Tuesday, April 24, 2007

Think It's Funny?

I'm not sure what to make of an article that I read recently (Scientific American: MIND, 18:2 p12). Always considering that I had as good of sense of humor as the next man - I mean... well... I know it's in there somewhere. I don't laugh at odd things, uncontrollably, or at odd times... and that's got to count for something. I have noticed lately, however, that fewer and fewer things seem funny. But, if I listen to Jennifer Uekermann from the Ruhr-University of Bochum, Germany, I might have a brain like an alcoholic. Me, who hasn't even tasted the stuff in all of my fifty(mmmft) years! Ms Uekermann, apparently has developed a test for "sense of humor" and is going around giving it to people. Try as I might, I can't find a copy of the test anywhere - I mean - not in medical journals or psychological supply houses or even the Internet!

It's not that I feel slighted that she didn't give it to me; or, that I want to surreptitiously take it so no one would see if it turned out that I REALLY didn't have one. It's just that I thought it might be a good read. Probably at least as good as the "Garfield" book I got for Christmas; and, yes, I admit it, I've got some surgeons that I want to try it on.

She says: "[We know that] alcoholism is associated with cognitive deficits, which have been interpreted in terms of a specific vulnerability of the frontal lobes to the toxic effects of alcohol." Huh? What she means is that the area of the brain behind your eyebrows is the most easily effected by alcohol; which, as it happens, is the part mostly responsible for "social behavior" stuff like the processing of "affective" (feeling) stimuli. Being able to discern "incongruity," it turns out, is a big part of having a sense of humor; as is, being able to put yourself into another persons situation.

So, she gives people a whole bunch of tests, to make sure they have "Normal" IQ, "Executive Functions," and "happiness" levels; I guess, so it won't foul up her "jokes." Then she gives her "sense of humor" test to groups of "otherwise comparable" people, like: alcoholics and non-alcoholics, old and non-old, hit-in-the-head and non-hit-in-the-head. It turns out that 92 percent of non-drinkers could pick out the only listed multiple-choice "funny" punch line to a "joke"; but, only 68 percent of alcoholics could. Was that statistically significant? Well, WHO KNOWS, because Johathan Beard (poor soul), who wrote the review article, apparently didn't think it mattered enough to include the figures; and, unfortunately, neither did any of the other reviewers who wrote the synopses in any of the more "official" publications that I found on the Internet. There were other publications with articles stating that "old" people lost some of it; but, not as much as those who had been injured in the head (either young or old). And, in fact, keeping a sense of humor was an important factor in "successful aging." Man, I can attest to that.

But, I really wanted to see the test because it sounds kinda neat. Apparently the victim, I mean testee, has to discern body language or voice inflection to interpret which, of several choices of punch lines, makes the most sense or is funny. It's called "prosody." High-falutin' people say that prosody refers to the intonation, rhythm, and vocal stress in speech. Us normal-falutin' people just know that it's the vocal intonation which modifies the literal meaning of words and sentences - like when you use sarcasm. You know, saying: "yea, it's really big!" isn't the same as saying "yea, it's really big!" accompanied with rolling your eyes. And, most surgeons know this. That's why they are usually able to keep a whole set of nurses entertained during long operations on a barely clothed, unconscious patient. You see, us Pediatricians wouldn't even get it — everything is "big" to us. And, of course, I said most surgeons because neurosurgeons would just say "big? In relation to what?" Poor fellows, they don't have any sense of humor at all... ever! Now, if Ms. Uekermann is trying to find a group that would have some statistical relevance for her comparisons, she should come to me. I could tell her.

You see a surgeon, a pediatrician and a neurosurgeon went into a bar...

Tuesday, April 17, 2007

Endless Corrections - Reviewers Needed

You know, if I re-read something that I have written 20 times, I still find things that could be more clear, spelled better or have better grammar. It's frustrating. What to do? It's great to have people respond in the "comments" section; but, I find that only a rare person will ever ask "what does that mean" or "what's that word" or "is that for all children?"

I'm new to this "blogging" business, but have created a Pediatric Health Care web site Pediatric House Calls for some time. Most of the articles have been either responding to parents questions and requests or sort of in "self defense" from things I find myself teaching many times every day. It is difficult to write so that many different people, with varied backgrounds, all can understand it. If anyone has similar experience I'd appreciate hearing how you have handled it.

Infant in too soft of bedA "lay-reviewer" or two might do the trick. Especially if you are a mother, father or grandparent of a child 0 - 20 years of age. If you are willing to check the blog a few times a month and respond with readability/understandability comments you would be much appreciated. Use the email to contact me rather than the "comments" section.

I've just finished "Part one" of an article in response to a question that a new mother asked me at church. She'd been talking with others in her women's organization about an unfortunate death of an infant from SIDS. A lot has been learned about the problem in the past couple of years and the problem has DRAMATICALLY been reduced. I'm disappointed that more parents don't know about the changes so wrote an article. Take look at it and let me know if (how) it could be better. This if the first time that I've also included a quick "mini-quiz" on the topic so readers can make sure they understand the issues.

