Tagore - Methodist Hospital, Houston

I slept
And dreamt that life was all joy
I awoke
and saw that life was but service
I served
And understood that service was joy!

Kannadasan Lyrics

Film : Avan Pithanaa?
Singer : P. Susheela, T.M. Soundarrajan
Lyric : Kannadasan
Music : R. Parthasarathi
Actors : SSR, Vijayakumari

கிழக்கு வெளுத்ததடி கிழ்வானம் சிவந்ததடி
கதிரவன் வரவு கண்டு கமலமுகம் மலர்தந்தடி
எங்கள் குடும்பம் இன்று ஏறெடுத்து நடந்ததடி
இன்று வந்த தென்றலுக்கு இதயமெல்லாம் சிவந்ததடி

Source: Guru
http://www.inbaminge.com
http://inbaminge.blogspot.com

Click here to listen to the song

A drinking song

Wine comes in at the mouth

And love comes in at the eye;

That's all we shall know for truth

Before we grow old and die.

I lift the glass to my mouth,

I look at you, and I sigh.

William Butler Yeats (1865-1939)

Amruta...

"A good teacher speaks in a language that people understand...at that time...at that moment in history."

In Italy

Quote

Change is the permanence of life.

(Movie dialogue)

My Shadow

I have a little shadow that goes in and out with me,
And what can be the use of him is more than I can see.
He is very, very like me from the heels up to the head;
And I see him jump before me, when I jump into my bed.

The funniest thing about him is the way he likes to grow-
Not at all like proper children, which is always very slow;
For he sometimes shoots up taller like an india-rubber ball,
And he sometimes gets so little that there's none of him at all.

He hasn't got a notion of how children ought to play,
And can only make a fool of me in every sort of way.
He stays so close beside me, he is a coward you can see;
I'd think shame to stick to nursie as that shadow sticks to me!

One morning, very early, before the sun was up,
I rose and found the shining dew on every buttercup;
But my lazy little shadow, like an arrant sleepy-head,
Had stayed at home behind me and was fast asleep in bed.

Robert Louise Stevenson (1850-1894)
Author of Kidnapped, Treasure Island and The Strange Case of Dr Jekyll & Mr Hyde.

Art of losing

The art of losing is not hard to master;
so many things seem filled with the intent
to be lost that their loss is no disaster.

Lose something every day. Accept the fluster
of lost door keys, the hour badly spent.
The art of losing isn't hard to master.

Then practice losing further, losing faster:
places, and names, and where it was you meant
to travel. None of these will bring disaster.

I lost my mother's watch. And look! my last, or
next-to-last, of three loved houses went.
The art of losing isn't hard to master.

I lost two cities, lovely ones. And, vaster,
some realms I owned, two rivers. a continent.
I miss them, but it wasn't a disaster.

- Even losing you (the joking voice, a gesture
I love) I shan't have lied. It's evident
the art of losing's not too hard to master
though it may look like (Write it) like disaster.

Elizabeth Bishop (1911-1979)

The arrow and the song

I shot an arrow into the air,

It fell to earth, I knew not where;

For, so swiftly it flew, the sight

Could not follow it in its flight.

I breathed a song into the air.

It fell to earh, I knew not where;

For who has sight so keen and strong,

That it can follow the flight of song?

Long, long afterwards, in an oak

I found the arrow, still unbroke;

And the song, from beginning to end,

I found again in the heart of a friend.

- Henry Wadsworth Longfellow (1807-1882)

Quote: Rabindranath Tagore...about Duty/Service & Hope

“I slept and dreamt that life was all joy,
I awoke and found that life was but service
I served and understood that service was joy”

— Rabindranath Tagore, Poet and Nobel Laureate
(Plaque at the entrance of Methodist Hospital TMC, Houston).

Hope:
The blackbird sings in the dark of the night, because it knows that the Sun will rise next morning.

(Or is this the quote: "Faith is the bird that feels the light and sings when the dawn is still dark")

If you ever meet my countrymen who do not know this quote, charge him!

I like Gandhi and Tagore. But, Tagore more because there is something mystical about Tagore and his writings.

10/20/2011: Had lunch with this beloved oncologist in UTHouston (Adan Rios, MD). First, he came and sat in table close to me saying "O'Lord, Thank you for the food and company" "A small prayer!" "French radio played Tagore's drama on hope/survival as the last broadcast when Nazi's took over the station during World War II."

Link to some Tagore Quotes: http://allspirit.co.uk/tagore.html

Infant Mortality Rate in US

NYTimes (Oct 15, 2011) article on a program called "Healthy Start" regarding high infant mortality rate in blacks in US.





















Infant Mortality in India:

Quote: Learning from other's mistakes

Learn from mistakes of others. You can't live long enough to make them all yourself.

- Eleanor Roosevelt

NYTimes: The Phantom Menace of Sleep-Deprived Doctors

http://www.nytimes.com/2011/08/07/magazine/the-phantom-menace-of-sleep-deprived-doctors.html?pagewanted=1&_r=2

Kids and Money

(From UT Health Leader Newsletter...always has some interesting articles like this one).

The right ages and stages to teach kids
about spending, saving and giving

"No, dear, the ATM does not print money."

"No, dear, the credit card company will not
take your baby teeth as collateral
until the tooth fairy pays up."

"No, dear, your piggybank
actually feels better when it's full..."
(And you thought the other Facts of Life
was a tough discussion...)

Read more in today's HealthLeader...

Self-appraisal

Self-Appraisal

A little boy went into a drug store, reached for a soda carton and pulled it over to the telephone. He climbed onto the carton so that he could reach the buttons on the phone and proceeded to punch in ten-digits (phone numbers).

The store-owner observed and listened to the conversation:

Boy: ‘Lady, Can you give me the job of cutting your lawn?

Woman: (at the other end of the phone line): ‘I already have someone to cut my lawn.’

Boy: ‘Lady, I will cut your lawn for half the price of the person who cuts your lawn now.’

Woman: I’m very satisfied with the person who is presently cutting my lawn.

Boy: (with more perseverance): ‘I’ll even sweep your curb and your sidewalk, so on Sunday you will have the prettiest lawn in all of Palm beach, Florida.’

Woman: No, thank you.

With a smile on his face, the little boy replaced the receiver.

The store-owner, who was listening to all this, walked over to the boy.
Store Owner: ‘Son... I like your attitude; I like that positive spirit and would like to offer you a job.’

Boy: ‘No thanks’.

Store Owner: But you were really pleading for one.

Boy: No Sir, I was just checking my performance at the job I already have. I am the one who is working for that lady, I was talking to!'


This is what we call ‘Self Appraisal’

(Received as a "forwarded-email")

The old man in the park

by Vaishnavi Ramesh

As the sun decided to hide its face,
The old man began to quicken his pace,
To reach the spot where he planned to spend,
A few peaceful moments which he felt the Lord would lend.

Old beautiful memories played in his mind,
Of pitch black koels singing the praise of their day’s find,
A man and his fiancé walking hand in hand,
And him asking for her favourite jewellery brand.

But what the retina in his eyes had perceived,
Did not coincide with what he thought the world had achieved,
A man cursing his wife for not making a meal of his choice,
A tiny girl weeping for her pretty doll which was ripped apart by a group of big boys.

