Better Doctors Focus on Mistakes

Everybody makes mistakes. But far too few people take the opportunity to learn from them. We'd all be better people if we did. And for doctors, acknowledging errors could mean the difference between a patient's life or death.

In a study where doctors were faced with a simulated medical emergency and had to choose from uncertain treatment options, a scenario requiring a certain amount of trial and error, doctors who paid more attention to their mistakes fared much better than those who focused on their treatment successes.

This is a message everybody could benefit from.

The doctors were presented with a situation where a patient had suffered a heart attack and given a simplified six-factor patient history. They then had to choose from two emergency drug treatments.

The key to choosing the right drug was whether the patient had diabetes. One drug had a 75 percent success rate in patients with diabetes and a 25 percent success rate in all other patients. The second drug gave completely opposite results. But the doctors didn't know this. They had to figure it out from seeing which of their virtual patients lived and which died.

They were given 64 computer simulated trials to learn from, with 10 seconds to select a treatment option for each patient. Results of their treatment were described as either success or failure. Then the same exercise was done as a test: 64 new patients, with no information given to the doctors on whether the treatment succeeded or failed.

Their success rates, their own written accounts, and brain scans taken while the doctors were going through this exercise all provided some very interesting results.

About one-quarter of the doctors eventually found the proper treatment pattern, choosing correctly between 77 and 98 percent of the time. The other doctors did much worse. Based on fMRI scans, which measure changes in blood flow to different parts of the brain, doctors who performed well tended to show high activity in their frontal lobe when treatments failed, while the doctors who performed poorly tended to activate the frontal lobe when a treatment was successful.

The researchers interpret this as meaning that the better performing doctors were focusing more on failed treatments and gradually learning from their mistakes. The poorly performing doctors focused more on successful treatments, with each success confirming what the doctors (falsely) thought they knew about which treatment was better. The researchers term this sort of behavior "success chasing." It's what happens when people ignore their mistakes.

The doctors' own written accounts give other clues about what was going through their heads as they tried to figure out why these drugs sometimes worked and other times didn't. Choosing the right drug was a puzzle. As they treated more patients, doctors altered their treatment strategies based on the results they were seeing. For example, at one point in the trial, one doctor was prescribing drug A for females over 55 and men under 55, and drug B for all other patients. As the trial progressed, the better-performing doctors made small adjustments to their treatment rules following both successes and failures, while low performers made large rule adjustments, and made significantly larger adjustments following successes than failures.

A very striking and unanticipated result was that the more experienced a doctor was, the poorer they performed during the trial.

So what's the take home message from the study? Probably that people can learn as much from their mistakes as their successes but tend to think that their successes are much more meaningful.

What about the fact that less-experienced doctors were better at solving the puzzle? The meaning of that was beyond the scope of the study and could have many explanations. Perhaps younger minds are more facile at solving puzzles. Or maybe older doctors simply are less fond of computer tasks. Nobody knows for sure. It's one more point to consider in the seemingly unanswerable question of whether people are better off with a younger doctor or a more experienced one.

Read more : http://www.theatlantic.com/health/archive/2011/12/better-doctors-focus-on-mistakes/249981/

Common Dinnertime Mistakes We All Make

In our fast paced lives, the dinner table is the only time many of us really have an opportunity to sit down, relax and enjoy our meals. For many of us, breakfast and lunch are “grab-and-go” meals, but dinner is the meal that allows us to kick back and unwind.

But there are s few things we must be mindful of when it comes to that final meal of the day. There are some common mistakes that people unconsciously make when it comes to dinnertime, and the Huffington Post Healthy Living section has six great things to be mindful of during dinner.

We’ll share three with you, but make sure you check out the entire post as well!

1. Making dinner the biggest meal

“Think of when you need the calories,” says Cheskin, adding that it’s most certainly earlier in the day when you’re expending more energy. The USDA counsels that dinner should add up to about 450 and 625 calories, based on a diet of 1,800 to 2,300 daily calories for women and 2,000 to 2,500 calories for men. But some nutritionists and experts think it can be much less than that – as little as 20 to 25 percent of daily calories.

“Nutritionally, dinner should be a light, well-portioned meal that is under 500 calories,” says Lanz. “Unfortunately, most Americans use dinner as their main source of food for the entire day and over indulge.”

2. Grazing in front of the TV

Many diners don’t make their mistake at the dinner table, but on the couch: Post-dinner snacking or snacking in place of eating a complete meal can be perilous if accompanied by mindless activities like watching TV or surfing the web.

