The Heroism of Incremental Care

Atul Gwande is an unusually talented observer, thinker, and writer who is a surgeon. I have blogged about his books in the past. If you are interested in health and healthcare, I think that you will find his article on incremental healthcare to be intriguing. Although it is long, I think that it will hold your interest. It can be accessed through Google.

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The Heroism of Incremental Care/ The New Yorker

 

 

 

 

 

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The Power of Habit:Why We Do What We Do In Life and Business

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Charles Duhigg

We cannot change behaviors – including visual behaviors – without changing habits. Habits are behaviors which have become so automatic that they require little or no conscious thought. We can override a habit through conscious attention but this exhausts our available working memory. We have all experienced the errors that we tend to make when our working memory is taxed, such as not being able to remember why we opened the refrigerator. Continue reading

Is It All In Your Head?

 

Suzanne O’Sullivan, MD

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Suzanne O’Sullivan reveals the power of mind-body connections through the enigma of psychosomatic illness. She is a neurologist, and while the treatment of this condition falls under the purview of psychology and psychiatry, the neurologist must first prove that there is not an organic explanation for the illness, have the patient accept the diagnosis, and convince them to engage in cognitive behavioral therapy.  Pharmaceuticals are not effective. The patient has real symptoms which convince them that it is an organic disease. “It can be very difficult for a patient to accept that they suffer from a conversion disorder (a medically unexplained neurological symptom) when that assumption is based entirely on what is missing.” Psychosomatic illness threatens an individual’s image of themselves and they fear that they will be perceived as being weak.

Suzanne O’Sullivan introduces the book with a discussion of blushing. “Blushing is an instantaneous physical change seen on the surface but reflecting a feeling of embarrassment or happiness that is held inside. When it happens, I cannot control it.” This leveler helps us to be more open about psychosomatic illnesses and understand that; they are real; they are no more a weakness than is succumbing to an organic illness; the patient cannot control them; their conscious mind wants to get better; it can happen to any of us. Somatization (a bodily response to a psychological effect) is usually benign, of short duration, and does not become an illness. Examples are trembling hands, perspiration, butterflies, shortness of breath, and laughing. “A psychosomatic illness is the body’s physiological response to stress. They serve a purpose even if that purpose is not always obvious.” The stress is not recognized because the subconscious moves the stress to the body. The person feels that they have handled the stress or may not even have recognized the degree of stress.Image result for blushing

“Illness is not the same as disease. Illness is the human response to disease. It refers to the person’s subjective experience of how they feel but does not assume an underlying pathology. Illness can be either organic or psychological.” “Approximately 70% of the people referred to me with poorly controlled seizures were not responding to epilepsy treatment because they did not have epilepsy. Their seizures were occurring for purely psychosomatic reasons.” “The effect the psyche can have on the physical self has long been observed, but for all that time, scientists and doctors have also been trying and failing to understand how it occurs.”

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We cannot live without stress. Positive stress motivates us (see The Upside of Stress). It is stress that continues and that we are impotent to relieve that causes changes in our brains. To balance the stress in our lives, we must maintain our resilience. One concern that I have is that I see an increasing number of children who are anxious. We went from the extreme of everyone receiving a reward because they participated, to accelerated curricula and the majority of “play” being on organized teams. Children have little free time, supervised from afar, whose importance in development is overlooked. Children need time for unstructured play; to daydream, relax, and decompress; to solve problems of their own or with peers; to imagine; to figure out how to occupy themselves other than an addiction to electronics; to create; and to learn from errors of their own choosing. (see What If Everyone Understood Child Development and How to Raise an Adult)

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Worried Sick

Behavioral and Emotional Problems Associated With Convergence Insufficiency in Children: An Open Trial 

Welcome to Your Child’s Brain

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We can hypothesize that John Irving may have undiagnosed and untreated visual problems which contribute to his dyslexia but that is not the most important message in the following excerpt from Grit by Angela Duckworth. Our patients who have worked successfully to remediate their visual problems have some advantages over those who have found everything to be effortless to this stage in their lives. If you wonder about grit, I suggest that you read this well-written story.

“Garp was a natural storyteller.”

This is a line from John Irving’s fourth novel, The World According to Garp. Like that novel’s fictional protagonist, Irving tells a great story. He has been lauded as “the great storyteller of American literature today.” To date, he’s written more than a dozen novels, most of which have been best sellers and half of which have been made into movies. The World According to Garp won the National Book Award, and Irving’s screenplay for The Cider House Rules won an Academy Award.

But unlike Garp, Irving was not a natural. While Garp “could make things up, one right after the other, and they seemed to fit,” Irving rewrites draft after draft of his novels. Of his early attempts at writing, Irving has said, “Most of all, I rewrote everything…. I began to take my lack of talent seriously.”

Irving recalls earning a C- in high school English. His SAT verbal score was 475 out of 800, which means almost two-thirds of the students who took the SAT did better than him. He needed to stay in high school an extra year to have enough credits to graduate. Irving recalls that his teachers thought he was both “lazy” and “stupid”.

Irving was neither lazy nor stupid. But he was severely dyslexic: “I was an underdog…. If my classmates could read our history assignment in an hour, I allowed myself two or three. If I couldn’t learn to spell, I would keep a list of my most frequently misspelled words.” When his own son was diagnosed with dyslexia, Irving finally understood why he, himself, had been such a poor student. Irving’s son read noticeably slower than his classmates, “with his finger following the sentence – as I read, and I still read. Unless I’ve written it, I read whatever ‘it’ is very slowly – and with my finger.”

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Since reading and writing didn’t come easily, Irving learned that “to do anything really well, you have to overextend yourself…. In my case, I learned that I just had to pay twice as much attention. I came to appreciate that in doing something over and over again, something that was never natural becomes more second nature. You learn that you have the capacity for that, and that it doesn’t come overnight.”

Do the precociously talented learn that lesson? Do they discover that the capacity to do something over and over again, to struggle, to have patience, can be mastered – but not overnight?

Some might. But those who struggle early may learn it better.

Dr. Gary J. Williams

DrWilliams@GWilliamsFamilyEye.com

 

 

BALANCE

A Dizzying Journey Through the Science

Of Our Most Delicate Sense

Carol Svec

Balance usually works so well that people don’t think about it until we get older. After over eighteen months of research, interviews, being an experimental subject, and writing, Carol Svec concludes, “We don’t have a sense of balance. We are balance. Balance gives us our place and space in the world, but it also contributes to our sense of self.”pensioners-2399602_960_720 Continue reading

Amblyopia and Neuroplasticity

Neuroplasticity – our brain’s ability to develop throughout our lifetime – is now understood, but neuroscientists did not accept neuroplasticity in the human brain until it was confirmed 50 years ago by David Hubel and Thorstein Wiesel through their research on the visual cortex of the brain. Over the last 50 years, research on neuroplasticity has continued to focus on vision. Continue reading