Sunday, August 14, 2016

Journey in spacetime 2

Senior consultant: Hi Kevin. Happy new year.

Junior consultant: Hi Chris. Happy new year. Sorry I missed your call. I was at the movies.

Senior consultant: Hey, not a problem. I was ringing to see if you had joined the Shoulder and Elbow Society.

Junior consultant: Um. No. Not yet. It’s on my to do list... Sorry it’s a bit noisy in here.

Senior consultant: That’s fine. What were you watching?

Junior consultant: Um… I saw Big Hero 6. (Disney Studio’s manipulation of a Marvel Comics creation designed to capture a market too young to fully appreciate the magnificent Avengers series and their dystopic universe and, despite the grating tearjerkers and predictable storyline, it was entertaining enough and points a malleable mind in a useful direction which is certainly a darn sight better than that disgraceful “Frozen” movie the popularity of which suggests that people in privileged societies don’t give a damn that their daughters entrench the belief they are born princesses even if the rest of the world doesn’t recognise it and that such entitlement - given that women are secretly in charge of everything - marks the downfall of Western economies and thereby the downfall of Western thinking and ideology...)

Senior consultant: ...

Junior consultant: It actually wasn’t too bad. I rather enjoyed it. It’s a kids movie...

Senior consultant: ...

Junior consultant: I like animation.

Senior consultant: Yeah, that reminds me. I was going to see a movie with my daughter this morning but she slept in. I guess we’ll go this afternoon...

Junior consultant: Yeah. It’s pretty hot today. There are lots of people at the movies. 

Senior consultant: I don’t think it’s that hard to join the Shoulder and Elbow Society. You are in the Hand Society aren’t you?

Junior consultant: Yes.

Senior consultant: Well you should apply to join the Shoulder and Elbow Society. You can use me as a referee if you like. That’s if you want to.

Junior consultant: Thanks Chris. I really appreciate your support.

Senior consultant: Not a problem…

I don’t ever want to grow up. I once had plans on becoming an artist. Or failing that an animator, or an architect, or a puppeteer. Serious. I transcribed this conversation last year (Jan 2015) because it felt somehow surreal. Today my application to join the Shoulder and Elbow Society was accepted. 

Status quo is not a default option. It never really was. And it will never be.

Sunday, July 24, 2016

Shoot the breeze

“I think I know why I get my headaches,’” I tell Anthony as we ride early one winter morning. “It’s because it’s so goddamn cold that my teeth freeze and it goes up to my brain. It’s up behind my left eye right now.” “Well maybe you should shut your mouth and stop talking for a while,” he chortles back. I pause a second or two as I figure it out, “Actually it’s ok. If I keep my lips over my teeth it’s not so bad.. Myeah mit’s metting metter malready..” 

Well, I have something to say. I often have something to say but today I have this to say: I think Google and the ability to easily check points of fact have, subtly (and sometimes not so subtly), diminished the value of conversation. Language provides an ability to transfer information but, while there can be no doubt about the importance of accuracy on matters of fact, I’m starting to understand that that’s probably not the main point of conversation. A conversation is a temporary sharing of a moment in time. It is just one of many possible interactions. Being right often has little to do with it.

I sit down as Anthony prepares a mug of hot chocolate for me and an expresso for himself. E. walks into the kitchen.

“Dad I think I left my towel in the car.” She gives Anthony a hug. Anthony returns the affection with one arm as he balances the jug of hot chocolate with the other. “Morning E.” he kisses her on the head, “That’s ok I found it last night and put it in the dryer. It was a bit damp.” E. pulls back, “But I need it now!” she says forcefully. “It’s just in the dryer honey. It should be dry by now," Anthony replies gently, "Why don’t you go downstairs and pick it up." E. twists her hips and wanders off to the door. She takes a few steps than comes back. “I don’t want to go downstairs. I don’t want to go on my own.” She sidles between Anthony and the table where he is preparing breakfast.

I smile at Anthony as I watch the events unfold. E. is nine years old and has a swimming carnival this morning. To be fair the area downstairs is technically outside the house and the sun has only just risen above the horizon. Morning clouds hide much of its glow.

