The Cholera Pump and the Oldest Operating Theater in London

Ever asked ChatGPT for tourism advice for medical professionals? I did. Its not what you think.

The Oldest Operating Theatre in London.

  • Totally worth a visit. My favorite story: a surgeon asked to be buried in his clothing when he died. The authorities did not respect his wishes, and when undressed for the casket, they found he was a woman. Served an entire career as a surgeon, in an age when women were not allowed to be physicians or surgeons. 
  • The theatre, here, lit only by skylight, with a steeply graded theater so all could see down into the body of the patient undergoing surgery. Survival rates were typically 30%, death usually from exsanguination or more likely infection, in the days before germ theory. 
  • Too many other stories and artifacts to recount. See if you can. 

 

The Cholera pump!

  • A reproduction of the original pump in London that ended up being the source of a major cholera epidemic. This is the spot of the birth of epidemiology, with the key insight by Dr. John Snow. 
  • At the time, cholera was a deadly disease, but unknown what caused it and how it was transmitted. Many thought it was due to bad smells called “miasma.”
  • The book “The Ghost Map” if you haven’t read it, is a riveting account. 
  • It all happened here, and John Snow plotted the graph and realized all the deaths centered geographically on this one pump.
  • Perhaps cholera was not airborne, but carried in the water from the pump!
  • He came, removed the pump handle AND THE PANDEMIC STOPPED. 

 

I guess I’m just a fan-boy of medical history. 

Digital distractions. Time to fix myself, again. Muir Woods and a reflection. Come along!

Why am I sucked in? Why is it bad for me? How will I solve this? How will YOU solve this?

Here I am again, scrolling social media when my brain is tired, or perhaps to procrastinate. You too? 

Here is what attention-grabbers do:

  • Digital distractions are the attention economy. All social sites want to capture your attention as often AND as long as possible. These are corporate goals, and AGAINST us thriving as humans. 
  • Social sites have gotten really good at this: first showing us posts by friends, then posts with photos and videos and now TikTok-ified short entertaining nothings that keep you/me scrolling just a little longer. 
  • Rarely, some sites, like GroupMe or BeReal allow us to curate a smaller community and stay in touch, without the pollution of advertising, click-bait and video snippets. They also encourage us to STOP scrolling after a few minutes, without an endless ongoing stream. Thank you to these companies, for injecting some opportunities for human connection and self-control. 

Here is how we are sucked in:

  • When we have a few minutes, to avoid being bored, we pick up the phone
  • We launch a social site and quickly turn off our working brains and mindlessly consume a finely tuned stream just-for-me.
  • Hours later, I wake from my haze and realize I’ve missed something, or I have not been present with friends or family.
  • Corporations want your attention, and care not for your well-being.

Until such time as the better angels of our nature come to rescue us (perhaps never), we must craft our own space, hack our own stations, take back our lives. 

Here is how I’m fighting back:

  • Deleted facebook and linkedin apps from my phone. I will instead go to a desktop to browse these sites if I really want to. Just like snapping a rubber band on your wrist 10 times when you get a craving for a cigarette outlasts the craving, this small effort will stop my instant-gratification cravings.
  • Deleted my favorite games from my phone. We’ll see how long that lasts.
  • I’m reading more paper books. Dungeon Crawler Carl, anyone? 
  • Turned my phone to grayscale display. For iOS: settings, accessibility, color filters, grayscale. Wow, my phone is much less like eye-candy. For me, this setting can last a few weeks before I relapse.
  • Revived my pomodoro habit (see my blog post). Setting a 25 minute timer improves my focus. Write out a small number of concrete goals, estimate how many 25-minute segments are needed to accomplish that goal, and let the ticking timer remind you to stay on task. 
  • Turned off all notifications on my phone. Be ruthless. Leave urgent secure chat, or a precious few apps, on. Literally everything else must go: alerts, badges, lock screen notifications: go into settings, notifications, and turn them off, app by app if you’re a control freak, like me. OR, go to settings, FOCUS, and choose what locations, what day/times you should not be bothered, which apps and which people can break through, and notice the buzzing and pinging clear from the air. 

And then, treat yourself

Find time for Forest Bathing. Get outside, find trees nearby. This is a photo of Muir Woods, a national park with soaring Redwoods that are thousands of years old. Astounding nature. Recharge your humanity.

Go to a museum. See beautiful stuff. These from the current exhibit at the de Young museum, SF. 

The Golden Gate Park Botanical Gardens is spectacular. We were there during intermittent rainstorms and sun. Gorgeous.

And why, not? A karate kata (Taka no ishi no bo dai) at the base of the Japanese pagoda, with a teapot of Sencha to follow. If only that guy would put the phone down…

Have you found other ways? Comment and share them here! We all deserve some quiet, some time to think. Our human brains, our trillions of neurons are not doing well in the battle against the corporate attention-grab.

Fight back!

5 questions clinicians should ask themselves when using AI in healthcare (JAMIA.org)

I like that smart colleagues are starting to write about automation bias, interruptions, skill decline. This academic paper poses 5 questions we should all be asking ourselves. So begins our hard work to welcome a new entity into the exam room, with careful forethought.

https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocaf123/8287602?login=true

From the discussion:

Effective AI integration requires human-centered and adaptive design. Five central research questions address: (1) what type and format of information AI should provide; (2) when information should be presented; (3) how explainable AI affects diagnostic decisions; (4) how AI influences automation bias and complacency; and (5) the risks of skill decay due to reliance on AI.

Read the article. Love the thoughtfulness and humanity.

