> He was tall and lean, ran six miles a day, and was a strict vegetarian. “I believe a physician should provide exemplary motivation to patients,” he once wrote. “I don’t smoke and have cut out all alcohol.”
> “Sometimes I worked from 6 a.m. to 3 a.m.,” he recalled, adding that the pressures had cost him his first marriage.
I don't understand how a medical doctor can fail to consider sleep deprivation and overworking not to be a health threat. There is just so much evidence out there that sleep deprivation has similar health effects as alcohol consumption, both in terms of impaired cognitive abilities and long term health effects.
Doctors are trained to believe that sleep deprivation isn't something that affects good doctors. During their residency, doctors routinely work 24 hour shifts. This goes back to William Halsted, who for all intents and purposes invented modern medical training at Hopkins. Halsted managed his always-on work ethic with his cocaine addiction, and drove his residents to the same extremes.
> Of course, the overworked, sleep-deprived doctor valiantly saving lives is an archetype that is deeply rooted in the culture of physician training, not to mention television hospital dramas. William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year (only later was it revealed that Halsted fueled his manic work ethic with cocaine), and for the next 100 years the attitude of the medical establishment was more or less the same. Doctors, influenced by their own residency experiences, often see hospital hazing as the most effective way to learn the practice of medicine.
It's bullshit, it's killing patients, it's ruining lives, everyone knows about it, yet no one does anything, because "it's the way we've always done it". If a doctor has been awake longer than 18 hours, and a patient dies on the table, they should be charged with manslaughter, traditions be damned.
I don't really agree about the manslaughter charge - if a doctor has been awake longer than 18 hours and there is no other doctor available, should they not attempt to treat the patient?
Personally, I don't think it's a doctor issue, I think it's a Medical Practice and Hospital Group issue. MD's don't really want to take call, but if they can take call for the entirety of one weekend and then have the next 3-5 off, they'd rather do that than take call for 12 hours 2 weekends in 4.
> if a doctor has been awake longer than 18 hours and there is no other doctor available, should they not attempt to treat the patient?
What lead to the systemic disaster that causes this situation to come up in the first place? The scenario is presumably a hospital in a major city in peacetime; doctors shouldn't be working those hours to begin with.
... because the rural hospital can't afford to hire enough surgeons to cover their shifts, because we don't train enough surgeons, because we overtrain surgeons, because everybody qualified to evaluate this has incentives to lobby for more training. Lack of training is a perfect scapegoat for any problem and increased training requirements create lucrative educational opportunities and decrease supply / increase prices of qualified professionals. We know this in general because we can evaluate results against other regulatory regimes, but if you drill down to specifics you run into the problem that everyone qualified to comment has perverse incentives.
Let's define "overtrained" to mean "we spent too much money on training" rather than "the training resulted in an excess of competence." I am sure the latter does happen occasionally, or even frequently, but I am also completely willing to believe that sometimes it... doesn't.
Why not? A pilot that works beyond their duty day will get a manslaughter charge if the flight results in the death of a passenger or person on the ground. Whats the difference?
It's an extremely unusual situation where if a person isn't flown immediately, they will die. It isn't that rare for people to need immediate medical attention.
I swear, a surgeon killed my dad. My dad's surgery was scheduled immediately after the surgeon returned from Australia -- he drove straight from a 30-hour flight to the surgery ward. His scalpel slipped and nicked a chyle duct, which took another half-dozen surgeries to correct. Sure, the cancer was gonna kill him, but spending 3 months in ICU probably took years away from us. I can't imagine the surgeon's hubris in that -- the medical profession seems to know so much, but individual practitioners think they're immune to sleep deprivation, exhaustion, and other simple well-understood aspects of the human condition. It's appalling and tragic
Individual practitioners are usually aware of the dangers of sleep deprivation. The problem is they have very few options when it comes to controlling their own hours and most of those "top ranked" hospitals are often among the most notorious for having these toxic working conditions. Medical residents are also forced to go through these conditions almost as a form of hazing, justified only by attendings who "also had to go through it, so why shouldn't you?". The whole culture of medical training and hospital administration is corrupt and toxic.
