get work, school, 3 meals a day, recreational classes, shower, laundry, and visitation rights when they are in there..... Let me tell ya, that is a heck of a lot more than what a lot of them could muster up on their own. It is like a 'free lunch' every time they are in there... I don't see why they wouldn't want to come back, as long as they can put up with people telling them what to do and also living within the wired fenced walls and locked gates.

Now, ideally, we would like to rehab these kids to become contributing part of society and that they can make a living and pour back their monies back into our economy... instead of costing hard earned tax-payer dollars... but, if all these kids are getting seemed to 'institutionalize' them, they do eventually become a social burden.

What do we do?

Cambodia - Post-Trip Update

Jim Rip Sua! (Formal hello in Khmer) This is called the 'Sompiah,' with palms pressed together and say 'jim rip sua' as you greet another. So, hello :)

I want to begin by thanking God for His divine guidance and protection, and to you for your continuous support and prayers. I have now been back from Cambodia for 2 weeks, and I have just begun to unpack my thoughts. I’ve learned so much about the history of the country and its people during my short 17 day stay there.

Dr. Pat (Pediatrician) and his wife Kacie with 3 kids [Trent (6yo), Diana (4yo), Talia (2yo)] and I landed in Phnom Penh, the capital of Cambodia 2 days after we left LAX. I love this family. They are so much fun.

Though my interests are in medicine and public health, I did not have any experience in their applications abroad. Since Dr. Pat has been doing this all over the world for the last 10 years, he decided to take me under his wings to show me how things work. I knew I have a lot to learn, so I have prepared myself to be as flexible as possible and to enjoy anything we get to be a part of. After we arrived at Phnom Penh, we spent about a week visiting churches, clinics, government agencies, and various NGOs to get feedbacks in how we can achieve our objective. Our goal was to set up a reproducible and sustainable ‘Community Health Program.’ This program would involve training Health-Promoters (HP) to become educators of health and hygiene in a pre-selected community. We would develop the HPs to grow in their skills of health and hygiene promotion and also in discipleship of their spiritual maturity. Their role is to make relationships in the community they serve and eventually transforming their health and hygiene standards and to help in the efforts of helping their community to know God better.

After meeting with various local resources, Dr. Pat and I developed a completed proposal for the Community Health Promotion Program. We also participated in a Health and Hygiene Seminar as teachers: Dr. Pat, Denise (dental hygienist), Hung (our wonderful God-sent translator), and I. I start the session by teaching topics of first-aid, followed by Denise’s oral-health lectures, and ended by Dr. Pat’s lessons on how to clean water, how to make oral rehydration solution, and diarrhea prevention/management. There were about 18 students in attendance from towns all over Cambodia. We have numerous question/answering sessions and breakout practical sessions built into the curriculum. At the end of the 3-day seminar, we invited them to stand in front of the class and teach all of us on any one topic of their choice, which many of them did with passion and zest. We felt that the students had a very good understanding of the material and are ready to teach. One of the most exciting and necessary part of the seminar is the topic of spiritual applications along with each health and hygiene topic. As we know, the most important reason that people seek healthcare, also often least addressed, is for emotional/spiritual assurance. So, as teachers, we offered tools by way of applicable Bible verses and simple visuals that the HPs could integrate into their health and hygiene education.

Some fun things we did were traveling to see different temples (Ankor Wat and Ta Prohm in Siem Reap), Toul Sleng Prison and the Killing Fields, Military AID/HIV Hospital, and friends in Battambang. Ankor Wat is the national symbol of Cambodian pride. It was built in the middle ages at the height of the Ankor Empire. It is also the 7th man-made wonders of the world and the largest religious structure on the planet.

