My Brush with God

My favourite twitter account is God. I have followed it religiously. I had been one of the almost 1.8 million followers who eagerly awaited his witty one to two sentence tweets. Whilst they will undoubtedly offend any given large proportion of the population, they equally provide comic relief for an adulating audience. I love this account and it is one of the first accounts that I recommend all new twitter subscribers follow. Each day, I would look forward to God’s latest instalments and I would retweet my favourites to my own humble following.

This all changed when I saw the following tweet appear on the timeline. I often screenshot the ones that I like for possible future use in a presentation on social media where I would highlight the use of humour to gather an audience. 

I saw the following tweet:-

I screenshot it and then was trying to retweet it but discovered that it had been deleted. I then tweeted to God with the cheeky line as follows

He was clearly not impressed when he send me a private direct message as follows:-

Clearly God was not impressed.  You dare to take up a point with God, you run the risk of him unleashing his power over us.  I shamefully dared to do so.

Immediately following this I was placed into purgatory and blocked by the account.  This is the first time that I am aware of being blocked on twitter.  If others have blocked me, then I have not known about it.  

Anybody who follows God knows that the account is not for one who is sensitive.  He will unleash his fury and nobody is immune from the wrath of God.  I am now God-less but will now survive on screenshots of his best tweets sent to me by DM by friends. Yes, I could set up another twitter account but this be trying to escape from the purgatory that I have been banished to. I need to do my time and hopefully one day I will be released.  Please pray for me.  Please tell him that I am sorry.

(David Javerbaum is a well known comedy writer in the US. On social media, he is particularly known for his very popular account known as @TheTweetofGod.)


Addendum 2 February 2015

Last night I was messaged by God who essentially stated that he hoped that I had learned my lesson in purgatory and that I was being welcomed back into the promised land. I had been forgiven. I thank everybody for their prayers and on line appeals for forgiveness. Clearly he was listening.

Once again, this is my favourite Twitter account. I have seen him put followers into periods of time out in purgatory with the usual expletive laiden barrage but he is always forgives.  Whilst I knew my time out was temporary, it was for how long that I was unsure about. Do follow @TheTweetofGod but don't take it too seriously because it never is.

The 2nd Addendum 2 February 2015

I had a dream. Crazy dream. It was good whilst it lasted.
For those who know, God only ever follows one account. It used to be Ricky Gervais but he later dropped him for Justin Bieber.  This of course fits well with his book called the Book of Biebs.

What Does Australia Day Commemorate? Not Something To Be Proud About.

The vast majority of nations have a national day that in some way commemorates an event that is directly linked with the formation of a national identity.  What Australia Day commemorates is in stark contrast to comparable nations. Australia marks a commemoration of white settlement of Australia when the First Fleet landed in New South Wales in 1788.  For the indigenous population, it is often referred to as Invasion Day.  For this reason alone, Australia Day will never be a fully inclusive day that will enable all Australians a reason to feel national pride or celebrate as a nation.

It is important to examine comparable nations for the underlying background behind their designated national days. The most relevant comparators are nations that grew out of British colonization and transportation, in particular, Canada and the USA.  Canada celebrates Canada Day on 1 July each year and this represents when its three provinces (Nova Scotia, New Brunswick, and the Canada provinces) united under the Constitution Act to become the nation Canada. Arguably the most famous or recognizable national day in the world is the 4^th of July which represents the declaration of independence of The United States of America from Great Britain. 

Culturally, the closest nation to Australia is New Zealand. The signing of the Waitangi Treaty, is regarded as being the founding document of nation of New Zealand. The day of signing is celebrated as Waitangi Day and is also known to a lessor extent as New Zealand Day. Whilst there can be argument over the manner by which the signing of the treaty occurred, its signing did legally define the creation of the ‘colony’ of New Zealand. 

Australia did not become a national entity until Federation on 1 January 1901. It seems ludicrous to reflect back to the landing of the First Fleet in 1788, where the intent for the British was to establish a penal colony rather than having any thought of creating an independent nation. Celebrating a time when white settlers set up camp in a foreign land is at total odds with other nations where there is national pride associated with a key event that defined the creation of a nation or a significant moment in the history as a nation.  It is almost cringe worthy when we have to explain to those from outside Australia when asked about the background behind Australia Day.

If we review the rationale behind the national day for the great majority of nations, we stand out alone as being frankly embarrassing. Other nations have designated national days that provide reason for its citizens to be proud and it is clear that an alternate day should be identified.  If we cannot identify a particular rationale to gazette a specific day, perhaps we should follow the lead of the United Kingdom, which does not have a designated national day.  They do not appear to have been worse for the absence of one.

An alternative Australia Day must be debated and change undertaken to not only allow inclusiveness but a reason to be proud of what it stands for.

Surgeons receive no empathy training. This needs to change.

