Things they didn’t teach in medical school: Part 11 Public Speaking

This will be a brief one: they didn’t teach public speaking in medical school.

I did toastmasters in high school and then after doing the college exams and losing all humility I thought I was OK at public speaking. The a couple of years ago I gave a talk at a conference I was all nerves – it was the International Liver Cancer Association Meeting and I think it was the first and only presentation from an Australian. The room was one of those in which you were blinded by lighting and couldn’t see the audience well. All of the ‘gods’ were either on the stage panel or got up to ask questions afterwards. For the first time in ages I got ‘nerves’.

Speaking in public is something I actually have to do all the time but it is not always straight forward.

Here are some tips – both practical an perhaps tongue-in-cheek:

Tips on Public Speaking

Accountability, Blame and Empowerment

A lot is being made at the moment about the growing patient/consumer empowerment movement. Empowerment and engagement is seen not only as a step to improving the health of individuals but also lowering total health care costs.

It is interesting to see these two contrasting views re-posted on the KevinMD site:

Stop blaming patients for not doing enough to stay health

&

Make patients more accountable for their health

These views highlight the complexity of empowerment. Yes people should be responsible for their health. At the same time incentives and penalties for taking/not taking responsibility should not be discriminatory.

One way to approach this is to de-emphasise the individual and look more at cultural and societal factors. If we look at the obesity epidemic for example – we’ve got here because of the marketing of myths about diet and metabolism and industries built around encouraging us to eat foods that predispose to insulin dysregulation irrespective of the total caloric intake. To address this needs changes in food policy and re-education. We aren’t going to cause a reversal in the obesity epidemic by penalising people for being fat.

The other thing is empowerment shouldn’t be burdensome. Empowerment should be about creating habits that people don’t have to think about. As I saw on twitter yesterday – what we need is to get people addicted to health.

“I don’t know where to start” – Studying during medical specialty training

Perhaps the commonest complaint of my trainees when they are in the first year of their specialty (medical oncology) training is that they just don’t know where to start. In one respect this is understandable – the party-line is you need to know everything.

These are my tips:

(1) study stuff that will make your job easier. If you don’t know how to prescribe anti-emetics to prevent chemotherapy-induced nausea then read up on this.

(2) study stuff you see in clinic or on the wards that you didn’t know anything about. This entails keeping a list – get a notebook, send yourself an SMS or email, use Evernote or a similar app to remind yourself what you need to look up.

(3) do sweat on the small stuff. In this case the small stuff is the basic science behind treatments. By knowing this you will be able to do the higher level activities better.

(4) have a plan. Set yourself a goal about knowing about a particular topic by a certain time.

(5) have a template of questions. Really – it is not possible to go and learn about ‘colon cancer’ without a targeted plan. Think of questions that that apply across disciplines e.g. is systemic chemotherapy useful for metastatic colon cancer, in monotherapy better than polychemotherapy, what is the optimal duration of therapy, etc, etc???

(6) study stuff that interests you – the other stuff will fall into place naturally

(7) volunteer to present at meeting or to teach – then you will be forced to study

(8) pick something you think you already know and revise it – get up-to-date

(9) close your eyes and drop your finger on a contents page