Ta Prohm, the temple depicted to the left, is a temple where trees grew out of the structures… also a temple filmed in Tomb-Raiders the movie… it is where God’s creations overcame the man-made building designed for spiritual oppression. It is a simple, yet powerful, display of God’s glory. All creation testifies to the knowledge of our Heavenly King. Simply awesome!!!
Along the way, we tasted many good Cambodia dishes and got to mingle with the locals. I have promised myself to eating at least one Khmer dish every day, and fell in love with the noodle-soup breakfast. And for me, one of the most exciting parts is to learn some language! I was able to greet, order my food, and count my numbers…

Here is a fast list of my first impressions: crazy traffic of cars/motorcycles/people going in all directions; beautiful smiles that stretches from ear to ear; rural feeling everywhere I go, even in many part of the capital; public sanitation is a literal disaster; not much of a public health infrastructure; air pollution is at least 10x worst than L.A.; overwhelming poverty; delicious foods; mosquitoes everywhere; and most of all, the pure hearts of youth who love our Father.

Battlefield Acupuncture

I was so excited to see this article appear in the Spring 2009 edition of Acupuncture Today. So, let me tell you the story. When I was taking my medical acupuncture training back in December 2008, I learn about a technique called 'Battlefield Acupuncture.' It is a technique discovered by a US Air Force physician, Col. Dr. Niemtzow, and he has been using this 'secret' in the battlefield of the Iraq war and the war in Afghanistan... and it has worked wonders for wounded soldiers. Basically, it is a technique of 5 acupuncture needles to specific points of the ear that changes any pain level from, ex. 8/10 pain, to 1.5/10 pain. Amazing huh?! Well, it worked! I've seen it done by the instructor of the course I'm currently taking, Joseph Helms MD, the founder of the Helms Medical Institute.

So, according to this article, seeing the effectiveness of Dr. Niemtzow's work, the US Air Force, a government agency, has approved 32 scholarships for Air Force physicians to be trained in Medical Acupuncture! They are collaborating with the Helms Medical Institute for this effort!

Yay, this is going to be very good for the soldiers who are suffering with pain, and acupuncture with Chinese Medicine could also have amazing efficacies in addressing Post-Traumatic Stress. It is so exciting. As I'm studying more of this art of Chinese medicine and acupucture, I can see more uses for its applications grow with each patient I encounter.

Amazement!

I was so ecstatic today! I paid a visit to one of my patients today. Remember the girl I told you about in a previous blog, who survived a plane crash and suffered burns all over her body. Several burn surgeons and I spent countless hours debriding and skin grafting her 2 months ago. She continued to have more grafts… Today, I had an opportunity to visit her in her room in the Burn ICU. As I entered the room, I had to take double looks! She was beautiful! She was setting up, chatting with some nurses… her deep green/blue eyes were open, looking around. Her face was flawless, little to no scars (her whole entire face was burnt). I remember doing surgery on her 2 months back, with her completely frail, hanging on by a thread, and her eyelids sewn shut. I prayed for her each day that she would survive and be there for her children and husband. God answers prayers! As I stood there, I was too much in shock and amazement to approach her. I was too shy to introduce myself to her to say how much I was a part of her recovery and how much I had prayed for her even shed tears for her. I thank the Lord and simply slip out of the room, in complete amazement!

Another day...

Another day in the ICU… Between rounding for 5 hours at a time, learning about fascinating physiology, learning to managing the ventilator, placing in central catheters and arterial lines, lumbar puncture, engaging in discussion about patients with the neurosurgeon/ gastroenterologists/ cardiologist/ nephrologist/ infectious disease specialist, I had another chance to witnessing patients dying today. Timothy, my friend, I really appreciated your comment in my last blog about ‘Death…’ I feel that to do the ministry as our Father called Christ and also us to do is to actually do something that is out of the ordinary. In essence, ‘going against the grain.’ To fight the urge to be the ‘status quo.’ (Btw, I like how you infer ‘status’ as ‘dead’ or ‘no influence’ as if the ‘status quo’ means ‘idle’ and ‘doing nothing’) How do I know that the patient needed to be left ‘alone’ to deal with grief? We assume that. May be we don’t need to expect ourselves to extend comfort and compassion to family at times when no comfort seemed to be enough. However, we need to show people we genuinely care. We also need to show people there is hope.

Death...

