Wednesday, October 31, 2012

An Argument AGAINST Standardized Education

The Animal School: A Fable

by George Reavis
Animal SchoolOnce upon a time the animals decided they must do something heroic to meet the problems of a “new world” so they organized a school. They had adopted an activity curriculum consisting of running, climbing, swimming and flying. To make it easier to administer the curriculum, all the animals took all the subjects.
The duck was excellent in swimming. In fact, better than his instructor. But he made only passing grades in flying and was very poor in running. Since he was slow in running, he had to stay after school and also drop swimming in order to practice running. This was kept up until his webbed feet were badly worn and he was only average in swimming. But average was acceptable in school so nobody worried about that, except the duck.
The rabbit started at the top of the class in running but had a nervous breakdown because of so much makeup work in swimming.
The squirrel was excellent in climbing until he developed frustration in the flying class where his teacher made him start from the ground up instead of the treetop down. He also developed a “charlie horse” from overexertion and then got a C in climbing and D in running.
The eagle was a problem child and was disciplined severely. In the climbing class, he beat all the others to the top of the tree but insisted on using his own way to get there.
At the end of the year, an abnormal eel that could swim exceeding well and also run, climb and fly a little had the highest average and was valedictorian.
The prairie dogs stayed out of school and fought the tax levy because the administration would not add digging and burrowing to the curriculum. They apprenticed their children to a badger and later joined the groundhogs and gophers to start a successful private school.

Note: This story was written when George Reavis was the Assistant Superintendent of the Cincinnati Public Schools back in the 1940s! This content is in the public domain and free to copy, duplicate, and distribute.

Friday, October 26, 2012

Be Progressive! (but not now)

Each political party wants others to “see it their way.”  We all want that, don’t we?  Why else do we spend so much time talking about politics and religion?  We try to convince people that our thinking is correct.  We want to people to change their minds, convert to our way of thinking.
Sometimes we don’t expect to change their mind, just to open it.  We want them to see that there are two sides to the argument, there are people who disagree and their opinion is just as valid.
We want people to be progressive, open-minded, and accepting.
A short online dictionary search of the word Progressive:
1.     favoring or advocating progress, change, improvement, or reform, as opposed to wishing to maintain things as they are.
2.     making use of (or interested in) new ideas, findings, or opportunities.
3.     moving forward or onward.
That sounds great.  That sounds like what most everyone wants. 
When it comes to politics however, we only want progress on our own timetable.
Democrats and Republicans want others to agree with their ideas…but only certain people, and not in an election year.
If Romney “progresses” at any point and has a different or new opinion - it isn’t progress.  It’s wishy-washy flip-flopping by a spineless, all-over-the-map, say-anything-to-get-elected, calculated businessman.  

Democrats are allowed to Progress (Obama was praised for doing a complete 180 on gay marriage and fully supporting what he had previously opposed.)
What if Romney said the EXACT SAME THING today?  Would he be embraced and lauded by the LGBT community?    
If Romney said he supports women’s rights and equal pay in the work place.  He supports abortion in cases of rape or when the mother’s life is in danger – what then?  Would he be lauded and applauded for making those changes; for making that “progress?”
Oh wait – he already has said those things, and we’ve seen the result. He’s been panned, ridiculed, insulted and scorned. 
So remember: Be Progressive! (But not now)

Wednesday, October 24, 2012

A Trivialized Election: Social Media and the "Ten Word Answer"

I fell for it.  I listened to social media.  I helped lead the charge!  I assumed that the superficial attacks, funny jokes, silly memes, and trending twitter hashtags might actually matter.

They do matter - but only to those who are already granite-set in their opinion and wouldn't change their vote even if their candidate said he wanted to be the next Hitler.

Here are some of the most popular and most oft repeated "lines" or "subjects" this election cycle.

"You didn't build that""Binders full of women" - "Horses and bayonets" - "Big Bird" - "Bunch of Stuff" - "I like being able to fire people" - "Ann Romney never worked a day in her life" - "I'm not concerned about the very poor." - "Battleship" - "Corporations are people"  - "Back in chains, y’all" - "Eastwooding"

What was said in the debates may have had substance.  The last debate was panned as boring (by me too) and dismissed - other than a few funny lines by the President.
There may have been deep meaning and important ideology behind their discussion of Syria and China and Israel.  But we'll never know it.

