September Blessing Rounds – Harms, Benefits, Things to Listen to, and Things to Ponder

A few of my favorite things in the past two months that have blessed me!

Medicine

• Vaccines for preventing influenza in healthy adults. Demicheli, V. Cochrane Database Syst Rev. 2018 Feb 1;2:CD001269.
  • Number needed to vaccinate (NNV)
    • 71 healthy adults need to be vaccinated to prevent one of them experiencing influenza
    • 29 healthy adults need to be vaccinated to prevent one of them experiencing an influenza-like illness
    • 94 pregnant women need to be vaccinated to prevent one of them experiencing an influenza-like illness
  • Other statistics
    • May lead to a small reduction in the risk of hospitalisation in healthy adults, from 14.7% to 14.1% (NNV 167)
    • May lead to little or no small reduction in days off work
  • Number needed to harm (NNH)
    • Can cause an increase in fever from 1.5% to 2.3% (NNH 125)
• The NNT.com
  • “The NNT offers a measurement of the impact of a medicine or therapy by estimating the number of patients that need to be treated in order to have an impact on one person.”
  • Examples
    • Antibiotics for otitis media in children
      • 1 in 20 experience decreased pain after 24 hours
      • 1 in 14 experienced vomiting, diarrhea, or rash
    • Zinc for the common cold
      • 1 in 5 were helped (reduced symptoms at 7 days)
      • 1 in 12 were harmed (minor adverse effects: bad taste, dry mouth, and nausea)
    • Aspirin For Preventing A First Heart Attack Or Stroke
      • 1 in 333 avoided a nonfatal heart attack
      • 1 in 250 suffered a major bleeding event
• Quantifying the “Pediatrics Opportunity Cost”
  • I’ve shared WCI articles before, but found this another great reminder to live like a resident out of residency.
  • It covers the finances of a pediatrician, but family physicians (and all other docs!) need to wake up and ascertain how much they are saving/proportioning.
• “What Makes a Doctor Truly Great”
  • This is an AAFP article commenting on a well known Atul Gawande article from the New Yorker about curiosity.
  • “A curious physician considers what life is like in the other person’s shoes and seeks to know the details of their patients’ lives that aren’t strictly clinical — their character, culture, past, hopes, etc. Your curiosity turns patients, especially the most “difficult” ones, into people with whom you can empathize and share a common core of humanity.”
• “Things We Do for No Reason: Prescribing Docusate for Constipation in Hospitalized Adults”
  • I was first introduced to the TWDNR series when I went to the Society of Hospital Medicine Conference in 2019.
  • We went over this article in the residency clinic I work in and it propagated to our hospitalist and even obstetrician colleagues!

Listen

• CCHF Talk
  • So good. I just got into podcast and was so blessed. A recent episode showed that Christians need to be aware of the injury we have made– sins that have been done in the past have caused and continue to cause systemic and generational problems.
  • Even if we work in a community health center (Christian or not), we need to be aware how we are contributing to the “sickness” of the population we are trying to address! We need to look at our “own demons” directly to address the true “root causes!”
  • “There is now a disconnect with the root causes that originally led the health centers being made for the community… We are all accountable for the need of these communities… There is neglect. There are clear choices that are being made generationally that people benefit from and people reap the damage of.”
• Essential Evidence Plus POEM of the week podcast
  • I’ve been listening to this for a few months and recommend it to everyone. They are all <5 minutes long and easily accessible for even the shortest of commutes!
  • My favorite one recently shared how some people on antidepressants are early responders and have a higher chance for remission at six weeks. However many non-early responders at six weeks will respond at 12 weeks, supporting my practice to really give adequate time for antidepressants to work.
• Forgiveness & Justice
  • A young man forgiving the woman who murdered his older brother.
  • It boils my blood thinking about the systemic prejudices we have as a country and how it literally affects people’s lives. It also brings me to knees as I think it is possible to forgive someone who doesn’t deserve it.
  • How do we discern between justice and forgiveness? How do we create a culture of forgiveness without compromising justice? How do we punish people without creating a tit-for-tat culture?
• Justice & Forgiveness
  • The Christian mother’s cry for justice.
  • “Forgiveness for us as Christians is a healing for us, but as my husband said, there are consequences. It does not mean that everything else we have suffered has to go unnoticed,” Mother Allison told the court.
  • “You saw investigations that were marred with corruption,” Mother Allison said. “While we walk as Christians, we still have a responsibility to ensure that our city does what is right.”
  • “Listening to the entire Jean family offers us a fuller picture of Christianity. In their words and posture towards Guyger and the criminal justice system, we hear calls for both forgiveness and justice. But if we elevate the words of one family member at the expense of another, we run the risk of distorting the gospel.”

Ponder

• Little Forest
  • An amazing film! My wife and I lean towards the urban life but this film really made me reconsider to live a life of simplicity and zen!
  • “Hye-won, a woman so frustrated by city life that she returns to her rural home. In the countryside, she acquaints herself with life’s simple pleasures, including growing and cooking her own food and drinking into the twilight hours. Each delicious meal offers Hye-won a renewed sense of self in four transformative seasons.”
  • (the link points towards a song from the movie but is much more representative of the slice-of-life simple cinematography than the actual Korean trailer)
• Difficulty is about trust and communication, not ‘hard’ vs. ‘easy’
  • I really enjoyed this philosophical understanding of the player and game developer “contract.” In game theory, difficulty level (easy, normal, hard, etc) is a very imprecise and a misunderstood aspect of gaming.
  • Game developers “discuss [difficulty] in terms of skill progression. All difficulty design is essentially that: crafting how players will learn, apply skills, and progress through challenges.”
  • “at the heart of things, a surprising amount of game design is about trust.”
• The language of video games
  • A husband watches his wife, who has very little video game experience, learn the language of gaming.
  • Another experiment involving “obfuscating “language” of video games and how that can be a barrier for those who didn’t grow up with the hobby”