In Every Patient Tells a Story

The experience of being ill can be like waking up in a foreign country. Life, as you formerly knew it, is on hold while you travel through this other world as unknown as it is unexpected. When I see patients in the hospital or in my office who are suddenly, surprisingly ill, what they really want to know is, What is wrong with me? They want a road map that will help them manage their new surroundings. The ability to give this unnerving and unfamiliar place a name, to know it on some level, restores a measure of control, independent of whether or not that diagnosis comes attached to a cure. Because, even today, a diagnosis is frequently all a good doctor has to offer. A healthy young man suddenly loses his memory, making him unable to remember the events of each passing hour. Two patients diagnosed with Lyme disease improve after antibiotic treatment, only to have their symptoms mysteriously return. A young woman lies dying in the ICU, bleeding, jaundiced, incoherent, and none of her doctors know what is killing her.

Lisa Sanders, MD
The doctor behind the "House"

Open your mind and see the world in a new way

I graduated from college just three years ago, so the confusion and anxiety I felt after graduating college is still quite fresh in my mind. I moved out of my parents' house a week after graduation and started at my new job, and since then I have learned a lot of things about the "real world". Here are some of my best advice for new graduates who are transitioning from the safe structured environment of school to a seemingly infinitely larger world.

Learn to manage your money - It does not matter how much money you rake in if you do not know how to manage it and make it grow. You can learn about personal finance by going to the library or reading the great personal finance blogs such as this one. Everyone has a different money management style, but the bottom line I adhere to is to not spend more than I can afford. Basically, live below your means and you will always have something to fall back on.

Work towards financial independence - I would have said "save for retirement now", but when I heard the word retirement at age 22 I figured it was 40 years away and I had plenty time to prepare. Now I know that I do not want to plod along for another 40 years , but I want to be financially free much sooner. I am sure most of you do not want to be bossed around for another 40 to 45 years, so mark the date you will be free and work towards it by saving, investing, or building a business.

Explore the world around you - I wish that I had taken a year off after graduating and just traveled around the world. In the last three years I did have the opportunity to go to remote areas of Southern China, and I was amazed by how diverse my own country is. I truly believe that traveling and seeing how others live give you perspective and insight into how to live your life. Once you are settled down with young children it would not be as easy to run away to the end of the world for a long time. You do not need too much money to explore and travel. For example, David DeFranza wrote a great article about exploring your own world by walking .

Keep in touch - Since graduating many of my best friends have scattered around the world. It is tough to keep track of everyone, but a few emails and an occassional phone call keep us in contact with each other so when there are times we could see each other again we can meet up. I think keeping friends is always better than losing them.

Build new relationships - I think many new college graduates feel the pain of loneliness when they leave school and move into a place far away from friends and family. Like I said before, most of my old friends are no longer near by. So this is a great time to build new relationships. I found a couple roommates when I just graduated so I would not be so lonely. Then I joined a great church and found new friends. Making friends is not as easy when you get out of school, but it is possible, and somewhat essential for your sanity.

Never stop learning - School is out, but there is a lifetime of learning ahead of you. Now you can take the art class you never had time for in college or you could read about the newest web technologies. You can learn just about anything you want without worrying about tests and grades and you can Learn from everyone and everything around you. With the wonders of the internet, you can even follow along courses from some of the top universities in the world .

Stay active - When I was in school I walked everywhere and took physical education classes to stay active, but now I am working and my lifestyle has become extremely sedentary. It is important to stay fit and be healthy because whatever you produce and earn comes from your body and mind. Staying healthy lets you enjoy life much more and you can save money on healthcare in the long run.

Always be on the lookout for better opportunities - Face it, for most of us, our first jobs are not our dream jobs . So do not be afraid to move on to a better opportunity. Usually the better opportunities do not just fall into your lap, so it does not hurt to constantly search for what you really want to do. If you want to be your own boss, quitting a crappy job and starting your own business is a lot easier when you are young and do not have to support others with your income.

Talk to your parents - Both my husband and I found that after college our relationships with our parents got a lot better since we became independent from them. Our teenage angst was all gone and now we know that our parents are probably our best allies in life. I know every family is different, but the time after college is a great time to show your maturity to your parents or former guardians. Talk to them as adults, and ask to be treated like an adult if they do not do so already, and your relationships may improve.

Give back - I think all of us have a human duty to give back to the world and make it a better place to live for everyone. You do not necessarily have to donate large amounts of money to charities, but you could do small things like planting a tree, or even save energy. Every small gesture that benefits the environment and others will also benefit you and your children.

