Teaching In Lyon

I have the distinct honor of being a guest speaker this week in beautiful Lyon.  When the call came a few months ago (during the dead of winter, several feet of snow on the ground) and they asked if France in May was appealing, I think I took about an entire second to say YES.
There are a few down-sides to this bonanza:

• I will have to fly over and back in just 5 days
• While flying into Paris, will ultimately have less than 2 hours there, all in a train station
• I need to construct an entirely new talk.

But I am not going to complain.  I have been working hard and a few days in a cultural and historical hub as a guest of honor should be restorative.  Will return to regular blogging next week.  Bon Voyage!

Save your Heart

"All work and no play, makes Jack a very dull boy."

Working overtime is associated with more heart disease-what a surprise!   A recently published study in the European Heart Journal followed a large number of office workers and noted that while working up to an hour overtime/day increased the incidence of heart disease from 5.7 to 6.7 (an 18% increase) and working 3 hours overtime rocketed the rate to 8.3% (another 24% increase). (Lay version details available here.  

Yet another reason for us all to work hard but also to take time to stop and smell the roses (also to exercise, eat well, and visit a doctor on a regular basis).  No one can live forever, but still good to avoid those things known to shorten our time on this good earth. 

My Kids Told Me

With their usual candor, my two college-age kids have told me that the current rage on campus (beyond the usual alcohol and marijuana) are...various prescription drugs.  Everything from adderall for academic performance enhancement to percocet for Saturday night buzz-college students across the country are transforming legal medicines into recreational tools.  As a physician who writes many prescriptions for narcotic pain medications (there is little a painful as a multi-level spinal fusion), I have gained a new appreciation for the potential impact I may be having on our young adults.  

The way I see it, these drugs are getting to campuses in one of a few ways:

1. Kids are stealing them directly from their parent's medicine cabinets (for use or sale),
2. Patients are selling all or a portion of the Rx that doctors write them,
3. Doctors are getting paid for Rx writing mills (more than one physician in my community has been caught red handed in this scenario), or
4. Drugs are being stolen from pharmacies or similar.

Some of you may be saying, so what? In every generation, the youth will find a way-in my college years the drugs were quaaludes and cocaine, for a while ecstasy and meth were all the rage (and still are in some places), why should the current fad prick up my skin? I guess as a physician who is committed to healing, I loath the idea that I may be contributing to addiction and ill-health.  Is there anything we, as conscientious physicians and/or parents can do?  I would recommend the following:

1. Mandatory directed education on narcotics, particularly on setting strong office policies that help prevent abuse,
2. Public awareness campaign regarding protecting medicine cabinets,
3. Accelerate reporting to physicians of patients receiving prescriptions from multiple physicians,
4. Provide greater incentive for physicians services related to drug detox/withdrawal (currently no specialty takes this on as their responsibility outside the extremes of inpatient drug addition facilities).

If you have other ideas, I would love to hear them-it is time we as physicians gain an increased awareness of how we may be inadvertently contributing to "unhealth", not part of our Hippocratic Oath.

Twice in a Day: We are our own worst enemy

The medical liability system is broken-every one who works in it or who is touched by it knows this but changing the system is harder than allowing inertia to just keep on keeping on.  The subject (my ruminations and potential solutions) is far too large to tackle head on but I would like to offer two cautionary tales, let me call them "The Enemy Within".
Chapter 1: The Enemy Strikes
I have always reviewed cases and offered to testify on both sides because otherwise, I am little more than a hired gun.  So, last week, I had a scheduled discussion with a lawyer who requested my expert review on behalf of the plaintiff.  Briefly, the case involved a veteran underwent a CT scan at the onset of a number of emotional issues.  The scan revealed a benign lesion of the cerebellum which was unrelated and further work-up was not pursued.  Years later (and after significant escalation of the psychiatric problems), new neurological symptoms developed and it was found the lesion had grown and surgery was necessary.  Surgery and recovery were uneventful but still the man opted to pursue a malpractice case against the physicians who first found evidence of the benign tumor.  I was baffled so I had to ask the lawyer what prompted the suit.  "That's easy," he said, "the neurosurgeon showed the patient the initial scans and then said something like, 'I can't believe they didn't see this back then.' That's what got him angry and after that, there was no turning back."
Chapter 2: The Thoughtless Enemy
Later on that same day, I received a communication from a former patient.  She has moved away but as we always had a good relationship (her words) she reached out when she developed some neck pain many years after the surgery I performed.  While she thought it was muscular, because of her history, she decided to see a local spine surgeon (which I had encouraged).  He told her I had completely messed up the surgery, had placed the screws in the wrong place and that is why she was having so many problems-urgent surgery was the only option.  Needless to say, my patient was angry and confused-the final outcome of this tale has not yet been told.

Epilogue: Think First, then Talk
Many studies have shown the key role physicians play in instigating malpractice suits.  Most are a result of a careless comment but some are related to greed, envy, competition and haughtiness.  Wake up doctors! Keep in mind that hindsight is always 20-20.  We constantly ask for congress and state legislators to help us out.  Let's start by helping ourselves.

Loss

Grief in Philadelphia

I saw him for the first time since
Had to be sad coming to where her light had formerly shone so bright
Too many memories crowding in
No place to hide
I knew the sadness in his eyes.

He asked if I had seen the art
I knew he needed to get away from the crowds
I took his arm and walked him through
His eyes missed Van Gogh, Matisse and more
Not as much as his heart missed her.

To my dear friend-if you read, know you are not alone and know too that it takes time and that I and others are here if you want us.

Winning with WINS

Just back from our neurosurgery meeting in Philadelphia.  The big news was our first every paperless meeting-everything was loaded onto an iTouch and I thought it was great and dug the "green" concept.  As usual, the highlight of the meeting was seeing my good friends and colleagues-particularly the women who have served as my close network for more than 25 years.

This year, WINS (Women in Neurosurgery) hosted Dr. Mary Sue Coleman, President of University Michigan who gave an inspiring talk on why diversity matters in college and beyond.  She has long been a proponent of this concept, being a driving force in her University taking affirmative action all the way to the Supreme Court.  What was most impressive, however, was how she used this theme as a foundation but then carefully and specifically related it to neurosurgery.  She also echoed the theme of Dr. Karin Muraszko's essay in Heart of a Lion, Hands of  Woman: What Women Neurosurgeons Do in stressing It Matters!!! 

Drs. Lauren Schwartz  and Susan Hemley

Drs. Ko, Nelson, Mazzolla and Zusman

Congratulations to all those involved in making this such an inspiring event.

Members and guests