#1 month clinical medicine

More than a month into full time clinical medicine. Big privilege to witness the life-time events in the lives of patients. Getting news that you will not live through the next week. Hear that the sickness that stopped you from finding joy in arts or seeing your friends will probably be with you throughout your lifetime. Being the partner to this patient, knowing she was the most outgoing person you have ever met. Getting news that your disabling disease is psychological in nature.

I perceived these moments as deeply moving and utmost human. They are evidence to what medicine is about.

This post could end here, and for me, it should.

there’s a second side to this experience. It is these human moments that many doc’s work for, for the better of their patients. Meanwhile, you stop seeing your own family. You cannot attend that dinner party because you have to finish an admission letter or fill in the two-page long prescriptions list into the computer. Sports and lengthy cooking are luxury when you come home after 10 hours of work driving home for an hour because you’ve got your rotation placement in another town, and all you want to do is rest and sit on the couch. You become tired. inconsiderate to colleagues. In the middle of high stress on the job, just having called for 20 minutes to correct a mistake you filled out on a scan order, you flip at a patient. You react tired and negatively to the request of a nurse.
You realize, after having followed this long path of education and early career that you ended up in a terrible position. With the very best intentions on the way, idealizing, generally being loving and warm, you realize that you became a person you don’t want to be. One you would disgust and turn away from.

To be clear, I’m not in this situation (yet). I believe that the academic work I’m doing will make it possible to evade some of the bad things.

Medicine has markedly improved. The health care that is provided today, having its flaws, makes our society possible. It makes you drink your favorite wine or loving that wife of yours twice as long as your great-grandfather did.
But: what are we doing to our doctors, while they aspire the best?

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Setting up a biomedical experiment: a hassle in itself (2015 edition)

When doing research that is more fundamental, you will want to do measurements at a certain point that no one else in this world has done before. Sorting that out can be quite a hassle, if turning out to work after all. But, especially in fundamental research, if it works it is worth it: most of the time you will get results that are exciting.

For future projects I have developed a strategy that will hopefully minimize efforts in the setup of methods, and give more time for the actual experiment, analysis and the writing it up. Here’s the flow chart:

For techniques that are NOVEL

  1. First, critically question whether the technique you are about to use will be absolutely necessary
  2. Secondly, try to get all the knowledge that you can aquire from the members of your research group. Find out who did similar things, or who has seen this maybe at an international visit somewhere else.
  3. Define clear end points: what do you want to measure? What if it doesn’t work (to your hypothesis, project, etc)?
  4. Always bring along very good controls when you are doing an experiment!! Good controls tell you if something worked, or didn’t, AND why.
  5. Dare to stop. If something is not working out, don’t try it more than a couple of times. Instead, think critically about your setup. Consult people (also from other fields, especially chemists or bioinformaticians can be sometimes helpful).
  6. Document well whatever you have done and when your technique worked, or not.

For adaption of well-known techniques

  1. Best thing possible is: someone in your lab has a working protocol and has tested it.
  2. If not, do a rigurous literature research. Find out how other people used the resources that you have to come to a desired outcome.
  3. Contact those investigators that have apparently well working methods. Ask them for their protocol, talk to them on the phone about it, be particularly eager to get clarifications. Try it out right away.
  4. Try to get one of the lab technicians involved in your thinking. They know generally a lot about the methodological tricks and might offer valuable input that you would have never gotten from PubMed or the book.
  5. Again, whatever you do, take along good controls that tell you where it went wrong.

Investing time in your methodological setup can be a hassle. But it will pay off eventually: both financial, and in terms of scientific outcomes (results, publications, impact on society).

How I keep up to date with literature using twitter and email alerts (2015 edition)

Twitter can be used in an informative way. For example, I follow the most interesting journals for me, directly getting notices and comments on recent articles.

