Author Archive
On a couple of evenings, most weeks during the summer, I go for a swim in the sea.
The first foray into the water in early June after the winter and spring layoff always comes as a shock to the system. No matter how many times I return after the break, the anticipation of the cold sea usually makes me hover at the water’s edge for a few moments, waiting for other swimmers to climb up the ladder to my launching spot to reassure me. ‘It’s just beautiful’, is the standard reply I get when I enquire about the temperature from from the hardy all year round swimmers. It’s all part of the ritual.
I usually jump straight in from the lower levels of a diving tower in Salthill known as Blackrock, so I can avoid the unpleasantness of having to immerse myself more slowly via the adjacent gently sloping beach.
The sudden cold shock of the water and the initial panic I feel as I look down into the unknown of the dark bottomless ocean, usually make me want to get straight back out again. But there are people watching and because of a little manly pride, I usually resist the temptation to escape and so I start swimming. After an initial burst fast strokes to warm up, the water no longer feels cold and within a few minutes I’m feeling good, into my rhythm and calmly pulling myself through the water a few hundred metres out to sea. Before I know it, I’m climbing out, reassuring the incoming swimmers that it’s just fine. ‘Its just beautiful’.
This week I’m back in the office after a week off and I’m getting a familiar feeling. Lets hope there’s no jellyfish…
Image of Blackrock from Flickr by Eoin Gardiner
Levels of Life by Julian Barnes. Published by Jonathan Cape (Hardback) 2013
This is a wonderful short book about ballooning, photography, love and more specifically, an attempt by its author, Julian Barnes, to come to terms with the death of his wife.
Levels of Life will be a gift to those trying to make sense of their own grief or indeed anyone who has ever loved - ‘Because every love story is a potential grief story’. In articulating his own grief, he helps us understand how love and loss behave like two sides of a balanced, inevitable equation; ‘The thing is – nature is so exact, it hurts exactly as much as it is worth, so in a way one relishes the pain, I think. If it didn’t’ matter, it wouldn’t matter.’
Although grieving is not an illness, reading this book brought me back to importance of stories and patient narratives in medicine; stories help their tellers make sense of their own world when it all goes wrong.
One of our jobs as health care professionals, according to writer and doctor Jay Baruch*, is to be ‘professional story listeners’. Bearing witness to, and acknowledging these stories forms an important part of the healing process. These stories also connect us on a very human level to our patients, and in listening we may unexpectedly receive comfort in return.
I’m happy to recommend it to anyone, particularly those trying to make sense of loss or those trying to help them.
* Dr. Jay Baruch presented ’Story-Centric: curiosity, a glass of water and other creative tools for future doctors’ as part of Millenial Medicine 2013.
Although readers of this blog will be aware that I’m a big fan of the new RSS Reader Feedly, I sense that its use by the broader medical community may be limited by a general lack of familiarity with RSS technology in general. A show of hands at a presentation I gave last week indicated that only 2 out of a room of about 20 healthcare professionals had actually heard of RSS.
I was therefore interested to learn about new iPad app called Docwise which allows users to collect updates from their favourite medical journals without having to use RSS directly.
Docwise is an ejournal / magazine for iPad which allows doctors to easily gather and display content from multiple medical journals, news sources and search terms all in one place. Once a doctor has registered their area of specialist interest on the app, journals relevant to their specialty are offered for inclusion. All recent articles from their chosen journals are then displayed in a nice clean ‘card’ format across the screen, along with some appropriately linked stock pictures (which help liven up the usual dull appearance of a short text summary of an article).
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- Register Specialty interest
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- Add journals
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- Add News Source
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- Main screen
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- Full abstract view
Clicking on the relevant article then links automatically to the original article abstract on the journal Website. Where you are a member of an institution which has signed up for the service, it is also possible to see the full text of the article. There is also an option to allow push alert which notifies you when the full free text of the article is available.
It possible to ‘favourite’ an article for later reading, download an article for reading offline, and add search terms (which will allow automatic searches across all subscribed journals). It is possible to share articles on Twitter, Facebook and email. The app also tracks the amount of time spent using and and reading artciles and allows this information to be collected by Docwise to produce a summary which can be sent to users.
The screen output is very attractive (resembling Flipboard), easy to read and navigating the various screens is very intuitive. The great strength of this app is that it allows content to added without having to search for the relevant RSS feeds for relevant journals (the term RSS isn’t mentioned once). It all works in the background.
Although I appreciate that this app is new and that additional features and platforms (iPhone, Android and browser compatable versions) will likely be added over time, I think it could benefit from a few additional features e.g.;
A wider range of options for social sharing (e.g. Evernote, Buffer.app, Google Circles).
It would also be great to see what other people are sharing i.e. ‘most Tweeted’ or ‘Most emailed’ articles for any particular journal.
