A Country Doctor Reads: June 1, 2019

Thought Provoking Titles and Concepts

This week I read some articles whose titles or first few words grabbed my attention and opened my mind to issues I had thought about only casually in recent months. These pieces put their concepts in the forefront of my thinking as a physician. The last item seemed thought provoking enough as it promised to tell the story of how human adipose tissue became a hot commodity a couple of hundred years ago, but the story gets better, or, rather, worse – much worse.

ARRIVAL FALLACY – NYT

Thursday’s The New York Times has an article titled “You Accomplished Something Great. So Now What?” It describes the phenomenon of striving for something you expect to make you happy, but once you achieve it, you just feel empty. This introduced me to the term “Arrival Fallacy”.

“Arrival fallacy is this illusion that once we make it, once we attain our goal or reach our destination, we will reach lasting happiness,” said Tal Ben-Shahar, the Harvard-trained positive psychology expert who is credited with coining the term.

Dr. Ben-Shahar said arrival fallacy is the reason some Hollywood stars struggle with mental health issues and substance abuse later in life.

“These individuals start out unhappy, but they say to themselves, ‘It’s O.K. because when I make it, then I’ll be happy,’” he said. But then they make it, and while they may feel briefly fulfilled, the feeling doesn’t last. “This time, they’re unhappy, but more than that they’re unhappy without hope,” he explained. “Because before they lived under the illusion — well, the false hope — that once they make it, then they’ll be happy.”

The article offers this advice on how to avoid Arrival Fallacy:

“We need to have goals,” Dr. Ben-Shahar said. “We need to think about the future.” And, he noted, we are also a “future-oriented” species. In fact, studies have shown that the mortality rate rises by 2 percent among men who retire right when they become eligible to collect Social Security, and that retiring early may lead to early death, even among those who are healthy when they do so. Purpose and meaning can generate satisfaction, which is part of the happiness equation, Dr. Gruman said.

https://www.nytimes.com/2019/05/28/smarter-living/you-accomplished-something-great-so-now-what.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

LANGUAGE OF TOUCH – NYT

Another piece in Thursday’s The New York Times with the title “Your Surgeon’s Childhood Hobbies May Affect Your Health” introduced me to the concept of “The Language of Touch”, similar to a language you learn as a young child as opposed to in college or graduate school.

Medical schools are noticing a decline in students’ dexterity, possibly from spending time swiping screens rather than developing fine motor skills through woodworking and sewing.

“There is a language of touch that is easy to overlook or ignore,” said Dr. Roger Kneebone, professor of surgical education at Imperial College London. “You know if someone has learned French or Chinese because it’s very obvious, but the language of touch is harder to recognize.” And just like verbal language, he thinks it’s easier to acquire when you’re young: “It’s much more difficult to get it when you’re 24, 25 or 26 than when you’re 4, 5 or 6.”

Dr. Robert Spetzler, former president and chief executive of the Barrow Neurological Institute in Phoenix, agreed. “Think about the difference between someone who has learned to ski when they were a little kid and someone who spent a long time, perhaps even the same amount of time, skiing as an adult,” he said. “That elegance that you learn when very young, doing that sport, can never be equaled by an adult learning how to ski.”

Dr. Spetzler earned a reputation as a virtuosic brain surgeon during his more than 40 years operating. He said he developed his dexterity as a child by playing the piano. And he began performing surgery in high school — on gerbils. All of them survived.

“The sooner you begin doing a physical, repetitive task, the more ingrained and instinctive that motor skill becomes,” Dr. Spetzler said. “What makes a great surgeon is unrelenting practice.”

https://www.nytimes.com/2019/05/30/well/live/surgeons-hobbies-dexterity.html?smprod=nytcore-ipad&smid=nytcore-ipad-share

DIAGNOSTIC OVERSHADOWING – NEJM

I have often thought of this phenomenon, but never heard this term for it: When someone has an important or severe diagnosis, we tend to blame it for everything else that ever happens to them and thus run the risk of missing new diagnoses in such patients.

So here is my speculation about Michael’s diagnostic delay. His providers saw a patient with complete quadriplegia, paralyzed below his neck. When he developed new symptoms, perhaps they succumbed to “diagnostic overshadowing” — the erroneous attribution of all new symptoms to an underlying health condition, especially in patients with disability. After all, maybe extreme MS-related constipation caused Michael’s distended abdomen; wheelchair users commonly have lower extremity edema; and breathing difficulties occur in late-stage MS. Perhaps they thought Michael’s PPMS was at its end stage.

https://www.nejm.org/doi/full/10.1056/NEJMp1903078?query=featured_home

SPONTANEOUS HUMAN COMBUSTION – The Atlantic

The Atlantic has a story about human fat that opens with a case of a corpulent woman who burst into flames, presumably a victim of what we now call Spontaneous Human Combustion.

The Lucrative Black Market in Human Fat

In 16th- and 17th-century Europe, physicians, butchers, and executioners alike hawked the salutary effects of Axungia hominis.

One night in 1731, Cornelia di Bandi burst into flames. When the 62-year-old Italian countess was found the next morning, her head and torso had been reduced to ash and grease.

https://www.theatlantic.com/health/archive/2019/05/human-fat-was-once-medicine-black-market/590164/

I had never heard of this phenomenon, but it has been described many times:

Though the term “spontaneous human combustion” is of fairly recent vintage, it was a rare-but-real concern to many in the 1800s. In fact, there are nearly a dozen references to people bursting into flames in pre-1900 fiction. The most famous example is Charles Dickens’s 1853 novel “Bleak House,” in which a character explodes into fire, though the phenomenon can also be found in the works of Mark Twain, Herman Melville, Washington Irving and others. In modern times, SHC has appeared in movies and on television shows, including “The X-Files,” and it’s even, sort of, the super-power of Johnny Storm, the Human Torch, in “Fantastic Four” comic books.

https://www.livescience.com/42080-spontaneous-human-combustion.html

3 Responses to “A Country Doctor Reads: June 1, 2019”


  1. 1 Laura June 1, 2019 at 12:10 pm

    Every obese person knows well the phenomenon of “diagnostic overshadowing”.

  2. 2 Laurence Bauer June 3, 2019 at 9:04 pm

    I love your curiosity and how you think. Thanks


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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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