Statcounter.com allows me to track what recent search terms people have used to find this site. A few people are clearly looking for this site specifically; most stumble on it with Google searches that lead them here--maybe the same way you ended up here.
Here's my favorite Google search phrase that led someone here, from a hospital-based server far far away:
"i'm a medical resident and i feel stupid"
This phrase put into Google's search box led the searcher to this blog. And all I can say is, brother or sister doctor-in-training, I feel you.
If hospitals finally designed truly rational production processes and became 24 hour enterprises, care might work better and be safer--but where would the romance of the night shift be?
I'm quoted today in White Coat Notes, a brief quote in which I say that in the hospital "We maintain by night and advance by day", which might be worth explaining a bit more.
The hospital is a constant production process. But it's in transition: it inherits many of the features of its pre-industrial roots. A truly efficient production process never stops, but the hospital slows down considerably at night. I think there would be a lot to be said for a truly 24-hour hospital. But that would require more health care workers, more money to pay people extra to work overnight, and a completely different way of arranging care.
Hospital care moves in fits and starts. We try to help people with the hospital's resources and then move them out of the hospital before they begin accumulating too many of the hospital's risks, like hospital infections, or unnecessary procedures stemming from results of unnecessary tests.
The five-day-a-week, 10-hours-a-day schedule of much of the healthcare system means that the discharge that could happen on Saturday waits until Monday because there's no skilled nursing facility screener who can come on a weekend to accept the patient. A CT scan that could take place overnight waits until the next day because there are only enough radiology technicians and radiologists to staff emergencies at night.
Meanwhile, there are things we do to advance care at night. For instance, we might start an infusion of medicine overnight. But most of what we do is planned and started in the daytime. We make our plans by day, do most of our testing and procedures and imaging by day, and make most of our clinical assessments by day.
A hospital would be more efficient, and care would happen more quickly and probably yield more clinical benefit if we operated hospitals on a 24 hour schedule. Care would probably be better if it took place at a constant pace rather than a stop-and-start pace.
The argument against the 24 hour hospital is obvious: it's nice that for a while, we can just let our patients sleep. On the other hand, most people don't sleep well in the hospital. If we could get them out 50% faster, they'd get more sleep where they're going than the hospital where they're staying. And at least from the house staff point of view, it's frightening to cover patients on a hospital floor where nurses and other staff don't regularly come in to rooms to take vitals and check on how they're doing.
On the other hand, maybe this is all self-justifying fantasizing from a pre-call intern, the root idea of which is: We're awake. Maybe the rest of the hospital should be too.
Late night in the unit. My resident and I are finishing up an admission and hanging out with the night nurses. They're experienced critical care nurses. Somehow we get to dumb ways that interns behave with nurses. These conversations are common and I think it's because they serve a social function: by telling these stories the nurses are saying, "We know you're not that kind of doctor", and also, "You better not even think about becoming that kind of doctor" and also "If you do become that kind of doctor, you better know we're going to laugh about you and tell stories about you behind your back, including to your colleagues." The doctor end of this conversation is, "I really want to be buddies with the nurses" and "I promise I won't become that kind of doctor."
Anyway, the best punchline to one of these stories was from one of their colleagues, who reportedly said to an intern she wasn't happy with:
[Note: click on the graphs to get a full view including more-or-less readable data labels].
Here's a shout out to the graphic designers at the New York Times, who often produce great pieces of informational design, and who illustrated this op-ed about the black vote and the white vote in the Democratic primary. (I hope one of the data labels is in error: it cites the end of the graph as April 2, when the graph would really only be truly relevant if the end was May 2.) The article and the graphic make an important point: while the media has been fussing about whether Obama can win over white working-class men (many of whom will not vote for Clinton in the general election either), fewer observers of this political spectacle have been paying attention to the black votes that Clinton has been more or less deliberately throwing away and probably permanently losing.
The NYT article and graph are about a very specific question.
Contrast this to the more general and more common political discussion of whether a candidate is viewed favorably or unfavorably overall. Here's my quickly Excel-graphed illustration of Obama's approval ratings from November until now.
This graph uses overall national "approval" polling data from Rasmussen (the raw data are here) to show Barack Obama's approval ratings over time. The graph shows that the primary season has probably not had that much impact on how the overall electorate views Obama: mainly, people's views have on average become more certain (more "very" and less "somewhat"), but have not changed whether they like or dislike Obama.
The biggest shift came in late February where his "favorable" ratings got as high as 56% and his "unfavorable" ratings as low as 42%. In other words, the monumental flux of this campaign has been about 8% of voters who moved the center line between "kinda like" and "kinda don't like" back and forth.
My graph shows the effects of the political circus, the "who's up/who's down" tallies of cable news--and reveals a much more stable and enduring divide among voters, the one that persists election after election and actually does transcend personality. The smaller fluxes in "favorability" of any given candidate may or may not be important overall.
