Rheum With a View

All the leaves are brown and the sky is gray.
I’ve been for a walk on a winter’s day.
I’d be safe and warm if I was in LA.
California dreamin’ on such a winter’s day.

But a recent issue of Science would suggest I be careful of my reflections (this was also featured in the November 12 Science Times section of The New York Times and elsewhere in the media).¹ Harvard researchers used the iPhone to periodically interrupt the lives of 2,250 subjects. They found that people’s minds wandered 47% of the time. They reported that those whose minds wandered were less happy than those focused on the task at hand. In nearly two dozen activities reported, subjects’ minds were wandering more than 30% of the time, except for during sex, when people seemed to be focused on what they were doing (90% of the time) and reported being happy. Following sex on the list were exercise, conversation, listening to music, walking, eating, praying and meditating, cooking, shopping, caring for children, and reading; personal grooming, commuting, and working were near the bottom. Overall, people were less happy when their minds drifted than when they were focused on the activity they were doing. Analyses suggested unhappiness did not necessarily lead to daydreaming; rather the opposite. It must have been an interesting subset of subjects, willing to accept the interruptions in their lives, even during sex. I might have considered participating, if asked, but I refuse to use a cell phone, even an iPhone. I always thought reflection was healthy, and there is certainly a robust literature on this; presumably the quality and quantity of “daydreaming”, as well as the context, is relevant. I must confess to feeling quite content, indeed happy, walking and, yes, even letting my mind wander pleasantly in the California sun this winter.

Communication Challenges

“O wad some Power the giftie gie us. To see oursels as ithers see us! …”—To a Louse, Robert Burns

I bet you think, like I do, that you communicate well with your patients. I bet, too, if we collected data that we’d both be chagrined at what patients think and say. A comparison of physicians’ and patients’ perceptions about communication (at a “community teaching hospital,” presumably reflecting reasonably educated patients and physicians not unlike ourselves) was sobering.² Only 26% of patients could identify the physician in charge of their care; only 57% knew their diagnosis; 90% did not recall being told of side effects of new medications; and only 58% thought physician explanations were understandable. Many, if not most of you, have probably heard that we physicians haven’t the patience to listen to patients for more than 13–16 seconds before interrupting, and that if we but let them tell their story, it rarely exceeds a minute or so (on average). I know, from observing my former residents and faculty, how often physicians speak technically and in medical jargon, so I am not really surprised at these data. I interpret this as a reminder to set aside sufficient time at each patient encounter for adequate communication, to not be complacent about what I think my communication skills are, to write down for patients everything that is important, and to query patients and families at the end of the encounter to assure that my perception was their reality.

American Versus Foreign Made

I grew up in medicine with the nonsensical and regrettable prejudice that we were better than anyone else, that “Americans” and American-trained physicians were superior to “foreign medical graduates” (FMGs). I’m embarrassed to recall when, as division chiefs, we disparaged applications from FMGs for fellowship positions and did not even consider them. As a child of immigrants, I should have known better (my parents were surely not intellectually inferior to their American peers). And as a Jew, I surely should have recognized the awful potential implications of racial or ethnic stereotyping.