Monday, November 11, 2013

Movember / Men's Health: Week One

11 days
Summary of Movember posts:

11/4/13 November is Movember, when you may notice some of the men in your life sprouting mustaches to draw awareness to men's health issues. While the growing of facial hair may seem silly as an awareness movement, men's health issues remain quite serious. Despite that medical science has long had a bias towards how problems affect men, men still have a lower life expectancy than women. Simply put, we need to start taking better care of ourselves. While the official Movember charity focuses on prostate and testicular cancer, I plan to highlight issues that are relevant to my own practice.

11/5/13 Hand-washing! 'Tis the season for common colds, stomach bugs, and the flu. The best preventive measure a guy can take is regular hand-washing Studies have shown that proper hand-washing (with regular soap) reduced respiratory illnesses by 21% and GI illnesses by 31%. Unfortunately, other studies show that guys are much worse than the ladies when it comes to hand-washing Grab the soap, men, and wash those hands!

11/6/13 Zinc. There is often a lot of talk about zinc around this time of year, as it is often used as a treatment to shorten the common cold. Zinc is often touted in supplements as a prostate panacea. While there is some evidence that zinc can support prostate health, too much zinc has been associated with prostate cancer. Most men get adequate amounts of zinc from their diet and should only supplement it if they are known to be deficient.

11/7/13 Ankylosing Spondylitis. Everyone should take care of their back. However, proper specific diagnosis of back pain is critical to order to guide specific treatments and obtain good results. This is particularly true for young men. Ankylosing spondylitis is a form of arthritis which predominantly affects the low back. Men are 2-3 times more likely than women to have this disease, which commonly manifests from the late teens to early 30's. Stiffness is a major symptom, often even more so than pain. While it is important to address the pain, it is critical to recognize and treat ankylosing spondylitis early in its course to prevent deformity and other complications.

11/8/13 Osteoporosis. Age related osteoporosis tends to occur later in men than women; with increasing life expectancy, we are seeing more and more osteoporosis in men. Osteoporosis can occur in younger men as well, often due to medical problems or medications. Men are more likely to die in year following an osteoporotic hip fracture than women. The best "treatment" is prevention: adequate amounts of calcium and vitamin D and regular exercise.

Sunday, August 25, 2013

Generalist vs. Specialist

Years ago, I was conflicted when choosing my medical specialty. I had always imagined myself as a primary care physician, as a generalist, but none of the specialties that fit that description really resonated with me. Even when I finally chose Physical Medicine and Rehabilitation, I was drawn to it breadth. I felt that it's principal difference from the primary care specialties was philosophical, focusing on function instead of disease. Since starting practice, I have struggled to maintain that breadth. I want to remain a generalist within PM&R, though frequently I have been pushed to subspecialize. In my first job, I was shunted into caring for pelvic pain. In my current position, at various times I have found myself sucked into orthopedic rehabilitation, spinal cord injury medicine, musculoskeletal medicine, adult cerebral palsy care, and medical acupuncture. Recently, I have been delving into performing arts medicine. Through this all, I have struggled to maintain my identity as a general physiatrist.

 Early on in medical school, I heard a joke that went something like this, "A generalist is someone who knows less and less about more and more until he knows nothing about everything; a specialist is someone who knows more and more about less and less until he knows everything about nothing." The dangers of both approaches are evident in medicine. I have seen generalists who can only manage the most basic conditions and end up referring their patients to consultants for almost everything. I have also seen subspecialists so focused that they cannot or will not manage anything beyond the one disease or body part of their focus. Not all physicians fall under these characterization, but it is disturbing how much of medicine has shifted to such specialized care.

My experience thus far in design has been different, though admittedly I am not far enough into it to make sense of it yet. I did go into design with a strong opinion regarding specialization, beyond choosing the discipline of interior design. However, soon after entering the masters program, we were encouraged to start thinking about the specialization for our thesis work. Being a physician, I was naturally pushed towards healthcare design. However, I was surprised how much we needed to learn about graphic design, landscape design, experience design, and urban design. So as I was becoming broader in terms of other disciplines of design, I was becoming more focused within my chosen discipline.