For a part of the program that I'm familiar with, a rotating fellow will be expected to be the sole physician of that specialty on-call for the entire weekend for 3 hospitals in a large US city. Then, on Monday it's back to work again at 6 AM. If it's a busy weekend, good luck getting more than 1-3 hours of a sleep a night during that time.
Just like the rest of us, the surgeon could have returned from his trip (presumably a vacation) a day or three early to recover. But you're spot on about the toxic working conditions and lack of concern that medical institutions give to proper rest.
I suspect in some professions hubris is so important that people who tend to be humble simply don't make it in them. For example, Chuck Yeager complained about the arrogance of test pilots and I've heard a couple of times surgeons comparing themselves to fighter pilots. The difference, of course, is pilots kill themselves while surgeons kill their patients.
>I've heard a couple of times surgeons comparing themselves to fighter pilots.
The comparison is a good one, because we have figured out how to minimize the risks for fighter pilots, but doctors rebel when asked to adopt the same style of work.
Before taking off, all pilots - from Cessna to A360 - go through a pre-flight checklist. No pilot is expected to remember all the things that need to be checked - we know that we can't rely on memory. We tried this before, and people died.
Yet doctors only now are starting to adopt checklists, which are known to drastically reduce simple, avoidable deaths[1]. Things like rates of IV-induce infections go down to nearly zero when doctors stick to a checklist -- but many won't; the practice is met with skepticism even though it is known to work.
It took a long time for doctors to start washing their hands and stop killing people that way.
To drag this conversation into further despair; an airshow pilot in the UK is currently being charged for manslaughter for when he, allegedly, negligently performed a risky manoeuvre and survived a crash that killed 11 people.
A drunk, alcoholic US Navy surgeon gave my grandmother a radical hysterectomy instead of an appendectomy, involuntarily sterilizing her. She had my father first, at least.
It's also pertinent to recall that surgeons evolved with and into the medical field from surgeon-barbers... yes, the people who give shaves and cut hair also used to cut into people.
I used to be friends with a surgeon and based on what he told me you need to have a certain level of hubris or arrogance to do that job. He told me of situations during surgery where he had to make a quick decision that could have either severely harmed the patient or led to success. He also knew cases where he had made the wrong decision. It requires a certain kind of person to take that responsibility and live with it.
I wonder if the humble ones are the ones that will adapt best to robotic surgery.
If that ends up being case then 'choosing a human' may quickly become a Market for Lemons situation - you might have gotten better outcomes from human surgeons except the only ones still doing it by hand are full of themselves and too proud to admit they are human and make mistakes.
Surgeons are cowboys. They know it and take pride in it. It's a cultural thing that will take work. This macho culture thing is so common it makes me wonder.
> but individual practitioners think they're immune to sleep deprivation, exhaustion, and other simple well-understood aspects of the human condition. It's appalling and tragic
Those I know do understand the effects of their working conditions. The "appalling and tragic" aspect is that we accept them until they affect us.
My brother was on call this weekend and got called in Friday night at 10 P.M. and Saturday night at 2 A.M., then had to be back to work at 7 A.M. Sunday. Obviously sleep deprived, but there's nothing he specifically could do. This needs to change at an institutional level.
I know there are some huge culture differences from surgeons, doctors, and nurses so I don't mean to conflate them. But I remember hearing that longer nurse shifts had better patient outcomes because so much was lost in handoffs between shifts. There was a study formalizing shift handoffs and patient outcomes improved significantly (I think it did beat out longer shifts, but I'm not sure).
I've been to specialists offices who had a rotating practice where you saw whoever was in that day. You still usually had a primary person you saw for scheduled appointments. I still think patients prefer dealing with a single person and am sure things get lost in doctor's notes or even if you make a phone call to the original doctor.
