Sunday, August 27, 2017

Old Footballers Never Die....They Just Play in Reunion Soccer Games

This one goes out to all who appreciate the Beautiful Game and the value of lifelong friendship.

Old footballers never die they just play in reunion soccer games! 

Thank you to all who coordinated, participated and watched the 1st Annual Oneida High School Alumni Soccer Classic. 

More so, thank you to all soccer alumni and friends for the wonderful memories, both past and present.

We will be back in 2018!

1st Annual OHS Alumni Soccer Classic: Photo of Teams

OHS 1988 Varsity Soccer Team-L to R: Jon Pawlika, Camilo Bearman, The Blogger, Brent Elford, Jeff Reese, Mark Lundrigan, Lars Ljungkvist

Pre-game with Swedish Soccer Star: Lars Ljungkvist

Pre-kick Off Huddle

Regrouping at halftime
Back in the OHS Goalmouth After 29 Years

With Special Guest Nick Meskos: West Genesee Soccer Standout and 1988 Empire State Games Teammate 

Pre-event Greetings

A Loyal Fan
1988 OHS Varsity Soccer Team

Wednesday, August 23, 2017

Success in Medical Education in the Era of Alternative Facts

This thoughtful article in the New England Journal of Medicine, by our very own Dr. Richard Wenzel, argues for the critical importance of teaching, inquiry, observation and reflection in medical education, particularly in an era of alternative facts where sound bites and reverence for patient throughput reign. 

Clinician-educators work under the pressures of increased revenue generation, frequently at the detriment of important intellectual and educational pursuits. Thought and reflection are undervalued. 

I fully agree.

As a Division Chair much of my job is to function as a steward of educational and academic opportunities so as to protect faculty time (typically 20%) for non-clinical work.  Setting reasonable RVU generation benchmarks is also important.This is not easy yet achievable.These structural mechanisms, along with mentorship, are necessary yet not sufficient for academic success.

Intrinsic motivation is key. 

There is little that can be done to motivate someone. As explored in the book Driveby Daniel Pink, highly functional people are driven by autonomy, mastery and purpose. Extrinsic motivators, such as more pay, prestige and enhanced benefits work less effectively.         

Spanish Nobel Prize winning physician, Santiago Ramon y Cajal published Reglas y Consejos Sobre Investigación Científica (1898), wherein he summarizes his observations and perspectives on medicine and scientific investigation. Many of the observations still ring true. Discovery is not necessarily a function of special talent, but a function of hard work, which creates talent, and, low achievement is less commonly from a lack of time and resources, it is more from a lack of willpower.

Intrinsically motivated faculty should be recruited, selected and celebrated. This will be fruitless without the appropriate environment to flourish.

Monday, August 21, 2017

Book Nerds Visit the Stacks! Rare Manuscripts and Magnificent Reading Halls

This is of little interest to most except the nerdiest bibliophiles. 

I made an appointment with a VCU Tompkins-McCaw medical library archivist (not librarian) to visit some of the 16th, 17th and 18th century manuscripts and books from the special collections and archives. Much of the collection is from that of Professor Herman J. Flax's collection of rare physiatry texts such as a 16th century french translation of Galen (pictured below). A Vesalius manuscript is also available for viewing via the Virginia Historical Society.

These books are old, frail, out of date, worn out and of no practical use. Regardless, they represent our ability to seek, learn and share, an inspiration for ongoing reading, learning, experimentation and growth.

I spent much of my medical school years studying in the Austin Flint Reading Room of Abbott Hall  at the University at Buffalo (last picture below). Much like I am inspired to compete on the football pitch or exercise in the gym, the library encourages thought and reflection.

I have been repeatedly reminded by the medical students and residents that 'no one goes to the library anymore.'  

Their loss.

Austin Flint Reading Room, University at Buffalo

Thursday, August 17, 2017

Medical Literary Messenger Spring / Summer 2017- Published!

As Editor in Chief of the Medical Literary Messenger I am proud to announce that the Summer / Spring Edition has published. This edition includes our first ever photoessay, featuring the VCU Global Health and Health Disparities Program in Honduras. Kudos to all MLM associate editors and contributors.

The publication can be downloaded as a PDF (click here) or as an EPUB/MOBI (here).

All prior editions are available on the archives section of MLM website.

Tuesday, August 15, 2017

Amazing vs. Hired!

I was reading the highly academic Moderate Drummer magazine the other day and came across this referenced cartoon. There is a lot of truth in it.

Having great technique ( 'chops' in drumming parlance) is wonderful but is useless unless you can play consistently and keep time with a band. Drummers who can keep time are generally hired for the gig!

I have seen something similar play out in other spheres.  I have known many knowledgeable and book smart physicians who are less than adept at applying the knowledge at the bedside.  I have also known many footballers (soccer players) with great skill and technique who cannot play a 90 minute match with a team.

Skill, technique and knowledge are absolutely necessary, yet not sufficient.  Application is key. 

If you have both then you are the real deal.                   

Tuesday, August 8, 2017

Test Stewardship and C. difficile: Vexing to No End

Test stewardship is an evolving topic in the medical literature. I recently wrote about test stewardship with respect to urine cultures and CAUTI rates.

Now, as reported here, computerized clinical decision support tools in the EMR can assist in reducing inappropriate C. difficile. Given that nucleic acid amplification tests can be overly sensitive and that C. difficile is part of the normal bowel flora, we are still looking for the 'right test at the right time' to make the diagnosis. A magic 'diagnostic' bullet of sorts.

In the above referenced paper, C. difficile test stewardship decreased inappropriate C. difficile testing, specifically, not testing patients with diarrhea while on laxatives. No significant harm was reported.  This is not salvation but at least a step forward in not over diagnosing hospital onset C.difficile. So I say, press on with such interventions (which we are doing at VCU).

Clostridium difficile infections in the hospital continue to vex us, largely because the extent to which they are preventable is highly debatable, as explored here.  

With the current state of science, solving our C. difficile problem is much like solving world inequality.

Sunday, August 6, 2017

Sepsis Antibiotic Protocols: Potential Downstream Effects

Sir Alexander Fleming
"The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism."  Thus were the words of Sir. Alexander Fleming, the discoverer of penicillin.

We have a potential tragedy of the commons with antibiotics. The consequences extend beyond the growth of antibiotic resistance. The implementation of an electronic sepsis initiative to standardize and maximize antibiotic use for sepsis cases resulted in increased hospital onset C. difficile, as reported here in AJIC. Not surprisingly, the protocol resulted in increased broad spectrum antibiotic use.

Protocols and standardization generally improve patient safety (central line checklists, surgical times outs) but the process is not foolproof. 

We need to monitor and formally study unintended consequences so as to be nimble, pragmatic and modify our infection prevention strategies. 

I am now back from my native Argentina and back to the grind.