The NYT graph shows something more important: the actual effects of Hillary Clinton's behavior on a specific part of her base, and what could be one effect of her tactics if she were to win the primary. There is a significant inference here--the assumption that favorability ratings drive turnout. Maybe, maybe not. It may be that black voters would dislike her but vote for her anyway, which would probably be a rational choice. And there are a lot of things left unexamined in this graphic: it compares one group's view of one candidate with another group's view of another rather than comparing both groups' views of both candidates, which would likely be a more nuanced and less dramatic picture. Nonetheless, this single comparison and the clear presentation of the difference is much more interesting and reveals more significant shifts than where her favorability/unfavorability ratings have been going overall. (Not much changed.)
Speaking of pop and dance... With YouTube, teen dance trends are documented in great detail, often via self-video and rapid upload from dancers' living rooms or the neighborhood internet cafe. Not exactly in preparation (who wants a doctor who tries to act like he's just like you?) but kind of to get in the mood for the "youth" clinic I'll be working in starting in a couple of months, I'm taking a little bit of time to catch up with the latest.
My home territory of California, having produced krumping (in the South) and hyphy and turf dancing (in the North) appears to be resting on its laurels--I'm not seeing what's new. Maybe I'm just not cool enough to know the right keywords. But here's what I found from elsewhere...
ANGOLA It's civil war--ON THE DANCE FLOOR! YouTube has a bunch of videos with dancing from Angola, part of a new movement ("It's not just a dance, it's a way of life" etc etc) called kuduro. Seriously, though, the fact that kids are having dance battles and making videos off their cell phones and posting them on the Internet, in Angola, is probably a pretty good sign. Here's a dance battle between two guys--the second is the one to watch, as the crowd reaction will demonstrate.
FRANCE AND BEYOND In France, the kids have been doing a techno dance they're calling techtonik, which has now spread at least to Greece, Turkey and Korea based on a quick YouTube survey; here's a young man who appears to be a YouTube techtonik superstar:
But wait! You say that techtonik is a registered trade mark of some party promoter and there's a South African technology trends article about the integrity of the techtonik "brand" in which we hear that "for French sociologist Francois de Singly, the phenomenon shows how 'capitalism has moved into such high gear that movements are becoming brands even before they are really born'"???
Sociologist? Isn't that just another way to say "cranky old hippie"???
BELGIUM/NETHERLANDS Jumpstyle is a club dance from Belgium and the Netherlands; here's the obligatory cheerful Northern European news feature about that dance those nice kids are doing in the mall:
The above newscast demonstrates the reason that the United States will still be the triumphant master of deeply-persisting teen trends (instead of flash-in-the-pan goofy techno dances). In the United States, mall security would be kicking these kids out and the police would be linking the new dance to gang activity, thereby giving the dance much more credibility and long-term prospects for product tie-ins. Which is how our security state collaborates with our entertainment export industry to make America still the greatest producer of pop culture the world has ever seen.
NORTHERN CALIFORNIA Like I say, I'm not cool enough to know the keywords to find the latest in YouTube crazes from Northern California. But the Bay Area has been producing "hyphy" for some time, as in the "hyphy movement" which includes up-tempo hip-hop, "turf dancing" and doing cavalier stunts with cars; here's a 2006 video which will illuminate how the American security/entertainment conflict/collaboration works, and provides an excellent contrast to the perky Dutch account of their new trend:
And here's some kids in 2006 at Berkeley High, explaining (or, sort of explaining) hyphy from the inside.
...and the inevitable documentary glorifying the trend, with the title of the movie celebrating one of its most dangerous and disturbing aspects, namely automotive disasters-in-the-making (truly):
Kind of makes European teenagers--and even Angolan teenagers--look pretty wholesome.
ADDENDUM: Yes, I recognize the red flags for diagnosticians and disability rights activists alike in a Northern California youth trend called "hyphy" as an abbreviation for "hyper" and by implication "hyperactive"; and in which positive adjectives include "stupid" and "retarded"; and in which there is the ironic glorification of the short yellow bus; and this trend is emerging among poor African American teenagers and other young people of color, who are disproportionately over-labelled and under-helped by the "special education" system. And obviously this would be a natural topic for this blog. But as you may have noticed, in a brief period of my internship in which I've been working fewer hours, I seem to be willfully off-topic.
video: Rihanna performing for the Nobel Peace Prize ceremony. (?!) Below, Madonna's "Hung Up" and the trailer for Rize.
I'm listening to Rihanna's "SOS" with that mash-up-style "Tainted Love" sample, and her "Don't Stop The Music" which includes a little synthesizer riff that echoes another woebegone 80s hit "I Wear My Sunglasses at Night". And while appreciating the latest in trashy but quite satisfying pure pop, I finally remembered to download the single "Hung Up" from Madonna's last album, even as her new album is about to come out. It's got a bore-into-your-body catchiness, with its roots sunk deeply into the dance floor. Absurd though Madonna may be in many ways, you have to give her credit: she knows how to make a pop song.