Why?  Because "The 80's called, they want their foreign policy back."

Candidates realize that a REAL response to foreign policy can't be tweeted in 140 characters.  No one is going to read a facebook post long enough to REALLY explain an issue.  They need punchlines, quotable quotes.  They need something people can easily remember and re-tell over dinner or around the water-cooler at work.  They need a "ten word answer."

Aaron Sorkin explained it well in The West Wing when he wrote this scene for a presidential debate:

Read more here:

Friday, October 19, 2012

The Day I Thought My Life Was Over


I'm a member of the LDS or "Mormon" church.  Which means that since I was a kid I have known that I would never try a single drug, never taste alcohol, smoke tobacco, or drink coffee.  I was never going to have sex until after I was married.  I would serve a two year mission for my church.  I would marry once, have a family, work in a respectable profession and serve in my church for the rest of my life.

Fast Forward to 2003:

Everything was going pretty much according to plan.  No - I had not lived a perfect life, but so far it was going basically as planned.  It had been three months since I had returned from my two year mission in Brazil.  I was going to school at BYU-Idaho (99% Mormon Students).  I was enrolled in pre-med classes, doing well, serving in church, dating girls and hoping at some point to meet "the one."  The Red Cross came to campus about every three months and TONS of students donated blood every time. 

I had donated many times before my mission, and I had already done it once since my mission.  Life was good.  Other missionaries who had served in parts of Europe couldn't donate for five years, so I felt lucky.  I happily donated blood again, and went off to play ultimate frisbee.

Two weeks letter I got home from class, grabbed the mail, and ran into my apartment to shower and get ready for a date that night.  I noticed a letter from the Red Cross - I thought "hmm, maybe they sent me a new blood donor card since mine is pretty old?

I haphazardly tore it open and read:  "You have tested Positive for HIV"

I'm sure there was much more written after that in the next four pages, but I don't remember it.
I sat there staring in disbelief.  All alone in my apartment I shrank to the floor in shocked silence. 

A thousand thoughts bombarded my mind at once.

"How is this possible?  HOW IS THIS POSSIBLE?!  I've never done ANYTHING that can result in AIDS.  I donated blood three months ago and I was negative then.  I haven't even had a cut or touched blood since then.  Do I really have HIV?   Am I dying? How long do I have?"

Then my mind shifted to thinking of all the social consequences...

"I can never marry because who would marry someone with HIV?  No one would have a child with an HIV positive husband because they'd get HIV.  Would my kids have HIV?  My wife certainly would...which mean I'll never marry.  I can't even date.  Because, at exactly what point in the dating relationship would I say "umm... by the way, I HAVE AIDS!"?

My life was shattered.  Even if people believed me - that I had never done anything against the commandments to contract HIV - it wouldn't really matter.  I would be "tainted" forever. 

It was a death sentence, not only physically, but socially, religiously, ENTIRELY.

My life was over.  I cancelled my date for that night, and in my mind I cancelled every date for the rest of my life...

...eventually I read the rest of the letter where it explained that this was a preliminary positive.  I need to go to a local doctor to get my blood drawn for the confirmatory test.

I didn't know at that time about ELISA v. Western Blot tests.  I didn't really know anything about the transmission or treatment of HIV.  At that time I thought everyone would assume I had either had sex or shot up IV drugs.  I was certain my life was over.

Where would I get my blood drawn?  I couldn't go to Student Health.  This is a Mormon college.  You can't even be admitted to the school unless you've agreed to live the standards.  If I told them I needed an HIV test, I was pretty sure I'd be expelled.  Even if I wasn't - the nursing students working in student health would know.  Word would get out.  I could hear the whispers in my head "There goes the one guy on campus with HIV."

I couldn't go to Student Health.  I couldn't even ask anyone for advice.  I couldn't talk to my roommates, or my school counselor - they're all Mormons, they'd assume I was just trying to get away with screwing up.

I thought "I can't tell anyone."

