The only skill that matters in treating a patient?

The ubiquity of UpToDate is not without its troubling features (although, to be fair, most UpToDate articles include more references to evidence-based medicine than old-school textbooks - or old-school colleagues - ever entertain). So Darshak Sanghavi's article in Slate serves a useful purpose.

But he really didn't mean to write this, did he?

However, the sheer abundance [of knowledge taught in medical school] crowds out an important—in fact, the only—skill that matters in treating a patient: how to critically appraise published clinical trials.

The only skill that matters? How about:

1. talking to the patient (not trivial!)
2. eliciting the patient's wishes and preferences
3. diagnosis (including the use of diagnostic tests)
4. elucidating the treatment options and formulating a question
5. judging what the best evidence is for the particular clinical question
6. applying the best evidence to the clinical question
7. discussing treatment options with the patient
8. ensuring patient compliance/adherence/agreement/cooperation/investment

Pediatrics (the author's specialty) can't be that different!

Who pays standup tragedians?

Standing on a streetcorner
making children sad.

The shade splinters sun
and my daughter from another room
spears me with a laugh.

I'm climbing the walls of guilt.
I feel the echoes
of your coming fury.

Every dying plant is reinherbated
growing sans boundaries:
just dirt.

One age, one stratum of stretching for light.
Of farting noises, ice cream cones
and springing eagerness for chocolate.

Happy Purim!

Who has time to get drunk on Purim? I rarely manage to have more than a shot or two. How is Blanca ever going to learn to say "Father, dear father, come home with me now/The clock in the steeple strikes one"?

Some doggerel, if you're not getting shalekhmones from me.

If you're a rabbi, judicate
If you're a doctor, cure
If you're a heretic, be in doubt --
if scalpling, be sure.

If you're a cookie, delectate
if Esther now, don't fast
Don't gird yourself for battle
The lots are long since cast.

If sworn enemy, think it over
If you're our God, defend
This year, Esther, let your hair down
like a child, pretend.

My minyan is a bunch of suckers

I don't show up for six months, and instead of berating me they let me lead davening. As the poet Nauen pointed out, it's because I don't show up every day. If I did, then familiarity etcetera.

Nice to form a part again of the jaunty ricketiness - my missed words here and there, my shaky transitions into and out of a near-perfect Torah reading (someone else read, hence the near perfection).

I always feel like Tachanun shouldn't be said during Adar either; someone always has to remind me.

Medicosocial misfits

I wish David Brooks' column on people with rank-link imbalances (i.e. those with "all of the social skills required to improve their social rank, but none of the social skills that lead to genuine bonding") didn't seem to apply so strongly to a number of people I know in medicine. Unfortunately, success in the profession of medicine requires social rank - but success in the craft of medicine (patient care!) requires genuine bonding.

Cernăuţi/Чернівці/Czerniowce/Czernowitz/Tschernowitz/טשערנעוויץ

Yiddishists: fighting against inferiority since 1908.

Ode to the Dove

I am still translating it - verrry slowly. Help me out.

Competent to judge: Adventures in hospital ethics

The guy with newly discovered metastatic cancer who was just told of his diagnosis - when he wanted to up and leave, that wasn't crazy of him. Nor was it necessary to call a psychiatrist to judge whether the patient was competent to leave against medical advice. Is there anything magic about psychiatrists which makes them able to judge competence? Some people like titles, and other people like subspecialties. Psychiatrists on call in the hospital become surrogate ethicists, for a reason I don't understand. Because psychiatrists are on call and ethicists are not? Or because we (doctors and everybody else) tend to confuse the legal with the ethical - and we're familiar with psychiatric judgments of mental illness?

It would be too easy - unfair, really - to say that some doctors who think patients are incompetent, or crazy, are unable to see why anyone might disagree with them. But I'll say it anyway.

Two sides of distress

I locked my friends in a cabin
and they love each other now.
Two sides of distress:
bloody sidewalk, topiary median.
I embrace their commotions
and have contracted them to draw,
in the dark cherry-ink of weavers,
victors standing over us.
Enveloped by perfect sight
I view the door clearly
but cannot feel for its handle.

Transformations, reincarnations, turnings, revolutions? - Gilgulim

Paris is beautiful and the Parisians' new Yiddish journal, Gilgulim, no less so. I'm honored to be represented.

The Poet Nauen

My friend Elinor (writer on baseball and cars and a powerhouse bal-tekiah) revs the engine on her new site.