Wait, but why?

Why would I, a busy person with a demanding job in academia, spend my precious free time doing even more writing? It’s hard enough to summon the focus to write grants, articles, reports, even emails. So on top of that, I write not just one, but two blogs: Zabbylogica is my personal blog, and I also contribute to the American Heart Association Early Career Voice.  I don’t do it for money or fame, I’ll tell you that. I don’t get paid and my #1 fan is my mom (Hi mom! Love you!). So why?

  1. Consistency. I find that making breakthroughs calls for consistent work, not just hitting it hard when inspiration comes around. Blogging creates a platform for being consistent. Whether I set my own deadlines, or work on the calendar of an editor, the time structure is key. I keep notes for post ideas, knowing I’ll need to pull something together this month. I follow up on “wouldn’t that be interesting” leads, because I have something to do with the results. I spend time writing that I might otherwise waste on internet rabbit holes. This creates a discipline of thinking and writing that’s not attached to the academic system. Which leads to:
  2. Freedom. Academic writing requires structure, and specific language, and particular kinds of work are more highly valued than others. On a blog, I can choose what to write about and how to write it, and this opens up my interests and allows me to explore areas that aren’t in the narrow sphere of my so-called expertise. I find this to be intellectually and creatively stimulating, and the knowledge I gain carries over into the more formal parts of my intellectual life.
  3. Speed. The time from idea to published post can be an hour or maybe a few days or weeks, not six months. This means I can address things that are happening in real time, whether that’s in my personal life, in the scientific literature, or in the news. This creates momentum, and it keeps me interested in things that are happening around me. For example, I just read some interesting research about women’s heart health, and instead of sticking it in my digital filing cabinet, I wrote a post about it. The rapid iteration of ideas is also a fun brain exercise and a great way to get unstuck.
  4. Community. I know other bloggers, online and IRL, and this is fun. My fellow AHA Early Career bloggers can sit together at lunch at giant national meetings. I’ve gotten to know other nurses, cardiologists, and basic scientists this way and learned about their work in ways I wouldn’t have otherwise. It also helps me keep in touch with friends even if we don’t talk much— we can see what each other is working on and thinking about.
  5. Professional advantage? I leave this as a question mark. Some people put blog posts on their CVs. I’ve written for the Arizona Health Sciences blog and an American Heart Association blog— my byline is associated with issues I care about in public places. That can’t be a bad thing!

Bloggers, why do you do it? 

Does the language of health care matter?

Disclaimer: Dammit Jim, I’m a nurse, not a linguist!
We’ve been arguing over the language of the healing professions for a long time. Providers. Midlevels. Doctors. Physicians. Physician Extenders. Do the semantics matter to the development of the roles? To the patient experience? To the politics and payment?

  In a 1951 article from the Medical Library Association, Thelma Charen took on the task of tracing the etymology of the word medicine. According to Charen, the latin roots of medicine are easy to follow, from medicina, to medeor or medicor: to heal or cure. Tracing the root back further to an ancient Indo-European root (MA, MAD —> MED), we land on “to think or reflect, to give care to”. This links medicine to meditate. Over time, language crystalized from the general idea of considered reflection to more specific applications, eventually to specifically caring for the sick. Interesting. Noble. Relatively free from baggage.  

What, then, about nurse or nursing? The line is less straight and narrow, and more fraught. Thomas Long takes us through it. Nutrice, latin for wet nurse (and also related to the word nourish), morphed into a more general term for caretaker of children— a female caretaker, specifically. In the medical context, Long notes, nurse first appears in Shakespeare. (I’ll leave aside the meaning as it relates to bees, though that might also be interesting to the sexual politics). So nursing, the profession, is linguistically linked to nursing, the act of feeding the child from the breast. And thus linked also to female-ness. Of course, just tracing the history of a word doesn’t capture its full meanings, but it’s not irrelevant. Not at all. Those of us who practice nursing will tell you that there are persistent biases related to power and gender that plague our profession. The health professions (notably medicine) have been slow to understand nursing as a mature, serious, and independent profession with its own ontology. Nursing’s metaparadigm includes the concepts of person, environment,health, and nursing— note the absence of “disease,” “orders,” “bedpans,” or “hospitals.”

The language isn’t neutral. It’s steeped in meaning and history. And it’s part of our cultural understandings of professional roles. These days, people like to say that health care is a team sport. Some organizations (you can guess) want to append that to say “and a physician is the team captain”. But that’s not always wise— physicians make great captains, in some contexts— but so do nurses, counselors, pharmacists, or physical therapists, in others. It doesn’t need to be a turf war or a hierarchy. Let’s all stick to the roots of our roles, evidenced in the language of medicine: Reflection. Caring. Let’s carry it forward into our professional practice, our praxis, and our teams. Let’s think about our unique bodies of knowledge and our relationships to our patients, and let that guide our teamwork. And let’s be careful, considered, and kind with our language. Do we all have to agree? Of course not! But let’s agree to be willing to listen and reflect.

Books about running that aren’t about running

I’m not a fast runner. I’ll never win a major race, and I’m not particularly interested in going after a big marathon. I just like to run. Similarly, I’m  kind of a lousy reader— slow, prone to mixing up letters and words, easily distracted. Yet, I love to read, and I love to run. I also love to read about running. And I’m in luck: there is lots of great writing on the subject, from technical manuals to memoirs to novels to philosophy. While I love a good geek-out, it’s these latter categories that really grab me. Maybe because running can be so solitary and long miles give us time to think, writing on running is often perceptive and introspective. In fact, much of this writing is really more about living in the world than it is about putting on foot in front of the other. 