Finally, do not be discouraged if these years right after graduation are difficult and you feel like you are in a crisis. It is normal to feel bewildered by a completely different lifestyle. You are young, and you have time to figure out what makes you happy and what works for you. Have fun, and never give up on improving your life and yourself.

WELCOME TO THE REAL WORLD

wisebread.com

The world belongs to the brave

"The secret of getting ahead is getting started. The secret of getting started is breaking your complex overwhelming tasks into small manageable tasks, and then starting on the first one." --Mark Twain

Learning arabic

Belajar bahasa arab dengan pengantar bahasa Indonesia
Arabindo

Arabisch lernen


Learning arabic

The best physician is also a philosopher.

To be great, a surgeon must have a fierce determination to be the leader in his field. He must have a driving ego, a hunger beyond money. He must have a passion for perfectionism. He is like the actor who wants his name in lights.

The superior doctor prevents sickness; The mediocre doctor attends to impending sickness; The inferior doctor treats actual sickness.

The person most often late for a doctor's appointment is the doctor himself.

Physicians are rather like undescended testicles, they are difficult to locate and when they are found, they are pretty ineffective.

Often the confidence of the patient in his physician does more for the cure of his disease than the physician with all his remedies.

No physician is really good before he has killed one or two patients.

No physician is really good before he has killed one or two patients.

Medicine is a science, acquiring a practice an art.

Life is short, the Art long, opportunity fleeting, experience treacherous, judgment difficult. The physician must be ready, not only to do his duty himself, but also to secure the co-operation of the patient, of the attendants and of externals.

Let the young know they will never find a more interesting, more instructive book than the patient himself.

It is a mathematical fact that fifty percent of all doctors graduate in the bottom half of their class.

If popular medicine gave the people wisdom as well as knowledge, it would be the best protection for scientific and well-trained physicians.

I wondher why ye can always read a doctor's bill an' ye niver can read his purscription.

Doctors are just the same as lawyers; the only difference is that lawyers merely rob you, whereas doctors rob you and kill you, too.

A physician is someone who knows everything and does nothing.
A surgeon is someone who does everything and knows nothing.
A psychiatrist is someone who knows nothing and does nothing.
A pathologist is someone who knows everything and does everything too late.

A physician is an unfortunate gentleman who is every day required to perform a miracle; namely to reconcile health with intemperance.

A doctor is the only man who can suffer from good health.

I don't dawdle. I'm a surgeon. I make an incision, do what needs to be done and sew up the wound. There is a beginning, a middle, and an end.

Another side of me

Quisera ser | I would love to be ...











Spanish pop music includes romance, excitement and has some amazing Spanish singers. When I watch music programs on Spanish TV I'm totally in awe at the maturity of the singers voices and their style of delivery. They will fill your heart with joy and their music scene is one of the best in Europe.

http://lyricstranslate.com/de/Alejandro-Sanz-lyrics.html
http://www.valencia-tourist-travel-guide.com/music-of-spain.html
and if you want more

This life

At the end of your life, you will never regret not having passed one more test, not winning one more verdict, or not closing one more deal. You will regret time not spent with a husband, a friend, a child, or a parent.
-- Barbara Bush

Courage is like a muscle. We strengthen it with use.
-- Ruth Gordon

Don't be afraid your life will end; be afraid that it will never begin.
-- Grace Hansen

Each day is a new canvas to paint upon. Make sure your picture is full of life and happiness, and at the end of the day you don't look at it and wish you had painted something different.
-- Author Unknown

Each day is a new canvas to paint upon. Make sure your picture is full of life and happiness, and at the end of the day you don't look at it and wish you had painted something different.
-- Author Unknown

I believe that imagination is stronger than knowledge -- myth is more potent than history -- dreams are more powerful than facts -- hope always triumphs over experience -- laughter is the cure for grief -- love is stronger than death.
-- Robert Fulghum

If you obey all the rules, you miss all the fun.
-- Katharine Hepburn

Kind words do not cost much. They never blister the tongue or lips. They make other people good-natured. They also produce their own image on men's souls, and a beautiful image it is.
-- Blaise Pascal

People take different roads seeking fulfillment and happiness. Just because they're not on your road doesn't mean they've gotten lost.
-- Dalai Lama

The grand essentials of happiness are: something to do, something to love, and something to hope for.
-- Allan K. Chalmers

