The Pursuit of Mastery in the Worlds of Medicine and Wine

Medical school becomes a blur after a few years in practice. You forget about all the hours spent in classrooms and then every night after a quick dinner. You somehow block out the “pimping” [There is a nice explanation on what this word means in medical school here] and public humiliation of being questioned about topics not quite under your belt. The worst feeling? The fear of wondering if you will master medicine enough to do no harm.

Medical training is, quite frankly, a brutal process that can make or break a person. Your every fear can come up during this process. It’s not enough to pass tests or to know the Krebs cycle. It takes physical and mental resilience to get through seven-plus years of intense training and learning. Then, imagine being a partner to someone going through this. The partner will always be secondary to the subject of study. And it almost has to be be that way… for a time. Missed birthdays and weddings…. Late nights studying with fellow students or your assigned cadaver…. Fictional television shows about doctors-in-training often focus on casual sexual relationships or budding romances. But in real life, I’ve seen marriages dissolve and people have nervous breakdowns under the stress, as well.

I had forgotten about all these details, anyway, until I recently watched Somm, a documentary about four men trying to pass the Master Sommelier exam. What is a Master Sommelier (MS)? See below (from website):

I was completely engrossed in the personalities of the candidates for the MS exam. While it may seem to have very little to do with medicine, I couldn’t help but see my medical student self (and former classmates) in these young men. If you’ve ever been a medical student or lived, breathed, and ate a specific topic for a specific goal, all the while foregoing sleep and relationships, you might relate to this movie. (Insert artist, musician, scientist, etc. here).  The marathon-like effort rewards a few, though many try. There are currently only 135 Master Sommeliers in North America and 19 of them are women. There have been 214 worldwide who have been given the title of Master Sommelier since the exam’s creation.

After you watch Somm, you realize drinking wine is clearly only one tiny part of becoming an MS. Many people have some knowledge about wine or medicine. But mastering these fields involves intense study to quickly calculate and retrieve applicable and accurate information. It also takes a certain amount of competitiveness, observed one of the MS candidates in the documentary who was formerly a baseball player, to attempt to pass “a test with one of the lowest pass rates in the world.” Even some of the terms they use to describe aspects of a wine’s taste or smell (“a freshly opened can of tennis balls”), while seemingly completely bizarre, are reminiscent of some of the unusual analogies we use to characterize various things in medicine. “Ground glass” on a CAT scan of the lung, for example, is not ground glass, but it is the best way to describe something and recognize it quickly.

If you’re curious about the world of wine, what it takes to be an MS, or the psychology of the pursuit of mastery of a subject, I would recommend watching Somm. Though the documentary is a little drawn out, it is not particularly long and you look forward to the ending to find out if any of them passed the test. 

Interestingly, at a recent dinner I had the opportunity to speak with an MS who was working at the restaurant. Everyone at our table had just seen the movie the previous night and we queried him about his experience studying for and taking the MS exam. He did corroborate that it was an intense period of study to learn all the minutiae and details about wine. He reflected that it was all about “the hunt” (to pass the exam). However, he said that in the end, after you pass, “fifty percent is about people skills.”

True in wine as it is in medicine.

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(*please note that original version of this post stated there were 135 Master Sommeliers. To clarify, there are 135 in North America and just over 200 worldwide.)

There Are Side Effects to Attending a TED Event

This past weekend, I attended TEDxRainier 2011 , which was a very full day of inspiring, enlightening, thought-provoking, and humbling talks by speakers from various fields. I cannot speak highly enough about the experience. The interdisciplinary examination of ideas and the unifying themes that were explored brought back fond memories of my favorite course at Boston University: the two-year undergraduate Core Curriculum course. This was my first live TED experience and hopefully the first of many.

Today, I received a letter via e-mail from the curator of the event, Phil Klein. This general letter, sent to all attendees, thanks the attendee and provides links to videos and feedback forms for the event. However, it also goes on to say the following:

“Some people report that the few days after TEDxRainier can seem a little difficult or dull in comparison to the vivid intensity of the prior day. That is common, so don’t worry too much about it. It may help to take some time to relax and reflect, or to engage and connect with others on a project or adventure that inspires you.”

This oddly touching acknowledgment of a phenomenon that I did, in fact, experience sounded like something…well, something a doctor might say. Perhaps a new diagnosis is in order here: the post-TED-return-to-regular-life syndrome….

Except, I suspect that you do not go back whence you first started once you’ve attended a TED or TEDx event.

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How Low Can We Go? A Ten-Year-Old Models in French Vogue

I appreciate fashion – not in the sense that I buy the latest designer clothes. Rather, I enjoy the aesthetics of it. It is creative and can be glamorous, silly, subdued, over-the-top, surprising, and even emotional (as is the case with wedding dresses for some people). Watching designs come to life on a show like Project Runway is entertaining and inspiring. Runway modeling, in particular, can be mesmerizing; the models’ bodies serve as moving canvases for art. However, needless to say, I was quite disappointed with the extremely unhealthy, waif-thin days of modeling. As personified by Kate Moss during that time, in the world of fashion, limits are always being pushed.

In fact, the newest controversy in the fashion world  surrounds a provocative photo shoot of a 10-year-old posing in French Vogue. Here we have a child (younger than a teenager) photographed in adult poses and dressed up as a grown woman with sexy make-up, stilettos, stare, and all. Thylane Blondeau is without a doubt a gorgeous and striking girl (emphasis on “girl”). She clearly has the genetics for a modeling career now and in the future. If I were her mother, perhaps even I might suggest a short stint in modeling at some point. But at the age of ten, are these images pushing limits?

Some feel quite strongly about protecting all children from the modeling world. I don’t take as extreme as a stance, but I do take issue with the way some magazines portray children. Vogue is a fashion/lifestyle magazine. What lifestyle is being sold here? And to whom? If we think that only adults and teens will be reading these magazines, we would be sorely mistaken. The children of women who read these magazines have access to them, circulate the ideas, and sometimes even imitate these images at school.

See, you can’t really understand the issue here until you have heard stories of healthy seven- and eight-year-old girls asking if they are fat or if their thighs are too big, putting themselves quietly on an unforced diet. It is practically a given that a woman in Western culture will spend most of her life unhappy with her body. But we need to take note that, today, our society’s young children – so full of potential and who have been on this earth for not even a mere decade – are obsessing about their weight. Really, it has gone quite too far.

This is my own opinion, of course, and not a professional one, except for the fact that body image issues do not just lead to anorexia. There are issues and struggles related to poor self-image that can be lifelong: making food excessively complicated, giving up easily on healthy eating, and looking at health as unattainable because it is associated with certain celebrity body types. Of course, there are those who say critics should “lighten up” about Blondeau’s Vogue pictures. But they are just ignoring the glaring reality that body image issues are starting younger and younger.

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**photo by BlackHawkTraffic (Flickr Creative Commons)

The Doctor Will Really See You Now

“All the world’s a stage, and all the men and women merely players.”

– William Shakespeare

In our respective tragedies/comedies (depending on the moment), some individuals are better actors, revealing and hiding emotions with relative ease, portraying exactly the “I” that is scripted in their minds. Others, such as those who turn red at the slightest bit of discomfort, may try as they might but eventually have to give in to the transparency of their physiology.

Well, the playing (acting) field may have just been evened.

MIT’s Media Lab has engineered a remarkable pair of glasses “that are set to transform how we interact with each other” by accurately detecting very subtle facial cues that would be otherwise missed. The initial concept was born with the intention of helping people with autism pick up on these cues.

Inside the glasses is a camera the size of a rice grain connected to a wire snaking down to a piece of dedicated computing machinery about the size of a deck of cards. The camera tracks 24 “feature points” on your conversation partner’s face, and software developed by Picard analyses their myriad micro-expressions, how often they appear and for how long. It then compares that data with its bank of known expressions(see diagram).

From New Scientist http://bit.ly/kl0lvh

Roger Ebert (on Twitter) says, “These spectacles could destroy social life as we know it. And diplomacy.” But just imagine the possibilities within a doctor-patient interaction if a doctor could more easily detect skepticism or hope or fear or frustration. Perhaps, the use of these “social x-ray specs” would be limited in the case of a highly botox-ed face, but for the majority of patients, it could potentially enhance doctor-patient communication.

So, I say, “Where can I get one of these?”

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Filtering Helps E-patients, per MIT Media Lab

For those interested in a contrasting viewpoint – because there are always at least 2 ways to look at an issue – to my recent post about the potential effect of the “filter bubble,” I am using this post to present the other side of filtering. Filtering – in layman’s terms – is the way by which companies  like Google and Facebook (“gatekeepers”) determine what your search results will be, using algorithms that incorporate data from your prior search habits. Ian Eslick recently sent me a link to an article that explains the positive aspects of filtering. Eslick is a PhD candidate at MIT Media Laboratory and is studying how filters apply to healthcare information on the web. Here’s an excerpt from that article:

In an era of increasing information overload, the filter is a necessary and valuable tool and we’re only at the beginning of the technology curve.  In the context of health, filters are critical to improving the effectiveness of the rising class of e-patients.

This is a fascinating topic that is not new, but that I have recently discovered. I certainly don’t claim to be an expert, which is why I am posting the MIT Media Lab’s perspective, as well.

Do any of you out there have thoughts on the topic? How about filtering as it relates to healthcare information? Did you know about the concept of the “filter bubble” or personalized search results or is this also the first you have heard of it? Do you see other pros and cons to it? Does this topic even matter to you?

The Internet and Delusional Thinking: A Take on the Effect of the “Filter Bubble”

Some suggest that social media is full of illusions. Real life people creating an alternate reality through the web and social media is not unfamiliar. Sometimes the alternate reality becomes so infamous it creates real danger and harm, as in the case of Kiki Kannibal.

But there may be a greater collective societal harm in our use of social media and the individualized way we in which interact with the internet and other people. We’ve created a sort of “selective hearing” with the introduction of DVR, Facebook friending (and de-friending), RSS feeds, podcasts, and Twitter. Even if we are not creating a fake image of ourselves, we are living in a world designed around our own self-interests.

Long gone are people telling us things we don’t want to hear. We can tune them out and tune in messages from like-minded people. If I believed in life on Mars, I can “program” my inputs from various channels to be heavy on that topic by selectively following those with similar interests, searching for corroborating articles on the web, and highly rating similar topics on DVD.

The internet and our current technological advances do more than just encourage us to create illusions. For a much larger percentage of us, if not all of us, they help us create and maintain our own delusions (I am not referring to the actual medical term here). Delusions are technically defined as false beliefs, but in the tweeted words of Jan Henderson, there is “no one right conclusion that stands the test of time indefinitely.” So I would argue that we are delusional if we only look at the world from a singular or narrow perspective, being unwilling to accept or selectively avoiding other opinions/ realities.

As I was pondering the above in recent weeks, I come across a video that, quite frankly, sent slight chills up my spine. It was a video of a TED talk given by Eli Pariser, author of his new book, The Filter Bubble, which deals with the notion that the major players in the internet world (like Netflix, Google, and Facebook) are tailoring your searches based on your previous online behavior. They acquire data regarding your pattern of clicking, your location, etc., to personalize your results. “You actually start to have – without you really knowing it – your own views fed back to you,” Pariser said in a recent radio talkshow. Why? To increase the likelihood you will click on the links presented. “You can make more money if you can show people stuff that they’re going to like.”

He explains this more clearly in the video (well worth watching for the 8-min duration)…. By the way, after watching the video, you get the sense that you have inadvertently sold your soul by engaging in a technology that, without which you would be considered obsolete and nonfunctional.

What are the implications of “the filter bubble” for healthcare? Potentially huge. People are now “researching” online for their healthcare information. And this is only going to increase over time. If I have a tendency to click on naturopathic medicine links and I get diagnosed with breast cancer, the first two pages of my google search regarding treatment might be related to alternative approaches because “personalized media is showing you the things… it thinks you want to see.” This type of filtering may affect my decision on who I call first and thus my treatment plan. It doesn’t take into account that I may have changed my mind about which approach to treatment I would prefer.

It is concerning to think that internet companies “have a lot of power to shape what you see and don’t see.” The web will assume our preferences for us, feeding us the information that substantiates our underlying tendencies. Even outside of the specifics of healthcare, there is potential for our biases become more deeply entrenched with personalized media. And I suspect that would not be good for the evolution of human consciousness. I personally feel fairly reassured because I believe I have a critical way of searching on the web. But other people (with less formal experience researching information) may feel they are just as objective, but in actuality, have less discernment. (This is exemplified in the case of a sensational article circulated on the internet recently.)

As it is, to be open to new ideas and evolve into broad-minded human beings requires much attentiveness and deliberateness, which can easily get lost in our fast-paced lives. The internet is now making it that much harder.

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Obama and Bono: Echoes of Inspiration

Like millions around the world, I viewed President Obama announce the death of Osama bin Laden last night. It was a message that progressed from a sense of relief and justice to perspective and caution and, finally, to inspiration. 

Though this idea of “justice” is controversial and questionable when looking at humanity as a whole, it was the last bit of President Obama’s speech that reminded me of the words of another famous individual. The closing paragraphs last night were an echo of Bono’s monologue prior to playing “One” while on the U2 Vertigo tour in Chicago 2005. President Obama and Bono each referred to a very different defining event in American history, but both of them reminded us of a not-yet-extinguished and (I believe) a still-defining characteristic of the American people.

The key parts:

President Obama’s speech (start at 8:26)

Bono’s monologue (Start at 0:33. End at 1:10)

If you cannot access the videos (well worth the view), here are the transcripts of both:

“…today’s achievement is a testament to the greatness of our country and the determination of the American people.

…But tonight, we are once again reminded that America can do whatever we set our mind to.  That is the story of our history, whether it’s the pursuit of prosperity for our people, or the struggle for equality for all our citizens; our commitment to stand up for our values abroad, and our sacrifices to make the world a safer place. 

Let us remember that we can do these things not just because of wealth or power, but because of who we are:  one nation, under God, indivisible, with liberty and justice for all.”

– President Obama

“When I was a boy, my first impression of America, was a man walking on the moon. I thought… I thought, ‘These Americans are mad. They are mad.’ But I thought. ‘What can this country do… What can these people do when they put their mind to it. It’s incredible.'”

– Bono

To be clear, the idea that the death of a man symbolizes “justice” is not one that is easy to comprehend. It’s an idea that people are struggling with today… as they should. However, it was the last bit of President Obama’s speech that I focused on. As this is a medical blog, you might be able to infer to what specific endeavor I feel Americans should really set their mind in order to show the greatness of the country’s abilities to reach its collective hopes and dreams….

P.S. Listen to the whole song “One.” Let’s combat poverty, malnutrition, poor health, social injustices. Most of all, let’s combat complacency, which is a greater enemy.

*pictures from Wikipedia

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