Oops! Spoke too soon!

Looks like I spoke to soon about bathroom doorknob hygiene freaks. Today's Globe and Mail gives the thumbs up to "fastidious, obsessive germophobe(s)", and finesses a link between sweaty, germ-encrusted gym equipment and necrotizing pneumonia.

The beauty of this article about fitness centre hygiene and infectious diseases is that it is completely generic. The setting for this health scare du jour could just as well have been a restaurant, library or water fountain. Any public place would do, because the writer doesn't mention any actual cases of nasty gym-acquired infections. She quotes a couple of doctors about community-associated MRSA, and name-drops SARS and necrotizing pneumonia, but there's no actual data showing a link between unhygienic workout equipment and anyone getting ill.

Slow news day?

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What's wrong with this picture? - V

Inside the men's washroom next to our office


Missed the garbage can... again!

I wondered what was going on when, regularly over the last few months, there were crumpled paper towels on the floor just inside the washroom door. But I think I've figured it out.

To keep their hands clean, guys are using the towels to turn the door handle. Because there's no garbage can beside the door... on the floor they go.

Bathroom architects take note: put a garbage can beside (or within 3-point range of) bathroom doors. Better yet, no bathroom doors, a la airport washrooms where you walk through an angled entrance that gives visual privacy.

I wonder what these hygiene-freaks do when the washroom has a hot-air hand "dryer" and no towels. Wait for the next guy to come along and open the door, I guess.

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Re-imagine!

"If you don't like change, you're going to like irrelevance even less."

General Eric Shinseki (quoted in Re-Imagine!)

Re-imagine, by Tom Peters, is a book about business, not health care. Yet, all the ideas in it can be applied to health care and how we can change it (and ourselves). Peters' theme is that businesses and individuals need to change radically rather than incrementally (Re-imagine!) in order to succeed (or even survive) in today's economy.

He's looking at life from a business point of view, but if you read this book wearing health-care goggles, it makes incredible sense for changing the way we provide service (yes, service) for our patients (dare I say, clients?).

The book's design makes it a fun read, full of asides and anecdotes. He takes his own advice in imagining a book that goes well beyond rows of text.

At about 350 pages, it's hefty, but I found myself stopping every few pages to ponder his ideas and consider applications to medicine.

I highly recommend this book!

If you want a taste of Peters' style, visit his website and flip through some of his (many) Powerpoint slides.

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World-class presentation by Hans Rosling

This video shows a world-class presentation. Hans Rosling shows off his Trendalyzer software (now sold to Google and being developed for free, public access). His finale is a show-stopper (don't try this at home!).

While the animated slides may not be appropriate for some presentations, the slide of the woman on a bicycle (at 13:23) is a great example of how to make a "Powerpoint" with visuals rather than bullet points.

See his 2006 presentation for background on the Trendalyzer program. Also check out the TED site for other terrific presentations.

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Illuminating the shadow

The CMAJ reports that BC's Fraser Health Region has banned "physician shadowing" by pharmaceutical and medical equipment representatives. This is a significant, often ignored, ethical issue in medical practice.


I've attended Oncology Rounds with a drug rep present and raised a question about his/her presence. I was assured that a confidentiality agreement had been signed. OK, let's say that confidentiality is looked after, then.

But, what about the physicians' ability/willingness to speak freely and openly about their opinion on a patient's care? Multi-disciplinary cancer rounds often require frank discussion about some difficult situations. There may be disagreements about therapeutic approaches. The meeting's purpose is to air those differences and freely debate treatment options.

The discussion relies on a certain "therapeutic detachment", that is, the ability to suggest a treatment option (or withholding of an option) without necessarily believing it's appropriate for the patient. Some physicians may be uncomfortable in sharing their opinion in the presence of an "outsider" who may misinterpret their intent.

This is only one example in the debate about pharmaceutical reps and clinical practice. The Company We Keep: Why Physicians Should Refuse to See Pharmaceutical Representatives offers a broader discussion of the issue. The comments about this paper are as interesting as the paper, and cover the range from those who piously refuse to interact with reps to those who are indignant that anyone would believe that their professional integrity and judgement could be compromised by a rep. (Those of you in the second camp should check out this article.)

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Cool Science!

Check out "Cellular Visions: The Inner Life of a Cell", an incredible animation made for Harvard biology students. It's about the inner workings of a white blood cell. My kids (age 7 and 10) are fascinated by it. They're asking all kinds of questions about cellular biology (although they don't know it!). I can't vouch for the explanation posted here , but it's better than I could come up with.

Wouldn't you have loved something cool like this to get you engaged in freshman biology?

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The Lost Art of Persuasion

I picked up a freebie copy of SOHO business magazine to have a look at "The Lost Art of Persuasion", an article on sales presentations. It's an "advertorial" for the author's book on the subject, but it has some great ideas on how to improve your presentation style. The article isn't on the online version of the magazine, but it's available verbatim on another site.


Can health professionals learn from sales and marketing techniques? Aren't we trying to impart serious information rather than influence a decision about what brand of widget to buy? A lot of us have been brainwashed into thinking this.

There's a stereotypical format for presenting medical/scientific information. It's formal, dry and serious:

Here is my hypothesis, these are the methods I used to test my hypothesis, these are the results of the testing, and these are the conclusions I have drawn from the results.

Here is slide after slide giving the exact words coming out of my mouth.

Is anyone out there still awake?

It's an unusual presentation that breaks out of that dreary mold.

And that's my point! If you attend a scientific presentation where the speaker engages and excites (surprises!) the audience with something (anything!) different, you remember that presentation. You talk about it. That speaker influenced you.

If uninspiring presentations are a part of the medical/scientific culture, how will we improve? Who will show us a different way? Check out Presentation Zen for links to videos of some inspiring presentations (of course, it's the presenters who are inspiring). The speakers demonstrate many of the techniques from Paul LeRoux's article.

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