Echo-Location In Humans Can Be Learned/Taught!

In the March/April 2009 edition of Acta Acustica Journal, a research paper by Spanish scientists entitled "Physical Analysis of Several Organic Signals for Human Echolocation: Oral Vacuum Pulses" was published. This research has shown scientifically that human beings can develop echolocation, the system of acoustic signals used by dolphins and bats to explore their surroundings. Producing certain kinds of tongue clicks helps people to identify objects around them without needing to see them, something which would be especially useful for the blind.

In order to learn echo-location, the scientists are developing protocols to allow any person learn this unique ability.

Read more about this here.

Distortion of Risk Assessment for Surgical Complications

Over time and experience as well as being exposed to some pop psychology by the likes of Malcolm Gladwell, Nassim Taleb, Ori & Rom Brafman, Robert Krulwich, Jad Abumrad, among others, I have realized that patients assess surgical risk in very different ways with most using irrational considerations.

Too often, physicians use statistics, numbers, and facts to counsel patients on risk whether it be surgical or some other medical intervention (medications, CT scan, etc). And we should. However, how patients process this information is more often based on emotive factors and anecdotal stories heard from friends, family, as well as internet.

Such "stories" whether from friends or the internet is perhaps one of my biggest allies as well as bane of my existence. Why? Because patients make decisions based on the experiences of a few individuals. Facts? Statistics? They play only a minor role. To make things worse, such stories are expressed in more negative terms than positive.

Why is that?

I think it's because people who experience a bad outcome are FAR more vocal from a perceived sense of injustice than those who experience the good (and expected) outcome.

As the saying goes, a person with a good outcome tells 1 or their friends whereas a person who has a bad experience tells 5 friends.

It is against just this kind of backdrop that patients "listen" to the statistics, but are influenced by the stories they hear.

To make things worse, risk evaluation is distorted by the lack of control patients feel. It is why there are so many people who are afraid of flying and yet have no trouble driving a car where the risk of death is MUCH higher. Or why most people are horrified by the idea of a gun in the house but won't blink twice about a swimming pool which kills far more kids than guns.

How is a physician to combat such forces in order to allow for a more reasoned decision made by the patient for a given medical intervention?

I have no solution to this problem other than to keep aware of what patients are hearing and being mindful of such emotive factors when providing counselling. In practical terms what does this mean? It means I read... a lot... and not just from medical journals either, but newspapers, magazines, blogs, and other sources that patients probably encounter before seeing a physician. Thank goodness for online news collators (Medical News Today, Topix.net, etc) as well as Twitter.

I also produce my own online literature to balance out (hopefully) the other materials that are out there, but more so in story format in layperson terms rather than factual & medical regurgitation and use of ambiguous language (where emphasis is "see your doctor" for more specific information) that plaque more reputable medical websites.

Washington Post: Perfect Pitch CAN Be Taught?!!

There is a fascinating article in the July 27, 2009 edition of the Wasington Post on page A8 entitled "An Elusive Musical Gift Could Be at Children's Fingertips." This article elucidates a technique to teach any child to have perfect pitch, the ability to identify a note simply by hearing it. The technique is called "Eguchi Method" and developed by Kazuko Eguchi who developed it 40 years ago in Japan.

In essence, the technique, in order to be successful, must start before the age of 4 years old and uses colored flags (or any other object) to musical chords. Over time, more colored flags linked to different chords are added. Frequency of practice is more important than duration.

To read more about this, click here.

Physician On-Call Communication System for Free! Thanks Google!

Since 2008, many patients in our practice are quite surprised when they actually reach a physician directly when they call our after-hours number.

What the patients don't realize is that our practice is also quite happy with this set-up!

Why? Well, that after-hours number is actually a Google Voice number and it provides amazing functionality that is FREE that would have costed us thousands of dollars otherwise.

Using Google Voice, the after-hours number can be forwarded to any physician who may be on-call easily and immediately. When the physician answers a call, an automated Google message is heard alerting the physician that the incoming call is from a patient. Should the call get missed, the patient can leave an answering machine message. Google Voice TRANSCRIBES the voice mail message and emails it to the physician's cell phone. This last bit is great as often calls come in while we may be in surgery or on another call.

SO, Google Voice provides options for the physician:

1) Answer an incoming call immediately and be alerted that it is a patient calling

OR

2) Read the transcribed voice mail (imitates an answering service and pager all-in-one) before returning a call

How cool is that... and all for free!

Check out the Google Voice service here.

Needle Biopsy of Thyroid Masses Misidentifies 50% of Thyroid Cancers!

In the July 2009 issue of Archives of Surgery, surgeons at the University of Wisconsin published a paper entitled "Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4 cm or Larger". They found that fine needle aspiration biopsy (FNAB) in 26 of 52 FNAB reported as benign (50.0%) turned out to be either neoplastic (22) or malignant (4) on final pathologic analysis after thyroidectomy. Among patients with nondiagnostic FNAB results, the risk of malignant neoplasms was 27.3%.

Even for smaller thyroid masses, FNAB is still not 100% accurate. Why is that?

Well, one must keep in mind that the FNAB samples (or removes) only a tiny tiny tiny part of the thyroid mass (think of a needle going into an apple and trying to hit the worm in the middle). Should the needle sample a part of the thyroid cancer mass where no cancer is present, it will come back normal, even if it is truly cancer.

What does this mean for a patient with a thyroid mass?

1) The ONLY way to know 100% whether a patient has thyroid cancer or not is to remove the thyroid.
2) IF the FNAB shows thyroid cancer, total thyroidectomy is recommended.
3) IF the FNAB does not show thyroid cancer, thyroid cancer can STILL be there; it's just that the FNAB was just plain wrong. Thyroid lobectomy should still be considered.

Of course, one needs to talk with your local surgeon on what the next step is.

Just keep in mind that the FNAB is not 100% accurate!

Read the abstract here.