Crash and burn

I teach the Evidence-Based Medicine curriculum at our residency program.  I'm passionate about this curriculum, as it teaches our residents how to be critical thinkers about the never-ending deluge of scientific data that can benefit our patients.

One of the tricky things about teaching EBM is that it involves numbers: calculating sensitivities, specificities, positive predictive values, etc.  Mixing these numbers up is not hard to do.  I create all of the materials used in this course, and I usually double and triple check my arithmetic - and then have someone else quadruple check it - before finalizing handouts and PowerPoint slides to present.

Something went terribly, terribly wrong yesterday.  The computer in the conference room was being buggy with 2010 PowerPoint, so, I opened my previously saved 97-2003 version.  As far as I could remember, it was pretty much the same.

Yeah, except that I had, in fact, actually tweaked all of the examples in between versions. The examples on the handouts that the residents had to work through. The examples on the handouts that had the wrong answers on every single PowerPoint slide.

My quadruple-checker was there, but unusually we had not been able to meet to confirm the quadruple check before-hand.  We've never had anything but a teeny tiny discrepancy before, I reassured myself.

Whoops.  Mass confusion quickly erupted as the residents started working through the problems and the wrong answers popped up on each slide.  The quadruple checker had the correct answers, thankfully, and we eventually salvaged the session by just working through the problems on a whiteboard.

I want so badly to teach that EBM doesn't have to be a scary avalanche of numbers and equations.  I want them to get the bigger picture, the concepts above the arithmetic that can enhance their patient care.  Unfortunately, today, all they got was an hour of group effort trying to puzzle through...a scary avalanche of numbers and equations.

More than teaching about EBM, though, I selfishly want my residents and colleagues to trust my knowledge and judgment.  Failing miserably in front of everyone exposed my imperfections, making me uncomfortably vulnerable.

I wish I was a perfect teacher and a perfect doctor, and being reminded that I'm far from perfect is hard to stomach.  Maybe, though, my public failure will make the people I work with a little less afraid to be imperfect around me.  Maybe this unpalatable dose of disgrace will break down any barriers I or others have about labels such as "teacher" and allow more genuine, unfettered working relationships.  That would almost make yesterday's debacle worth all of the humiliation.

Almost.

"Beauty" - at what price?

Wrinkles are bad.

So are small breasts.

Also crow's feet and age spots.

Jiggly arms and muffin tops.

Don't forget untrimmed pubic hair.

This tirade isn't limited to women.

Guys, are your muscles ripped?

Chest gleamingly hair-free?

Male member sufficiently enhanced?

On a regular basis, I see 9 to 11 year-old girls who tell me that they're cutting back on what they eat because they're "fat."  While I'm examining them, they will point to the normal pubertal fat deposit just below the belly button and bemoan this unwelcome detraction from a perfectly flat abdomen.  Although some of these girls are overweight, most are not.  What have we done, as a society, when preteen girls are this unhappy with their bodies?

Why are we allowing advertisers and mass media to define beauty? Since when did aging become a condition or disease to be treated?  How did 18-year-old Barbie doll figures become the standard of beauty?  Mass media and the beauty industry - admittedly only pandering to what consumers respond to - have picked up on our insecurities.  We are assaulted on a daily basis by advertisers' impossibly airbrushed and retouched models selling everything from stilettos to vitamins.*  These companies succeed at convincing us of our "flaws" that their products can "fix."

As physicians, we must beware of being caught up in this over-emphasis on appearance. We contribute Botox for wrinkles, silicone for sagging breasts, and the diet pills to lose 10 pounds.  In so doing, though, are we contributing to the problem?

Beauty treatments and the desire to look attractive are not, in and of themselves, fundamentally bad, and neither are the health care providers who assist with them.  The danger lies in allowing our focus on those treatments' goals to pervade our internal sense of self-worth.  As physicians, we have a sacred trust with our patients; we treat each person, regardless of appearance, with dignity and respect.  We must be cautious against contributing to the fallacy of perfect appearance with our skills and prescription pads.

Our intrinsic value as human beings has nothing to do with our skin and breasts and muscles.  Each of us can help to push back against these social pressures by teaching that the altered pictures of people in magazines make us long for what is unattainable.  We can compliment each other as often on our internal qualities as we do on new hairstyles or clothing.  My patients' resilience, patience, and thoughtfulness, often in the face of great struggles, are what is truly beautiful about them.

Let's shift the conversation toward that definition of beauty.

* A new movement is committed to exposing the excesses of retouching in the beauty industry: http://jezebel.com/5115667/2008-photoshop-hall-of-shame, http://www.sfgate.com/opinion/article/Jamie-Lee-Curtis-has-nothing-to-hide-2805025.php#photo-2210632, http://www.diet-blog.com/06/celebrity_retouching_10_reasons_to_revise_your_reality.php.