Like many doctors, I’m interested in a lot more than what is presented to me from medical journals or trade press. It would nice to see some additional news sources added (e.g. from lay press – New York Times, The Guardian Health etc) or the ability to add blogs. The ability to subscribe to, or at least manually add RSS feeds, from other sources would also be welcome. A more seemless way of making posts disappear from the feed once read would also a good addition.
Docwise will appeal strongly to healthcare professionals who want to keep up with updates relevant to their specialty without the nuisance of having to receive those ever so annoying table of contents emails. At present it is likely to suit those who are happy to keep their information feeds exclusively related to healthcare but those with broader interests might have to wait a little while before more features are added.
I’m looking forward to future updates.
Updates provided by RSS feeds, alongside those presented on Twitter, form the main source of in-bound information in both my professional and personal life. RSS allows me to capture, filter, index and save news and updates from a wide variety of information sources in the one place for review at a time that is convenient to me.
This weekend (along with 500,000 other users) I changed my default RSS reader from Google Reader, to a new RSS service called Feedly. This was prompted by an announcement by Google that they would be retiring their ‘Google reader’ service from July of this year.
What is RSS?
For those unfamiliar with RSS (Really Simple Syndication), it is a web format that allows Websites to distribute lists of content and updates to users. All of the major scientific journals, most blogs and news outlets produce an RSS feed which lists all new content as it appears. Feeds typically include a title, short description and a link to the relevant article / update.
This feed can then be subscribed to any user interested in that content, using software known as an RSS reader. An RSS reader allows multiple feeds to be indexed, highlighted, saved and shared with others (either by email or using social networks).
What is Feedly?
Feedly is an RSS reader application which works across most Web based browsers (Chrome, Firefox and Safari, not Explorer) and mobile devices running IOS and Android. It allows the user to compile information from a variety of different sources, customize the display of that information and share the information with others. Here’s how it all work
How to sign up
Signing up is easy. All you need to do is register for the service by signing in with a Google account login (if you’re not sure whether you have a Google account or not, read this). If you have previously used Google Reader, it will automatically sync all of your feeds in seconds. If you don’t have a Google Reader account, don’t panic. Feedly provides a number of options to allow you to find and add RSS feeds to your account;
How to Add feeds
The easiest way is to find and add RSS feeds is via a search box within your home screen. Simply type the name of the Website or journal you are looking for and the relevant RSS feed index will appear. Click on the link to the feed and it will open in your main screen. Once you are happy that you’ve got the correct feed, click the green ‘add’ button and Feedly will add it to your account. This works well for most sites.
If the RSS feed you’re searching for doesn’t appear automatically, it is possible to add it to Feedly manually. All you need to do is open another tab within your browser and locate the Webpage you are looking for directly. Locate and click on the RSS icon and your chosen RSS feed should open within Feedly automatically. If it doesn’t link to Feedly automatically,copy the URL of the RSS feed and paste it into the Feedly Search box.
How to Organise Feeds
Once you have subscribed to a number of feeds, it is then easy to set up different categories of RSS feeds within Feedly (eg for articles from medical journals, bloggers, general or trade press feeds etc) and move feeds between them.
How to view your feeds
The main display looks lovely, is clear and easy to read with the posts nicely arranged in the centre of the screen. The addition of photos into the feeds brings livens up the usual dull presentation format of RSS feeds and is welcome. There’s a sidebar on the left which includes a list of RSS categories as arranged in the ‘organise’ section, a ‘Featured’ section at the top which includes a selection of the three most popular (as determined by ‘Likes’ on Facebook and Google Circles) posts from all of your feeds and the posts themselves. There’s also a ‘saved’ section where archived content can be viewed.
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- Magazine layout
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- List layout
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- Card Layout
The appearance of the page can also be changed so that posts appear as a straightforward list of titles (for more high density content like medical journal articles), or also as a mosaic layout (for more visual content). The layout can also be arranged separately for each category of feed.
Sharing your feeds
Sharing content from within Feedly is very straightforward with links which allow posting to Twitter, Facebook, Buffer, Evernote and a large variety of platforms.
Mobile apps
Feedly captures your online subscriptions and delivers them in a magazine-like format on the iPad and iPhone (I have not seen the Android version but the screenshots look similar). The user experience is similar to that of using Flipboard for those familiar with it. You can quickly skim and browse content from sites that you are subscribed to by swiping through the home screen and by using a menu in the footer area of the app. The design is even nicer than on the Web version but not so nice as to distract from the reading experience.
Impression
Overall I was very impressed by Feedly and would happily have paid for this free service if asked. Whether you are new too RSS or an existing Google Reader user, the registration process, adding of RSS feeds, display and sharing capacity of the service are excellent. If I had a gripe it might be the fact that you need a Google account to login but I note that Feedly have plans, using a project called ‘Normandy’, to make its service independent of by the time Google Reader retires.