Communication skills are an essential part of clinical practice.  It plays an especially important role in creating patient satisfaction, delivering bad news and conflict resolution.  Unfortunately there is little training in communication skills, particularly in the surgical specialties.  As surgeons, we generally think we are fine with this and quickly acquire the skills with clinical experience.  We do tend to have self confidence in our skills which possibly goes hand in hand as to why we have become surgeons in the first place. But then again, it is probably the very reason we need to be better trained in communication skills.

General practice training in Australia includes hands on training in communications skills. Trainees are observed as they interview and assess patients for full sessions.  Additional to this, they undergo patient interviews that are video recorded and then reviewed with a mentor where self reflection and critique of the interviews are undertaken.  With surgical training, it is uncommon (why don't we make that never) to ever have a single patient interview observed by a mentor.  Certainly, there would not ever be any video recording of a patient interview for training purposes.  The closest we get to supervised patient interview is a mini CEX which in reality has been a tick box exercise for surgical trainees in Australia and even the majority of trainers do not take it seriously. 

So where is all this leading to? I recently attended the Urological Society of Australia and New Zealand NSW Section Meeting held in Hobart.  It was an honour to be there as an invited keynote speaker but an even greater honour to meet Helen Reiss who is a psychiatrist affiliated with the Harvard Medical School and Massachusetts General Hospital in Boston.  Dr Reiss has become prominent in the teaching of communication skills, particularly empathy.  Her address to a urological surgeon audience was warmly received and taught us about empathy and interpersonal skills training.

See her TED talk.

It was quite notable that the talk by Dr Reiss was attended by those who probably least needed to see the presentation.  It was also interesting that the preceding talk by Dr Nader Awad was on the subject Narcissism in Surgery - it was a bit a of joke over lunch where everybody felt that those most in need in seeing these presentations were absent from the meeting.

This week I have taken the opportunity to do the online modules created by Dr Reiss and are available on the Empathetics website.  It takes about three hours to complete the three modules.  Without performing a detailed critique of the modules, I am convinced that every doctor in clinical practice with face to face contact with patients should be doing this type of course or equivalent. I am convinced that empathetic practice can be taught. 

It seems crazy that in spite of the fact that our work as front line clinicians involves communication there is minimal such content throughout our training.  Do the Empathetics course modules and you will change your mind if you do not already have such an opinion.

Predatory Journals. Academics Are as Much a Part of the Problem.

Medical doctors in academia are gullible. They are so gullible that they are amongst a number of groups, the perfect target for predatory publishing companies. The definition for a predatory journal or publishing company can be found on this link.  They appear to be growing in numbers at a seemingly exponential rate.  It is obviously worth the effort for the creators of these on line publishing companies who try every tactic to trick academics into paying excessive fees to publish.  In other words, there are always enough gullible individuals to make if worth the effort. This is all well documented and whilst there is growing awareness of these scams, it is disappointing to see how academics are quick to give up their credibility by becoming a part of the problem.  They allow themselves to become the bait to attract other academics to submit their manuscripts to the journal.

I get these emails all the time. These are invitations to join the editorial boards of these junk journals.  This one gives the impression of being US based but when you visit the website, it is obvious that the authors of the website are not native English speakers and most people would be able to work out that it is really based in India.

The emails often butter up the recipient with glorified praise about their eminence in the field. That aside, being invited to be a member of an editorial board is generally considered to be something of value and the more editorial boards one can boast the better. Without much thought, academics respond in the affirmative and their picture and bio soon appears on the ‘journal’ website.  These predatory journals have also been in the habit of placing academics on their editorial boards without permission but from my own investigations, it appears that the vast majority have actually consented to the process without having given a thought to where they have gifted their own good name as well as the good name of their university.

We are all keen to see these journals run out of business. It is not only the gullible academics who support them by submitting manuscripts but also our gullible academics who provide some resemblance of credibility to these journals. We are very much part of the problem.


(Related post:-
http://surgicalopinion.blogspot.com.au/2015/02/if-you-pay-omics-will-play-all.html)

Disclosure - Henry Woo is on the editorial boards of Prostate Cancer Prostatic Diseases, Prostate International and World Journal of Men's Health which are all Pubmed/Medline indexed.  He is also the Editor in Chief of BJUI Knowledge, a new CME portal of the reputable BJUI Company.

Getting a Second Opinion for Cancer Surgery

Second opinions for medical advice is nothing new and an accepted part of modern day medical practice. Practically all doctors are happy to provide second opinions for patients who seek them.  It goes without saying. My own surgical practice has a significant proportion of patients who come through such channels.  I usually ask them how they came to see me and in the vast majority of circumstances it was due to a recommendation from a friend or acquaintance who had been treated by me for the same condition.