Cheskin says this is the biggest problem he sees in clinic. “[It's] the mindless eating while attached to a screen of some sort. I like to get people to separate the eating from other activities.”

3. Grabbing that dessert

Routinely finishing with a sugary dessert is a way to add excess calories for tradition’s sake, not for satiety. What’s more, that spike in blood sugar could keep you wired — or even wake you up in the night.

Read more http://www.corepower.com/blog/common-dinnertime-mistakes 

Mistakes to Avoid When Purchasing A Bus

My previous article, in the January 2008 issue of Religious Product News, focused on recommended steps for purchasing a new bus. The focus of this article is on suggestions for what not to do when purchasing a bus. These suggestions are based on two decades of working with purchasers, many of whom devote the time and energy to make sure they do it right.

A good first step is disassociating the process of purchasing a bus with purchasing a car. It may be hard to do since we all have experience with buying cars, but, the fact is, a bus is not a car, and the buying process is not the same either.

Automobile manufacturers mass produce thousands of similarly designed cars and trucks every year, while bus manufacturers produce customized, purpose-built units in small quantities as ordered by their dealers for either specific customers or for their inventory. A Ford Taurus is the same whether it you buy it in Florida or Washington; a bus on a dealer's lot in Florida is likely to be equipped very differently than the same brand on a lot in Washington. Automobiles have had over a century of product and design evolution; small buses, as we know them today, have been around for about 25 years.

Small buses built on Ford or Chevrolet chassis have an automotive look on the surface that gives the impression that they are all the same. The fact is that all buses are not the same. It is very likely that a bus dealer in Minnesota is going to stock buses with more heating capacity than cooling. Pity the purchaser from Phoenix who buys such a bus rather than from the local dealer who knows how to equip a bus for a desert climate.

If you want to purchase a bus the right way, there is actually a lot to learn about buses. What is the best source of information? A reputable dealer, preferably one that is relatively close to you.  Unlike car dealers, you are not going to find a bus dealer in every town, but you can find more than one typically within driving distance. Make an appointment and go see at least one. Take your committee. Test the dealer's product knowledge. Check out their facilities. Are they committed to the business, and are they here to stay?  Do they have product support staff and offer repair service?
                                  
You may be inclined to try to save that time and just shop and buy on the Internet. In my view, that is a mistake. The Internet is a great way to gather information or to buy a pair of pants or a book, but not a bus. Don't treat this purchase like a commodity that you can buy just anywhere. A bus is not a mail-order item. Learn about the different brands, the history of the manufacturers, the features that they offer, their warranty policies, their product testing, safety record, etc. 

Your church will very likely own a bus for at least a decade. Is saving a small fraction of the price worth it when you consider what's at stake? Just because someone claims something about their product or themselves doesn't make it true. It's certainly easier to verify the facts looking someone in the eye than it is on the phone or via e-mail. 

There are a number of very solid and reputable bus dealers located throughout the country. If you call a reputable manufacturer, they will refer you to their dealer for your area. 

What about buying factory direct? Again, I suppose the attraction is saving money by cutting out the middle man. However, factories are designed to produce products. To the extent that they are structured to provide service, it is usually to their dealers. It is the job of the dealer to provide service to the end user. 

"Well, they said I could just take it to any Ford or Chevrolet dealer for service." That's a line that is often used when the seller cannot provide you with service. Ford and Chevrolet dealers are trained and set up to service products they sell, including a bus chassis. But, when it comes to electrical systems, entry doors, air conditioning, wheelchair lifts, and other components not common to that brand of automobile, a Ford or Chevrolet dealer is at a real disadvantage to provide service efficiently. It may be your only choice in a pinch, but it is not the best long-term solution for bus maintenance and repair, in most cases. And, when it is a solution, it is usually because that Ford or Chevrolet dealer has the support of the selling bus dealer's product support staff to guide them through the areas that they are unfamiliar with.

Having the right size and appropriately equipped bus for your church can add so much to the activities that you provide your members. The number of options that are available to you is staggering. The best way to find out about them is by working with a dealer who is interested in doing more than just selling you a bus quickly. Take your time, do your due diligence, and focus on more than just the cheapest price. In the long run, you'll be glad you did.

Read more : http://www.religiousproductnews.com/articles/2008-September/Supplement/Mistakes-to-Avoid-When-Purchasing-A-Bus.htm