The old lad grumbled to himself in utter silence,
Wondering whether the whole world was filled with such tyrants,
Because of whom the world is like a machine with no grease,
Who deplete this planet from what it lacks,peace.

To me,a nobody in this train of life,
It seems like we will forever suffer in this strife,
Life,which used to be pictured as a boon by many,
Will just become a never ending movie where the villain never dies and to all the innocent living will cause agony.

Quote: Vaue yourself

From Shaman by Noah Gordon (p.536)

I should like to presume to give you some advice. Do not be reluctant to value yourself highly, for others do so. Nor should you hesitate to aspire to any goal, because God has been lavish in his gifts to you. (Reverend Mother to Shaman)

Common mistakes at doctor's office

http://www.cnn.com/2011/HEALTH/05/26/dumb.doctors.office.ep/

Powerpoint tricks at the podium

David Pogue's column on NYTimes.

1) Presenter's view on Powerpoint and Keystroke
2) What if they don't have hook up at the podium...print a hand-out and keep it with you.

Quote: Public Speaking - Roscoe Drummond

"The human mind is a wonderful thing—it starts working the moment you are born and it never stops until you get up to speak in public.” —Roscoe Drummond
(From Dr. Bricker's talk)

“What this country needs is less public speaking and more private thinking” - Roscoe Drummond

First Woman Doctor in India - Anandhibai Joshi (1865-1886)

This was sent by Karthik: http://thankyoudotcom.blogspot.com/2011/05/anandhibai-joshi-1865-1886-first-hindu.html

Interesting read... (if you haven't read before) bout Anandhibai, one of the first two women doctors of India. Especially the letter (Click here to read the scanned letter), dated June 28th 1883 is more interesting ...

http://en.wikipedia.org/wiki/Anandi_Gopal_Joshi

Excerpts from Wikipedia:

Born in 1865.

Married at 9 yrs.

Had a child at 14 yrs - who died after 10 days.

Enrolled in Women College of Medicine, Philadelphia in 1883.

Graduated in 1886.

Unfortunately, died in 1887.

Other Inidian women graduated from Drexel - med school in 19th century: visit Scroll.in
http://scroll.in/article/remarkable-photos-of-19th-century-indian-women-in-us-medical-school?id=659624

Innovation: Rib Spreader Saga

Turning to Biomechanics to Build a Kinder, Gentler Rib Spreader
By CARL ZIMMER

Ryan Collerd for The New York Times

INVENTORS
Over the past twenty years, Charles Pell, left, and Hugh Crenshaw have profitably translated their understanding of biomechanics.

Physcient is, in fact, a medical technology company. But its décor speaks to the exceptional careers of its co-founders, Hugh Crenshaw and Charles Pell. They both got their start studying biomechanics — how creatures fly, swim and crawl. Mr. Pell built models of muscles and fish heads. Dr. Crenshaw earned his Ph.D. figuring out how single-celled creatures swim. And over the past 20 years they’ve profitably translated their understanding of biomechanics into inventions, from robotic submarines to pill sorters.

Now they’re turning their attention to the world of surgery. The instruments that surgeons use today, they argue, were invented before biomechanics became a mature science. They work against the physics of the body, instead of with it. “The technologies remain remarkably unchanged,” said Dr. Crenshaw. “Maybe we can do better.”

Dr. Crenshaw and Mr. Pell are starting with a kindler, gentler rib spreader. Surgeons often treat the broken ribs and other painful side effects of open heart surgery as inevitable. But Dr. Crenshaw and Mr. Pell have invented a new kind of rib spreader that takes into account how bones can bend, rather than break. Their preclinical studies on pigs suggest that it causes far less damage.

If it turns out to work as they hope, the inventors will turn their attention to other tools of the trade. “The entire surgical tray is going to be transformed,” said Mr. Pell.

As a boy, Mr. Pell was, in his words, “a congenital geek.” He spent his free time building rockets, cars and wave machines. He went to art school and earned a master’s degree in sculpture, but his sculptures were more like robots than marble busts. After graduate school, Mr. Pell headed for California, where he ended up director of research and development at a company that built robotic dinosaurs for museum exhibits. He continued to come up with strange designs, like a water-filled arch that fish could swim inside to travel from one pond to another.

To figure out if a fish could physically survive the journey through a water bridge, Mr. Pell called up Stephen Wainwright, a pioneer in biomechanics at Duke University. “He said, ‘Who are you, and why are you doing this?’ ” recalled Mr. Pell. Despite his initial misgivings, Dr. Wainwright ended the conversation by offering to fly Mr. Pell to Duke for a visit. Not long afterward, Mr. Pell became the director of the BioDesign Studio at Duke.

At the studio Mr. Pell helped Dr. Wainwright and his colleagues build models to test their ideas about biomechanics, creating models of spinal cords, muscles, jaws and dozens of other animal parts. “These models can physically surprise you,” said Mr. Pell. “They can show you things that you didn’t think of before you built them.”

One of Mr. Pell’s biggest surprises came when he tried to make a simple model of a swimming fish. He built a rubber tube with a rounded front and then stuck a rod a quarter of the way down its length. When he put the tube in water and turned the rod back and forth between his fingers, it generated a wave with its tail. While making a new version of that tube, Mr. Pell accidentally nicked the tail end. That new shape, he discovered, caused the water to flow in a different pattern around the tube, creating thrust.

Mr. Pell, Dr. Wainwright and their colleagues got a patent for the design and started a company called Nekton to develop products from it. First, they turned it into a commercially successful bathtub toy. But when the Navy discovered Mr. Pell and his colleagues could get fishlike thrust from something without any moving parts, they encouraged him to get into the business of building underwater robots. Mr. Pell and his colleague at Nekton ended up making a highly maneuverable yardlong robot called the Pilot Fish.

“We started out as a toy company; we ended up as a defense contractor,” said Mr. Pell.

One of the people who encouraged Mr. Pell to go into business was Dr. Crenshaw. At the time, Dr. Crenshaw was at Duke studying a particularly tricky question in biomechanics: how microscopic marine organisms swim. Most marine creatures smaller than three millimeters and larger than 30 microns swim in a corkscrew. “It’s the most common pattern of motion in the world,” said Dr. Crenshaw.

Despite these wild spinnings, spiral-swimming creatures manage to navigate very well. To uncover their trick, Dr. Crenshaw built a tank in which he could film organisms spiraling in three dimensions. Dr. Crenshaw found that the organisms navigate by sensing the intensity of a stimulus — light in some cases, a particular chemical in others. If the organism is heading straight toward the stimulus, the level doesn’t change. If it drifts off in the wrong direction, the stimulus fades. The organism can simply change the curve of its spiral to change direction. “It’s a really simple rule,” he said.

Dr. Crenshaw and Mr. Pell discovered their obsession with biomechanics ran equally deep. “Chuck and I would literally just wind up chatting in a room somewhere, and an afternoon would disappear and the chalkboard would’ve been erased four times before we were done,” said Dr. Crenshaw. One evening they scribbled a plan on a napkin for a robot that swam in spirals.