Procedural specialties have particularly taken to having an on line presence for marketing of their services.  It makes a great deal of sense.  The more patients you can attract so as to be able to perform procedures, the more income that is generated.  Increasingly we are seeing offers of seeing patients for second opinions appearing on the websites of surgeons. Often there will be a form to complete where you type in your basic demographics and some basic information about one's condition which in turn invites the surgeon or designated staff member to make contact and subsequently encourage the patient to make an appointment.

What concerns me is that the second opinion marketing is mainly directed to newly diagnosed cancer sufferers.  These patients are vulnerable and on the steep learning curve with the acquisition of knowledge about their condition whilst trying to cope with the unknowns that lie before them. The second opinion websites often boast the achievements of the cancer surgeon being promoted but with very little possibility of the reader being able to verify the statements.  

We see statements such as 

“I was the first…” 

“I have done the most…..” 

“I pioneered the introduction of ……..”

Not uncommonly these statements bear zero relationship to the consultative or clinical or technical skills of the surgeon.

Rather than allow these websites seed one's mind about that the current care being received is inadequate, readers should instead consider why is it that such great efforts are being made to promote the availability of a second opinion service.  It is nothing more than a mechanism to goad patients into switching doctors when at their most vulnerable time. There should not be a need to promote that second opinion services are available as this goes without saying. If a surgeon had such a good reputation, why would they need to market for those second opinion cases. Do they have a deficiency of work that necessitates such action?  

There is nothing wrong with seeking out information on suitable surgeons to see for a second opinion but perhaps one could do better than a cold call to a website.  Consider other sources for recommendations. Start with the family doctor and additionally, staff who work at the hospital you would like to attend, if you know any.  Look the overall digital footprint of the provider and in particular independent sources of information.  When searching provider websites, be wary when there is over the top self promotion and whether you feel that a second opinion form is being thrust into your face. If it was from anything other than a medical provider website, you would probably consider it differently.  Remember that marketing is marketing and I'm afraid to say that even doctors partake in provision of information under the guise of marketing.

As a junior specialist, I recall being advised by a senior colleague that my patients would be my best ‘advertisement’.  All I had to do was to treat them with respect and compassion and to do what I would wish to have done for myself or my close relative. This was sound advice and I continue to uphold this principle.  I am grateful that my practice is sufficiently busy to never feel a need to market for second opinions - but why should I need to market for them when it is after all, a normal part of medical service provision.

Note- this piece is written in the context of Australian medical practice

Do You Know Who I Am.

It also happens in the hospital system but maybe not in the celebrity sense.

I never forget the moment when I was a junior doctor working in a major teaching hospital.  I was in a staff lift and the only other person in the lift and as far away as he could be from me was this cardiac surgeon.  There was no eye contact and I did not dare say a word or even a nod in acknowledgement.  Back then, these cardiac surgeons were the gods of hospital and quite frankly, I was scared of them. The lift opened on the next floor and wardsman trips over the slight step between the floor and the lift and bumped into him - yes, he dared to touch him (even though by accident).  Apart from a bit of a fright, definitely no physical harm done.  I remember clearly to this day how the cardiac surgeon then commenced a barrage of abuse of how dare he push him and does he know who he is.  The wardsman apologised multiple times to no avail with it only coming to an end when the surgeon had to get off at the next floor.  This would not likely happen in an Australian hospital these days - apart from being unacceptable behaviour, cardiac surgeons can no longer have the reputation of being a total jerk given that their livelihood is now so dependent upon the good will of cardiologists - what a contrast to my days as a junior doctor where I observed cardiologists literally begging surgeons to take on their cases for coronary bypass surgery. Stents have changed the dynamics of the cardiologist/cardiac surgeon relationship completely as well the behaviour of cardiothoracic surgeons.

I thought of the above story as a "Do You Know Who I Am incident".  It came to mind because of a more recent event involving myself.  I was coming in to operate after-hours and I was entering the theatre complex at the same time as another staff member. She was wearing her hospital ID card with her name fully visible and the picture on it clearly matching her face. I wasn’t wearing my ID card because I was wearing a T shirt and jeans and there was nowhere to clip it to.  I had it in my pocket.  The staff member asked me politely if I knew where I was and if I needed assistance or in other words, she was asking if I had a purpose to being in this restricted area.  I have been a surgeon at this hospital for almost 20 years and could have thought that the majority of people would know me.  I was initially surprised to be asked but instinctively, I took out my ID badge and showed it to her and explained that I was coming in to do a operative case. Given that she worked after hours shifts, she would not see me on a regular basis and sporting a scruffy Mo for the month of Movember probably did not help.  She did the right thing.

These thoughts lead to another thought about DYKWIM in hospital systems and the answer is often “No”.  Staff members are increasingly hiding their names on their ID badges - easily done under the guise of the badge having to attached to other essential badges or being turned the wrong way around. When you call a ward, how often does the staff member indicate who is on the phone. So much for Garling Report recommendations on staff identification.

(Typical hiding of the name on a ID badge of a hospital worker.  I took this sneak picture in a hospital lift)