Posted in academic, narrative medicine, politics

How to interview someone, and how to not.

I am waaay behind on podcasts, and just listened to the Fresh Air interview with Robert Caro, author of the 4-volume LBJ biography. It was sort of meta and recursive, listening to an interview about interviews. I’ll be honest, I have zero interest in reading the LBJ biography, partly because I find little value in celebrating the lives of Great White Men who lived in an era that was even more misogynistic than our own.

But one thing really struck me about the Fresh Air take. Toward the end of the interview, Caro talks about how he was reticent to discuss LBJ’s numerous extramarital affairs, purportedly because he didn’t want to embarrass Lady Bird Johnson, who was still alive at the time. But one of these women, Alice Glass, apparently played a big role in the Johnson presidency, and writing about her and the affair would be unavoidable in a comprehensive biography.

So Caro tells Fresh Air’s Dave Davies (“in for Terry Gross”) that he received a summons one day from Lady Bird Johnson to come to the ranch, where, “without preamble,” she started telling him all about Alice Glass and how much she admired this woman who did so much for her husband’s presidency. Caro tells Davies that he took copious notes and then went home and wrote whatever it is he wrote about Glass. And that’s the end of that.

It’s shocking to me that neither Caro nor Davies press the point further. To them, it’s an anecdote about how Lady Bird Johnson ignores whatever her own personal pain must have been in favor of what was good for her husband’s career; isn’t she a good little wifey? To me, it’s just the opposite — it’s an anecdote about a woman who had very little explicit power of her own (I mean, even the nickname Lady Bird, which is the only name I and most others know her by, is infantilizing), is almost literally dictating the terms of how the world is going to read her husband’s mistress. Neither Caro nor Davies seem to consider that Mrs. Johnson might be an unreliable narrator, that she might have an agenda of her own. I can’t help me think that if Terry Gross had been conducting the interview with Robert Caro, it would have gone in a very different direction.

And that’s not unlike what it’s like to take a medical history, to be honest. You have to be willing and able to to question why a person is telling you what they are telling you, and to ask about what they might not be telling you. I work with students a lot, and most of them either take the patient’s story at face value (reporting rather than interpreting) or will hinge on something like a disability claim and declare that the patient is out for secondary gain and must be malingering. It takes an understanding of how stories work to realize how to pick apart the loose strands and reshape them into a medical note.

Currently reading: Mudbound, by Hilary Jordan, a decade-old novel that is oh so good. Talk about multiple perspectives! Haven’t seen the movie yet, but it stars Carey Mulligan so it’s sure to be excellent.

Posted in academic, lecture

To conference or not to conference?

Like most academics, I get a lot of invitations to random conferences. They are usually pretty scammy, like Greetings, Fellow Doctor! We read your recent article with great interest and wish to invite you to talk on a subject of your choosing at our coming conference in Barcelona Spain, in August 2019. Please reply immediately if you wish to seize this remarkable and unforgettable opportunity!

Ron Swanson disapproves of spending
taxpayer dollars on conferences

To be fair, legit conferences do this too, with reminders about registration and abstract submission deadlines. I flag the ones I’m interested in, and ignore the rest.

So when I got email reminders about an upcoming well-known conference in my field, I didn’t think much of it.

Then about a month ago, I got an email about CME (continuing med ed) disclosures. Huh, I thought, and moved on with my life.

Then, this morning, I got a link to upload presentation files. Hey, wait a minute!

So I logged in to the conference website, and there I am! Listed as a speaker! On a panel talking about a topic I actually know a lot about!

I’m not giving a keynote (I think????)
but the sentiment is the same

So then I really freaked out. Started combing through my emails to see if I had missed an invitation or worse, had responded to an invitation without realizing it. I know one of the other panelists so contacted them asking if they had nominated me (without checking? that would be weird?) or if they were blindsided too. Found a hotel room on (free cancellation!) and started looking at flights.