They won another grant from the Defense Department and began to build a new robot, which they dubbed MicroHunter. It was small — about the size of a cigar — and exquisitely simple. Dr. Crenshaw and Mr. Pell put a light sensor at one end, a propeller at the other. The propeller was programmed to push the robot in a corkscrew path, which could be adjusted as light levels changed.

Dr. Crenshaw gave the robot its first test in a Duke swimming pool. He turned off the lights in the room and put a light at the deep end of the pool. Then he put the robot in the shallow end, pointing the other way. “It turned around and came back and hit the light bulb,” he said. “It was a perfect first try.”

Dr. Crenshaw and Mr. Pell helped open the way for other biomechanics experts to turn their insights into technology. Some researchers are building self-burying anchors based on razor clams. Others are adding bumps along the edges of windmill blades to mimic whale fins.

After their adventures with MicroHunter, Mr. Pell and Dr. Crenshaw moved off in different directions for a few years. Dr. Crenshaw left Duke in 2001 to work at the pharmaceutical company GlaxoSmithKline. He designed mazes of microscopic tubes, devices for testing potential drugs. Meanwhile, Mr. Pell continued to come up with new inventions at Nekton, like a rapid-fire pill-sorting robot. In 2008, the Massachusetts-based robotics company iRobot purchased Nekton for $10 million.

Dr. Crenshaw left GlaxoSmithKline in 2007 and began to lay the groundwork for Physcient. He decided to work in medical technology, hoping that his experience in biomechanics would let him spot opportunities to invent new devices. He lured Mr. Pell out of his post-Nekton retirement, and soon the two inventors found a medical device crying out for a biomechanical overhaul: the rib spreader.

Every year, surgeons use rib spreaders to open the chests of an estimated two million people, repair their hearts, and then close them back up. All the rib spreaders in use today are variations on the model invented by the Argentine surgeon Enrique Finochietto in 1936. Mr. Finochietto used a hand-turned crank to ratchet open two metal arms.

The Finochietto rib spreader gets the job done, but it can cause serious side effects. Survey had indicated that somewhere between 10 and 34 percent of patients end up with broken ribs. Nerves are sometimes crushed, and ligaments can be ripped. After surgery, some patients require heavy sedation for the pain, and their shallow breathing can make them prone to pneumonia. Even after leaving the hospital, some patients continue to feel pain for months.

“There was room for something different here,” said Peter Smith, the chief of thoracic surgery at Duke University School of Medicine and an adviser to Physcient.

Given all these side effects, Dr. Crenshaw and Mr. Pell were surprised at how little research had been done on the forces generated by rib spreaders. “We can’t understand why people didn’t measure forces on ribs the day that there were strain gauges to measure them,” said Mr. Pell.

Dr. Crenshaw and Mr. Pell collaborated with Greg Buckner, an engineer at North Carolina State University, and Dr. Gil Bolotin, chief of cardiac surgery at Rambam Health Care Campus in Haifa, Israel. Dr. Buckner and Dr. Bolotin had developed technology for sensing forces generated by rib spreaders. Physcient licensed their technology.

The Physcient team began to measure the force of rib spreading on pigs, which are biomechanically similar to humans.

They found that a Finochietto rib spreader delivered jolts of force that increased until they equaled the weight of the pig’s entire body.

“It’s almost equivalent to hanging a patient by the rib after it’s opened — just hanging them in the air,” said Mr. Pell.

“I said, ‘Well, there’s a biomechanics project if I ever saw one,’ ” said Dr. Crenshaw.

Bones may be hard, but they’re not brittle like chalk. Stretchy collagen fibers and other elastic proteins allow them to flex, like a green tree branch. Bend a branch too quickly and it snaps. But deliver the same force slowly enough, and the branch’s fibers have enough time to stretch and shift.

Dr. Crenshaw, Mr. Pell and their colleagues set out to build a rib spreader that took advantage of the physics of bone and other tissues. In their office shop, they built a prototype that was smoothly opened by a motor instead of being jerked open by a hand crank. Instead of two straight bars, they devised two rows of curved metal hooks, each of which can independently cradle a single rib or part of the sternum.

They first tested out the device on sides of pork they bought from a butcher, recording the strain on the ribs at different speeds. They noticed that a few seconds before a rib broke, they detected tiny popping sounds. These were from individual fibers snapping inside the bone. Dr. Crenshaw and Mr. Pell realized they could use these pops to avoid breaking bones.

“If you pick up a twig and start bending it, you’ll hear something snap before you ever notice any real damage to the twig itself,” said Dr. Crenshaw. “We’re doing something similar here.”

Dr. Crenshaw and his colleagues programmed the rib spreader’s onboard computer to stop advancing it within a quarter of a second after sensing one of these pops. It allows the fibers in the bones and ligaments to shift and stretch before it starts to move again.

Recently Dr. Crenshaw and Dr. Pell collaborated with their North Carolina State colleagues to test their invention, in a study financed by the National Institutes of Health and the National Science Foundation. The veterinarians opened up the rib cages of 10 live pigs — half with the new design, and half with the conventional one. It took about the same amount of time to open up the pigs with both devices. But the traditional spreader cracked ribs in four of the five pigs. The Physcient spreader broke only one rib, in the second pig the surgeons operated on, and that was caused by an accidental jam. The researchers improved the design, after which none of the remaining three pigs broke a rib.

The researchers also found that in the Physcient trials, the pigs had higher blood oxygen levels than when the surgeons used the traditional rib spreader, because they could breathe more deeply. The pigs also needed fewer painkillers, and recovered more easily.

“We hit all the important pre-clinical endpoints that we were going for,” said Dr. Crenshaw. He and his colleagues are aiming to bring their rib spreader to market in late 2012.

If all goes according to plan, the inventors want to take a look at other surgical tools that push and pull on the bodies of patients. “We’ve got years of products to bring out,” said Mr. Pell.


A version of this article appeared in print on May 17, 2011, on page D3 of the New York edition with the headline: Turning to Biomechanics to Build a Kinder, Gentler Rib Spreader.

Osler: Longevity

Longevity is a vascular question.

A man is as old as his arteries.

Physician Compensations Survey

15,000 physicians were surveyed across US in early 2011. The results are released by Medscape.

2011 Physicians Compensation Survey.

Cardiologists were the highest paid (median 325 K)...after Orthopedists and Radiologists. Pediatricians are the lowest paid (median 149K). Unclear if pediatric cardiologists were included in under cardiologists or pediatricians!

Osler: Words

Beware of words - they are dangerous things. They change color like the chameleon, and they return like a boomerang.

Medical History: The Legacy of Andreas Gruentzig - CardioSource Video News

The Legacy of Andreas Gruentzig - CardioSource Video News

Humans are classifiable into 3 types based on enteric bacterial flora.

NYTimes article

dt. April 20, 2011.

Quote: Advice to physicians

Keep your minds open, your hearts full, and your ears attuned to the calling. And, for goodness' sake, physicians, take care of yourselves!

Leon R. Kass
"Care of the Doctor"
Perspectives in Biology and Medicine 1991;34:553-60.

Photoshop tutorial videos

http://psd.tutsplus.com/tag/basix/

http://psd.tutsplus.com/tutorials/photo-effects-tutorials/photo-retouching-basics/

Quote: Robin Williams

At 59, I take life at the speed of life. Take it easy. What's the hurry?!