“Ok honey. Let’s go pick it up.” Anthony saunters downstairs with E. skipping at his side. He comes back up carrying a load of washing and drops it into a basket. E. dives in to grab her things. Anthony gets back to breakfast. “It’s competition day,” he tells me. “It’s a bit like this on competition day,” he says with a grin. E. comes back with a white shirt in her hand. “There’s a stain on this dad. Look,” she points out a faint black mark that looks like a washed out ink stain. “Oh yeah you’re right,” Anthony replies attentively as he takes the shirt from E. “And here’s another,” he says opening up the shirt sleeve, “and here’s another on the collar.” E. peeks over Anthony’s shoulder. “Oh yeah.. I wonder how that got there,” she asks. “I’m not sure,” Anthony replies, “It’s probably something in the dryer.” E. furrows her brow as she scrutinises the stain, “I don’t think so dad,” she replies. “Dryers don’t cause stains. It has to be the washing machine. Something dark in the washing machine has caused the stain.” She takes the shirt from Anthony and wanders back to her room.

I grin at the small, innumerable travails that parents contend with each day. “I like how your kid’s problem suddenly becomes your problem,” I tell Anthony as he places a steaming mug of hot chocolate in front of me. I wrap my hands around the mug. “Thank you,” I sigh as the warmth hits me, “I reckon some people never grow up beyond that stage.” Anthony nods as he tamps his coffee. “It’s a bit like that isn’t it?” he replies, “But I think there is a limit of what we can absorb.” Anthony continues, “When I have the kids over the weekend I find that I can be a bit short with some of the patients I see at work the following day.. You know those people that sit down in front of you and tell you their problem, and, then, before you know it, it becomes your problem.” “Absolutely!” I laugh in agreement as I rock back in my chair, "I know the kind well.” Anthony’s coffee machine hisses to life. He continues, “Well, after a big weekend with the kids I've reached my fill so I'm like, ‘Hang on there, this isn’t my problem mate. This is your problem. I’m just here to help you.’” He pauses a microsecond and moderates, “‘This is something we can sort this out but it's something we're going to have to do together.’”

We grin in mutual understanding. Anthony takes his expresso and sips at it. He sits down as E. walks back into the kitchen.

Sunday, June 19, 2016

The captain's call

We live in strange times..

Over the weekend I was involved in the selection process for the next round of orthopaedic trainees. This is done each year with a simultaneous set of interviews for each state of Australia. These interviews form a critical part of a junior doctor entering the training program and thereby setting him (or her) on course to becoming an orthopaedic surgeon. The station I was assigned was “leadership”. There are other stations that assess specifics about communication, ethics, high pressure technical and/or emotional situations, and basic medical knowledge.

It is no secret that junior doctors specifically train to answer the questions asked in these interviews. Each year the questions are different but the essence of the topic remains the same. Evidently the key words in the scenario on leadership (which places the interviewee in a tricky situation where he has to show evidence of leadership) were “collaboration” and a “non-confrontational approach" as every candidate started off with this. An exhaustive use of local and peripheral resources then follows as the hypothetical situation escalates.

There’s a phrase in Australia made infamous last year by our previous prime minister, Tony Abbott. The phrase is “captain’s call” and was the Macquarie Dictionary's 2015 Word of the Year. It refers to a unilateral decision made by an assigned leader without consultation with colleagues. Mt Abbott’s frequent and politically injudicious use of the term has expanded the use of a “captain’s call” to include a unilateral decision that goes against the majority opinion even after consultationThe phrase may be vilified but essentially refers to any unilateral decision made by an assigned leader.  

After the main question with the hypothetical situation was answered we had the opportunity to ask a question about any previous experience where the candidate had to show leadership skills. Not surprisingly most candidates at the interviews have had quite a deal of experience: most through sporting endeavours but also in debating or chess teams, as school prefects/ captains, and as members of organising committees and charity events. We then had to probe further for specific instances where they had to deal with a difficult situation. Most described situations that were resolved collaboratively for the collective good. Some described scenarios where the issue could not be resolved in such a utopian manner. In these situations I asked them whether they had to make a “captain’s call”. To their credit most said they did. 

A good leader should lead from the front. He has to take charge in decisions for what he perceives to be the greater good. A leader should also make sure he is well-informed and check that what he perceives to be the “greater good” is a reflection of reality. For this he has to be perceptive, communicative, motivating, and a good team-builder. It also pays to have vision, charisma, and a tall stature (and, at least historically in my discipline, white and male). 