I finally went to the urgent care a few blocks off campus.  Rexburg is a small college town.  The population at that time was 17,257.  Who was I kidding - the receptionist, nurse, and doctor would all know.  There was no this was not getting out.
"What brings you in today?" asked the nice but ignorant woman at the front desk.
I fumblingly tried to tell her that I needed a blood test.  I refused to give details.

In the exam room I tried to be nonchalant with the doctor (who I was sure was also Mormon).  I tried to say in a bored tone of voice that I'd had a false positive HIV test and the confirmatory test was just a formality to getting it all cleared up.  I tried to keep an expressionless face, show that I wasn't worried because the result was a foregone conclusion.  I'm sure I looked terrified.

The nurse came in, washed her hands and put on gloves.  The thoughts came again: "Is she scared she might get HIV from me?  Does she know?  Did the doctor warn her?  Is she scared to even draw my blood?"

I spent the next two weeks trying to act like everything was fine, when inside I was dying.  Everyday, all day, I was thinking of how my life could either be put back on track or derailed eternally.  It all depended on the results of that test.

The letter arrived, the result was Negative.

I'd like to say that life went back to normal - and in most ways it did.  But some things have never changed.  I'm still on the Red Cross "cannot donate list."  I know that if I contact the Red Cross and ask for a re-test they could clear my name and I could start donating blood again.  I could have done that nine years ago.  I could have donated every three months for the last nine years.  Twenty-seven times I could have given blood.  Thay's maybe fifty people who could have been helped or saved with my blood.

Something keeps me from doing it.  I know I've been tested for HIV since.  Through medical school and Residency I've been checked plenty of times.  But I still can't bring myself to go back to the Red Cross.  I'm sure they'd be understanding, even welcoming, but the memory of that experience is so strong that I shake even as I type this.  It was horrific.

I know I over blew things in my mind,. Many of my assumptions were wrong.  I know that I had loving people around me, they would have helped.  The people at my college and in my religion are better than I gave them credit for. They would have cared, they would have consoled me and loved me.  But at the time I couldn't see it.  All I could see was isolation, a lifetime alone.

Now I think.  What about all those people who REALLY have HIV?  How are they treated?  What stigma accompanies that disease?  How do I treat them?

I felt the dread and fear of HIV for only a few weeks.  How would it be to live with it for a lifetime?

Wednesday, October 17, 2012

Depressed Doctors: When everyone expects you to "heal thyself."

What percentage of doctors suffer from depression?

The same percentage as anybody in any other profession.  Doctors are JUST AS likely to suffer from depression as the population at large.  They're also just as likely to have a seizure disorder, MS, diabetes or anything else.

Being a doctor doesn't mean you're immune.  But when it comes to depression, being a doctor does make a difference.

Compared with the general population - how often do doctors commit suicide?

Male physicians are 1.4 times more likely, and female physicians are 2.27 times more likely.


2 main reasons:

1.  Doctors know how to die - they see it every day.  They know what pills will kill them.  They can write the prescription, fill them, and take all they need to go quietly into the night.

2.  They don't get treatment.  The stigma for mental illness may have gone down for patients - but not for doctors.  Doctors still expect each other to "get over it."  When medical students were anonymously polled - 14% met the diagnosis for depression.  (about average for any population)
 - Here's why they didn't want to seek treatment or tell anyone:

 - 53% thought telling a counselor would be "risky"
 - 62% thought they'd be seen as "less intelligent"
 - 83% thought they'd be seen as "unable to handle responsibilities"
 - 56% thought their opinion would be less respected

Of practicing doctors that were polled:

 - 14% prescribed their own antidepressants (VERY DANGEROUS AND ILLEGAL)
 - 10% feared losing their practice privileges
 - 8% feared losing their medical license

Doctor's know intellectually that depression is an illness just like every other.  But we all went through med school, we know what's expected, and we know that doctors aren't supposed to get depressed.  We are taught that depression is weakness.  If you do feel depressed you should just buckle down and work harder and push on through.  Seeing a counselor or therapist is weak.  Take a pill if you have to - but deal with it on your own.  If you play the depression card - you'll be on the outside looking in.