Distilling the Wisdom of C.E.O.’s by Adam Bryant

NYTimes
Published: April 16, 2011

This article was adapted from “The Corner Office" by Adam Bryant

IMAGINE 100 people working at a large company. They’re all middle managers, around 35 years old. They’re all smart. All collegial. All hard-working. They all have positive attitudes. They’re all good communicators.

So what will determine who gets the next promotion, and the one after that?
5 Qualities of a leader are the following:

1) Passionate Curiosity

Many successful chief executives are passionately curious people. It is a side of them rarely seen in the media and in investor meetings, and there is a reason for that. In business, C.E.O.’s are supposed to project confidence and breezy authority as they take an audience through their projections of steady growth. Certainty is the game face they wear. They’ve cracked the code.

But get them away from these familiar scripts, and a different side emerges. They share stories about failures and doubts and mistakes. They ask big-picture questions. They wonder why things work the way they do and whether those things can be improved upon. They want to know people’s stories, and what they do.

It’s this relentless questioning that leads entrepreneurs to spot new opportunities and helps managers understand the people who work for them, and how to get them to work together effectively. It is no coincidence that more than one executive uttered the same phrase when describing what, ultimately, is the C.E.O.’s job: “I am a student of human nature.”

The C.E.O.’s are not necessarily the smartest people in the room, but they are the best students — the letters could just as easily stand for “chief education officer.”

There are plenty of people who are passionate, but many of their passions are focused on just one area. There are a lot of curious people in the world, but they can also be wallflowers.

Though chief executives are paid to have answers, their greatest contributions to their organizations may be asking the right questions. They recognize that they can’t have the answer to everything, but they can push their company in new directions and marshal the collective energy of their employees by asking the right questions.

Some of the most important advances come from asking, much like a persistent 5-year-old, the simplest questions. Why do you do that? How come it’s done this way? Is there a better way?

2) Battle-Hardened Confidence

Some qualities are easier to spot than others. Passionate curiosity? It’s there for all to see. There’s an energy from people who have it. Other qualities are tougher to discern, especially the ability to handle adversity. Some people embrace adversity, even relish it, and they have a track record of overcoming it. They have battle-hardened confidence.

The best predictor of behavior is past performance, and that’s why so many chief executives interview job candidates about how they dealt with failure in the past. They want to know if somebody is the kind of person who takes ownership of challenges or starts looking for excuses.

“You can never really tell how somebody deals with adversity. When you have a difficult situation, some people just take it and run with it. Some people see adversity and they cower, as talented as they are. You could ask them about the adversity they had in the past, but you never really know the intensity of that adversity” said Jen-Hsun Huang of Nvidia.

Many C.E.O.’s seem driven by a strong work ethic forged in adversity. As they moved up in organizations, the attitude remained the same — this is my job, and I’m going to own it. Because of that attitude, they are rewarded with more challenges and promotions.

“I will ask them directly: ‘Give me an example of some adverse situation you faced, and what did you do about it, and what did you learn from it?’ The people I’ve hired who have had that ability to describe the situation have always worked out, because they’re able to sort of fall down, dust themselves off, and keep fighting the next day” said Nancy McKinstry, the chief executive of Wolters Kluwer, the Dutch publishing and information company.

Do they tend to blame failures on factors they cannot control, or do they believe they have the ability to shape events and circumstances by making the most of what they can control? It’s a positive attitude mixed with a sense of purpose and determination. People who have it will take on, and own, any assignment thrown their way. They say those words that are music to a manager’s ears: “Got it. I’m on it.”

3) Team Smarts

At some point, the notion of being a team player became devalued in corporate life. It has been reduced to a truism — I work on a team, therefore I am a team player. It’s a point captured in a cartoon, by Mike Baldwin, in which an interviewer says to a job candidate: “We need a dedicated team player. How are you at toiling in obscurity?”

The most effective executives are more than team players. They understand how teams work and how to get the most out of the group. Just as some people have street smarts, others have team smarts.

Team smarts is also about having good “peripheral vision” for sensing how people react to one another, not just how they act.

George S. Barrett, the chief executive of Cardinal Health, described an example of how he assessed managers when he moved into a new role.

“We were sitting with a group of about 40 to 50 managers, and people were standing up to raise certain issues,” he recalled. “And I watched this one executive. People were riveted to him, really listening and engaged. And then this other executive addressed the group, and I watched everyone’s eyes. And their eyes went back down to their tables. It was a clear signal that said, ‘You’ve lost us.’

Companies increasingly operate through ad hoc teams. Team smarts refers to the ability to recognize the players the team needs and how to bring them together around a common goal.

“Early on, I was wowed by talent, and I was willing to set aside the idea that this person might not be a team player,” said Susan Lyne, chairman of the Gilt Groupe. “Now, somebody needs to be able to work with people — that’s No. 1 on the list. I need people who are going to be able to build a team, manage a team, recruit well and work well with their peers. The people who truly succeed in business are the ones who actually have figured out how to mobilize people who are not their direct reports.”

4) A Simple Mind-Set

There is a stubborn disconnect in many companies. Most senior executives want the same thing from people who present to them: be concise, get to the point, make it simple. Yet few people can deliver the simplicity that many bosses want. Instead, they mistakenly assume that the bosses will be impressed by a long PowerPoint presentation that shows how diligently they researched a topic, or that they will win over their superiors by talking more, not less.

Few things seem to get C.E.O.’s riled up more than lengthy PowerPoint presentations. It’s not the software they dislike; that’s just a tool. What irks them is the unfocused thinking that leads to an overlong slide presentation. There is wide agreement it’s a problem: “death by PowerPoint” has become a cliché.
A lag exists in the business world. There was a time when simply having certain information was a competitive advantage. Now, in the Internet era, most people have easy access to the same information. That puts a greater premium on the ability to synthesize, to connect dots in new ways and to ask simple, smart questions that lead to untapped opportunities.

5) Fearlessness

Are you comfortable being uncomfortable? Do you like situations where there’s no road map or compass? Do you start twitching when things are operating smoothly, and want to shake things up? Are you willing to make surprising career moves to learn new skills? Is discomfort your comfort zone?

In other words, are you fearless?

Risk-taking is often a quality associated with entrepreneurs, the kind of people who make bet-the-farm wagers on a new idea. But risk-taking doesn’t quite capture the quality that many C.E.O.’s embody and look for and encourage in others.

With the business world in seemingly endless turmoil, maintaining the status quo — even when things appear to be working well — is only going to put you behind the competition. So when chief executives talk about executives on their staffs who are fearless, there is a reverence in their voices. They wish they could bottle it and pass it out to all their employees. They’re looking for calculated and informed risk-taking, but mostly they want people to do things — and not just what they’re told to do.

“One of the things that I characterize as fearlessness is seeing an opportunity, even though things are not broken,” said Ursula M. Burns, the C.E.O. of Xerox. “Someone will say: ‘Things are good, but I’m going to destabilize them because they can be much better and should be much better. We should change this.’ The easiest thing to do is to just keep it going the way it’s going, especially if it’s not perfect but it’s not broken. But you have to be a little bit ahead of it, and you have to try to fix it well before you have to. Companies get into trouble when they get really complacent, when they settle in and say, ‘O.K., we’re doing O.K. now.’ ”

“Specifically, in this culture I have to have people who not only can manage change but have an appetite for it,” said Mindy F. Grossman, the C.E.O. of HSN, the parent company of Home Shopping Network. “They tend to be more intellectually curious, so they don’t just have vertical climbs. I ask for those stories. I love hearing them and it gives me a real sense of the person.”