As we run down the stairwell from the Medicine Intensive Care Unit (ICU) to one floor below, the attending physicians and our team of 12 ICU residents, interns, and me (the fourth year medical student) arrived at a chaotic scene. There was a surgeon doing chest compressions so vigorously, it seemed as though he could have touched the floor, through the patient and the bed, with each pump. There were respiratory techs managing her ventilator, there were nurses standing by to push medicines to revive her heart, and other nurses with the electric shocker near by. Patient’s husband was at her side, grasping tightly to her hand, and fighting the flood gate of tears that was ready to explode as if the dams are crumbling.

She was young... actually, not much older than I am. I am sure her life was clean, and she hadn't tried everything to destroy her body like many of our patients before they end up in our unit. She was dealt a pitiful lot. Her vice was one that she didn't ask for, or earned. It was a very rare kind of cancer that had spread all over her body. She was so young.

Just as we stopped compression and almost stopped all the meds, her heart got stabilized. A few minutes passed by before her heart rate started to show signs of the peculiar rhythm that we are too often familiar with before patients breathe their last. At that moment, as I tried to fight back the tears in my eyes, the following image was burned into my mind: there was silence in the room... There was nothing to be said... well, nothing can be said. The husband had his head buried in her neck, his cheek to her cheek, in their ‘essence’ saying the last goodbye... One dying heart and another left forever broken and crushed. I can't help myself; I don't know what to do...

Then, as cold and manner-of-fact as we came, we left the scene. The patient’s heart was still beating, but, not for long. I knew the Lord was taking her home.

I have seen at least a patient die every day or every other day since I been here. Other than doing the best we could to help patients maintain all of their vital functions, what else could we do to help them and their families transition into the next chapter of their lives? What do I do when I see the husband’s heart break and bled out right in front of me? Why were my feet so glued to the ground that they won’t move an inch even when my heart wanted to be next to his? How do we become compassionate for the patient and their loved ones? How do we not become a machine, an ‘artificial intelligence’ filled with medical knowledge and algorithms? How do we apply ourselves in ministering to God’s Beloved in their last moments? How do we deal with all the sadness and brokenness we see? How do we deal with the feeling of being inadequately prepared to respond to the broken heart?

The Beach...

I am in Ventura, CA! I am renting a room from a very nice older lady. She has a cute country like house. Walking into the house today, I passed by the trickling water in the garden, through the kitchen that's filled with the smell of freshly baked lemon bars and apple casserole in the oven, then by the living room with soft jazz of the Titanic theme song playing, into a very clean room with 2 beds. After I met the 2 baby orange tabbies (Lewis and Clark), introduced myself to the African-gray parrot named Mona, I decided to take a bike ride down to the Ventura Pier. It was a lovely ride.

Leaving the Burn Unit in Phoenix, I felt a little sad. It is the combination of 1) leaving all the patients that I've come to feel so much for, 2) leaving the OR, 3) I won't have another surgery rotation for the rest of the year, 4) and, out of all the surgeries I've done, I like burn surgery the most. I wanted so bad to see the patients recover and heal. Perhaps one day God would use me to help people in that situation again.

Turning over a page... I am excited to start a rotation here with the Ventura County Medical Center's Family Practice residency program. I am doing ICU and Peds this month. Along with In His Image, I am ranking these 2 places at the top of my list. Oh, did I tell you? I have finally decided to choose Family Medicine as the specialty I want to go into. Though I had wanted to be a surgeon for awhile, I feel there are many advantages of becoming a Family Doctor:

1. Get training to take care of obstetrics/gynecology, pediatrics, medicine, minor surgeries, emergency care.
2. Additional fellowships trainings in wilderness medicine, tropical medicine, sports medicine, and osteopathic manipulative medicine.
3. Family doctors are very well suited to work in the mission field.
4. Family doctors see everything first, then decide who gets what types of specialty care... so a good family doctor could potentially 'try' to do as much as possible before referring. So, a family doctor could potentially be all that a patient would see in their life time.
5. I am very well suited for those things mentioned above, because I am very interested in a broad training program.
6. Family doctors has more time to spend with family and hobbies... more vacations!
7. Family doctors can offer spiritual care in a much thorough way compare to any other specialty.

So, I have many reasons of why I want to be a Family Doctor... I know there are many that have encouraged me to do something else, but after much evaluation, I still think that Family Medicine would be the best fit for me. Thank you for all your prayers... this process has been very difficult, so, thank you for your supports and prayers.

