Funtabulously Frivolous Friday Five 356

Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF, introducing the Funtabulously Frivolous Friday Five 356.

This edition has been inspired by the book Compassionomics by Stephen Trzeciak and Anthony Mazzarelli.

If you only wish to dip your toe in this topic, then watch Dr Stephen Trzeciak’s TED talk.

Question 1

Who first coined the term “survival of the fittest?

Reveal the funtabulous answer

Herbert Spencer (1820-1903)

Spencer was an English philosopher, psychologist, biologist, sociologist and anthropologist. He originated the expression of “survival of the fittest”, which was published in Principles of Biology (Volume 1: 1864) after reading Charles Darwin’s 1859 book On the Origin of Species.

By natural selection or survival of the fittest – by the preservation in successive generations of those whose moving equilibria happen to be least at variance with the requirements, there is eventually produced a changed equilibrium completely in harmony with the requirements.

This survival of the fittest, which I have here sought to express in mechanical terms, is that which Mr Darwin has called “natural selection, or the preservation of favoured races in the struggle for life

Spencer 1864

What Darwin actually concluded was different. According to Darwin, the communities with the greatest compassion for others would flourish.

…for those communities which included the greatest number of the most sympathetic members, would nourish best and rear the greatest number of offspring.

Darwin 1871: 79

This makes sense. If you managed to hunt a big meal, you couldn’t eat it all, but by sharing the spoils, you helped support the community and ensured others would share when times were tough for you. This ‘other-focused’ mentality meant that more compassionate humans were the ones who survived and passed on their genes.


Question 2

In February 2007 in Sweden, two buses collided head-on. One bus driver was trying to overtake a parked truck on their side of the road, and the icy conditions resulted in a devastating collision, with one bus being torn in half. Six people died that day, but 56 were saved thanks to a very complex rescue operation. Five years later, the survivors were interviewed.

What were the two major themes these survivors remembered five years later?

Reveal the funtabulous answer

  1. The physical pain on impact and shortly afterwards (to be expected)
  2. The lack of compassion of healthcare workers.

It’s both surprising and shocking to think that five years after this incident, all 56 survivors commented on the lack of compassion in healthcare. Even more concerning is the fact that these survivors were taken to multiple hospitals, highlighting the fact this issue is systemic.


Question 3

How long do physicians wait before interrupting patients?

…if you are feeling brave, guess the times for 1984, 1999 and 2018.

Reveal the funtabulous answer

11 seconds (currently…)

1984 – The original answer was 17 seconds. Medical schools responded quickly, and communication skills were added to the medical curriculum.

1999 – A JAMA article some 15 years later showed an improvement up to 23 seconds. We were almost winning, getting closer to the magic number of twenty-nine seconds (the average time it takes a patient to express their main concern).

2018 – Unfortunately, we’ve all slipped back to 11 seconds, creating a situation where patients again don’t feel like we are listening to them.

It reminds me of the quote

Listen, listen to the patient’s story! He is telling you the diagnosis.

The quote is most commonly recorded as “listen to your patient, he is telling you the diagnosis“, and attributed to Sir William Osler (1849-1919), but there is no official recording of the quote in any of his publications. The first attribution to Osler is in 1964 and then in 1968 as an inscription on a medal to honour Professor Masakazu Abe, President of Jikei University School of Medicine.

However, it is most probably by John Benjamin Murphy (1857-1916) of Murphy’s sign renown. The earliest direct attribution we can find is in a 1939 JAMA publication by Dr NC Gilbert, expounded upon by JB Herrick in his 1949 memoirs

“No, sir, you are wrong, and I’ll tell you why.” Dr. N. C. Gilbert tells how Dr. Murphy used to shake his finger in the students’ faces and say in his shrill voice, “Listen, listen to the patient’s story! He is telling you the diagnosis.” Lessons taught m this dramatic way never failed to make an impression.

JB Herrick. Memories Of Eighty Years. 1949: 183

Question 4

Below is a painting by Sir Luke Fildes, 1891, depicting the physician at the bedside. Intensely watching the child with nothing distracting him.

What percent of the working day do resident (trainee) physicians spend at the bedside seeing patients?

The Doctor exhibited 1891 Sir Luke Fildes 1843-1927 Presented by Sir Henry Tate 1894 http://www.tate.org.uk/art/work/N01522

Reveal the funtabulous answer

12 percent.

This statistic comes from a Johns Hopkins study. 40 percent of the time was spent on a computer. This is not only a U.S. problem but worldwide. A Swiss study found half the day was spent away from patients working on a computer. It’s hard to connect if you are in a different room or behind a screen.

See this funny video depicting our changing work environment from the days of Sir Luke Fildes to the ubiquitous EMR, and watch these proud parents observing their child play ‘doctor’ from Athena Health. Let doctors be doctors video.


Question 5

What is the cure for the common cold?

Reveal the funtabulous answer


In a study of 406 participants who received a syringe of cold virus up the nose, 32% didn’t develop symptoms, and the protective attributable effect was hugs.  Those who had high levels of stress in their lives were more likely to get symptoms (not surprising), and those who had received hugs and had higher levels of social support and connection did not get symptoms.

In a separate study of 350 patients with the common cold, high levels of physician compassion enhanced the immune system (doubled the interleukin-8 level), decreased the duration of symptoms by one day and decreased the overall severity of symptoms by 15%.


… and finally, quotes

Love and compassion are necessities, not luxuries. Without them, humanity cannot survive. With them, we can make a joint effort to solve the problems of the whole of humankind

Dalai Lama

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Funtabulously Frivolous Friday Five

Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.

BA MA (Oxon) MBChB (Edin) FACEM FFSEM. Emergency physician, Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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