The math on AI agents doesn’t add up (Wired.com)

I wish we had a crystal ball for what is coming. If we thought that the acceleration from internet-generations and rapid change was uncomfortable, what do we call this, the generative-AI-powered generational change? Hyper-change? Articles like this are fascinating glimpses behind the scenes at AI companies thinking ahead to AI agents and what they might be doing now, and able to do in a few weeks or months.

https://www.wired.com/story/ai-agents-math-doesnt-add-up/

Medicine: the last uncompressed profession? (Liminal MD)

Bryan Vartabedian calls out the idea of “compression” where standard process and measurement have transformed many professions. Yet, medical care at its root is a sick patient that may not fit easily into a measurable box. Healthcare as a profession cannot be compressed. A must read.

Medicine as the last uncompressed profession

The difficult uncompressible work of medicine is unmeasurable. How might we measure “difficult diagnosis”?

What value do we place on the master diagnostician who can sort out many vague complaints into an unexpected diagnosis, when no one else can?

Sure, routine treatment of straightforward diabetes or asthma can be ‘compressed” into measurable process and goals, but “failure to thrive” or “fragile elderly with polypharmacy” or “internal medicine patient with 17 diagnoses who is falling more often” or “undifferentiated severe abdominal pain” doesn’t fit anywhere, can’t be measured, and its care cannot be made more efficient.

Are we training a generation of doctors who are excellent at compressed care? When our older generation of doctors retire, will patients with unmeasurable suffering no longer have someone to care for them?

In all the noise of “Value based care” and “Private Equity” and “squeezing the inefficiency out of the bloated US healthcare industry” where are the quiet ones, the hidden heroes out there caring for patients?

Yes, Generative AI is coming. Yes, EHR tools and “clinical decision support.” Yes, advances in team-based, multidisciplinary, highly coordinated care.

And yet.

Where are the ones championing the statement attributed to Hippocrates:

Cure sometimes, comfort often, care always.

iPhone notes app is the purest reflection of our humanity (Wired.com) and a medical informatics observation

What’s on your notes app in your phone? WIRED argues that this simple, unfiltered blank page is the easiest place for us to store our unfiltered thoughts. How true. For me: fragments of blog post ideas, books I hear about, movies to watch, hilarious quote from family members, messy to-do lists. Hotel room numbers. Parking garage locations. Who knows? What’s on yours?

https://www.wired.com/story/iphone-notes-app-purest-reflection-of-our-humanity/

Sometimes the simplest note-taking apps are the most profound.

As medical records technologists going back to the 1800’s discovered, if we over-engineer our tools, doctors and nurses will break the bounds of what is allowable documentation to let the story come out.

From Annals of Internal Medicine (requires login) a brilliant history of medicine article by Eleanor Siegel

https://www.acpjournals.org/doi/10.7326/0003-4819-153-10-201011160-00012

The image:

What is fascinating is that: in the 1800’s, hospitals began keeping paper medical records, one book for each HOSPITAL WARD of about a dozen patients. No patient-specific medical records. If you wanted to look back, you would find the ward book for the year, find the day the patient was in the hospital, then look for the patient’s name.

Each patient would be an entry on the page for the day. There was only room for ‘intervention’ and ‘outcome’. No place to write thoughts, observations, theories, learnings.

So, doctors would at times turn the page over and use the blank back of the paper to write (in this case):

This patient came in with what appeared to be an apoplectic stroke. He was interesting in that he had a dextrocardia. He later developed a clinical picture which we could not explain.
Diagnosis: Hemorrhage into cerebrum
Complication: ?Syphilis

Kpop Demon Hunters, yes, I’m a fanatic. Interview with EJAE (wired.com)

I am a huge fan of Kpop, and of Kpop Demon Hunters specifically. Read the interview with EJAE. I very much align with her Asian-American vibe and insights. So cool for a colleague’s success and for the American melting-pot. And the song and movie: excellent as well.

https://www.wired.com/story/how-k-pop-demon-hunters-star-ejae-topped-the-charts/

Do pictures change patient behaviors (James Stein substack)

I don’t often cite other blogs, but this is a worthwhile quick read about changing patient behaviors. Wonderful story about a physicians failure with a patient and the lessons he draws from using a calcium score to try to get a patient to change. Did not go well. And I will change how I think about this as a result.

https://jamesstein18.substack.com/p/do-pictures-change-patient-behaviors

Is AI Dulling our Minds *news.harvard.edu

This is very much on my mind as we race to embrace our newest AI assistants. If we outsource more and more of our tasks and thinking, does that make us duller? Yes and no, depending on …

Is AI dulling our minds?

I think this is a big deal; how will we work with our new AI partners?

We could either ask: “tell me the answer about XYZ” then we learn how to be great at copy and paste, but we don’t learn anything.

OR, we could ask: “Quiz me on the important principles of XYZ, and when I get it wrong, correct my understanding. Lead me to a deeper understanding of __”

When the AI becomes a helpful assistant, where I am the primary learner, this helps.

There is a big difference between cognitive ease for repetitive tasks that we don’t care to get faster at, VERSUS productive cognitive friction for topics that we, as humans, want to understand better.

Struggle is important for learning.

I have spoken.

--Ughnaught pilot Belin, from the Mandalorian

Can a Hydroelectric Dam Make the Days Longer? *Wired.com

I love questions like this, that don’t make sense, then then slowly start to make sense, and then draw you into the math and science and … woop! There’s an answer to the question.

https://www.wired.com/story/can-a-hydroelectric-dam-really-make-the-days-longer/

Math and science for the win, on unexpected questions.