Let me say for the record that in college I wrote a fairly serious 35 page paper about the semiotics of dance in Madonna's videos. To put this in historical context, this was during the same semester that a group of women students at my college put on an equally serious forum and discussion entitled "Is Madonna a Feminist?" (Though I think it has always been clear that the answer to that question must be given in three parts: yes, no, and who cares?)
Madonna is a genius of pop music, whose calculating intelligence about the genre has allowed her to outlast just about every other pop star of her original era. She is no longer the center of pop music, and she will never be the startling new thing. Now that she is the age of the mothers of the most ardent pop music consumers (teenage girls), her place in the pop world is as a commenter as much as a practitioner.
This music video is one example: it's a little visual review essay about the dance trends of the time it was made. Those trends, and the kids who create them, are juxtaposed against Madonna wearing the kind of clothes and haircut she likely wore when she was their age.
Madonna, like anyone serious about pop music, knows that pop music and dance are always being born and reborn again and again in poor neighborhoods and gay clubs. So, at the end of this video, you have a group of kids from South Central LA taking a taxicab which ends up at a club in London. In reality, the only link between Madonna's world in London and these kids is probably a DVD of the documentary Rize, about krumping. But I don't think Madonna is asking us to believe that she is from the South Central LA world of krumping, or even that she understands it. Just that she celebrates it, along with Dance Dance Revolution (the dance video game seen at the end), the French acrobatic street stunts of parkour, and some kind of crazy disco dance with a fish in an Asian restaurant which for all I know represents some other kind of trend.
Now that this video has become dated, its underlying idea is actually more clear. It's about the enthusiasms of youth, which always date themselves in their details, but are also timeless in their general outlines: combinations of dance, desire, doubt, determination. It's about a woman who's now much older, remembering that time and that way of living, the time in her life when she was driven to make her mark but had not yet made it. Dance songs then were about "You don't appreciate me so I'm going to go on without you" (Gloria Gaynor was playing on the club speakers singing "I Will Survive" when Madonna came to New York) and this dance anthem is yet another variation on that eternal club anthem theme.
As for me, I remember the nerdy earnestness of the teenage record store guy who spent hours listening over and over again to a jazz record and then more hours listening over and over again to a 12" club remix of a pop song; then goes to a college and writes a paper about Madonna; goes to San Francisco and gets caught up in AIDS with the same nerdy earnestness; and then becomes a doctor, which in fact is the ultimate culmination of nerdy earnestness. Which I think makes this post the equivalent of Madonna's pink late-disco-era leotard, my memory of who I was when I was young.
The race for Minnesota's US Senate seat, US data on hypothetical McCain-Obama matchup for the general presidential election, and Pennsylvania Democratic primary polling, as shown by Pollster.com
I have a new addiction. Pollster.com is the website political junkies have been jonesing for even before we knew what it was. It clusters the results of polls that ask the same question--like, Who are you going to vote for? or, Do you think the country is on the right track? Then it puts them together into a single graph with a unifying trend line. It's imperfect--I can't satisfy myself that the trend line weights for sample size--but it's a lot better than reading the polls one by one.
The medicine parallel is in what we call meta-analyses--when we try to figure out a medical question by combining a number of studies that try to answer that question. Even if a bunch of smaller studies contradict each other, the idea is that by combining a number of studies you get the effect of having one huge study, and in this kind of data (with simple results like "worked better" vs "worked the same"), sample size is all. Thus, if you can create a meta-analysis that has the effect of creating one very large set of data, the answer those data give may be more reliable.
Like any kind of statistics, the problems get more complex as you try to get around the simplest problems. For instance, even when you weight for sample size, you can't throw less-reliable studies and more-reliable studies together and act like they're equivalent--so an ideal meta-analysis gives the data from more reliable studies more weight in the final result. But judging quality, and the appropriate weight given to difference between studies, begins to become a bit more subjective the more you try to fine-tune this problem. (What is quality? And how much weight does which measure of quality get?)
Pollster.com doesn't seem to do any weighting for sample size or other aspects of reliability, but even their relatively straightforward trend line is better than a lot of nonsense political handicapping you hear on TV politics talk shows. By giving more raw data and by combining large sets of data, these graphs and datasets allow you to begin cutting through some of the worst excesses of data-mining by stupid or biased pundits. In other words, you can be your own pundit.
I am aware, of course, that one of the ways that I manage to avoid coherent political action is by being a political junkie--an observer rather than a participant. Another thing that I need to change a little bit in the coming years.
Hemodynamics is a blog I worked on mostly as a medical resident; I keep it up for historical interest only. Still I would keep the same description and disclaimer: This is a blog about the social world of medicine, and sometimes about other things that interest me. It is not a good place to seek medical advice. None of it should be read as medical advice.