It was a humbling lecture to hear today.  I sat in a room with 200 of my colleagues, and we talked about how much we care for our depressed patients, yet we continue to hold each other to a "higher" (impossible) standard.  Of all professions - Doctors should be the most understanding.

It was sad to read the studies, and see the results.
The medical community isn't just as bad as everybody else - we're worse.

Monday, October 15, 2012

Studying For Tests: My Two Decades of Evolving Study Techniques

Last week I took the PRITE exam.  (Psychiatry Resident In Training Exam)

I still have more tests to take in the future: Child Psychiatry Board Exam, General Psychiatry Board Exam, etc...
I may be a doctor, but I only got here by becoming an expert test taker first.  Which means I had to learn how to study.
I am not the smartest or best test taker by far.  I did not glide through medical school, and I was not in the top of my class.  I worked hard, constantly evolving my study skills to meet the latest challenge.  Here is my journey.


 - I almost never studied.  It was so bad that when there were spelling tests and two words were pronounced the same (red, read) I'd have to ask the teacher to use the word in a sentence because I had never looked at the list.
I only studied when there was a competition.  When I was in a Geography competition I spent hours and hours at home memorizing all the countries.

 - I studied a little for classes, but I knew there was one test that mattered most: The ACT.  I checked all the colleges I wanted to go to - and figured out what ACT and GPA I would need for a scholarship.  My GPA would take consistent work - but the ACT was a single test with HUGE results.  That's why I needed to figure out how to take it.  I took it my freshman year - I didn't get the score I wanted.
I took a review course and took it my sophomore year - still too low.  I took it again my Junior year - too low.  I took another review course and then took it again my junior year - 1 point too low.
I took it for the fifth time my Senior Year - NAILED IT!

I earned the scholarship I needed to be able to pay for college, and off I went.

 - This is where I learned the necessity of study groups.  I walked into a physics class and quickly discovered - I didn't get it.  I could go to lecture and read the book and it still made no sense.  So about the 2nd week of class I paid attention to who was bored, but always knew the answer.  Two guys in the front (Jake and Pete) were always joking together, but when the teacher called on them - they answered everything right.
I walked up to them after class and asked if I could study with them. 
They already had a study room reserved 3 days a week at the same time for the whole semester.
All 3 of us aced Physics.
I then took Calculus.  I couldn't find a good study group so I went to the math tutoring center.  I sat there every afternoon for 4 months.  I used the same tutor every time.  He got paid by the school, I learned calculus, and thanks to him I aced that course.
Then came Genetics, Anatomy, Physiology, Organic Chemistry, Evolution, Pathophysiology, etc...
That's when I found my perfect study partner - Kyle.
He was more "bookish" than I was.  I knew the lectures.  I knew what the teachers liked, what topics they cared about and what lecture facts they were most likely to test.
Kyle new the book.  He knew the concepts, the underlying theory.  We sat in study rooms and wrote on white board for hours and hours - recreating metabolic pathways and memorizing names, equations, and formulas.  If not for him, I never would have passed those classes.
For a "pre-med" there is one test that determines the rest of your life: The MCAT.
It is the test to get into medical school.  I couldn't just take it 5 times to get the score I needed, because med school's don't just get your top score, they get all your scores.  They want someone who took it once and nailed it.
So - I decided to study for 1 year with a group of eight guys.
We took the formal practice exam nine months before the real thing.  We all scored too low.  We then met EVERY Saturday and practiced.  We reviewed practice questions, took practice tests, quizzed each other, wrote practice essays.  We worked, and worked, and worked.  One year later - I had my high score, and I was accepted at multiple medical schools.

