Each month a member of the ARRO Communications Subcommittee will review a non-fiction book that radiation oncologists may find particularly relevant or interesting. A preview of the review will be included in the ARROgram and residents are encouraged to read the full review at the link provided.
Blindspot: Hidden Biases of Good People
Mahzarin R. Banaji and Anthony G. Greenwald
Review: Dee Seneviratne, MD, Mayo Clinic Florida (PGY-3)
“Blindspot: Hidden Biases of Good People” is a book that explores how implicit bias informs our view of the world. The authors argue that although one may assume that he/she/they are able to assess every situation in an egalitarian manner, our outlooks are heavily influenced by our unspoken biases. This book points out that associating certain factors as “good vs. bad” is a natural phenomenon that many of us utilize to distinguish friends from enemies, and comfortable from threatening situations. However, this same innate ability can sometimes prove to be detrimental when applied to inappropriate situations. The books states that we subconsciously perform prejudiced actions daily, such as make connections between “good and thin”, instead of “good and fat”, and continue to subtly support racial/financial inequality by providing preferential treatments to white or wealthy individuals. This text is particularly interesting given that it was written by two psychologists, analyzes data from various psychosocial studies, and provides many examples of unconscious bias. For instance, the book discusses how professional women generally prefer a male boss and self-associate being a woman with family, and therefore often limit their own career ambitions. The text also heavily explores implicit racial bias and the concept of “white preference” that is held by many well-meaning individuals.
Additionally, the book discusses the utility of Race IAT test which attempts to reveal unspoken racial biases that the test taker may not be aware of. The authors note that the discrepancy between the IAT scores indicating prejudice and the lack of overt declarations of prejudice by these same individuals is usually related to societal expectations and the desire to be perceived as a non-biased individual.
Although the book does not investigate the impact of implicit bias on the delivery of healthcare, I felt that the its’ general points are quite applicable to our day to day interactions with the rapidly diversifying US patient population.
Unfortunately, the book does not discuss the origins of implicit biases in individuals, and whether early childhood neural network formation may play a role in the expression of prejudice as an adult.
Overall, I enjoyed this book and encourage others to read this and carefully examine their own biases. As the authors argue, being aware of these biases can help us better counteract them, and hopefully help us become better doctors and human beings.
Chasing My Cure: A Doctor's Race to Turn Hope Into Action; A Memoir by David Fajgenbaum
Review: Gavin Jones, MD
David Fajgenbaum, a former hale and hearty quarterback for the Georgetown University football team and an enterprising medical student at The University of Pennsylvania, noticed that he was feeling uncharacteristically ill whilst in the middle of his third-year Obstetrics/Gynecology clerkship rotation. With an innate sibylline presage that “[he] was dying,” without knowing how or why, David suddenly found himself in the throes of multisystem organ failure. In spite of an exhaustive workup and deliberative medical counsel - which included daily briefings with NIH directory Dr. Anthony Fauci - the etiology of Fajgenbaum’s diagnosis remained elusive and inscrutable to an army of health professionals.
When a barrage of medical tests finally yielded a putative cause, Idiopathic Multicentric Castleman Disease (MCD), the clouds of misfortune did not ceremoniously part. Fajgenbaum survived this initial harrowing encounter at death’s door, but he would later suffer multiple relapses of his condition, each time uncertain if this hospitalization would be his last; an ever-present reminder that the pathophysiology of his disease was not well understood, his treatment options increasingly limited, and his overall prognosis poor.
In spite of his tumultuous health saga, David proceeded to graduate medical school, residency and a Hematology/Oncology fellowship. After learning in his medical training that select cases of MCD had driver mTOR pathway mutations, Fajgenbaum - emboldened by a renewed sense of personal and professional purpose - sought to explore the potential therapeutic advantage of the drug sirolimus in his disease. His transformative discovery validated the notion that sometimes the most seemingly impenetrable obstacles in life submit to the most prosaic of solutions. Indeed, Dr. Fajgenbaum has prevailed to become an expert on Castleman disease, and continues to forge a path ahead as an internationally-recognized leader in the realm of MCD research.
There have been very few instances where I have found myself so engrossed by the contents of a book that I read it from cover to cover in one sitting. Such, however, was the case with Chasing My Cure. This book is positively gripping from start to finish - so lucid is the narrative and so absorbing are the sequence of events. It offers an interwoven medical mystery, love story, and redemption tale in one, recounted with a sense of candor and immediacy that reflect the author's uncommon humility, joie de vivre and strength of character.
So often in the medical literature, it seems that we are presented with narratives from either the patient or physician perspective. Rarely does one encounter a story that subsumes both domains - the physician as patient - much less one that offers a more moving account of the tribulations of sickness and health. The book’s ultimate, affirmative message is one of galvanizing hope into action. As Theodore Roosevelt once said: “Life brings sorrows and joys alike. It is what a man does with them - not what they do to him - that is the true test of his mettle.
