Confession of a dishonest physician

PUBLISHED ON  February 16, 2015

WRITTEN BY  Roni Zeiger

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I’ve assessed the patient, we’ve made a plan, and they’re being discharged from clinic. Now I’m at the computer writing my note, deciding how the story will be told. The thing is, I have a conflict of interest. I want to be the hero, the one who asked just the right question and guided the patient to the appropriate treatment.

At a minimum, I don’t want to sound dumb.

I’ve been trained to get good grades, earn praise. On rounds as a trainee, to describe physical findings and construct a thoughtful differential diagnosis to professors and fellow students. Now when it’s just me documenting the truth in the medical record, how can I resist? I confess to claiming I asked a question which in fact I forgot to ask. I confess to omitting from the record a comment that doesn’t fit well enough with the diagnosis I made.

I want my story to be smart. But the real story has a far more interesting tension between the categories we wish to fit people into and the messy details of their experiences and needs and priorities.


Transparency and beautiful data

PUBLISHED ON  January 3, 2015

WRITTEN BY  Roni Zeiger

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compost-transparencyAll the talk about transparency in healthcare will eventually make a difference. Much current focus is on price, because we know how to measure it. Quality is harder because we don’t have enough randomized trials to prove what really works and because data in our healthcare system is still a mess. This will improve, especially as we learn to analyze big data to answer questions in a more scalable (if much less perfect) way than randomized trials can.

In the meantime, let’s not forget that data can teach us what questions we should be asking in the first place. At home, we mused about this while enjoying our new composting bin in the kitchen. It has an accidental transparency feature, which lets us observe what we’ve been eating, and ask questions like… Which are the healthiest fruits? What food don’t we put into the compost bin (what data aren’t we measuring)? How can the beauty of this data inspire us?

What are they thinking?

PUBLISHED ON  December 9, 2014

WRITTEN BY  Roni Zeiger

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Yesterday, I helped my son with homework for the first time. He’s in first grade. The two memorable parts of this milestone were (1) I had to explain to him what a VCR is since it was part of a word problem, and (2) when he was done, he said: “Well, that was boring.” At least he thought it was interesting that we used to rent video tapes and pay extra if we forgot to rewind them.

Then this morning I biked to school with my daughter (in 5th grade). We ended up talking about how staying safe on the road means you have to get good at guessing what others are thinking. Do they see me? Are they going to try to exit the parking lot before or after I pass?

I realized that homework is often about the same thing: guessing what the person who wrote the question was thinking. This is actually a really useful skill, but I’m afraid he’s going to get good enough at in a few weeks.

Why hasn’t homework changed as much as VCRs?