Funtabulously Frivolous Friday Five 356

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.

Reference:

• Darwin, C. On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life. 1859
• Darwin, C. The descent of man, and selection in relation to sex. London: John Murray 1871
• Spencer H. The principles of biology. 1864

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.

Reference:

• Lennquist, Sten (Ed.). Medical Response to Major Incidents and Disasters: A Practical Guide for All Medical Staff Berlin: Springer 2012.
• Doohan I, Saveman BI. Need for compassion in prehospital and emergency care: a qualitative study on bus crash survivors’ experiences. Int Emerg Nurs. 2015 Apr;23(2):115-9. d

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

Reference:

• Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med. 1984 Nov;101(5):692-6.
• Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the patient’s agenda: have we improved? JAMA. 1999 Jan 20;281(3):283-7.
• Singh Ospina N, Phillips KA, Rodriguez-Gutierrez R, Castaneda-Guarderas A, Gionfriddo MR, Branda ME, Montori VM. Eliciting the Patient’s Agenda- Secondary Analysis of Recorded Clinical Encounters. J Gen Intern Med. 2019 Jan;34(1):36-40.

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.

Reference:

• Block L, Habicht R, Wu AW, Desai SV, Wang K, Silva KN, Niessen T, Oliver N, Feldman L. In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time? J Gen Intern Med. 2013 Aug;28(8):1042-7.
• Wenger N, Méan M, Castioni J, Marques-Vidal P, Waeber G, Garnier A. Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts. Ann Intern Med. 2017 Apr 18;166(8):579-586.