 - This is where I learned the art of note taking and an exact / never changing schedule.  By this time I was married with a child and I would have two more children before the end of medical school.  I needed family time, and I needed it to be dependable and predictable.
So I car-pooled with three classmates.  We left at 6:30 a.m. and came home at 5:30 p.m.  Whether we had classes or not - we were at school for 11 hours a day.  Saturday mornings I spent at the library from 9-12... always.
I learned that there was WAY too much material to review.  I needed one place to put all the pertinent information.  ONE page of notes for each test.
My first year the page looked like this:

By second year it looked like this:

I had to have a faster way to review, and to know what was important for the test.
We had study groups every day.  We always got together the night before a test to review again.  We always invited our friend Joel (the smartest guy in the class who lived near us) to join us.  He would give us the info we never thought to learn.  He would know the answers to questions no one had asked, and no one cared about...except the professor.  I learned enough to pass from my study group, I learned enough to do WELL from Joel.
When the 11 hours got too boring - I found a way to make studying more fun.  When studying anatomy I purchased flash cards with every muscle, bone, artery, vein, and organ labeled.  I'd place the cards all around the edge of  a pool table - and start a game.  Every shot I took - I'd memorize everything on the card under the cue before I took the next shot.  My games of pool took a long time - but I aced my anatomy tests.
I also learned to relax and recoup.  After EVERY test, we'd play basketball.  About 15 guys showed up every time, and we'd play for an hour or two. (you have to do something to stay sane.)

In medical school, there is a test that MUST be passed to go to residency -  the General Medical Boards.(USMLE or COMLEX)  It's actually three tests, each about one year apart, hundreds of questions, hundreds of dollars to take each.
I studied for each one for six months.  I bought the books, I listened to the review lectures, I took the practice tests.  I spent thousands of dollars on review materials, travel, hotels, and the tests themselves.  I didn't get the highest scores, but I passed every single test the first time. 

 - It finally happened.  I got to the point where I can read a book and understand the material and remember it.  I now have 4 kids and a very busy position in my church.  I really don't have time to get together for study groups.  So I read.  I have a book with me EVERYWHERE.  I have one at work to read between appointments.  I take one to the DMV while I wait in line, read it on my lunch breaks, and keep one on my night stand to read before going to bed.
That way I can always play with my kids, and when they move on to something else - I can read. 

Why do I mention all of this?  Today I spoke with a sophomore in college whose grades are slipping.  He told me "I've never had to study and I just don't really know how."

This is what I told him.  You start by looking for new solutions.  You go to the tutoring center, you ask people if you can study with them, you make routines and schedules, you find a way.

I didn't make it through school unscathed.  I never had a 4.0 in high school or college.  I almost failed a course in med-school (the week after my 2nd baby was born).  I am not the smartest, or the brightest.  I'm smart "enough," and I learned how to study.  That is the "secret" of my success.

Wednesday, October 10, 2012

Book Review: Long-Term Psychodynamic Psychotherapy

First – I’m really curious to see if ANYONE reads this review.  I mean really – with a title like that – how many people are really going to find this on a google search?  This isn’t exactly a popular topic. Hunger Games and Honey Boo Boo it ain’t.

But – I read it – it helped me, and here’s what I thought.
The author did a good job writing about a topic that few would read past the first page. 
The first topic?  MISCONCEPTIONS.

They explain that it isn’t about the stone faced therapist, sitting mostly in silence and only speaking to say “mmm-hmm” or to ask about the patient’s sexuality.
It’s about the relationship between the therapist and the patient.  They’re both real people – both have backgrounds and upbringings and biases and conversation styles and patterns and soft spots and rough edges etc…

The author explained Klein, Freud, Kohut, Bolwby, Stern and others.  But none of them are God; none should be followed precisely.  They are people who had theories, and their theories taught us something.
This book helped me the most by teaching me what NOT to do.  Don’t over analyze, don’t interpret too quickly.  If the patient says I remind them of their father, just leave it alone.  If they mention a past experience, just listen.  Once they mention the same subject 3 or 4 times, once a pattern is readily apparent - then bring it up.  Don't assume to know what it means - just bring it up.  Sure I'll have idea and theories, but not push them on the patient or they'll pull back.

If they mention a dream - don't try to interpret it.  If they give an interpretation - fine.  If it reminds me of a recurring thing they've brought up many times - ask if there might be a connection.

I learned to slow down and avoid jumping to conclusions.

This book teaches how to do psychotherapy, how to deal with resistance, when to interpret and when to just listen.  It taught the good and the bad of transference and countertransference - when to bring it up and when to just acknowledge it and move on.