I follow the following twitter accounts:

  • European Cardiology (great for important clinical research and policies)
  • Stanford Medicine (sometimes interesting)
  • Ben Goldacre (author of Bad Science column in the Guardian) – he is also twittering about the pubcrawls though
  • BMJ
  • BMJ students (largely crap, but sometimes shining stars)
  • John Hopkins medicine (sometimes interesting)
  • The Lancet
  • NEJM
  • Cochrane Collab
  • Nature Medicine

You can also sign up for e-alerts of most of the journals. Then, you will receive an email every time a publication is due. I did that for some time, but in the end I had a lot of mails from the journals and only part of it was of particular interest to me. I had to read through all of the mails though to get the information I really wanted.

Thus, my strategy today is to have twitter as a general source of information in medical sciences (and health care), and to have a few e-alerts from journals that are really important to me. To not miss on anything, I also have installed a PubMed email alert on my specific field (sign up on PubMed, then just search your field and press notify me on updates).

I also follow the twitter accounts of my affiliated institutions and of a couple of befriended researchers.

The end to days full of meetings and my resuscitation of the paper agenda (2015 edition)

Recently I read the book ‘The four hour workweek’ by Tim Ferris. One of the things Tim advocates for in detail is about stopping to attend meetings. He argues that a lot of times meetings are held just for the sake of having the meeting, or tend to be unproductive etc.

I agree to a certain degree with this, especially in academia (to my experience, business meetings are a lot more to the point). In contrast also disagreeing in the sense that I believe sometimes meetings can be important, either because information is transferred more directly or human, emotional communication alongside the message is beneficial. Also, during the past three years, I learned a lot of stuff by just attending meetings. Anyways, there is something to Tim’s meesage.

In 2012, having a lot of responsibilities at university, my general agenda would be filled with at least three or four meetings a day. Usually, I would more or less hurry from one meeting to the next one. People in academia are not necessarily used to ending meetings on time, and this also produced marked confusion in my schedule.

At some point, I radically changed my way of meetings. I reduced the number of meetings to three a week, only keeping up the regulars that I absolutely needed to attend to, or those were I would have a guaranteed learning experience.

This was cutting on my input a little, but left extra hours of time for research, sports or preparing a nice dinner.

On a project committee which required regular meetings, we scheduled the meetings on short notice and with a clear agenda.

I tend to rely on having a clear agenda of subjects beforehand. Also, I foster wherever possible to cut on meeting duration (15-20min is a good goal) to be more productive. I also try to plan as few meetings as possible to leave more time for more important tasks. Only having a meeting when it is really necessary helps you to keep focused.

By reducing the overall meetings I have been able to increase my productivity and total spare time effectively. I also bought a paper schedule that I now use instead of the iPhone/iCloud calendar. This makes me focus on 2-3 things a day (there is no more physical space in the schedule to fill in more meetings anyways). The rest is for pure work!

 

Measuring the Gains from Medical Research

A book I have been reading the past couple of weeks is ‘Measuring the Gains from Medical Research: An Economic Approach’. It is edited by the health economists Kevin Murphy and Robert Topel from University of Chicago.

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Health care spending has exploded in the past decades, while research spending in the field of medicine also increased markedly.

In this book, leading health economists ask whether we are getting our money’s worth. From an economic perspective, they find, the answer is a resounding ” yes”: in fact, considering the extraordinary value of improvements to health, we may even be spending too little on medical research.

In a collection of papers from several contributors, the editors argue that investment in medical research actually increases the wealth of a nation, thus being a worthwhile thing to do.

Murphy is Professor of Economics at Chicago University. Likewise, Topol is from the same area, but apparently focusing on labor market.

Quoting from Murphy’s website:

In 2007, Murphy and fellow Chicago Booth faculty member Robert Topel won the Kenneth J. Arrow Award for the best research paper in health economics for “The Value of Health and Longevity,” published in the Journal of Political Economy. The award is given annually by the International Health Economics Association.

Well, it’s a book worth reading!

You can get it at amazon here.