Saturday, April 21, 2012

In Summary

I have been struggling with two distinct but complementary tasks of summary: writing a research abstract and a novel synopsis.  In both cases, I must capture the key points of a much longer work.  I must provide the busy reader with the highlights and also stimulate an interest to read more.  Perhaps most difficult of all, I must give away the ending.

The abstract gives a 300 word version of a 3500 word article.  It follows a predetermined structure with the background, methods, results, and conclusions of my research study.  The essence of a work that took two years to complete must be distilled into a form that takes ten minutes to read.  I have to admit that although the details are of great importance to me, they are not necessarily wanted by the reader. 

The synopsis is an even more daunting challenge.  I have more experience reading and writing research abstracts.  I have internalized the expectations and know how to meet them.  I am much less familiar with the literary world.  Synopses are not published with their novels, as abstracts accompany their papers.  They are read primarily by publishers and agents.  I have never played either of these roles and have, at best, a hazy impression of them.

In addition, the synopsis must summarize a 120,000 word book.  It has taken four years to write and has existed in some cognitive form for even longer.  All the subtleties of characterization, sub-plot development, imagery, and texture must be sacrificed in squeezing it down into a few pages.  It is not a pleasant task. 

However, it is necessary.  In order to send my intellectual works (both scholarly and literary) into the world, they must be accompanied by their summaries.  I am sure it is good for me in some way to go through this process, attempting to discern the most important elements and convey them to others with no prior knowledge of their source.  Even so, I will be happier when I am done!        

Sunday, April 15, 2012

More Difficult Questions

“Doctor, do you believe in God?”

This question comes up more often than I had expected when entering medical training.  I was immersing myself in the world of science.  I anticipated questions from patients and family members about diagnosis, prognosis, or treatment options.  My studies prepared me to address these inquiries.  But science is not the only worldview on patients’ minds.

In general, I plan to avoid discussing religion and politics, since these tend to be divisive topics.  However, both are inextricably linked to the practice of medicine and cannot be ignored.  And I’m sure I am not the only one who has been asked this question in a patient care situation, so it is worth wrestling with it here.  I cannot claim to have a good answer for dealing with this, but I can offer my experience.

The most recent instance was a patient who was struggling with losing his job, in the context of depression, anxiety, and a history of alcohol and drug dependence.  Suddenly, his security, future plans, identity, relationships were all disrupted.  I have also been asked this question by a woman undergoing ovarian cancer treatment, the mother of a comatose patient in the intensive care unit, a man in recovery from a debilitating stroke, and a man dying slowly of congestive heart failure.

I could decline to answer.  There are plenty of questions that I consider outside the scope of our doctor-patient relationship and redirect the conversation away from them (such as questions about whom I plan to vote for).  But questions of faith are, in fact, relevant. 

I want to know my patients’ values and beliefs.  They are important not only in life-and-death decisions but in any condition that could be affected by social support or coping skills.  If it seems helpful to my patients to know my values and beliefs and they directly ask me, I will share.

I usually do not know the agenda behind the question at the time.  My patient and I may have very different backgrounds and perspectives.  The important thing is not that we have the same belief but that we seek to understand each other.  So, I answer honestly.  And I open up the conversation and make it okay for my patients to talk about the spiritual side of their health and illness.

Happy Easter to everyone celebrating, this week and last week. 

Sunday, April 1, 2012

Behavior Change

“I am a physician, and as such, I demand that you alter your behavior.”
Lvov in Anton Chekhov’s Ivanov, Act 3

I love this quote because it exemplifies the opposite of how I believe physicians should go about changing patients’ behavior.  In Chekov’s play Ivanov, Dr. Lvov is highly critical of Ivanov’s treatment of his wife Anna (who is dying of tuberculosis) and skeptical of his intentions toward Sasha (and her dowry).  As you might imagine, ordering Ivanov to change is not particularly helpful and several people end up dead before the play concludes.

As a physician, I am invested with a certain authority to give people advice.  When I do, it is not simply my personal opinion but based on a body of scientific literature and the outcomes of other similar patients.  I tell you to quit smoking (for example) because I know the data on increased mortality.  In addition, I have seen people die of lung cancer, esophageal cancer, heart attacks, strokes, COPD, blood clots, and other preventable smoking-related causes.  And I have seen people suffer from chronic lung and blood vessel damage for years before they die.  It’s not pretty, and I want to spare you from a similar fate, if possible.

However, demanding that you quit because I say so is not likely to work.  I also have data and experience to draw from in the realm of facilitating behavior change, favoring more patient-centered counseling styles.  The key is to help you help yourself, by exploring your point of view and working with it. 

If your goal is to breathe well enough to keep up with your kids, we can aim for that.  Or if your goal is to stop wasting money on cigarettes, we can aim for that.  You know what is important to you.  You also know the challenges you are going to face: the smoking co-workers, the morning cup of coffee, driving, or whatever your personal temptations are.  We can treat the chemical side of addiction, but also need to think about the patterns of your life.

Whenever you make a change, you have to find the way that is going to work for you.  Everyone has unique barriers and strengths that have to be taken into account.  You know yourself better than anyone else.  I can point you in the right direction, but the motivation has to come from you.  In the end, it is not about me (or Dr. Lvov). 

Chekhov: the Major Plays, translation: Ann Dunnigan
Signet Classic: Penguin Books, USA Inc, New York, 1964.