5 hour surgery... "Cultured Epidermal Autografts"

I was involved in a surgery today skin grafting a patient who had a lot of body surface areas burnt in a horrific accident. So, I learned something new... CEA = Cultured Epidermal Autografts. So, there are several types of skin grafts: autograft (from self), allografts (from a cadaver or another human), and xenografts (from another species, most commonly a pig). The main purpose of grafts is to provide coverage for open wounds and to protect patients from fluid loss and infection. So, CEA's are a type of autograft. It was approved by the FDA on Oct 25, 2007. To make CEA's, the company that culture them and produce them takes a biopsy of the patient's skin. Then, they prep and place the parts of skin in a culture medium to 'grow' the new skin. The new skin is consisted of about 10 cell layers thick of keratinocytes and takes about 12 days to grow. (10 cell layers is about 1/2 of the thickness of the grafts harvested from the patient) Each of these new 'autografts' swatches are about 2''x3" and costs about $1,280 per swatch. So, in a person like me, I probably need about 300 to cover my entire body... so, you do the math. Let's say we use 300 of them... it would be about $384,000 for just the autograft swatches alone. This does not include surgeon fees, OR fees, and all the material that goes into it. The surgery took about 5 hours and a lot of swatches!

Then you can ask, why CEA's? Well, when patients have more than 30% of total body surface areas burns, they may not have enough of their own skins for autograft harvesting. So, one way to go around that and still have your own skin coverage is to grow them in a lab then transfer them to your body.

Then you can ask, how much of this CEA are we expecting the body to take and incorporate into the tissue and have it survive? Well, the literature supports the success of CEA grafts to have a mean graft survival rate of about 65%. Some studies state the graft survival rate up to 80-90%. There are several good studies out there: French Study from 1997, Slovenia Study from 2001, Pediatric burn from 2000, and Recent Study 2006. There are lots of good articles in the scientific journals, but they all require subscriptions.

Here is the package insert from Genzyme, the company that produces the CEA's we used today: http://www.genzyme.com/business/biosurgery/burn/epicel_package_insert.pdf

So, I think the surgery is going to give this particular patient much benefit. I do pray that her body incorporate these new cells. God is the healer, we just do the best we possibly can.

The Burn Unit

I am doing well in my Burn Surgery rotation. I am very much enjoying the rotation. I think it comes very naturally to me to be doing procedures, whether it be handling the knife, doing excision and debridement of burns, skin grafting, sewing grafts in, doing wound vacs, performing venous and arterial access and line placements, and anything I can get my hands on. I am absolutely loving it and very comfortable in the Burn Unit. I know the people I treat will most likely never recover their appearance 100%, but, to help them to be able to function with the least amount of disfigurement leaves me feeling very satisfied.

One thing about burn surgery that I didn't know is that usually the Operating Rooms are chilled and quit comfortable even under all the sterile gown and gloves. But, the Burn ORs are tuned to the patient's body temperature... because when we lose our skin, we lose our temperature regulating barrier. We also lose the water keeping barrier, so we dehydrates very fast. So, to keep the patients' body from dropping their core temperature, we keep the room at their temperature. Yeah, imagine operating in a room of 98 degrees F. I was totally drenched in sweat from head to toe!

I also have made some advances today on my own, I have successfully placed several arterial and venous lines today! Yay... I loved it. It is all for the patients' benefit. I am among some really good surgeons here.

That's all for now, don't forget to check out the Sarah Palin video in the blog below. Good night!

(*) May God Take Care of Them...

Today was a sad day for me... because of confidentiality I cannot share anything other than: couple, plane crash, and burn survivors. I've learned a lot working as an assistant to the surgeon on all of these cases doing excision and debridement of wounds and then doing skin grafting. I am seeing how laborious the work is in caring burn patients.

The surgeries consisted of: taking a patient back into repeated surgeries to remove eschars and to keep the wounds fresh and viable for healing and growth; harvesting skin grafts, using allografts (from another human), using xenografts (from another species, usually a pig); doing the grafting; changing the dressings; maintaining the patients' vital needs (nutrition, respiration, etc...); tubes in, tubes out; releasing of contractures when wounds heal; escharotomies when eschars form during healing... the work goes on and on.