But it still all feels really weird. I was not planning to go, before I got this email today. It’s a very well-regarded conference in my field, and an invited talk, even on a panel, would be fantastic for my CV. But the location’s kind of a pain to get to, and it’s coming in the middle of a very busy season — I’ll have just gotten back from one overseas conference, then I have two (local) talks scheduled, then am prepping for another conference just after this one.

What do you think, Gentle Readers?

Posted in academic, faculty, fellowship, MS-0, MS-4, narrative medicine, residency, writing

The Most Wonderful Time of the Year

So, July 1 came and went with a minimum of fuss. For those not in the know, July 1 is the start of the new academic year in medical training, that day when all the fresh-faced young interns, who just spent the last 4 months (since Match Day) slacking on the beach, are suddenly tasked with Being A Doctor.

I vividly remember my July 1, walking toward the mirrored glass doors of the hospital in my new long white coat (freshly laundered: first, last, and only time it was actually white) and thinking, Who’s that doctor coming toward me so fast? and then realizing OH WAIT THAT’S ME.

My other big July 1 memory is when I was walking down one of the hallways and they announced over the loudspeakers “Rapid Response to the angio suite,” and some lady in street clothes grabbed me and was like “What does that mean?” and I, having just sat through hours of orientation, unthinkingly parroted “It means someone needs CPR,” and the lady just collapsed in from of me. Like she just fell to the floor in tears.

July 1, as an attending, is a little different. It’s more of the same old, same old over in clinic; we do have a fellow this year but she is off-cycle. But the other thing about July 1, or summer more generally, is that it’s application season! I read medical student applications last summer and probably will again, but in the meantime, am going through applications for the upcoming fellowship crop. And ye gods, they are making the SAME MISTAKES on their damn personal statements. I feel like I’m in Groundhog Day.

So, in the interests of trying to make things better for next year (sigh), here’s the Scrivener’s Top Five Tips for a Winning Application Essay.

Posted in academic, narrative medicine, writing

Paris in June

I recently returned from the Medical and Health Humanities conference, hosted this year by Columbia, which very wisely opted to hold the conference not in NYC but in Paris! In June! Yes, please, and thank you!

The Death of Marat, Jacques-Louis David and unknown student

The theme of this year’s conference was Health Beyond Borders, which invites a wide range of interpretations — traditional “global health,” the digital divide, academic silos. The speakers were fantastic, particularly Sam Roberts’ keynote on how substance use intersects with social history, and Craig Spencer’s keynote on “Health Between Borders” i.e. the work of MSF.

The ironical borders of Columbia’s Reid Hall, where the conference was held.

My own paper, an analysis of border-crossing in Mohsin Hamid’s Exit West, was fairly well-received, especially the formalist aspects of it (this was, after all, a fairly literary/humanist group). I am not totally sure if they “got” the transition to metaphors of border-crossing in professional identity formation, but I am planning on giving an expanded version of the talk to a mostly medical audience this fall, so maybe it will land better with them.

Susan Sontag, la grand-mère la médecine narrative; Cimetière du Montparnasse

Perhaps most importantly, I made some great connections within the world of Narrative Medicine and Medical Humanities, people whose work I was familiar with but whom I had never managed to meet. Next year’s conference is in Denmark! In June! They announced the theme — spaces and places — and I’m already starting to consider how I can justify going.

Fly away home
Posted in narrative medicine, neuro, politics, writing

The ethics of writing about patients

I’ve been somewhat silent over the last several months, I know. Adjusting to life as an attending has been … interesting. Someone once told me that the biggest learning curves in medicine are your clerkship year, your intern year, and your first year as an attending. So true!

Anyway, I’m popping my head up to talk about an issue I’ve been thinking about a lot recently — the ethics of writing about patients. The Green Journal — aka Neurology, flagship journal of the AAN — has a section called Reflections: Neurology and the Humanities. (Personally, I think they really missed a trick by not calling it Reflexions, because come ON.) They are usually personal essays about relationships with patients, challenging situations, professional growth. I love ’em.