I was, and am, truly inspired by David’s story. Take my advice: Read this book.
The Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good Life
Author: Mark Manson
Review: Mudit Chowdhary, MD
Do you find yourself feeling that you don’t know enough information during residency? Or feel like you are lagging behind your colleagues as they seem to be constantly publishing papers and winning awards? This form of thinking is called imposter syndrome, which is a collection of feelings of inadequacy that persist despite one’s own evident success. Imposter syndrome is particularly prevalent in medicine as perfectionism and competition is highly encouraged.
To help overcome these feelings, I highly recommend reading “The Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good Life by Mark Manson. Contrary to the title, Manson does not actually encourage people not to care. Rather, he urges "learning how to focus and prioritize your thoughts effectively -- how to pick and choose what matters to you and what does not matter to you based on finely honed personal values." The book helps teach self-awareness, values, and responsibility. So instead of spending time writing a manuscript just because everyone else is, you can focus on wholeheartedly pursuing your passions. Ultimately this helps you to become the best version of yourself, which provides more happiness and less anxiety in the long run.
Author: Vinayak Prasad, MD, MPH
Review: Gavin Jones, MD
Over the past few years, Dr. Vinayak Prasad has gained a reputation as this generation's medical “enfant terrible”—an iconoclast unafraid of ruffling a few feathers in pursuit of a higher plane of understanding and practice in healthcare. In his latest literary contribution “Malignant,” Dr. Prasad duly upholds that esteem in its best sense. In spite of all of the major medical inroads made in the name of our longstanding “War on Cancer,” it seems that the discipline of Oncology still falls prey to the predisposition of partiality, reaping of reward, and siren song of sensationalism to a disconcerting degree. Or so Malignant makes its case.
Consider, for instance, the use of autologous stem cell transplantation in breast cancer—a story that typifies so much of what the author sets his sights on in this book. Despite a hefty price tag of nearly $200,000 and no randomized clinical trials to support its use, this therapy was nevertheless adopted as a means to “rescue” patients from higher doses of toxically myeloablative chemotherapy from 1989 to 1995. Through an insidious combination of hype, biological plausibility, and surrogate clinical endpoints, scores of women were subjected to what was ultimately revealed to be an ineffective medical treatment costing billions of dollars in health care expenditure, and resulting in thousands of patients' deaths. Dr. Prasad singles this anecdote out early on as an illustration of how otherwise good medicine can, and does, go wrong in manifold ways. In doing so, he enjoins us to ask the questions explored in the remainder of the book: How are cancer therapies developed and delivered? How much should cancer therapies cost? How do we assess the effectiveness of cancer therapies, and what outcomes are really most important to people with cancer? As it turns out, the venial sins exemplified by the stem cell breast cancer debacle are still replete within the warp and weft of modern cancer care. This is not to mention the perverse incentives ensconced within our pharmaceutical market, or the corrupting influence of financial conflicts polluting many of its constituents.
In spite of all of this, Malignant never devolves to the level of contemptuous invective, nor is the text some wistful lament of the present day state of Oncology as a discipline. Instead, it offers a thoughtful and well-researched analysis of its topics, and is written with an elan that seems particularly well-suited to reading by medical students, residents, and fellows—those persons inhabiting the world described in the book, but not so advanced as to be deeply inculcated by its workings, or wholly resigned to its flaws. In this vein, the book is equally prescriptive as it is proscriptive, and Dr. Prasad outlines some common-sense measures to help ameliorate many of the problems he lays bare throughout its pages.
One of the most valuable themes that emerges from this text is the importance of independent medical literacy. We physicians find ourselves amidst a landscape in which the ability to scrutinize information is increasingly paramount. It is indeed hard to “do the homework” and filter through data on our own accord—to not to cede to the chorus of popular opinion or capitulate to suppositions of sloppy science. Dr. Prasad’s message, however, is resoundingly clear: to err is to be human, naturally, but we nevertheless owe it both to our patients and ourselves to put forth, and hold to, the best standard of cancer care possible. We may true the compass by which we chart our course in Oncology through a sound commitment to academic, financial and moral probity.
The Simple Path to Wealth: Your Road Map to Financial Independence and a Rich, Free Life
Author: J.L. Collins
Review: Ashley Albert, MD University of Mississippi Medical Center
One of the most popular presentations from this past year’s ARRO Annual Seminar was “Financial Literacy for Residents” by Dr. Kyle Russo and Dr. Trevor Royce also recently discussed financial health as an important component of resident wellness. So, we know trainees are seeking out financial information alongside their pursuit of becoming excellent radiation oncologists. In The Simple Path to Wealth, J.L. Collins lays out an easy-to-follow road map for financial success. As expected, simplicity is a key component of the financial plan described by Collins which makes it even more appealing for those who have dedicated years to their medical training but did not have the time or bandwidth to become financially literate. For anyone intimidated by the subject, this is a perfect starting place and as we face the economic impact of COVID-19, this information may be of even greater value. And for those who don’t want to spend money on the book purchase, most of the same material can be found in the Stock Series on the J.L. Collins blog!