I do not feel that being either generalized or specialized is necessarily better. In both medicine and design, there is room for both. There needs to be constant assessment and adjustment as to the balance between them.

Sunday, July 21, 2013

Conference Geek

This weekend I am in Snowmass, CO for the 31st Annual Symposium on Medical Problems of Performing Artists sponsored be the Performing Arts Medicine Association (PAMA). This is a fascinating conference, not just because of the content, but also because of the attendees. So many of the conferences I attend are populated entirely by physicians. The PAMA conference is attended by physicians, therapists, musicians, and music educators. It is so refreshing to see collaborations and to hear different points of view.

As a physician, there is a constant need for continuing education. Some of that need is internal. I enjoy learning. I feel an ethical obligation to keep learning. There are also external requirements, from the state, from the hospitals where I have privileges, and from the specialty boards to which I belong. Physicians are required to get a certain numbers of continuing medical education (CME) credits; the amount for a given time period varies by who is doing the requiring. A certain percentage of the credits need to be in the physician's specialty. This tends to focus continued learning on achieving depth of knowledge in a specialty. I'm in a very luck situation. Working at an academic hospital, I can achieve all of my required credits within my specialty just be attending weekend noon-time grand rounds. Since it is so easy for me to meet my requirements passively, I am able to direct further efforts towards areas of interest or towards building breadth of knowledge.

Medical conferences can be a great source of both education, as well as CME credit. However, they carry a reputation of being excuses for doctors to go on fabulous vacations, with a little education thrown in for good measure. While there is more regulation now, often these educational junkets would be funded by pharmaceutical or medical equipment companies. This could certainly bias the attendees towards the funder, and in worse case scenarios even bias the content of what was being presented. Even at more reputable conferences, the presence of various interests in an exhibit hall and underwriting of some activities are potential sources of bias.

Since I use conferences as a supplementary education source, I have the luxury of being a little more picky in which I select. I try to focus on topics that I want to take a deep dive into, or on areas that I feel a pressing need for further knowledge. Even when the locations are fabulous, I tend to be a bit of a geek. I actually love going to the presentations; it is so nice to be able to show up rested and be able to stay awake for an entire lecture! I also feel guilty about skipping lectures to go off and do something fun; I could miss good learning or networking opportunities. I enjoy the opportunity to be able to focus on learning, without the distractions of work and home life.

Saturday, July 20, 2013

Book Freak

I am a self-acknowledged book geek. I love books. I love reading them. I love holding them. I like the feel of the paper. I don't mind when the ink of cheap novels smear all over my fingers. I love fiction, non-fiction, poetry, science fiction, and fantasy. I love graphic novels, I look cookbooks and design picture books.

I get the current fascination with e-readers like the Kindle and Nook, though I haven't felt the urge to buy one. I know an e-reader would be a lot easier for reading on the bus or train. An e-reader would also allay one of my great fears: running out of books while on vacation. However, that would also deny me a great pleasure, namely exploring great bookstores while on vacation.

Last evening, we had some time to kill before dinner and happened upon Explore Booksellers in Aspen, Colorado. Rob needed a new book, and we both love independent bookstores. The store is in a cute, little house. All of the tiny rooms were filled to the ceiling with shelves packed with books. I've been in similar stores in the past, and they often have an chaotic, musty sense to them. Explore was organized and very neat, which made exploring the extensive collection so much more enjoyable. While they did have a cafe upstairs, I was happy to note that the smell of the books completely outweighed any aromas that might have come from the cafe.