Chief executives advise that you will be rewarded for fearlessness, because so few people live that way and bring this attitude to work. It is risky. You may unsettle people by shaking up the status quo. But if you have the best interests of the organization in mind, you can unlock new opportunities for the company and for yourself.

C.E.O.’s can act as mentors to speed people along that learning curve. They may not develop silver-bullet theories, but they are experts in leadership because they practice it daily. And many of them have spent years honing their leadership styles, studying what works and what doesn’t, and then teaching others.

Chief executives face criticism from many corners, and it is often deserved. But there is no arguing that they have achieved a great deal.

Through their stories, lessons and insights, they have much to offer beyond the hard numbers.

Tsunami video from NYTimes

http://video.nytimes.com/video/2011/03/13/world/asia/100000000723617/amateur-video-of-tsunami.html

Talking money with Elmo

http://video.nytimes.com/video/2011/04/15/business/100000000776361/talking-money-with-elmo.html

Osler, on being scientific

By scientific, I do not mean the acquisition of the bare facts of science, but an understanding of its methods, a realisation of its meaning and an inoculation with its spirit...It is an attitude of mind, a sort of reflex, which at once on the presentation of a problem makes a man burn until its solution is accomplished. until he knows the status of the question among the investigators of the world.

The Reserves of Life. St. Mary's Hospital Gazette 1907;13:95-98.
From Osler by Charles Bryan 1997.

Little girl

Little girl gesturing to the story:

Gorilla Glass by Corning

David Pogue's article in NYTimes about Gorilla Glass.

Safety Announcement

Data Visualization

Link to related article in NYTimes.

Quote: Knowledge & Wisdom

Knowledge is proud that he has learned so much;
Wisdom is humble that he knows no more!
- Cowper.

..."sense" or "wisdom" is knowledge, ready for use, made effects and bears the same relationship to knowledge itself that bread does to wheat.
(From Osler by Charles Bryant. Oxford Univ. Press. p. 116)

Knowledge comes but wisdom lingers.
- Tennyson

Osler: Art of Medicine

Osler: The whole art of medicine is in observation.

Paraphrased by William Thayer in his book about Osler.

Osler: The way to learn & practice medicine

Paraphrased by William Thayer (Osler's student at Johns Hopkins):

Observe, record, tabulate and communicate.

Use you five senses. The art of the practice of medicine is to be learned only by experience; 'tis not an inheritance; it cannot be revealed.

Live on the ward. Do not waste the hours of daylight in listening to that which you may read by night.

Memory plays strange pranks on facts. The rocks and fissures and gullies of the mountain-side melt quickly into smooth, blue outlines of the distant panorama. Viewed through the perspective of memory, an unrecorded observation, the vital details long since lost, easily changes its countenance and sinks obediently into the frame fashioned by the fancy of the moment.

Always note and record the unusual. Keep and compare your observations. Communicate or publish short notes on anything that is striking or new.

Do not waste your time in compilations, but when your observations are sufficient, do not let them die with you.

Study them, tabulate them, seek the points of contact which may reveal the underlying law.

Somethings can be learned only by statistical analysis. If you have the good fortune to command a large clinic, remember that one of your chief duties is the tabulation and analysis of the carefully recorded experience.

Osler: Reading and General practitioner

It is astonishing with how little reading a doctor can practise medicine, but it is not astonishing how badly he may do it.

Self-centered, self-taught, he leads a solitary life, and unless his every-day experience is controlled by careful reading, or by the attrition of a medical society it soon ceases to be of the slightest value and becomes a mere accretion of isolated facts without correlation.

Books and Men in Aequanimitas 210-211.

Osler: Value of libraries

It is hard for me to speak of the value of libraries in terms which would not seem exaggerated. Books have been my delight these thirty years, and from them I have received incalculable benefits. To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not go to sea at all.

Osler: Medical Teaching

"Teach [the student] how to observe, give him plenty of facts to observe and the lessons will come out of the facts themselves".

Medical News [New York] 1903 (82):49-53

"Eye cannot see what the mind does not know."

"The whole art of medicine is in observaton, as the motto goes, but to educate the eye to see, the ear to hear and the finger to feel takes time, and to makea beginning to start a man on the right path, is all that we can do. We expect too much from the student and we try to teach too much. Give him good methods and a proper point of view, and all the other things will be added, as his experience grows."

"The Hospital as College" Aequanimitas 315-316.

Osler: Instruments of Learning

Observation plus thinking has given us the vast stores of knowledge we now possess of the structure of the bodies of living creatures in health and disease. There have been two inherent difficulties - to get men to see straight and to get men to think clearly; but in spite of the fraility of the instrument, the method has been one of the most powerful ever placed in the hands of man.

Glasgow Medical Journal 1911(76):321-333.

Osler: About poorly educated physicians

A man cannot become a competent surgeon without a full knowledge of human anatomy and physiology, and the physician without physiology and chemistry flounders along in an aimless fashion, never able to gain any accurate conception of disease, practising a sort of popgun pharmacy, hitting now the malady and again the patient, he himself not knowing which.

Aequanimitas 121. "Teaching and thinking"

Osler: Life long learning

If the license to practise meant that completion of his education how sad it would be for the practitioner, how distressing to his patients! More clearly than any other the physician should illustrate the truth of Plato's saying that education is a life-long process.

Importance of post-graduate study. Lancet 1900;2:73-75.

Mediocrity

“He has lulled himself into a false sense of competence.”

(Don't know the source)

Cricket - Field positions

From Wikipedia

Quote: Strong men

Shallow men believe in luck. Strong men believe in cause and effect.

-Emerson

Literature: Teaching to the Text Message

By ANDY SELSBERG

NY Times, March 19, 2011

I’VE been teaching college freshmen to write the five-paragraph essay and its bully of a cousin, the research paper, for years. But these forms invite font-size manipulation, plagiarism and clichés. We need to set our sights not lower, but shorter.

I don’t expect all my graduates to go on to Twitter-based careers, but learning how to write concisely, to express one key detail succinctly and eloquently, is an incredibly useful skill, and more in tune with most students’ daily chatter, as well as the world’s conversation. The photo caption has never been more vital.

So a few years ago, I started slipping my classes short writing assignments alongside the required papers. Once, I asked them, “Come up with two lines of copy to sell something you’re wearing now on eBay.” The mix of commerce and fashion stirred interest, and despite having 30 students in each class, I could give everyone serious individual attention. For another project, I asked them to describe the essence of the chalkboard in one or two sentences. One student wrote, “A chalkboard is a lot like memory: often jumbled, unorganized and sloppy. Even after it’s erased, there are traces of everything that’s been written on it.”