I am thinking, I have never seen patients as sick appearing and as acute as the patients I've seen in the burn unit. If you can be trained to help these patients, you can treat anyone!

When I was in the OR doing the surgery on one spouse today, I thought to myself, how can anyone sustain this much injuries? Then, when we finished her surgery and went to her husband's room, I saw all the pictures of them together and their beautiful family, it hit me. I, then suddenly felt really sad. They will never be the same, if they can make it out of the unit!

There is a dear friend who recently lost a grand-baby to an automobile accident, and their kids were very seriously and traumatically injured... my heart goes out to you and to my patients and their families!

Then, finally, my mind took me to how amazing everything is. Think about it, as doctors and surgeons, we can do our best, everything we can, and be as proactive in treatment as we can, most people will live, but some will die. But, there is something else that is governing the healing of the body. We can give the necessary nutritions and the body will heal. We can give it the right environments, and the 'missing' pieces will attempt to grow back! ISN'T THAT AMAZING?! I think many of us in the health care field get so compartamentalized that we take the whole 'healing' process for granted. We doctors only attempt to put things back, but God had designed our bodies to do all the rest! Doctors are like good stewards of what's been given to them, and God is the one that heals.

Like the surgeon, Dr. Gawande, who I did a book review ("Better") on earlier, shared: as we enjoy medical and surgical advances, we are able to save many more lives. However, we haven't yet learn how to deal with the incredible kinds of disabilities by simply saving people out of their traumatic injuries. People who are missing all limbs, or missing a face, or permanently disfigured... how do we help them to function? When should we stop fighting for our patients and just let them go? How far do we go to save someone? Do we ever think about what they have to do if they do survive? I think, as a doctor, we always have to do our best as our profession prescribed.

Dear Father in Heaven, holloweth be Thy Name. Thank You for every blessings of a new day. Thank You for giving us health and providing for us. Thank You for always being Faithful and Loyal and loving. Thank You for always giving us HOPE for eternity. Thank You for Your PROMISE of an eternity in Your LOVE, without sorrows, disabilities, disfigurements, and disappointments. Thank You for Jesus Christ's death of atonement to redeem us from our sins so we can worship You in Your Holy presence. Thank You for blessing us with all Your beloved on this Earth as we walk this pilgrimage together. Father, please take special care for those who are in physical suffering. Please be their Comforter and their Peace. Give them strength to live through and face their future. Give them courage to face themselves and to share their incredible story to further glorify Your Name. May all your saints say... Amen.

My First Day in the BURN unit!

So, I have started my first day of the 4 week surgery rotation in the 2nd largest burn center in the USA: Arizona Burn Center at Maricopa Medical Center. This center admitted over 826 burn patients last year, cared for 1,500 patients in the burn E.R., and over 3,500 outpatient visits. This is also the referral center for areas including the entire state of AZ, western NM, NV, western CA, and northern Mexico. Let me tell ya, there is probably no better place to be trained in how to take care a burn patient than here.

As I started my first-day today, and considering how busy this place is, I was thrusted straight into the O.R. within about an hour of being introduced onto the service. Within 5 minutes in the O.R., I was holding up someone’s arm (skinless with escharotomies on both medial and lateral surfaces of both arms and forearms), the arm was oozing copious amount of serosanguinous fluids, while ripping out staples from the temporary grafts.

Ok, I am being really careful with my words here. I have to say that I have never seen anything in medicine that’s as graphic as this. I don’t have a weak stomach for things like this, and I am very eager to jump right in there and help with whatever needed help and to do surgery. However, I have got to remind myself that not everyone’s stomachs agree with mine. So, this is one topic I probably wouldn’t bring up around the dinner table!

I have seen what having skin grafts do to the patients, they are wonderful! Even though the surgery itself looks barbaric, the end results for the patients are life changing! I feel so interested in this work and at the same time feeling that I am contributing to these patients’ well-being that they otherwise could not have received. Simply Life Changing!!! Also, God really designed our body beautifully to heal itself, even at times under unimaginable traumatic stress!