Established media that is rigorous and independent brings people, companies, leadership and regimes to account. Social media can promote accountability but often lacks rigour. And the pervasive nature of social media often clouds an ability to lead from the front. It can be corrosive for reputations when people who can choose to remain anonymous leave commentary that is ill-informed and inflammatory. Anyone with a grudge can state their claim on a number of available platforms. This can gain traction with other naysayers, the naive, and the nescient. The ability to leave a permanent record of what used to be fleeting and inconsequential makes many, especially those with a tenuous hold on their position as leader, wary of inciting such a response. Elected politicians seem to bear the brunt of this with the result being indecision and pointless muttering and fluttering. That and referendums (= ballots forced on people who are typically less informed than the leaders they elected to make such decisions in the first place).

Leadership is about decision and direction. Sometimes that means collaboration and compromise. Sometimes it takes a captain’s call. 

And, sometimes, if you want to get things done, it pays to have a strong constitution, a thick skin, and a good social network of supportive family, friends and like-minded collaborators.

That's old school..

Sunday, May 22, 2016

The Good Doctor

There are four questions a patient might think about when he sees a doctor.

“Will he listen to me?”
“Will he make the correct diagnosis?”
“Will he prescribe the right treatment?”
“Will he do the right thing by me?”

That is, if the patient even thinks about it. More often a patient sees a doctor because of an ailment or injury which he believes the good doctor might help solve. Only if there are problems along this road might the patient think about such questions.

So the same questions are more often framed retrospectively.

“Did he listen to me?”
“Did he make the correct diagnosis?”
“Did he prescribe the right treatment?”
“Did he do the right thing by me?”

In the majority of cases a doctor can make a diagnosis within a few minutes of the patient sitting down in front of him. A specialist, who only has to deal with a limited number of possibilities, can often make a diagnosis within the first minute. But complex systems have many areas that can go wrong. Some are relevant to the presentation and some are not. Even orthopaedics, widely regarded as the least mentally taxing of the medical professions, has elements of obscuration. For example, a middle aged, diabetic woman presenting with carpal tunnel syndrome may also have trigger fingers. Surgery to address the obvious presentation (typically the carpal tunnel syndrome) can make the other condition worse. A middle aged man presenting with shoulder impingement may have a rotator cuff tear and a labral tear. Subtleties in the clinical presentation determine whether a repair of the labrum should be considered at the same time as the cuff repair if, indeed, either is required. Treatment algorithms help but cannot (and should not) dictate management.

When a client comes to a service provider - be it a mechanic or a doctor - he typically has a problem for which he is soliciting information and a solution*. A rumbling engine has many possible causes as does a rumbling tummy. The client is sometimes able to articulate the problem in language that makes it clear to the service provider. But more often than not it takes a bit of time to extract this information. The more complex the system the deeper the service provider has to listen and probe. Asking the right questions helps. Training and experience guides this process.

Clients should expect the service provider to have the capacity to provide the service advertised. In addition to this the medical industry as well as some other sectors of the workforce (eg the clergy, the police force and emergency services) are expected to have a certain duty of care. Some are legally binding whilst others fall in a vaguely-defined area of good social conduct. Medicine is specialised and complex enough that the clinical decision of it’s practitioners often lie beyond the critical judgement of those outside the profession. But not beyond the scrutiny of peers. A basic respect for humanity should underscore the wellbeing of the patient and the opinion of others. 

Not that I think it necessary for a doctor to “care” about the overall wellbeing of his patients. By that I mean he should take into account the factors that might play a role in the clinical presentation but not absorb any emotional burden that may come with it. A doctor’s life is hard enough as it is and there’s that fine line where “care” becomes unwelcome or just plain creepy. But a doctor, like all service providers, should focus on optimising results. After all, that is the job he is paid to do.

But, as elsewhere in life, shit happens.

There are four questions that a patient might think about when he sees a doctor.

“Will he listen to me?”
“Will he make the correct diagnosis?”
“Will he prescribe the right treatment?”
“Will he do the right thing by me?”

A good doctor makes sure the patient never needs to ask those questions. And if he does the answer is in the affirmative.

he could also be looking for a quote or a second opinion

Sunday, May 8, 2016

The Italian American

And the Captain.

In an alternate universe Steve Rogers was resurrected in the mid 1950s and didn’t mind the odd race car or two..

In keeping with the “off-topic’’ Marvel theme: