The Pursuit of Mastery in the Worlds of Medicine and Wine

SOMM movieMedical 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):

Cour of Master Sommeliers

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.)

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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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Doctor 007

Let’s imagine an action-packed screenplay full of suspense and intrigue and romance (just a little) and… medicine.  Yes, medicine. And why not? After all, in medicine we have potential for biochemical warfare, technological advances in diagnosing infectious disease in relatively remote areas , glasses that would detect the slightest bit of emotion in an enemy’s expression, issues of governmental influence, conlicts of interest, and public confusion surrounding the intent of our efforts. Take the CIA’s strategy to catch Bin Laden by implementing a vaccination campaign, for example. Legitimate controversy surrounds this approach, but even the most imaginative screenwriter couldn’t have written that storyline.

Well, if one were to write this Bond-esque screenplay, the hero/heroine would likely be unrelenting and bullheaded. At times, he/she might be somewhat simplistic in his/her purist nature. This person would be dealing with frequent bureaucratic issues and reprimands from above while still trying to save the world from injustices. This doctor would have no time for meaningful relationships and would most likely be closer to a “cowboy” than a member of the “pit crew.” Like Bond, this doctor would be simultaneously loved and hated.

And if one were to produce this screenplay, there would be no need for a new theme song, as it has already been written:

Lyrics (though the music –having the classic 007  “feel” to it – is worth listening to):

Monday finds you like a bomb

That’s been left there ticking there too long

You’re bleeding

Some days there’s nothing left to learn

From the point of no return

You’re leaving

Hey hey I saved the world today

Everybody’s happy now

The bad things gone away

And everybody’s happy now

The good thing’s here to stay

Please let it stay

There’s a million mouths to feed

And I’ve got everything i need

I’m breathing

And there’s a hurting thing inside

But I’ve got everything to hide

I’m grieving

Hey hey I saved the world today

Everybody’s happy now

The bad things gone away

And everybody’s happy now

The good thing’s here to stay

Please let it stay

Doo doo doo doo doo the good thing

Hey hey I saved the world today

Everybody’s happy now

The bad things gone away

And everybody’s happy now

The good thing’s here to stay

Please let it stay

Everybody’s happy now

*Thanks to Jan Handerson for inspiring this post by pointing out the appropriateness of this song to the field of medicine (sometimes, anyways).

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Dear Electronic Medical Record

Dear EMR (Electronic Medical Record),

Where to start? When we first met, I was enamored. We were both young and much less jaded back then. Things were simple. You knew what I needed and I knew what you needed. And it worked. But a lot has changed over the years. Our initially simple relationship has gotten messy and much more complicated. I still want you in my life because I believe in you and your potential. Your intention is definitely good, but as I’ve gotten to know you over the past few years, it’s gotten hard to tease out the real you from all the other stresses. You are constantly pre-occupied with the finances and have become more demanding. I am willing to forgive you for hanging out with the girls in billing and the lady lawyers in their fancy high heels. I won’t leave you, and, anyway, we’re practically inseparable at this point. But I do keep vacillating between just working around the idiosyncrasies you’ve developed and trying to change you back to your previous self. But, we both know that won’t happen, don’t we? We won’t ever be that simple or young again. But let’s not forget for whom we should really exist… each other.

Image: Simon Howden / FreeDigitalPhotos.net

Eyes in the Exam Room

Scientific American published an article earlier this month that revealed the results of a study corroborating the idea that “we tend to be on our best behavior when we know that we are being observed.” The researchers actually demonstrated that posters of staring human eyes were enough to change people’s behavior.

 …During periods when the posters of eyes, instead of flowers, overlooked the diners, twice as many people cleaned up after themselves.

The article goes on to hypothesize how or why this effect occurs, citing evolutionary reasons (“detecting lurking enemies”). It is then suggested that images of staring eyes could prevent theft and other bad behavior.

Looking around my exam rooms, bare but for the essentials, I think there might be some use for some “art” in the form of staring eyes. Would patients be more honest or forthcoming about their recreational activities? Would my diabetic patient be more inclined to admit that he has been eating ice cream and cake every night for the past few nights?

Or… it might even keep me in check. Not that I’m dishonest. But it might help me stay consistent with my values surrounding practicing medicine when days get harried or stressful. Hey, I may be a doctor, but I’m human, too. A little subtle evolutionarily-based trick can’t hurt.

 

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*picture:freedigitalphotos.net Salvatore Vuono

Twitter Church

Engaging in Twitter as part of healthcare social media can feel a little like being part of a church. Here’s why:

1. There are preachers and notable figures (those with higher Klout scores) and there are followers.

2. There are prophets (proposing the healthcare of the future).

3. There is a belief in a metaphorical “witchcraft” (poorly supported healthcare information that most doctors engaged in healthcare social media are trying to dispel.)

4. Nonbelievers (skeptics) do not attend.

5. Nonbelievers are being encouraged to convert. (Recruiting other healthcare individuals into social media).

6. Reading your Twitterfeed is like getting your “Daily Bread.”

7. There are a lot of “Amen!”s from the crowd (apparent as comments or retweets)

8. Support and advice are freely given within the group.

9. There is a desire to reach the farthest corners of the earth (with the goal being the safety, health, and well-being of patients.)

10. Oh, and the most obvious similarity? If a regular attendee is missing, people start to worry (“Has anyone seen @insertnamehere?”).