This was great, but I want to go shorter. Like many who teach, I keep thinking the perfect syllabus is a semester away — with just a few tweaks, and maybe a total pedagogical overhaul. My ideal composition class would include assignments like “Write coherent and original comments for five YouTube videos, quickly telling us why surprised kittens or unconventional wedding dances resonate with millions,” and “Write Amazon reviews, including a bit of summary, insight and analysis, for three canonical works we read this semester (points off for gratuitous modern argot and emoticons).”

The longest assignment could be a cover letter, and even that might be streamlined to a networking e-mail. I’d rather my students master skills like these than proper style for citations.

A lot can be said with a little — the mundane and the extraordinary. Philosophers like Confucius (“Learning without thought is labor lost. Thought without learning is perilous.”) and Nietzsche were kings of the aphorism.

And short isn’t necessarily a shortcut. When you have only a sentence or two, there’s nowhere to hide. I’m not suggesting that colleges eliminate long writing projects from English courses, but maybe we should save them for the second semester. Rewarding concision first will encourage students to be economical and innovative with language. Who knows, we might even start to leave behind text messages and comment threads that our civilization can be proud of.

Andy Selsberg, the editor of “Dear Old Love: Anonymous Notes to Former Crushes, Sweethearts, Husbands, Wives and Ones That Got Away,” teaches English at John Jay College.

Quote: Smell the flowers

I hope that while so many people are out smelling the flowers, someone is taking the time to plant some.
- Herbert Rappaport

Osler: "Aequanimitas" - Student Life...its really about the teachers.

Successful teachers is no longer on a height, pumping knowledge at high pressure into passive receptacles. The new methods have changed all this. He is no longer Sir Oracle...,but he is a senior student anxious to help his juniors...When a simple, earnest spirit animates a college, there is no appreciable interval between the teacher and the taught - both are in the same class, the one a little more advanced than the other. So animated. the student feels that he has joined a family whose honour, whose welfare is his own, and whose interests should be his first consideration.

From p75. Osler by Charles Bryan (Oxford Univ. Press, 1997)

This is quoted from "Aequanimitas" series by Osler. Title: The Student Life.

Photography: "Chimping"

NYTimes

March 17, 2011, 2:59 PM

Excerpts from the article.

Lessons learnt from a private lesson from Tom Bear

So what do you do if there’s too much shadow on one side of the face? A real photographer would hold up a reflector on that side—if there’s an assistant and fancy equipment handy. But in a pinch, Tom uses snow, a sheet from the hotel room, a piece of paper, somebody wearing a white shirt, or even—on our photo-safari lesson—a MacBook laptop, whose silver aluminum body makes a perfect diffuse reflector. “That’s why photographers use Macs,” he joked.* Like any good shutterbug, Tom thinks a lot about light. When he’s taking portraits, the subjects are frequently baffled to see him staring at his own fist in front of his face. What he’s doing is gauging the “wrap”—the degree of light falloff from the brightest side to the darkest side. Some degree of wrap is desirable in a portrait (photographically speaking, about 1.5 stops’ worth); you don’t want to shoot in direct sunlight, where you get squinty eyes and deep black unflattering shadows. On the other hand, you don’t want the face to look completely flat, either.

* Tom says that prints don’t show as much noise and pixels as you see on the computer screen. You might be dissatisfied with the way a photo looks on your computer screen, considering it too “noisy” (has too many color speckles)—but you’ll be surprised at how well it prints. You don’t see that much noise, partly because the ink smooths them out, and partly because people don’t look at prints with their noses pressed right up against them.

* Tom almost always shoots slightly overexposed. You can always tone down the brights in Photoshop later. But if the shot was underexposed, it’s much harder to recover the details that are lost in shadow. “And always overexpose women,” he said. “Overexposing kills wrinkles.”

(Note: Several readers left comments that David Pogue got this overexpose advice backwards. But, all agreed with "overexposing kills wrinkles")

* Tom suggests being careful to avoid “chimping,” a term I’d never heard before. That’s where you get so excited about looking at the playback of your photos on the camera’s screen that you miss the great shots still available around you. (Why is that “chimping?” Because you’re standing there, looking at your playback like an idiot, going, “Ooh! Ooh! Ooh!”)

A link from a readers' comments: http://www.luminous-landscape.com/tutorials/expose-right.shtml

Quote: Courage (Mark Twain)

Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain

Quote: Life

Life is just one damned thing after another.

- Elbert Hubbard

Osler: Mentor-Protege relationship

From Osler by Charles Bryant (Oxford Univ. Press, 1997) p. 59 & 62

Origin of Mentor: (Greek legend) Ulysses, king of Ithaca went to Trojan war - leaving behind his wife Penelope and Telemachus under Mentor's care. Telemachus learned practical wisdom from Mentor, that can not be learnt from books.

Mentor-protege relationship can not be forced. The would-be mentor should have competence, character and patience. The would-be protege must show ability, enthusiasm and a willingness to help.

Their personalities should be compatible.

A shared sense of humor is highly desirable, since relationship should be fun.

In general, the story of Mentor-Protege relationship is as follows: The eager young man expresses interest in another's work, formed a bond, and received guidance, focus and affection.

Osler: Quarrels among medical disciplines; Commercialism

1903 Speach to New Haven Medical Association:

Quarrels in medicine seem to make a pretty chapter in the history of medicine. Each generation seems to have had its own.

Quarrel among physicians has existed even in ancient times...

The Coans and the Cnidians, the Arabians and the Galenists, the humoralists and the solidists, the Brunonians and the Broussaisians, the homeopaths and the regulars in different centuries, rent the robe of Aesulapius. But these larger quarrels are becoming less and less intense...

Standard of the profession:

One has only to visit different parts of the country and mignle with the men to appreciate that everywhere good work is being done, everywhere an ernest desire to elevate the standard of education and everywhere the same self-sacrificing devotion on the part of the general practitioner.

Men will tell you that commercialism is rife, that the charlatan and the humbug were never so much in evidence, and that in our ethical standards there has been a steady declension. These Elijahs who are always ready to pour out their complaints, mourning that they are not better than their fathers...But, I am filled with thankfulness for the present and with hope for the future.

Garth in 1699 states the following:

"Now sickening Physick hands her pensive head

And what was once a Science, now's a trade."

Of medicine, many are of the opinion....that ancients has endeavoured to make it a science and failed, and the moderns to make it a trade and have succeeded. To-day the cry is louder than ever, and in truth there are grounds for alarm; but on the other hand, we can say to these Elijahs that there are more than 7,000 left who have nto bowed the knee to this Baal.

p.52-53 Osler by Charles Bryant (Oxford Univ. Press, 1997)

Travel Tips - Spending and tipping during travel

Is There a Right Way to Spend Money When Traveling?
By KEVIN SALWEN
Published: NYTimes March 9, 2011

1. Fix a daily or weekly budget. You may not be able to avoid feeling like a patsy or a skinflint, but a budget of how much to spend, tip or give will create a structure for your own sanity. The goal is to walk that tricky line between helping and having every encounter turn into a negotiation. You’ll never make everyone happy, but at least you’ll have a framework.

2. Overbuy gifts for yourself and others. This is our favorite method of economic development. It helps fuel employment (the most dignified form of money transfer) and it has the residual benefit of having something to bring back home. On a trip to India, we bought a gorgeous hand-woven rug in Jaipur, a piece that we were told took more than four months to make. As our guide, Ashok Verma, later told me in Varanasi, India: “Crafts are the best thing to buy; they have people’s dreams woven into them.”