Anyway, the Feb 12 2019 Reflections essay, “Lucky and the Root Doctor” by a dude named William Campbell, was a straight-up racist minstrel show. Opening lines:

“My first encounter with him was a side-splitter. He came with his wife, a roly-poly woman with laughing eyes. Reggie had entered the office tapping a long white cane before him. His face was terribly scarred and his eyes were open but opaque and unseeing. When asked what had happened to him, he related that a pistol had blown up in his face 20 years before, causing severe burns and blinding him. Taking his history was entertaining and maddening, with frequent schedule-wrecking but humorous digressions.”

From that shockingly bad opening (both in a literary sense and in a patient care sense — since when is blindness and traumatic injury a “side-splitter”???) the piece just gets increasingly stereotypical and rambling — bizarre obsession with black male sexual prowess, no fewer than three (THREE!) Jolly Mammies, and a sprinkling of voodoo thrown in for good measure. Honestly, Gone with the Wind — that paean to the antebellum South and the glories of the KKK — had more nuanced African-American characters.

I no longer get the print version of the journal (it’s a non-recyclable glossy, and last year they switched to a dumb “visual abstract” format which doesn’t even contain articles, just infographics and typed links to the actual article online, so I told them thanks but no thanks), so I first heard about this essay through a Facebook group for women neurologists, where it generated a great deal of outrage — very appropriately, I thought. I was also contacted by a couple non-neurologists I know who are interested in diversity and health equity, so it was clearly getting attention beyond the nerdy world of neurologists.

The Journal, very rightly though somewhat belatedly, retracted the article (though it was still indexed on Google until I pointed that out to them yesterday). The Reflections section has been suspended indefinitely — which is a shame, and I hope it comes back in a better, peer-reviewed format. The AAN has also announced the creation of an Equity, Diversity, and Inclusion section, which is in my opinion long overdue. (Article in Annals, login required.)

What irritates me, though, is that there seems to be a blowback against these decisions by the AAN. I’m on the Ethics subsection of Synapse, the AAN’s online forum, and there, the retraction has been characterized as “censorship” and pandering to political correctness. One person, who as best I can gather from his profile picture, is a white man, expressed the opinion that a D&I section at the AAN was unnecessary. Another person linked to a blog post by Justin Sattin acknowledging that the essay is “regrettable” (note: this is minimizing terminology — like calling a drone strike on civilians “unfortunate”) but also saying we should forgive Dr. Campbell because he has “authored many papers.”

… the actual fuck?

First of all, journals retract articles all the damn time, and that’s not censorship — that’s the editors deciding that they do not endorse whatever said article was about. Retraction does not make the article go away, especially if it’s already attracted attention from outside sources. Just ask the Lancet editors after they retracted Andrew Wakefield’s autism-MMR paper.

But on a bigger level, I’m so, so tired of white men defending and forgiving white men, when they never seem to extend that courtesy to people of color. I don’t know either Dr. Sattin or Dr. Campbell personally, so I’m not going to go so far as to call them racist (because, you know, white fragility), but I want to point out, on the record, that they are endorsing racist behaviors, whether they are aware of it or not. Implicit bias is a major issue in healthcare and contributes to poor health outcomes, whether because a patient feels unheard by their physician and seeks alternative sources of care — as in this essay — or because physicians don’t treat women and minority patients the way they treat white male patients. (Just the other day, I saw a woman referred to me by the ED after presenting 2 weeks prior with acute onset L arm paresthesias AND CHEST PAIN, and an EKG actually demonstrating an anterior infarct. Cardiology was not consulted when she presented with her textbook acute coronary syndrome, because numbness/tingling must be neurology, right?) Implicit bias also affects med school admissions, meaning unless we do something to change this, we’re going to end up with a medical workforce that looks less and less like the population we are meant to serve.

So yeah, the ethics of writing about patients. I think it’s hugely important for us as physicians to be able to revisit complex cases, whether they are challenging from a medical standpoint or from a sociocultural standpoint. But as with everything we do professionally, it MUST be with the patient in mind. JAMA has a similar series called “Piece of My Mind,” which requires a signed consent by the patient/family to release the story. When the Reflections section returns to the Green Journal — and I sincerely hope it’s when, not if — ensuring that the patient/family has read and approves the piece would be an excellent way to ensure this sort of “regrettable incident” does not happen again.