My hours are very interesting, like all surgical discipline, they are long. I start tomorrow morning at 4:45am and the end of the day is “whenever.” Normally, I would start at about 5 or 6am, and ending “whenever.” No joke… this is how it appears on my schedule “0600 – whenever.”

I feel very privileged to be able to do a rotation here, because there is probably no better place to learn about burn surgery. And besides, I get to see people’s lives change right in front of my eyes. I have a lot of respect for these surgeons and the work they do.

Good night, I’ve got to catch some shut-eye before the rooster crows.

Test in Philadelphia: Conshohocken, PA

My beautiful room... too bad I didn't have any one to share it with :(

Train stop in Conshohoken

Stop in the middle of track; my train ticket

You know what Conshohocken means? It means "A pleasant place" in a Native American tongue. Well, I've just finished all of my medical board exams that I have to take during medical school. This last one in PA was the practical exam. Basically, it was a 6 hour test plus a 1 hour orientation and 30 min lunch break. During the test we rotated through 12 different patient encounters, in which we get 2 final scores: one from the patients and one from physician graders who grades our SOAP notes.

Let me tell ya, I was nervous... I don't know why, I've been seeing patients on my own many of times in this past 2 years, but, my heart was pounding so hard that I felt that it was going to jump straight through my throat. I think I did the best I could, of course, there are always things I could've done better, but, I believe I did my best. Thank you for all your prayers, I felt that God kept my mind clear and my tummy and bladder calm *very important!

Thanks for keeping me on your mind and walking through this anxious test with me.

Medical Acupuncture

Hi... I am doing a quick post on Acupuncture. I am right now taking a continuing medical education (CME) class through UCLA School of Medicine on medical acupuncture. This class is affiliated with the Helms Medical Institute, which is associated with both UCLA and Stanford. I have chosen to take the most complete course, which is 300 units over the next year. So, I have just finished a book "Getting to Know You" by Dr. Helms MD.

Acupuncture, as it has been practiced, has been part of the standard medical care offered by the Chinese for thousands of years. It has been universally accepted in Europe, and was considered common practice by French physicians since WWI. In the US, it has been labeled as alternative medicine for a long time. Helms Medical Institute is the oldest institution that has dedicated themselves in training physicians (MD's and DO's) to perform medical acupuncture.

It was amazing, as I read through this book, how much acupuncture complements and adds to osteopathic manipulative therapy (OMT) and modern medicine. It offers ways to evaluate patients in a different perspective, a more complete perspective. Instead of treating patient's sickness, acupuncture's way of evaluation takes into account of overdrive or deficiencies of various organs of influence. Like OMT, Acupuncture does not replace, but adds an extra tool of diagnosis and treament to the patients. Ultimately, it is win-win for the patients as far as improved health and money saved.

This book dives into details regarding understanding people as generally three different biopsychotype profiles, or biological-psychological makeup: Vision/Action, Nurture/Duty, or Will/Spirit. Each of the characteristics are also associated with one elements: Wood, Fire, Earth, Metal, Water... in this particular order, each element gives rise to the next (Cycle of Generation) and each element also dominates the element that's 2 degrees away (Cycle of Control: for example: Wood dominates over Earth, Earth dominates over Water, Water dominates over Fire, Fire dominates over Metal, Metal dominates over Wood). With this paradigm, each of the elements are associated with a season, a flavor, a color, and an organ system:

1. Wood=Spring/Sour/Green/Liver&Gallbladder,
2. Fire=Summer/Bitter/Red/Heart,
3. Earth=Harvest/Sweet/Yellow/Spleen&Stomach,
4. Metal=Autumn/Spicy/White/Lung,
5. Water=Winter/Salty/Black/Kidney&Bladder.