Time is a dressmaker specializing in alterations.
-- Faith Baldwin

Whoever I am and whatever I am doing, some kind Excellence is within my reach.
-- John W. Gardiner

Your children are not your children.
They are the sons and daughters of Life's longing for itself.
They come through you but not from you,
and though they are with you, yet they belong not to you.
You may give them your love, but not your thoughts.
For they have their own thoughts.
You may house their bodies but not their souls,
for their souls dwell in the house of tomorrow,
which you cannot visit, not even in your dreams.
You may strive to be like them, but seek not to make them like you.
For life goes not backward, nor tarries with yesterday.
--Kahlil Gibran

great-inspirational-quotes.com

if ye are in doubt concerning the Resurrection

Hai manusia, kamu dalam keraguan tentang kebangkitan (dari kubur); maka (ketahuilah) sesungguhnya Kami telah menjadikan kamu dari tanah, kemudian dari setetes mani, kemudian dari segumpal darah, kemudian dari seumpal daging yang sempurna kejadiannya dan yang tidak sempurna, agar Kami jelaskan kepadamu dan Kami tetapkan dalam rahim, apa yang Kami kehendaki sampai waktu yang sudah ditentukan, kemudian Kami keluarkan kamu sebagai bayi, kemudian (dengan berangsur-angsur) kamu sampai pada kedewasaan, dan diantara kamu ada yang diwafatkan dan (ada pula) diantara kamu yang dipanjangkan umurnya sampai pikun, supaya dia tidak mengetahui lagi sesuatupunyang dahulunya telah diketahuinya. Dan kamu lihat bumi ini kering, kemudian apabila Kami turunkan air diatasnya, hiduplah bumi itu dan suburlah dan menumbuhkan berbagai macam tumbuh-tumbuhan yang indah (QS. 22:5)

O mankind! if ye are in doubt concerning the Resurrection, then lo! We have created you from dust, then from a drop of seed, then from a clot, then from a little lump of flesh shapely and shapeless, that We may make (it) clear for you. And We cause what We will to remain in the wombs for an appointed time, and afterward We bring you forth as infants, then (give you growth) that ye attain your full strength. And among you there is he who dieth (young), and among you there is he who is brought back to the most abject time of life, so that, after knowledge, he knoweth naught. And thou (Muhammad) seest the earth barren, but when We send down water thereon, it doth thrill and swell and put forth every lovely kind (of growth). (QS. 22:5)

Happiness associated with deep talk

Happy people spend more time conversing about serious subjects rather than chitchatting about the weather or engaging in other idle banter, a team of researchers has found.

Their study, published in Psychological Science, doesn't purport to prove a cause-and effect relationship between happiness and serious conversation. On the one hand, their report says, happy people may be “social attractors” who facilitate deep social encounters..

"On the other hand, deep conversations may actually make people happier. Just as self-disclosure can instill a sense of intimacy in a relationship, deep conversations may instill a sense of meaning in the interaction partners. Therefore, our results raise the interesting possibility that happiness can be increased by facilitating substantive conversations," the authors suggest.

There is anecdotal evidence that deep conversations do, in fact, lift the spirits. For example, members of the Inland Empire Atheists, Agnostics and Skeptics in Riverside enjoy serious talk about topics such as the meaning of life, the origin of the universe, evolution and politics.

Studies show atheists and agnostics on average have a higher IQ than others. Many have advanced degrees, or are otherwise informed about science and philosophy.

One Riverside atheist commented on joining the Inland Empire Atheists that he was glad to be around people who know what "a priori" means.

Charlene Powell, who organizes the West Side Lunch discussion group for the Inland Empire atheists believes that more meaningful conversations make people happier on many different levels:
"When we discuss more meaningful topics we are telecasting to the world our own deeper worth and meaning," she says.

Gayle Myrna, another IEAA member, notes one of the reasons she joined the group was to engage in intellectual discussions:
“Since then, I have not been disappointed. Our group has a high level of bright people...so the discourses are always engaging, whether or not I always agree with someone's position on a topic.”

She says she finds the discussions "very uplifting."

Dr. Matthias R. Mehl of the University of Arizona and his fellow researchers studied thousands of conversations by 79 undergraduates over a four-day period. They equipped each with a digital recording device that took samples every 12.5 minutes, analyzed the results to determine whether the participants were alone or talking with others and characterized their conversations according to complexity.

The research team found that --- consistent with other research --- people who were happy with their lives were more gregarious and talkative.

