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?

Sunday, July 7, 2013

How Much Is Too Much?

There is joke among doctors, "What is an alcoholic?" "Someone who drinks more than his doctor."

Recently, a friend was injured when he fell following an evening of drinking. While his injury was fairly significant, thankfully there shouldn't be any long-term physical sequelae. This isn't about him.

What has been fascinating [is that the right word? Interesting? Challenging?] has been the ripples of responses within our circle of friends. There are all varieties of drinkers amongst my friends. Some barely drink at all. Some drink fairly impressive amounts on a regular basis. A few have discriminating tastes, and they take pride in their knowledge of variety of wines, crafted cocktails, and high end beers. Others have palates which are not so picky. Equally diverse has been the reactions following our friend's injury. Some barely acknowledge that anything happened. Some have considerably curtailed their own drinking, whether consciously or not. It seems like a few have even doubled down and picked up the pace.

Which leads me to the question I posed in this post, "How much is too much?"

As a physician, I've often struggled with this question. In rehabilitation, we often care for people who have had serious injuries caused by alcohol, as consequences of their own drinking or someone else's. I've care for people with head injuries, spinal cord injuries, severe fractures, liver failure, and burns. With each patient, I am stunned how quickly a life can change in a moment of bad judgment. After such an injury, however, my role is fairly clear cut.

What to say to people who haven't (yet) been affected? In my outpatient practice, it is fairly routine to ask people about smoking and drinking habits during an evaluation. These are people who may be coming to me for neck pain, tendon problems, sports injuries, or arthritis. What should be my flag to act on the information I collect and express concern about alcohol?

One might think that there is consensus among the healthcare professions about guidelines for alcohol consumption. I'll be the first to acknowledge that I am not an expert. There are guidelines which indicate amounts that may be beneficial for one organ systems, but often they conflict with guidelines for amounts that could harm a different organ. There is disagreement about how guidelines should be adjusted for gender or body weight. Genetics can influence how well people process alcohol, and they seem to influence who is at risk for addiction. Honestly, even if I knew how to weigh all of these different factors, I don't think I could effectively do that during a clinical encounter when I'm supposed to be treating knee pain.

I have equal confusion in a social context. There often is not a good correlation between the people who drink a lot and the people who suffer consequences from drinking. That makes it hard to rally support to intervene, when the people needed to help with an intervention may actually drink more than the person who really has a problem. Then, there is not even great agreement about what constitutes the best help: programs that advocate abstinence or ones that focus on harm reduction? Programs that are professionally based or community-volunteer led?

I really struggle with this both professionally and personally. I want to be a good physician and a good friend. I want to be an effective resource and advocate. How do I distinguish who needs help from those who are simply enjoying a vice responsibly? Then, how do I help? I know there are no easy answers to any of this. I have been struggling with the questions of how alcohol (and other substances) fit within a social milieu since college. It just feels more acute, more emotional, right now having had a friend get hurt.