The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care
Author: T. R. Reid
Review: Austin Sim, MD, JD, Moffitt Cancer Center
Health care reform has become an increasingly polarizing lightning rod in quotidian political discourse, but what does an affordable and equitable health care system actually look like? Although it is more than a decade old, T.R. Reid’s case study of global comparative health economics details his quest to obtain care for a shoulder injury in France, Germany, Japan, the UK and Canada. By systematically describing how his condition would have been treated in each country’s health care system, he outlines the tradeoffs each country has made to manage coverage, quality, cost and choice, giving us insight into the cultural underpinnings of each solution and presenting potential aspects we could import to ameliorate our own system in the United States.
With facile prose and clarity, T.R. Reid is able to distill complex systems into manageable sips, which can provide rich context to the ongoing health care debates during this election year and beyond. Physicians can only do so much good in a broken system. To truly optimize care, we must fix the system and T.R. Reid gives some insight into some tools at our disposal.
HBR Guide to Being More Productive
Author: Harvard Business Review
Review: Mudit Chowdhary, MD, Rush University Medical Center
Overwhelming. That’s the best descriptor for the beginning stages of radiation oncology residency. Time always seems to be in short supply as we are rushing back and forth between patient care to learning unique treatment planning software to finding time to study oncology, anatomy, radiology, radiation biology and physics. Thankfully, I was gifted the Harvard Business Review Guide to Being More Productive, which taught me some useful strategies for maximizing my time as a resident.
The book itself is an easy to read collection of short stories with tips on a variety of topics including time management, identifying your personal productivity style, improving your focus, dealing with distractions, how to motivate yourself even when you don’t really want to, setting boundaries with colleagues, among others. My favorite section though is on letting yourself take time off if feeling stressed!
Residency can be very stressful time and learning time management in order to find balance is key. I highly recommend this book for all incoming residents!
Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope
Author: Anthony Back
Review: Ashley Albert, MD, University of Mississippi Medical Center (Class of 2020)
Mastering Communication with Seriously Ill Patients: Balancing Honesty with Empathy and Hope is an informative guide written by physician experts on doctor-patient communication. While we all likely received some type of training in patient communication as medical students, this well-written book teaches more in-depth techniques based on research about how to genuinely convey empathy and compassion in order to gain the trust of our patients and understand their needs. This book challenges physicians to examine their current methods related to patient communication and ask for honest feedback from patients and others. It also provides useful roadmaps for various types of conversations we have with our cancer patients.
A particularly helpful section in the book deals with discussing prognosis. The approach physicians take to this step can be quite variable. Physicians may be categorized as a “realist,” “optimist,” or “avoider.” Each of these styles has advantages but it is important for oncologists to be aware of their own tendencies so that the delivery of information related to prognosis is done in a way that is best for each individual patient.
This book is full of valuable and insightful information that will encourage you to go beyond just learning the technical aspects of our field but also strive to excel in communication so that you can better serve your patients and their families.
Author: Liz Weisman
Review: Austin Sim, MD, JD, Moffitt Cancer Center (Class of 2021)
Multipliers explores the influence of different leadership styles and behaviors on team productivity. She puts leaders on a spectrum from “multipliers,” who extract and extend the intelligence of their team, to “diminishers,” who squander the talent of their team. While “multipliers” are able to effectively optimize their team by providing space and challenges to allow for growth into new roles while maintaining accountability, “diminishers” build empires rather than talent and attempt to remain the smartest in the room via micromanaging and dominating decision-making. Very few leaders act maliciously, but many exhibit unconscious behaviors to become “accidental diminishers.”
The exploration of leadership styles in this book serves as an easy-to-read primer as well as a practical how-to guide to identify negative leadership behaviors and promote positive ones with examples, cases, and exercises. Leadership skills are more important now than ever to ensure our patients receive the best care. Although we as radiation oncologists routinely lead teams once in practice, we get little formal training during residency as compared to residents in other medical specialties, in part due to the apprenticeship model employed by radiation oncology programs. In addition, while the majority of medical training has emphasized individual accomplishments optimal patient care requires building up the team rather than the individual. Thought-provoking and straight-forward, Multipliers is eminently readable in a span of a few hours and provides concise summaries at the end of each chapter; it deserves a spot on every provider’s shelf.