“For example, compared with the unhappiest participants, the happiest participants spent about 25% less time alone and about 70% more time talking.”

Moreover, the happiest also had about one third as much small talk and twice as many substantive conversations as the least happy.

The study " "Eavesdropping on Happiness: Well-being is Related to Having Less Small Talk and More Substantive Conversations” is available online.

The authors are Matthias R. Mehl, Simine Vazire, and their students, Shannon E. Holleran and C. Shelby Clark. Further research is planned to test the hypothesis that deep conversations engender happiness.

Their findings seem to have been anticipated by a philosopher who lived 2,400 years ago. “The unexamined life is not worth living.” --- Socrates

examiner.com

Residents are learning a lot of their medicine from the computer

In “The Hostile Hospital,” from the Lemony Snicket “Series of Unfortunate Events” books, the three young orphans at the center of the story visit the fictitious Heimlich Hospital, where Babs, the head of human resources, asks them if they know what the most important work done in a hospital is.“Healing sick people?” one of the children asks innocently.

“You’re wrong,” Babs growls, silencing the children. “The most important thing we do at the hospital,” she continues without flinching, “is paperwork.”

It’s a satirical stab that comes uncomfortably close to the truth.

Paperwork, or documentation, takes up as much as a third of a physician’s workday; and for many practicing doctors, these administrative tasks have become increasingly intolerable, a source of deteriorating professional morale. Having become physicians in order to work with patients, doctors instead find themselves facing piles of charts and encounter and billing forms, as well as the innumerable bureaucratic permutations of dozens of health insurance companies.

But despite the paperwork burden, there are few studies on the amount of time current doctors devote to charting, ordering, filling out forms and dictating. That is, except among one subset of doctors — doctors-in-training, or residents.

According to a study published earlier this year, residents now spend up to twice as much time on documentation as their counterparts did two decades earlier. Analyzing the results of a national survey of over 15,000 trainees in internal medicine, researchers at the Mayo Clinic in Rochester, Minn., found that a majority of residents reported spending as many as six hours a day documenting, while only a small fraction of residents spent as much time with patients.

In other words, young people who are learning to doctor spend as much time writing, typing or dictating about their patients as they do seeing them.

“Residents are learning a lot of their medicine from the computer,” said Dr. Amy S. Oxentenko, lead author of the study and an assistant professor of medicine at the Mayo Clinic. “That does nothing to foster the relationship with the patient.”

But the increase in paperwork has not only been absolute; it has also been relative. For residents, the sheer volume of administrative tasks they must complete is compounded by the fact that their work hours have decreased while documentation requirements have remained unchanged. “You can only fit so many activities into a day,” Dr. Oxentenko said.

Even though fatigue-related errors might be decreasing as a result of duty hours reform, new types of errors are now on the rise. Residents must make clinical decisions with less time to investigate the complexities of a patient’s symptoms and relatively little information culled from a one-on-one interview. “If you are spending so much time entering a note just because you have to enter a note,” Dr. Oxentenko said, “that’s less time to review that patient’s history, drug interactions, contraindications and the best test to order for that particular patient.”

While the introduction of electronic medical records has increased overall efficiency by allowing access to all of a patient’s previous documents, they have also spawned a whole host of electronic ways of bypassing actual patient contact when doctors are pressed for time. Residents may rely on notes written by other doctors instead of talking to the patients themselves. These other notes may have also been pieced together from previous notes rather than from actual interactions with the patient. As a list, a paragraph or whole sections get pasted into progressively more documents, important information, like a reaction to a certain treatment, can be lost in the transfer. Clinicians who rely mostly on computer notes for their information are at risk of inadvertently choosing the wrong therapeutic course of action for a patient.

A doctor’s note turns into a cut-and-paste collage instead of an accurate and personalized narrative of illness; and documentation becomes an electronic and potentially dangerous version of the game “Telephone.”

In the years ahead, achieving some kind of balance between documentation and patient interaction for physicians-in-training will be an ongoing challenge for doctors and medical educators. But the fundamental question driving these changes will be even more difficult to answer. Doctors and, even more significantly, patients must ask themselves what is the most important thing that young doctors must do with their limited hours of training.

“We have to ask ourselves, ‘Where do they really learn medicine?’ ” Dr. Oxentenko added. “If it’s with patients, then we have to make sure we preserve that face-to-face time. We have to preserve what is really important in terms of the learning environment because the habits doctors-in-training learn now will become their practice habits long-term.”

source: nytimes.com