Tuesday, April 10, 2007

Finding (Selecting) a Good Doctor

I recieved an Email question on one of my websites, the companion to this blog, asking whether or not I would make a housecall to the Brooklyn area. Of course that is not the purpose of the web-site, but it raises an interesting question: "How should you find and choose a doctor?" IF you were in Managed Care (i.e. a relatively lower cost medical insurance product which covers "wellness," "preventive care" and other benefits NOT often included in Indemnity insurance) it would be substantially more easy to find what she was seeking - despite what Mssrs. Clinton and Kennedy from her neck of the woods are telling her!

The physicians in an accredited managed care product ALL have undergone a rigorous credentialing process that included, at the minimum: An application which disclosed all previous training, office policies, malpractice claims and hospital affiliations. Then all of those items were meticulously verified in writing, along with other "database" sources, professional references and an on-site audit of his office, before they were individually reviewed by a company physician medical director. When all the information was gathered it was presented to a group of physicians (NOT employees of the company) who used careful criteria to select those qualified into the network. Then, once they began seeing patients, careful records were kept about diseases and their outcomes, patient complaints and very specific audits of his/her patient records. All mishaps and patient complaints are handled rapidly by a dedicated department of the company, reportable directly to it's highest authority, and could, if warranted, lead to a dissolution of the doctors contract with the company. In addition, on a regular basis, ALL of the doctors credentials are completely re-verified (for changes), coupled with utilization and quality audits, patient satisfaction surveys and complaints, and taken, once again, back to the physician committee of peers for re-credentialing.

It should be no suprise to anyone then, that some doctors choose NOT to participate in that depth of scrutiny - for whatever reason. I used to be in charge of that whole process for several insurance companies; but, now, like my correspondent, must try and find a doctor to go to for myself. How does one go about it without all the abilities and resources of a major company like that? Can you see yourself asking an office receptionist - "has the doctor had any malpractice claims or complaints from other patients recently?" And, even if you could, do you think they would answer you honestly? or, could you do it every year or so? So, now that I've moved, what do WE do now?

Although it was originally written to help a father obtain medical care for his son with tonsillitis, there are some suggestions about choosing one on this web page: "The Hitchikers Guide to Sore Throats" And, this is what I wrote back to the "mom in Brooklyn."
... If you'll accept the advice: you are ill advised to select a physician for your children from the internet. If you don't have a physician - talk to neighbors (for their preferences), call the local medical society (for a list), check credentials (get a pediatric specialist).

What you want, are opinions from someone who doesn't have a vested interest. Calling a hospital or "referral service" is highly vested in their own interests. Neighbors, on the other hand, are usually are not.
So, how about it, I'm sure that I'll have more to write as I continue the process of trying to find a new doctor now that I've moved. What has been your experience? How did you find/choose your doctor (good or bad)?

Monday, April 9, 2007

Pediatric House Calls - Obtaining Medical Care for Infants, Children and Teens

[Ok, the picture is an old picture... very old. The bear has graduated, served a two year church mission, married, gotten a den of his own and has his own cubs. And so has little Robert]

Coming back a little early from vacation, I turned on the light in my office and was greeted by the glowing eyes of my fish (every pediatrician has a fish tank). Now, in the light, I can see seven days worth of mail, charts from phone calls, medication samples and other notes from my nurse and secretary. It's all coming back to me and I remember why I haven’t taken such a long time away from the office before.

I have just returned from one of the most enjoyable fishing trips I believe I have ever taken, and, the entire trip back, I begrudged the fuel pump in my car, which has cut my trip short. The first two days of the trip I spent almost the entire time thinking about patients: their problems and how they were doing. In fact, I almost called the office the second day - but then remembered I had left my practice well covered with an on-call physician (and besides the fish started biting).

Going through all my messages I can see that Tina's mother has called and was referred to the on-call doctor. Tina is a premature baby who we referred to Primary Children's Medical Center four months ago for open-heart surgery. Her parents are both young and needed a lot of help and teaching at first; but, they have become quite proficient in medical terms and procedures.

And, it looks like Nathan has started wheezing again. He and his parents have just completed the Lung Association’s asthma program; so, hopefully, this time it wasn’t too bad. Connie has had another ear infection and was treated. I have to chuckle. I hope that she didn't put up too big of a fuss with the other doctor. Although I have been trying for almost a year, she has not quite yet forgiven the medical profession for putting stitches in her chin! On the other hand, the doctor saw Sean too, and he's a gem. Once, during his sisters visit, he had become quite loud and disruptive. So much so, conversation couldn't be carried on in the room. Instinctively, I picked him up and held him on my lap then realized, as he “snuggled in,” that he had just felt left out and wanted some “doctoring” too. Now he is a joy to see.

Well, as I think about it, I guess it is kind of good to be back from vacation. These are my kids. This is my kind of medicine ~ Pediatrics. In this column, I would like to share with you the kind of things that I share with my patients - in talks, handouts and newsletters.

Most columns like these, write about the most up to date recent clinical advances, I will too. But, in addition to that, wouldn’t you like to know occasionally just what's going around - how to treat it, what to watch for and when to call the doctor?

Also, I know that the cost of health care is frequently written about; but, would it help you to know how to obtain cost effective medicine from an“insiders” viewpoint? And, there are also some “wives tales” which aren’t entirely wrong you know, and home remedies, which are inexpensive and effective. Also, to tell the truth, there are some things that I would like to say about which, out of all the things given to children, are really the best gifts. I really hope you will join us each week for the upcoming articles on all these topics.

[This Web-Log does have a companion web site: Pediatric House Calls containing many in-depth articles on children's health issues.]