Medical training seems to promote normalizing very long work ours and sleep deprivation. I know I've heard about law suits trying to point out the egregiousness of it. Long shifts and being on call 24/7 definitely simplifies staffing. I was in a tech support department that went from 40hr support to 24/7 and it was significantly more challenging to manage.
I hope we can improve things because it seems almost inhumane in how we treat medical professionals as well as patients.
My grandfather owned a tiny hospital in a small town. He was a surgeon. He went to france during the great war with the British Army. There were only two surgery rooms at the town. His room was one of them. His hospital was half his big house. His home was the other half. He lived busy until age ninety. The war never finished for him.
Many experts feel they have the right to ignore other experts in their field. It's scary how some doctors pick and choose the research findings to reinforce their perspectives, regardless if it's fact based.
I very much agree with this from what I've seen. I do think it's a bit of an odd situation (I'm not trying to defend sleep deprivation here). Patients often choose doctors because of things specific to them and generally seem to reject the commoditization of things (seeing whichever doctor your insurance tells you or whoever is on call that day). Me, being fairly young and only really seeing a doctor when I need a physical or have an annual exam, I don't care. My mom, who sees a doctor more regularly and has a closer relationships with her specialists has more strong opinions.
I also remember hearing from a vet student that their mentor used older techniques, medications, and practices for certain things, but because he had used them for decades were way more comfortable using them than newer techniques (which can some times be more idiot proof, but less nuanced). That student was convinced it was better than if he had stayed up to date and used modern practices.
Similarly, I remember hearing about aviators relying on automated controls so much that they're less capable in emergency situations. I'm not sure what you can do about that. Ideally, in aggregate passengers are safer overall.
Just to share another perspective, doctors, and especially surgeons, save lives by the hour. Every minute they're not working, they forsake compensation of course, but more saliently, they are letting people die. Wouldn't you feel at least a bit compelled to work the extra odd hours here and there?
It's probably easier to say that when your hands aren't literally saving lives on a regular basis. There must be a certain level of guilt that sets in when you take time to relax. I'm not saying doctors shouldn't take it easy, just that it's human nature for them not to want to.
A lot of people think you can overcome sleep deprivation and stress by being 'healthy'. They overestimate the effects of diet and drinking and underestimate the effects of stress.
One other thing to consider is that a vitamin B12 deficiency is associated with elevated stroke risk. We get most of our vitamin B12 from animal products, namely meats.
Interesting legend, tried to search for him on youtube and other places but nothing showed up. I'm not saying this man can't rap, but how can you call that being a legend if there isn't a single recording?
Nowhere in the article is there a link or an embed to an example of his legendary rap.
> Like a true underground star, he shunned mainstream success. He did appear in a documentary about Leimert Park, not as a novelty act, but as a regular member of the crew.
Interesting that you're postulating a ~19 year conspiracy to fabricate a man across at least two LA Times articles from 2000 and this Atlantic piece in 2019. And I guess celebrity rapper KRS One, quoted in the Atlantic, would have to be in on the fabrication too. And the LA Times photographer who sold his images to the Atlantic.
You mean celebrity rapper KRS-1, who (a long time since he was a success, and when he was trying to start a weird hip-hop religion) met Dr. Rapp, gave him "rap lessons" and planned to write a book or do a record with him (neither of which came to fruition.)
This also all happened in 1999, right before the LA Times articles in 2000. This was a KRS-1 publicity project that didn't end up working.
BTW, it's a straw man to pretend that this story being a fabrication means that the man himself was fabricated. I'm sure some retired white guy after having a stroke went to a rap open mic battle, got noticed by KRS-1 who thought he might be able to use him, which gave him the social capital to attend events regularly and make friends. I also don't doubt that once or twice during the period of his "rap lessons," KRS-1 trained him like a parrot to have a good minute on stage. Especially with the novelty, I'm sure people gave him a break, and there's no indication he wasn't trying hard, and people like when you try hard.