Posted in faculty


I’m not totally sure why people feel the need to offer unsolicited commentary about other people’s (read: my) choices.

I’m at the movement disorders conference in Hong Kong right now, which means meeting up with former attendings, and a lot of networking. (I’m getting better at this, slowly.) I moved from a high-profile training institution to a faculty job at a place that you have definitely heard of, but does not have the intense academic reputation of the places where I trained. It is in a mid-sized city in the South. So in the eyes of most academically-oriented conferencers, it already has two strikes against it.

Conversations I’ve had with people in the first 24 hours of the conference:

Them: Why would you go there?
Me: They gave me the perfect offer. I’m doing exactly what I thought maybe I’d get to do in 20 years’ time, but to do it straight out of training….
Them: Well, there’s the job, and then there is life.

Them: So how do you like it there?
Me: I’m still getting to know the city and the region, but it’s been great so far. I really like XYZ.
Them: I would never move to the South.

Them: What do you like least about it?
Me: The car culture has been tough. I miss being able to walk or bike almost everywhere. Errands are a little easier with a car, but you don’t engage as much with the world when you’re locked in a 2 ton vehicle, and everything’s a little less spontaneous.
Them: That’s tough. I bet that’s why people are racist. [see below]

Them: Is it segregated?
Me: Some. It’s a majority minority city, but it’s gentrifying hard, and a lot of the wealth is concentrated in newish suburbs, or million-dollar-condo projects downtown. Honestly, though, most segregated place I’ve ever lived was New York City. It was like there was one NYC for the rich and the tourists and the movies, and another for those of us who actually lived there. And “neighborhood feel,” like in Flushing or Washington Heights, are really just a hipster name for segregation.

Them: Are people racist?
Me: Some are. There are good people and bad people everywhere.
Them: Not in the Pacific Northwest!
Me (in my head): Seriously?

I’m not even emotionally connected to this new city (and actually, the decision to take this job was emotionally fraught for other reasons; I am still somewhere in the grieving process on that, so these conversations are really not helping right now), but I’m angered on its behalf that people are so comfortable with spouting broad stereotypes to someone they just met without examining what led them to those ideas — just like the racists they say they hate.

Posted in books, faculty

Exit West

Mohsin Hamid’s newest novel, Exit West, has been on my to-read list for several months. So when I finally got an e-book copy through the library, I devoured it in a weekend, then promptly bought a copy when I found out he was coming to town for a book-signing.

Exit West is what I would call a generous novel. It’s a novel about migration, but not only in the “refugee crisis” version of migration (though yes, that is the main story) but also in the sense of migrating through time. In doing so, it is far kinder to the nativist xenophobes than I am capable of being right now, but I recognize that my best self would be just as empathetic toward the people who feel the world has shifted around them as the people who has shifted around the world.

After the talk, I went up to have my book signed, and as usual, was thoroughly tongue-tied. (I’m going to blame that on the Pinot Gris they were served as part of the book-signing reception, and not my introverted, author-worshipping self.) As I was walking to my car afterwards, I was thinking through all the things I would have said/should have said: that my parents migrated here in the early 1980s, planning to stay for a year or two, but then hey presto I showed up and they stayed because schools and extracurriculars and college and all the reasons a parent subverts their own desires to the hegemony of the child. That they are about to move back to their “hometown” after 35 years away during which time the town has changed out of all recognition. That I’m no stranger to the mental gymnastics of moving back to a familiar-unfamiliar space, and the never-ending “that didn’t used to be here” dance. That this is one of the few novels that captures what it is to be a physician (weirdly, because there are like no physicians in it?) because being a physician requires the constant migration in and out of medicalese, the constant border-crossing and instability of training, the constant tension of “being a doctor” and “being a person.”

Anywho. You all should go read this novel, because it is AMAZING.