3. Don’t bargain down price, bargain up quantity. Joan wanted to buy a set of colored stamps with bindi (Indian forehead dots) for her students (she teaches seventh grade). One hundred rupees, the vendor said. No, too expensive, she replied, following cultural norms of bargaining. The negotiation was on. Finally, Joan bought three sets for that same 100 rupees (about $2). The man got his price, she got more stamps. Ms. Honey urges travelers to stop bargaining before they are the only winner. “Let people earn a real wage,” she cautions.

4. Try to be more than a consumer. Local citizens “may be economically poor but they are often culturally rich,” says Harold Goodwin, professor of Responsible Tourism Management at Leeds Metropolitan University in England. So, engage in their culture by getting off the large bus and taking an interest in how they make their living. It’s O.K. to take photos of individuals who capture your interest — but only if you ask first and pay if requested, he adds. The rule is simple, Mr. Goodwin says: “Treat them as you would like to be treated.”

5. Let others earn a living by helping. In American airports and hotels I never get help with my luggage; wheeled bags roll, don’t they? But overseas, I’ve learned to relax and let someone else carry my suitcase. It’s a rational way for local residents to feed their families, and certain people have turned luggage-carrying into an art: when we were leaving the Varanasi train station, a man offered to carry our bags, then stacked both my and Joan’s roller suitcases on his head for our 200-yard walk.

6. Don’t give to panhandlers. Handouts send a multitude of wrong messages about dependency and the value of work. Plus, handouts encourage more begging, often by children (an awful alternative to school). Long-term change never starts with a quarter or even $10 stuck into someone else’s palm. Still, even Ms. Honey concedes she breaks down sometimes. “I tend to give to women and children because they are the most vulnerable.”

7. Instead, buy stuff on the street. The hawker’s life is a tough one, always a fight against weather, traffic and crime. So if you want to help, buy more than you usually might. Granted, I acted counter to this by not buying that T-shirt from the boy in Palmyra, but, as I think about it now, what would it have harmed if I had? Since then, I’ve purchased boiled eggs, bagged water, toys, even a novel. (I politely said no on the kitchen strainer.) Why not bolster that small-business spirit?

8. Sample local food. Tourists in the developing world often eat at a limited number of hotels or restaurants deemed safe by guidebooks. There’s logic to that, especially where food-borne illness is concerned. But you’d be missing out on part of the reason you travel in the first place.

“Buy food and beverages from local producers, taste the locally produced foods and enjoy this as part of your holiday experience,” Mr. Goodwin says. For instance, you haven’t really tasted a banana if you’ve never had one grown for immediate consumption (compared with ones modified for export and sold blemish-free in United States supermarkets). Peels help keep the fruit safe, as does boiling in the case of a cup of local tea. The winners are the farmers, who often are at the bottom of the economic pyramid.

Kevin Salwen and his daughter, Hannah, are the authors of “The Power of Half: One Family’s Decision to Stop Taking and Start Giving Back.”

A version of this article appeared in print on March 13, 2011, on page TR3 of the New York edition.

Quote: Osler - Importance of medical societies

p.50

The daily round of a busy practitioner tends to develop an egoism of a most intense kind, to which there is no antidote. The few set-backs are forgotten. The mistakes are often buried, and ten years of successful work tends to make a man touchy, dogmatic, intolerant of correction and abominably self-centered. To this mental attitude the medical society is the best corrective, and a man misses a good part of his education who does not get knocked about a bit by his colleagues in discussions and criticisms.

From Osler by Charles Bryan, Oxford Univ. Press, Oxford. 1997.

Online Software: Photo editing

Collected from an article on NYTimes (Mar 10, 2011)
photofunia.com

photo505.com

aviary.com
pixlr.com
splashup.com
citrify.com
taaz.com (makeup)
bighugelabs.com

Regional Bias in Rate of CABG surgery!

Data Watch
NEJM March 9, 2011
Dartmouth Atlas: Surgery rates for preference-sensitive conditions depends largely on where patients live and the clinicians they see.

Coronary artery bypass surgery (CABG) per 1,000 Medicare beneficiaries among hospital referral regions (2003-07)The colors on the map represent the rates of CABG surgery per 1,000 Medicare beneficiaries in each HRR. Rates are adjusted for age, sex and race. The highest rate, 8.9 procedures per 1,000 beneficiaries, was seen in McAllen, Texas. The lowest rate, 1.9 procedures per 1,000, was seen in Pueblo, Colorado. In other words, patients in the McAllen HRR were more than four times more likely than patients in the Pueblo HRR to undergo CABG during 2003-07. The national average rate of CABG was 4.6 per 1,000. The greatest variation within a single HRR was seen in Denver, where the rate of CABG surgery ranged from less than 2 per 1,000 beneficiaries in the Steamboat Springs, Colorado HSA to more than 7 per 1,000 in the McCook, Nebraska HSA.
Source: Improving Patient Decision-Making in Health Care: A 2011 Dartmouth Atlas Report Highlighting Minnesota

Quote: Osler - Find a calling, Stages of life

From Osler by Charles Bryan (Oxford Univ Press 1997)

p.32

Age specific developmental tasks:

(According to Carl Jung,...later by Erik Erikson)

21-35: Stage of identity

35-55: Stage of generativity

>55: Stage of consolidation

p.33

Osler to gradulating nursing students 1891:

...And happy life shall be yours, because busy and useful; having been initiated into the great secret - that happiness lies in the absorption in some vocation which satisfies the soul;that we are here to add what we can to, not to get what we can from, life.

Physical Examination & Words of Comfort - Abraham Verghese

cAN WATSON DO THAT?!

OP-ED CONTRIBUTOR

Treat the Patient, Not the CT Scan

By ABRAHAM VERGHESE

Published: NY Times February 26, 2011

Palo Alto, Calif.

Christian Northeast

THE other day as I walked through a wing of my hospital, it occurred to me that Watson, I.B.M.’s supercomputer, would be more at home here than he was on “Jeopardy!” Perhaps it’s good, I thought, that his next challenge, with the aid of the Columbia University Medical Center and the University of Maryland School of Medicine, will be to learn to diagnose illnesses and treat patients.

On our rounds of the wards, Watson would see lots of other computers with humans glued to them like piglets at a sow’s teats. We might visit a patient with a complex illness — one whose second liver transplant has failed, who has a fungal meningitis and now also has kidney failure and bleeding and is on a score of medications.

Watson might help me digest the sheer volume of data that is in the electronic medical record and might see trends in the data that speak of an impending disaster. And since Watson is constantly trolling the Web, he would perhaps bring to my attention a case report published the previous night in a Swedish journal describing a new interaction between two of the drugs my patient is taking.

Better still, if Watson could harness data from all the patients in our hospital and in every other hospital in America, we might be alerted to mini-epidemics taking shape. For example, Watson might recognize that the kidney failure in our patient is linked to kidney failure in a patient in Buffalo and another in San Antonio; all three patients, he might inform me, were taking a “natural” weight loss supplement that contained a Chinese herb, aristolochia, that has been associated with more than 100 cases of kidney failure.