Those lyrics are horrific, though. Also, shit features like this remind me that if the media wasn't 24-hour Trump, it still wouldn't be covering anything important, it would just have to find 10x more stories about waterskiing dogs and rapping grandpas.
It's a case study of the unusual effects of a stroke on the human brain published to the health section of a news website. Seems like a reasonable topic for a health story to me.
On what basis are you suggesting I suggested the Atlantic article is made up?
I suggested the more general idea that journalists make up stuff frequently (even in more important and more fact-checking outlets). So my comment was in the line of "don't rule out that possibility".
Also, don't you have it backwards? Isn't the burden of proof of those presenting a story?
The story is itself a summation of evidence - quotations from interviews, links to other news articles, detailed facts found in research, photographs, etc.
It's reasonable and healthy to question the summation or the evidence, of course, but if you are going to suggest a fabrication -- which is quite a serious charge -- it seems to me you should have some specific facts of your own in support of that. Or at least some specific impressions (e.g. "this particular quote rings false because...").
(To reply to your first question, it seemed you were suggesting fabrication given the context in which you said that journalists frequently make things up, as a reply to a comment defending the newsworthiness of the story topic rather than commenting on its accuracy. Maybe you intended to reply to the parent comment?)
The Atlantic headline is IMHO bad though -- I would agree that applying the "Rap Legend" title is questionable when it doesn't even appear that Dr. Rapp cut a commercial release. Typically in music and art, individuals that get this term applied to them tends to be pioneers, very influential artists, or artists that have some other large notability. (IMHO KRS-One could qualify for the tag, for instance.)
The story is fine and interesting, the headline just detracts from it. The headline from earlier articles (such as the 2000 LA Times article http://articles.latimes.com/2000/apr/03/local/me-15542 -- "The self-prescribed therapy of Dr. Rapp") is much better IMHO.
I was a breaker all throughout highschool, and I loved it. I felt a strong sense of community I hadn't felt anywhere. Someone new could come in, willing to learn, and pretty much just get accepted to the group. My group of friends from that time were by far the most diverse (Chinese, Phillipino, Black, Australian, Native American, Mexican). And I'm from Utah-- Not a place known for diversity.
We all knew each other's skills, but we still respected each other. It was a pretty interesting dynamic. I love hip-hop culture, and, like the Dr., think violence has no place in it. Ahhh, the good ol' days.
For all the people saying it is fake unless there is a video on Youtube, pay attention to the dates in the article. Though clearly there were camcorders in 2000, not many people just carried them around. Some people did art, rap, music, sports, etc. just to do it, they didn't need to record it to satisfy their vanity for likes and comments.
Yeah, all these comments about Youtube videos, etc. are people that have either forgotten or are too young to remember a time before ubiquitous smartphones. It sounds like he was never signed to a label or recorded in a music studio so its completely reasonable that he was never recorded rapping.
> “There was a famous guy in Italy who had what they called ‘Pinocchio syndrome,’” said Alice Flaherty, a joint associate professor of neurology and psychiatry at Harvard Medical School. “When he told a lie, he would have a seizure. He was crippled as a businessman.”
Just for the young ones who might be tempted to believe the trolls -
Pre internet we still had the AP (Associated Press), if this was real we would have heard about it and seen it (Which we didn't)
There's more to it than "it's not on Youtube because camcorder footage is pre-Youtube".
And the point is the "Rap Legend" bit.
Stokes will cause people to do strange things, maybe he might have chosen rap when he never would have before.
But the concept it gives you superpowers it wrong and dangerous, it does not ever happen. A 62 who suddenly raps will not be good.... but might be having fun.
> “Sometimes I worked from 6 a.m. to 3 a.m.,” he recalled, adding that the pressures had cost him his first marriage.
I don't understand how a medical doctor can fail to consider sleep deprivation and overworking not to be a health threat. There is just so much evidence out there that sleep deprivation has similar health effects as alcohol consumption, both in terms of impaired cognitive abilities and long term health effects.