Of course, I left with a new book. I have so little control in a bookstore. I love wandering around, picking up books based on their title or cover. I like reading the backs or jackets. I appreciate when the staff highlights books by making little displays on tables or shelves. In one of my favorite bookstores, Unabridged in Chicago, the staff write up little reviews of their favorite books and tape them to the shelves. After a while, you learn which of the staff has taste most similar to yours and you seek out their reviews. It's like having a personal book shopper. I don't get the same experience shopping online; I will buy through Amazon if I know there is a specific book that I need. However, there is no joyful experience. I love browsing for books and getting suggestions from staff, and I will almost always leave an bookstore, especially an independent local store, with a few books.

Saturday, July 13, 2013

There Is Nothing Like A Broad?

"There is nothing like a dame
Nothing in the world
There is nothing you can name
That is anything like a dame"
  --There Is Nothing Like A Dame

"My doll is as dainty as a sparrow
Her figure is something to applaud
Where she's narrow, she's narrow as an arrow
And she's broad, where a broad
Should be broad..."
  --Honey Bun

South Pacific (1949) Rodgers And Hammerstein

As I go traipsing down the street, as often as not the soundtrack in my head is as likely to be provided by a Broadway musical as it is my current pop music. I have a particular fondness for South Pacific for two reasons. My parents frequently played the original cast recording, featuring Mary Martin and Ezio Pinza. Along with Mame, Showboat, and Fiddler on the Roof, these formed some of my earliest musical memories. In college, I sang with the University of Florida Men's Glee Club, and music from South Pacific was a staple of our repertoire. On the way to work last week, I was humming through South Pacific and the word "broad" got stuck in my head.

I love words. I truly do. I love how English freely accepts and morphs words from so many different sources. I love how words can have contradictory meanings. I love how words evolve in form and meaning over time. I love when I get to struggle with a word.

I am not a prescriptive (or proscriptive) linguist. Throughout my degree in English, I prided myself in being a descriptive linguist. I find the self-proclaimed grammar experts/snobs to be tedious. Languages evolve or they die. It is far more interesting to see how languages are actually used, or even abused, in the real world. I am capable of using "correct English" for formal writing or speaking; the rest of the time, I oft choose not to.

I tackled "broad." The origins of the word as a noun referring to a woman are a bit murky. A brief internet search provided reams of contradictory information from experts who state the validity of their "research" with absolute certainty. I have learned that "broad" is associated with "woman" because it used to mean:
  • playing card. Later, in the gambling scam Three Card Monty, the player would need to select the card/board with the queen.
  • entry or transportation ticket. Somehow, that got associated with a prostitute being a pimp's meal ticket.
  • the widest section of a ship. As ships were often referred to as "she," this term was transferred to women.
  • a shortening of "abroadwife." This was a woman separated from her husband, often by slavery.
Some of these definitions came with references, of varying levels of quality. I followed the trail for a while before I got bored.

For my current inquiry, the etymology really doesn't matter that much. I more curious about the current connotations. As always, a quick check over at Urban Dictionary proved to be entertaining but ultimately unhelpful.

My own sense of the word is that there is something vaguely negative associated with the word, that it shouldn't be used for some reason, but that the reasons are at a meta-level. When I think of "broad" I do not associate any specific negative meanings. In fact, most of the uses that come to my mind are fairly positive. I think of "tough broads," "tough old broads," "classy broads," and "sexy broads." I would envision a broad as being secure, powerful, resilient, middle-aged to senior, and refined without being overly sophisticated. Women who spring to mind would include Bea Arthur, Margaret Thatcher, Hillary Clinton, Bette Davis, Bette Midler, and Whoopi Goldberg. For me, the meanings attached to the word are admirable, but I still struggle with a sense of disapprobation in using it.

Of course, what it means to me is only relevant in my head. From a use standpoint, how other people consider and react to the word is what is important. So I welcome discussion. Is "broad" permanently tarnished or has it evolved to become a useful term for a particular type of woman? Is the shift in meaning I talk about due to evolution or due to an active reclamation of the word?