In short, Watson would be a potent and clever companion as we made our rounds.

But the complaints I hear from patients, family and friends are never about the dearth of technology but about its excesses. My own experience as a patient in an emergency room in another city helped me see this. My nurse would come in periodically to visit the computer work station in my cubicle, her back to me while she clicked and scrolled away. Over her shoulder she said, “On a scale of one to five how is your ...?”

The electronic record of my three-hour stay would have looked perfect, showing close monitoring, even though to me as a patient it lacked a human dimension. I don’t fault the nurse, because in my hospital, despite my best intentions, I too am spending too much time in front of the computer: the story of my patient’s many past admissions, the details of surgeries undergone, every consultant’s opinion, every drug given over every encounter, thousands of blood tests and so many CT scans, M.R.I.’s and ultrasound images reside in there.

This computer record creates what I call an “iPatient” — and this iPatient threatens to become the real focus of our attention, while the real patient in the bed often feels neglected, a mere placeholder for the virtual record.

Imaging the body has become so easy (and profitable, too, if you own the machine). When I was an intern some 30 years ago, about three million CT scans were performed annually in the United States; now the number is more like 80 million. Imaging tests are now responsible for half of the overall radiation Americans are exposed to, compared with about 15 percent in 1980.

With that radiation exposure comes increasing risk for cancer, but what worries me even more is that this ease of ordering a scan has caused doctors’ most basic skills in examining the body to atrophy. This loss is palpable when American medical trainees go to hospitals and clinics abroad with few resources: it can be quite humbling to see doctors in Africa and South America detect fluid around patients’ lungs not with X-rays but by percussing the chest with their fingers and listening with their stethoscopes.

Of course, we still teach medical students how to properly examine the body. In dedicated physical diagnosis courses in their first and second years, students learn on trained actors, who give them appropriate stories and responses, how to do a complete exam of the body’s systems (circulatory, respiratory, musculoskeletal and the rest). Faculty members stand by to assess that the required maneuvers are performed correctly.

But all that training can be undone the moment the students hit their clinical years. Then, they discover that the currency on the ward seems to be “throughput” — getting tests ordered and getting results, having procedures like colonoscopies done expeditiously, calling in specialists, arranging discharge. And the engine for all of that, indeed the place where the dialogue between doctors and nurses takes place, is the computer.

The consequence of losing both faith and skill in examining the body is that we miss simple things, and we order more tests and subject people to the dangers of radiation unnecessarily. Just a few weeks ago, I heard of a patient who arrived in an E.R. in extremis with seizures and breathing difficulties. After being stabilized and put on a breathing machine, she was taken for a CT scan of the chest, to rule out blood clots to the lung; but when the radiologist looked at the results, she turned out to have tumors in both breasts, along with the secondary spread of cancer all over the body.

In retrospect, though, her cancer should have been discovered long before the radiologist found it; before the emergency, the patient had been seen several times and at different places, for symptoms that were probably related to the cancer. I got to see the CT scan: the tumor masses in each breast were likely visible to the naked eye — and certainly to the hand. Yet they had never been noted.

Too frequently, I hear of (and in a study we are conducting, I am collecting) stories like that from all across the country. They represent a type of error that stems from not making use of basic bedside skills, not asking the patient to fully disrobe. It is a more subtle kind of error than operating on the wrong limb; indeed, this sort of mistake is not always recognized, and yet the consequences can be grave.

IN my experience, being skilled at examining the body has a salutary effect beyond finding important clues that lead to an early diagnosis. It is a ritual that remains important to the patient. Recently my ward team admitted an elderly woman who had been transferred from her nursing home in the night because of a change in her mental status. A CT of the head and all other tests were determined to be normal; the problem had been dehydration, and she was better, ready to go back. But as our team was about to enter the room, my intern warned me that the patient’s lawyer daughter was unhappy with the plan to return her mother to the nursing home, and was waiting impatiently to see me and contest the transfer.

After introducing myself to the patient and to her daughter, I did a thorough but quick neurologic exam. I put the patient through her paces: mental status, cranial nerves, motor and sensory function, used my reflex hammer and pointed out interesting things along the way to my interns and students. I then said to the daughter that her mother seemed back to normal. To our surprise, the daughter seemed comforted, and now had no objection to her mother’s return to the nursing home.

Later, our team discussed what had just happened. We all felt that the daughter witnessing the examination of the patient, that ritual, was the key to earning both their trusts.

I find that patients from almost any culture have deep expectations of a ritual when a doctor sees them, and they are quick to perceive when he or she gives those procedures short shrift by, say, placing the stethoscope on top of the gown instead of the skin, doing a cursory prod of the belly and wrapping up in 30 seconds. Rituals are about transformation, the crossing of a threshold, and in the case of the bedside exam, the transformation is the cementing of the doctor-patient relationship, a way of saying: “I will see you though this illness. I will be with you through thick and thin.” It is paramount that doctors not forget the importance of this ritual.

An answer that might have been posed on “Jeopardy!” is, “An emergency treatment that is administered by ear.” I wonder if Watson would have known the question (though he will now, cybertroller that he is), which is, “What are words of comfort?”

History: "Boxes" - a poem by John Gibbon Jr.

Boxes

The boxes line up row on row

In and out of boxes all our lives

The womb's a box

The coffin, too

Big concrete slabs pushing to the skies

Filled with boxes

Inside the box, softness lies here and there

To cushion our bodies in chairs and lounges

To hold our bodies in gentle sleep

As we coast down hill from cradle to the grave.

John Gibbon Jr.

Jefferson Medical College, Philadelphia.

Invented an early version of Heart-Lung Machine in 1930-40s.

Barney Fife: Two rules at The Rock

Don Knotts from Andy Griffith's Show.

The Rock refers to Alcatras?

Humor: Forwarded Email

Rec'd from Sathya:

Hilarious Leave Applications

Infosys, Bangalore: An employee applied for leave as follows:
"Since I have to go to my village to sell my land along with my wife, please sanction me one-week leave."

This is from Oracle Bangalore: From an employee, who was performing the "mundan" ceremony of his 10 year old son:

"As I want to shave my son's head, please leave me for two days..."

Another gem from CDAC. Leave-letter from an employee who was performing his daughter's wedding:
"As I am marrying my daughter, please grant a week's leave.."

From H.A.L. Administration Dept:
"As my mother-in-law has expired and I am only one responsible for it, please grant me 10 days leave."

Another employee applied for half day leave as follows:
"Since I've to go to the cremation ground at 10 o-clock and I may not return, please grant me half day casual leave"

An incident of a leave letter:
"I am suffering from fever, please declare one-day holiday."

A leave letter to the headmaster:
"As I am studying in this school I am suffering from headache. I request you to leave me today"

Another leave letter written to the headmaster:
"As my headache is paining, please grant me leave for the day."

Covering note:
"I am enclosed herewith..."

Another one:
"Dear Sir: with reference to the above, please refer to my below..."

Actual letter written for application of leave:
"My wife is suffering from sickness and as I am her only husband at home I may be granted leave".

A candidate's job application:
"This has reference to your advertisement calling for a ' Typist and an Accountant - Male or Female'... As I am both (!!) for the past several years and I can handle both with good experience, I am applying for the post.