You do have to note that each of these 'organs' mentioned are not necessarily referring to an actual organ. In Chinese Medicine, each of these 'organs' has controls over severel physiologies in the body in terms of 'balance' and 'imbalance.' If you insist of using 'Western' terminologies to evaluate what you are learning, you will be extremely confused. Let me tell ya, this is a complete different system of addressing medicine/health/dysfunction. Each elements also have associated biopsychotypes:

1. Wood=Vision/Action
2. Fire=Action, Spirit
3. Earth=Nurture
4. Metal=Duty
5. Water=Will

So, by understanding these Cycles of Generation and Cycles of Control with respect to the three general biopsychotypes, we can make sense of why certain people maintain health and why in certain individuals health break down. It is essential to understand how health breaks down in order to find ways to restore it. This is the essence of acupuncture.

If you would like to find out which biopsychotype you are, click on: http://www.acupunctureprofessor.com/index.php This site has basic synopsis of the book and also has a FREE evaluation tool, under "Learn More About YOU."

Enjoy, I learned to day that I scored roughly equally in Nurture/Duty and Will/Spirit biopsychotypes. What does that mean anyway? I will tell you later.

"Better" by Atul Gawande MD, a general surgeon's notes on Performance

This book is the second book written by a general surgeon, Atul Gawande MD, from Harvard. The theme of this book is about performance in medicine. “As a doctor, you go into this work thinking it is all a matter of canny diagnosis, technical prowess, and some ability to empathize with people. But it is not, you soon find out. In medicine, as in any profession, we must grapple with systems, resources, circumstances, people, and our own shortcomings, as well. We face obstacles of seemingly unending variety. Yet somehow we must advance, we must refine, we must improve.” The picture to the left is from http://www.amazon.com/ you can also buy the book there.

In medicine, there are three core requirements for success: Diligence, Doing Right, and Ingenuity.

• Diligence is “the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles. It is central to performance and fiendishly hard.”
• Doing Right is dealing with and puzzling “over how we know when we should keep fighting for a sick patient and when we should stop.”
• Ingenuity is “thinking anew. It is often misunderstood. It is not a matter of superior intelligence but of character. It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change. It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions.”

Betterment is a perpetual labor. Dr Gawande gave some illustrations in the book regarding each of these three principles. For Diligence, he gave stories of the “efforts to ensure doctors and nurses simple wash their hands; one about the care of the wounded soldiers in Iraq and Afghanistan; and one about the Herculean effort to eradicate polio from the globe.” For Doing Right, he gave examples to address some uncomfortable questions about “how much should doctors get paid; what we owe patients when we make mistakes; and participation in executions of prisoners. For Ingenuity, he gave examples of people who have transformed everyday medicine by improving “the way babies are delivered; the way an incurable disease like cystic fibrosis is fought; and exam how much more of us can do the same.”

Those people who can successfully attempt and accomplish these three principles, Dr Gawande calls them the “Positive Deviant.” Here he gave 5 suggestions on how to become one:

1. Ask an unscripted question – our job is to talk to strangers, why not learn something about them?
2. Don’t complaint – “nothing in medicine is more dispiriting than hearing doctors complain. Medicine is a trying profession, but less because of the difficulties of disease than because of the difficulty of having to work with other human beigns under circumstances only partly in one’s control. Ours is a team sport, but with 2 key differences from the kinds with lighted scoreboards: the stakes are people’s lives and we have no coaches. Doctors are expected to coach themselves. We have no one but ourselves to lift us through the struggles. But, we are not good at it. Wherever doctors gather, the natural pull of conversational gravity is toward the litany of woes all around us. But, resist it. It’s boring, it doesn’t solve anything and it will get you down.”
3. Count Something – do a study of your success and failures, count how often mistakes happen of certain sort that interests you.
4. Write Something – put in words your experiences to add some small observation about your world. Don’t underestimate the effect of your contribution, however modest it may be.
5. Change – people respond to new ideas in one of three ways, “A few become early adopters, most become late adopters, and some remain persistent skeptics who never stop resisting. Make yourselves early adopters and look for opportunity to change. Be willing to recognize the inadequacies in what you do and to seek out solutions. The choices a doctor makes are necessarily imperfect but they alter people’s lives. Because of that reality, it often seems safest to do what everyone else is doing. But a doctor must not let that happen.”

Once you become a physician, the question is not whether you have to accept the responsibility. By doing your job well, you have accepted responsibility. Then the question becomes, “having already accepted responsibility, how does one do such work well.”