Owego Rotary Club Rotateller

Karla had accolades for the Rotary Leadership program, Part II. She had an opportunity to learn more about the Rotary Foundation than is possible in our weekly meetings.

Annette also praised the program and shared her perspective that it was even better than Leadership Tioga.

At the graduate level, Orv shared that they discussed the five ways to motivate volunteers based on their characteristics. They discussed PR, which has not been that effective. In our Club, Judy was successful at getting more press exposure for our activities, but it is difficult to measure what that has done for the club. Bringing people to the meetings and one-to-one contacts as Merl is stimulating will always be the most effective.

BRING GUESTS!

The last week of April, Merl will host all guests. This is an opportunity to expose interested community members in a group. I was looking at the roster today as we were voting. We have what I consider to be an outstanding club, but there are not many new names. Many of the people in the club have already served as president. It is good that people stay as members for a long time, but without new members we, like all other organizations, will stagnate.

MRINALINI AND SUZANNE:

Vern transported them to Bainbridge for the weekend and Carolyn Wright brought them home. They got to visit Albany and the State Museum. They practiced for the talent show, roller skated shopped and went to Laura’s on Sunday. Suzanne went to a hockey game on Sunday evening. Mrinalini is playing tennis.

INTERACT:

Kyle gave a nice report and shared that the OFA and NV clubs are planning a picnic.

PROGRAM:

Karla introduced Dennis Mastro from NYSERDA. His region covers eight counties in the Southern Tier. This is an energy smart program. There is $175,000,000 to be distributed this year. Dennis told us about some of the mechanics of the program, but I had to leave before he got to the specifics. If anyone has seen “An Inconvenient Truth”, for example, we are convinced that we can do better and must do better at using energy efficiently. With this much money being directed towards this project in NY, we would expect there to be measurable, positive, outcomes.

The following book review is long. I wrote it for a journal and am putting it in in its entirety because I think that includes a great deal of information which is of general interest.

This book is written primarily for the lay reader to help them understand the challenges doctors face in making the correct diagnosis and the best decision as to how to treat patients based on the diagnosis and other characteristics about the patient. I highly recommend the book; for the patient in us, for the doctor in us, and for us as decision-maker in life. The traps that doctors fall into or that create misdiagnoses through patient-doctor interactions, also occur in many other situations in life. We can all do better.

The book is well-written and brings in the personal experience of the author. Like Oliver Sacks in A Leg to Stand On, it is helpful to have experienced the world from the other side. It is refreshing to see the concern with another individual’s total welfare and not only their disease. Groopman’s approach, as revealed in the following excerpt, is functional and behavioral.

Similarly, a movement is afoot to base all treatment decisions strictly on statistically proven data. This so-called evidence-based medicine is rapidly becoming the canon in many hospitals. Treatments outside the statistically proven are considered taboo until a sufficient body of data can be generated from clinical trials. Of course, every doctor should consider research studies in choosing a therapy. But today’s rigid reliance on evidence-based medicine risks having the doctor choose care passively, solely by the numbers. Statistics cannot substitute for the human being before you; statistics embody averages, not individuals. Numbers, can only complement a physician’s personal experience with a drug or a procedure, as well as his knowledge of whether a “best” therapy from a clinical trial fits a patient’s particular needs and values.

Groopman extensively discusses the importance of communication and the patient feeling comfortable with the doctor, but it could receive even more emphasis. How much of our wellness or sickness is based on our attitudes, reactions to stress, support from our family and friends, and confidence in our caregivers? How much can we enhance our patients’ outcomes through good communication and honestly caring? But this was not the primary theme of his book.

The following excerpts show that he is not afraid to put statements in print which may not be well-received by parts of the medical community. They also apply to many situations outside medical care.

But few of us realize how strongly a physician’s mood and temperament influences his medical judgment.

At each step along the way, we see how essential it is for even the most astute doctor to doubt his thinking, to repeatedly factor into his analysis the possibility that he is wrong.

Much has been made of the power of intuition, and certainly initial impressions formed in a flash can be correct. But as we hear from a range of physicians, relying too heavily on intuition has its perils.

Judy Hall, the social psychologist, has focused further on the emotional dimension of the dialogue between doctor and patient: whether the doctor appears to like the patient and whether the patient likes the doctor. She discovered that those feelings are hardly secret on either side of the table. In studies of primary care physicians and surgeons, patients knew remarkably accurately how the doctor actually felt about them. Much of this, of course, comes from nonverbal behavior: the physician’s facial expressions, how he is seated, whether his gestures are warm and welcoming or formal and remote.

Experts studying misguided care have recently concluded that the majority of errors are due to flaws in physician thinking, not technical mistakes.

One of the most celebrated statements in clinical medicine comes from a lecture delivered by Dr. Francis Weld Peabody of Harvard Medical School in 1926: “The secret of the care of the patient is in caring for the patient.”

Moreover, “The narrowest subspecialist, the reasoning goes, should also be able to provide this range of medical services. This naļve idea arises, as do so many other wrong beliefs about primary care, because of the concept that doctors take care of diseases….Wrong. Doctors take care of people, some of whom have diseases and all of whom have some problem.

Lock told me that doctors send children for surgery to close these holes if there is a two-to-one shunt, meaning that twice as much blood flows through the right side of the heart than the left. “Do you know where that two-to-one number came from?” Lock asked. I imagined that it came from careful clinical studies of children with the hole. “You would think so. But you’d be wrong. At a medical meeting in the 1960’s, a pediatrician presented the question ‘When should the hole be closed?’ to a group of cardiologists.

Rather, they are speaking not objectively, but from faith .It is not uncommon to find such believers among physicians.

Rotary Club of Owego, NY

VISITORS AND GUESTS:

MUSIC:

LEADERSHIP:

BRING GUESTS!

MRINALINI AND SUZANNE:

INTERACT:

PROGRAM:

Rotateller Rotary Club of Owego, NY
Tuesday, April 3, 2007 Gary Williams, Editor