It explained the goals, the purpose, the meaning behind it all.  It gave me another useful tool to use with patients.  I think that's the point, if you learn lots of medications, lots of therapies, and lots of ways to help - you'll have a better chance of picking the right one.  "If all you have is a hammer, everything becomes a nail."

Here are a few of my favorite quotes:

"When in doubt, be human." - p. 57

"The young therapist - fearing spontaneity, human engagement, and a naturalness of response - is overly rigid and formal." - p. 71

"Therapists are privately passing judgments on the patient all the time." - p. 72

"We might regard resistance as a way that patients show us who they are...resistance is not 'bad' behavior on the part of the patient." - p. 117

"Patients are boring for different reasons...the art of therapy includes making the boring patient a fascinating subject of study." - p. 161

Thursday, October 4, 2012

Romney Will Win Future Debates - Thanks to Jim Lehrer

Romney did his homework.  He knew his topics, knew his talking points, and knew his game plan.  Push Back!  Engage!  Look President Obama in the face and call him out!

Romney won – that much is fairly clear.
So why can’t Obama come back in the next debate and do the same thing back to Romney?  Why won’t Obama have a chance to have the same effect?  Why will Romney win the next 2 debates?

The answer is – The Moderator (Jim Lehrer)
In all fairness, I think Jim Lehrer gave the American people exactly what they wanted.  He gave them a debate.  He let the candidates go.  I don’t think it was on purpose - I think Lehrer got run over by both candidates.  Romney handled it better, and Romney came out on top.  But what really matters it what happens next.
The Moderators for the next 2 debates have watched all the news coverage – they know that Jim Lehrer is getting eaten alive by the media: CNN, ABC, CBS, NBC, FOX, etc…  You name the media outlet – they’ve pointed out Lehrer’s failure to control the debate.

The two remaining debate moderators (Candy Crowley and Bob Schieffer) are practicing their game plan now.  They’re making sure they aren’t bulldozed when their time comes.  They will make sure the debates follow format, stay on topic – and lose everything that made this first one great.
President Obama will have no chance at attacking Romney’s positions the way his own were attacked last night.  The Moderators won’t let it happen because they have learned their lesson from Lehrer.

Romney won the only REAL debate, because the next 2 are going to be nothing more than side by side speeches.  Lehrer made sure of that – and Romney should thank him.

Monday, October 1, 2012

Blog Post #100

I created this blog in April 2010.  It began as a book blog to post my book reviews as I read throughout the year.  I broke form on Independence day when I posted the Declaration of Independence.  Then a few months later I posted my first off-topic post - about Conservatives not being close-minded.
I posted a total of 13 times that first year.

In 2011 I didn't do much.  I posted 11 times, mostly about books again and also one really LONG post comparing two of my favorite father figures - Tevye and Jean Valjean.
Then in February of this year I decided I wanted to get more serious about writing.  I also decided that I wanted a forum to share my thoughts.  I've now written 76 posts this year.
I knew that to have a popular or successful blog I would need a specific topic - some niche or genre to draw people to my blog.

I failed.

I didn't want to be limited to discussing politics, or religion, or psychiatry, or medical research, or books.  I wanted to discuss EVERYTHING!  I wanted a venue where I could write anything too long to put on Facebook.
(maybe that's why my blog only has 4 followers after 100 posts?)

I don't know everything, and I am not THE EXPERT on the topics I blog about.
 - I really am a Simple Citizen who is just trying to make a difference in this world.  Someday I hope to write something important enough that it gets referenced from some big news source and thousands of people end up reading my writings.  I'll never monetize my blog - because that's not the point.  I'm not here to make money, I'm here to make a difference.

For now I'll practice on all of you.  Most of you are Facebook Friends who follow one of my links here.  The rest of you - I have no idea how you landed here.  But if you have feedback, critiques, encouragement, corrections, or even topics you'd like me to research and write about (because I'm nerdy like that) - just ask.

Also - on the off chance someone else wants to try writing a blog post - I'd be happy to have my first "Guest Blogger."  I guess we'll see. 

Thanks for reading.  It's nice to know at least a few people are reading what I write.