‘I just can’t do it anymore doctor. I’m a wreck’.
Mary is a widowed 72 year old lady who has a bad back, sore wrists and shoulders and as a result, has difficulty sleeping and sometimes even dressing herself can be a struggle. These symptoms make her own life difficult but her main concern is not for herself. She’s afraid she’ll no longer be able to care for her 2 preschool grandsons.
She’s helping out her daughter who has had to return to work to help make ends meet now that her husband’s salary has been cut. Her daughter drops the two boys round on her way to work, 5 days a week, and picks them up on her return.
Its a long day, but Mary is glad to be able to help out. She loves the kids and enjoys spending time with them but the physical and emotional demands of feeding, changing, cleaning up and entertaining them is taking its toll. She feels that her arthritis pains are worse, finds it difficult to make time to visit her friends, exercise or to attend her hospital clinic appointments.
She’s not alone. As the financial pressure mounts on cash strapped families in this recession, grandparents are more frequently being asked to give a hand with childcare. Even during the financial boom, unpaid relatives were the main source of non-parental childcare in 11.5% of preschool children. There’s an increasing proportion of single parent families of whom 1/3 will avail of the services of an unpaid relative to help with childcare. For many Irish grandparents, there’s no escape either. In Ireland, 20% of grandparents live in the same house as their grandchildren and up to about a third live within 25 Kilometres.
Looking after small kids is hard work. I frequently see young mums (more so than young dads…) overburdened with the physical and emotional demands of raising small children in my practice. Perhaps its not surprising that older people, particularly those with a pre-existing condition such as arthritis might struggle in the same situation.
However, a 2007 study found no evidence that ‘caring for grandchildren has dramatic and widespread negative effects on grandparents’ health’. It did suggest however that likelihood of negative impact of grandparent health might be determined by the particular circumstances and ‘workload’ circumstances of the carer. For example, there might be a positive health advantage to those doing a little babysitting, but potential for problems where the grandparent is helping out in ‘skipped generation’ families (where the parents are, for whatever reason, absent), or those who provide ‘live-in’ care. It clearly depends on the circumstances.
Although there are no hard and fast rules to how to manage requests for looking after grandchildren, and I’m always cautious about offering life advice to my elders, here’s some of the advice.
1. If you enjoy looking after your grandchildren and feel up to it, keep on going! You are unlikely to do harm to your health and you are providing a great service to your children and your grandchildren.
2. In order to care effectively for grandchildren you need to look after yourself. This means making time to exercise, socialise with your friends and (if necessary) see your doctor. If you don’t have a hobby or outlet, get one. Its easier to say no when you’ve got an Art class to go to.
3. If you feel the need to set limits on your commitment, its better to do it early. Before the baby is born is ideal or at the very least, very soon after. It gives your family time to set realistic expectations and time to make alternative arrangements.
4. Don’t move in if you can help it. There’s evidence that grandparents who co-habit fare worse with their overall than those who live independently As nice as it is to spend time with your grandchildren, its nicer doing so knowing that you can give them back.
5. If you find that you are not coping physically or emotionally and don’t feel comfortable or guilty bringing it up with your own children, it can be helpful to involve your doctor. I have, for example, written letters to my patients to ‘recap’ on advice given at clinic regarding the need to pull back form childcare which they can in turn, show to a relative.
Here’s a little bit of extra advice from Ile Nastase, the veteran tennis star on the benefits of exercise and of having small children around.
Have you ever sneakily checked your Twitter feed while having a conversation with someone or felt compelled to check it, bleary eyed in the middle of the night? Have you ever lied about the amount of time you spend on Twitter or checked your feed for mentions while sitting on the toilet? I have.
Much as I love the buzz of Twitter and the network of people, ideas and information it has introduced me to, I often worry that it has taken over my life. I have become too dependent on the frequent squirts of endorphin associated with Twitter mentions, re-tweets and positive feedback. Large amounts of time spent on-line have also resulted in losing a perspective which would provide a cushion for me when things don’t go quite so well online (negative feedback, minor arguments or simply being ignored).
I miss the relative boredom of standing in line for lunch, waiting for a kettle to boil or even watching TV without feeling compelled to see what my social network is sharing. I’ve been finding it increasingly difficult to read fiction, blogs that are any longer than a few hundred words and concentrate on any job in hand that doesn’t involve some sort of instant feedback (how am I doing so far?).
Over the few months I’ve been doing my best to limit my exposure to the online world to set times of the day. I have deleted all Twitter clients from my phone (permanently), taken self imposed social media breaks every few weeks, bought a non-internet ‘pay as you go’ phone for vacations and limited the number of people I follow.