I certainly haven’t read every book about running (yet). But I find myself coming back to some favorites. The books I return to share a theme of running not just as a sport, but as a conduit for humanity. The first one that pulled me in was Haruki Murakami’s What I Talk About When I Talk About Running. Fans of Murakami’s fiction will recognize his voice: keen observation, simple description, slightly magical air. He writes about the routines of running, the suffering, the odd sense of comfort, and how these mirror the writing life. Reading it was meditative for me. Another classic, Running & Being, from the so-called “philosopher king” of running George Sheehan, delighted me in a different way. The chapters are titled things like “Living”, “Discovering”, “Learning”, “Racing”, and “Meditating”. Sheehan, like Murakami, is preoccupied with the suffering of running. Is this the secret sauce? Suffering? I don’t know, but there’s something about it that compels runners and writers alike.

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Book Club: An American Sickness

The U.S. healthcare system is a hot mess. Even people who know things are convoluted and expensive might not realize the extent: we pay far more for just about all aspects of healthcare here than anywhere else, and our outcomes are worse pretty much across the board (see this article from the Commonwealth Fund for details).  As tempting as it is to implicitly trust that you’ll get the best care in the world right here, the facts would suggest otherwise. Every other major developed economny in the world as some form of universal access. So why do Americans cling to the idea that our healthcare market is somehow sacred, and that a market-based approach is the answer? I’ve talked about why healthcare is not just another commodity before, but it’s still true.

Elisabeth Rosenthal, a physician turned journalist who has worked for the NYT and Kaiser Health News, wrote a book last year. In it, she exposes a lot of the causes and effects of the major malfunctions in our healthcare system. Much of this is illuminating— examples about hospital conglomerates and pharmaceutical pricing are spot-on. But what seems to lack punch is the explanation for why this upside-down, losing system persists. When healthcare is treated like every other business, greed drives, incentives are bonkers, and lobbyists shape policy. When healthcare is considered as a public service, things are different. But once powerful people are making obscene amounts of money, it’s nigh impossible to unring that bell. Are there market failures? Big time. Can the people affected muster enough influence to combat the big-money lobbying of professions and industry that have become accustomed to fat-cat money? Fat chance.

Aother quibble: Rosenthal is mercelessly physician-centric. She doesn’t consider the unique added value of team-based healthcare or other professional expertise, choosing instead to lump unique professions like NPs and PAs together as “extenders”. Barf. Dr. Rosenthal, I wish you’d take a broader view of health.

That said, give it a read. It’s interesting/depressing. And you might pick up some useful tips for your nex hospital visit, knock on wood.

What we talk about when we talk about research findings in the news

What happens when journalists report the findings of a scientific study to the general public? Often, the findings are stated out of context, broadly interpreted, and stripped of the nuance and uncertainty that characterize much of scientific research.  Should this scare us back from publicizing findings to a wider audience than you might typically find in a scientific journal? Or is publicity critical to uptake?

What is our responsibility as scientists to communicate our findings, not only through dedicated dissemination and implementation planning, but also through the popular press?

Here’s a recent example. JAMA published the findings of a study by Mandager et al.  on the association of cardiorespiratory fitness (CRF) with long-term mortality. CRF was measured by exercise treadmill testing in a sample of over 120,000 patients who were having this test done anyway as part of their care (that means these people were mostly being evaluated for symptoms potentially related to cardiovascular disease). The investigators quantified CRF as peak estimated METs. They separated by sex and age to calculate percentiles and then stratified CRF based on those percentiles. They used public and hospital records to determine mortality. Median follow-up was 8.4 years. The investigators concluded that CRF was significantly inversely associated with all-cause mortality (i.e., the fitter you are, the less likely you are to die). They went on to state that low CRF was as risky as or riskier than diabetes, CAD, or smoking. They also noted, importantly, that “there does not appear to be an upper limit of aerobic fitness above which a survival benefit is no longer observed”, but “there continues to be uncertainty regarding the relative benefit or potential risk of extreme levels of exercise and fitness”. They go on to offer several other sensible caveats, including that the study population may not be representative of the general population, and there are potentially significant unmeasured factors in this retrospective study. All things considered, though, this seems to represent very good news: a modifiable factor is strongly associated with increased longevity in a large sample with a long follow-up.  Bravo!

So how did this get reported in the popular press? Gizmodo’s headline reads “No Such Thing As Too Much Exercise, Study Finds”.

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high score screen

In praise of being a generalist

There’s something undeniably alluring about being highly accomplished at something. Being the best. Being at the top of your field, your game, your performance. But there’s an opportunity cost to this kind of excellence— the time and focus you dedicate to one thing, you are not dedicating to anything else. Can single-minded focus actually undermine your effectiveness? It depends on what you are doing. . .

Let’s think about this through the lens of running for a moment. We are not all 100m sprinters, even though that’s impressive, and you can win cash and medals and huge endorsements and titles like “the fastest man in the world.” But is Usain Bolt, impressive as he is, better at everything than you are? Is he a better human than you are? His speed is truly amazing, but it’s just speed. This is why obstacle course races are cool— you have to be fast, but you also have to be tough, have power, have strength, have skills. Even the crossfit games (as mixed as my feelings are about crossfit) are a good example of testing a broad set of competencies rather than a narrow one.

I’ve been thinking about this a lot because I am not, shall we say, a highly focused individual. I am curious, a bricoleur, a person who loves to say yes and follow side trails. My grandmother once wrote a poem about my twin sister and me, where she was the arrow and I was the hummingbird. She was a smart lady, my grandmother.  Continue reading