Learning Log – February 2016

There are so many ways that we learn new things. Since I started logging something new I learn every day – I am more conscious of how varied what I’m learning and the way I am learning it really is.

Observation is a way to learn new things. Birds were very active in February in our area and two ‘new to me’ observations were mourning doves making and geese climbing from open water up onto ice!

Experience. Several items on my learning log fit this category: 1) I started experimenting with not wearing my glasses and discovered that I rarely need them when I am working at my computer…and the neck/shoulder discomfort I had started to feel sometimes later in the day has completely disappeared. 2) Another learning experience this month was having a thyroid nodule biopsy; it was not bad but I really am not keen to have another one. 3) I learned to use a laminator (to make a tree identification guide more durable). It isn’t a big thing but was ‘new to me.’

Books. I started looked at the Hathi Trust collection of online books; there are so many items there is it overwhelming; botanical prints are my first ‘theme’ for browsing. On the physical book side, I read several books about Wild Life Refuges and have already started applying what I read to vacation planning; we’re going to visit the 4 National Wildlife Refuges on the Eastern Shore (of Maryland and Virginia) in March: Eastern Neck, Blackwater, Prime Hook and Chincoteague. In the Internet Archive arena my theme for browsing in February was ‘wallpaper’ with particular focus on wallpaper catalogs from the year I was born!

Udemy’s Photography Masterclass: Your Complete Guide to Photography). I finished as much of the class as I was interested in. I learned a few things but realized that I am spoiled by the quality of the courses I’ve taken on Coursera and Creative Live. The 4 Udemy courses I have taken are just not up to the same standard in terms of production or content.

Coursera’s Soul Beliefs (Unit 1). I finished the 11 ‘weeks’ of lectures for this portion of the course and will start on the Unit 2 lectures in March.

Coming up in March – there are already some other types of learning coming up: travel and ‘live’ classes.

The Participatory Patient

I am past the stage in my life that I accept everything a doctor tells me without question. I’ve come to realize that they are specialized and trying to meet patient expectations that can vary considerably. There may be some patients that always want a medical procedure or drug to solve a perceived problem since that is what my doctor seems to expect of patients. My expectation is just opposite; I want to avoid drugs and medical procedures unless absolutely necessary - where it is very clear that the benefit to me is greater than the risk (both short and long term).

I like the standards of care but expect that they are tweaked with data from my particular test results. And I expect the doctor to be current on the recommendations from analysis of similar situations (i.e. the big data of medicine) and be able to clearly explain their rationale for me.

But it is hard to be a participatory patient…and hard on doctors to with new studies coming out all the time and not necessarily in their area of specialty.

The situation that started my thinking about this was a recommendation that I get an ultrasound guided needle biopsy on a thyroid nodule. I did a search and discovered that my nodule was the minimal size for this recommendation. When I met with the surgeon, I brought this up and he admitted that it was ‘low risk, low value’ but recommended that I go ahead and have the biopsy before the nodule got bigger. I acquiesced – but it was marginal.

The procedure was done and then the results came back via the surgeon’s office a few days later: the nodule is benign and I was told to have another thyroid ultrasound in 6 months. In checking the literature, I discovered that new guidelines re thyroid nodules came out from the American Thyroid Association in January of this year…and their recommendation after a ‘benign’ cytology from a biopsy is 12 months for a thyroid ultrasound.

The net of all this is - if I don’t challenge the doctor’s recommendation the ultrasounds will be done more frequently than the guideline and that increases the cost to me (both in $ and time) and to my insurance company.

Now I’m beginning to wonder about the timing of a lot of diagnostics and checks. It is hard being a participatory patient!