The good news is that compulsion to check, recheck and share seems to be abating. I’m reading some fiction again (ok, short stories) and getting more writing done. Maybe I’m cured of my addiction. Maybe I’ve just grown bored. Or maybe, my relationship with the object of my affection has evolved from the feverishness of a new love affair to the more sustainable pace of a long term and healthy relationship.
I’ll let you know how I get on.
Last week I attended a hospital based workshop which focused on how to manage discussions with patients in the setting of an adverse healthcare outcome.
Whereas an acknowledgment of the problem and an appropriate apology are essential, we were also reminded about the importance of encouraging patients to tell their version of events in a way makes sense to them.
Those of us who have met anyone who has been recently bereaved or who has experienced a physically or emotionally traumatic event will have noticed their compulsion to tell (often repeatedly) of their recollection of the experience. Although these stories don’t always follow a linear narrative and may include digressions and things that seem irrelevant to the listener, it is the actual telling of these stories helps people make sense of their experience. Our listening and response to those stories as health care professionals bear witness to them and plays an important part of the healing process. It takes time but is always worth the effort.
Any other time pressed doctors who are in any doubt as to the role (and power) of patient stories in healing should listen to this 12 minute witness impact statement by Ed Gavagan, a from TEDMED 2012.
Over the last couple of years I’ve been putting together a small waiting room library of books for my patients to read. I thought of the idea after visiting a restaurant where they had left cookery books lying around for patrons to look at while waiting for their food.
The challenge was choosing suitable reading material, beyond that of our usual selection of magazines, newspapers and disease specific information pamphlets. I wasn’t convinced that making gory, illustrated medical textbooks available to those waiting would be conducive to relaxation either. Although I sometimes run behind a little, things are never so bad that a patient might complete a Russian novel there’s probably time, to read a couple of poems, browse a few cartoons or even read a short story.
As a result, I started to put this little collection together and it has been a hit with my patients. There’s a couple of books of poetry for strange times, a book of photographs of bad hairstyles (not sure why a 1970′s me wasn’t included), a book including important medical facts such as ‘why men have nipples’, a collection of essays on famous hypochondriacs (which goes down better than you might expect), a hilarious book of New Yorker medical cartoons and a book on meditation (for those waiting more than 40 minutes).
As some of my patients will be coming back to see me for many years to come, I’d like to try and keep the selection fresh.
What would you like to see included?
I don’t usually get emotional listening to the proceedings of our national parliament but this week found myself overwhelmed and tearful while listening to a speech by our Taoiseach, Enda Kenny.
He was apologising, on behalf of the Irish State and its citizens, to women who had been incarcerated in a group of Catholic church run institutions, known as The Magdalen Laundries. The apology followed the publication of a recent report confirming “significant state involvement” in the incarceration of these women in these organisations, where they had been detained in inhumane and cruel conditions to provide slave labour.
Although the his speech is a good example of the effectiveness of a genuine, heartfelt apology, it was also, to my mind, a masterclass in using the power of empathy to heal.
Kenny had, in the previous few weeks visited some of the victims to listen to their stories. Many of those interviewed on radio and TV were clearly moved by the efforts he had made to listen to them. Their heartbreaking stories, which he repeated as part of his apology affected him deeply, and it shows.
For anyone in doubt of the impact of the apology on the survivors (a group of women, no doubt well attuned the insincerity of political rhetoric over the years) should have a look at this photo below of them from the LA Times. Although some form of financial redress and support will follow, I sense that the healing has already begun.
The full apology is published here
Anyone who’s been in my office in the last year or so might have noticed two little girls looking down at them from my wall.
The photo caught my eye at an exhibition by Galway photographer Joe O’Shaughnessy a few years ago so I bought it, not really knowing where to put it. Recently, in an effort to cheer up my office a bit, I decided to dust it off and hang it on my office wall.
It has been a great hit with patients. There’s something about the cheeky, defiant pose of these twins (pictured on their first day at school), that raises a smile in most who notice it. I recognise the flicker of distraction in patients eyes as they register the picture behind me, the pause, smirk and then the questions. ‘Are they your girls?’ they ask. ‘Aren’t they just great!’ ‘Are they twins?’ ‘I’ve seen that look before!’
Truth be told, the time it takes to explain how the picture came to be there, and answer questions about it slows me down and probably contributes to my running behind a little. Nonetheless, its here to stay. People seem to take strength from these two brave girls as they prepare for their journey into the unknown.
A first visit to a hospital can be intimidating, disorientating, and stressful for patients. Much like our first day at school, it may not be as bad as you think.
Thanks to Nicole and Rachel Healy and their Mum Mairead for permission to use this picture. Good luck in the Leaving Cert girls.
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