Infinite Yest
It is Friday! I have today and then two more days before I switch work activities. What a month. The strange passage of time and it’s perception, amirite. Well, I threatened to turn this into a running blog if no one read yesterday’s post and it appears that no one read yesterday’s post. Time to come clean, that was an empty threat. I will be keeping my exercise references to only “as needed” with a very high threshold to meet the standard of “as needed”. As referenced yesterday in my post that no one read, just Final Thoughts Walkn’Talks this weekend. My next improv activities are two, 1-hour long sessions at the beginning of May with the Pathology department and for the Physical Therapy Department. I am excited to do more of these 1-hour sessions. I also need to plan a focus group for attendees and facilitators of this year’s Faculty Development workshops (small break to send an email to get that going…)
I just gave the presentation to the PA students about my other teaching activity, the Hospital Medicine Mystery Case of the Week. I’ve brought that up before in previous entries. I was thinking about why I do that and what about it do I enjoy it. Then I realized my two main teaching activities are practicing Yes, and… with medical care. The Hospital Medicine Mystery Case of the Week is the act of understanding what really is going on the with the patient. The session starts with giving some very broad information about a patient and then asks that participants build a differential diagnosis (list of possible diagnoses the patient may have based on the information available). The participants do this in small groups and share ideas with each other. Then we bring all of the small groups back to a big group (we have been doing it by zoom until recently, now we are doing hybrid). Then myself or one of colleagues shares an approach to the main problem (shortness of breath, fever, weakness, etc…). This is the most important part of the session because the tendency is for medical students and learners in general to just say what they think the diagnosis is rather than to think what the diagnosis could be***. Then each small group gets more and more information and make refinements of their differential diagnosis or decide what additional information would be the most helpful in diagnosing the patient^^^. Then they go to the lab machine (an excel sheet that the chief residents before me at Tulane made. It allows you to order labs and imaging while calculating the cost of the evaluation). Many learners comment on how infrequently they are the people who order the tests that start the evaluation of the patient+++. Then the participants put together all of the information and they are graded on 1. Team Name (up to 2 points) 2. The most specific answer to the Mystery Diagnosis (up to 5 points) 3. Money spent in the lab machine, the most appropriate amount, not the cheapest necessarily (also up to 5 points) 4. Tie breaker question that is usually a question about my personal life (up to 5 points, but is usually just used at our discretion to reward groups that have excellent discussion)@@@. I believe I have explained the trophy in a past entry but it was a stolen 4th place dance trophy that a former participant had stuck away in her closet. That greatness awaits you if you are the winner. It is in this way that we say Yes to patients’ reality. The and… portion is all about how we then communicate that with the patient and their family members. For that might I recommend an improv workshop %%%%!
}}}
***I didn’t realize until typing this how similar this thought process and activity itself is to what happens on the improv stage. To go on stage with no idea is not great, to go on stage with absolute certainty is probably worse. The Mystery Case activity is breaking the habit of developing certainty in our medical diagnosis without the appropriate justification
^^^ See video
+++It is one thing to know an improv skill, it is an entirely different thing to know when to use it on stage. Ordering labs and imaging is pretty similar to that
@@@Make things a game to promote Flow State.
%%%
}}}My intern mentioned David Foster Wallace today. Shout out to him