Practice Illusion of knowledge Mastery Enjoyment and pleasure Guidelines

1. Practice • Illusion of knowledge • Mastery • Enjoyment and pleasure • Guidelines

2. Hugh H. Macaulay, III, MD Occupational Medicine Consulting Englewood, CO hhm@occmedconsult.net

3. Colorado Medical Treatment Guidelines: A Practitioners Perspective

4. Practice of medicine • Illusion of knowledge • Mastery and Enjoyment • The Guidelines

5. What is the Practice of Medicine?

6. Free Dictionary • Noun1.practice of medicine - the learned profession that is mastered by graduate training in a medical school and that is devoted to preventing or alleviating or curing diseases and injuries

7. Shamanism Remains

11. Medical Practice is a journey

12. The illusion of knowledge • information and accuracy • belief that our basic understanding is actually a deep understanding

14. http://www.youtube.com/watch?feature=player_detailpage&v=IGQmdoK_ZfYhttp://www.youtube.com/watch?feature=player_detailpage&v=IGQmdoK_ZfY

18. The illusion of knowledge: When more information reduces accuracy and increases confidence Organizational Behavior and Human Decision Processes, Vol 103, pp 277-90, 2007 Drs. Hall and Ariss, Department of Psychology, Princeton University Basketball wagers based on statistics and then with knowing the teams

19. Dr. Daniel Simons, Department of Psychology, University of Illinois notes: There is a phenomenon in cognitive science popularly known as the “Illusion of Knowledge,” which says that we have “the tendency to think we have a better understanding than we actually do.” One element of this illusion, Simons says, is our belief that our basic understanding is actually a deep understanding.

20. Our over-confident brains can leave us with a false sense of security about daily decisions. The illusion of knowledge is necessary to prevent us from having to face our own incompetence.

22. Mastery

23. "A little learning is a dang'rous thing; Drink deep, or taste not the Pierian spring: There shallow draughts intoxicate the brain, And drinking largely sobers us again.” Alexander Pope, An Essay on Criticism Fir'd at first sight with what the Muse imparts, In fearless youth we tempt the heights of Arts, While from the bounded level of our mind Short views we take, nor see the lengths behind; But more advanc'd, behold with strange surprise New distant scenes of endless science rise! So pleas'd at first the towering Alps we try, Mount o'er the vales, and seem to tread the sky, Th' eternal snows appear already past, And the first clouds and mountains seem the last; But, those attain'd, we tremble to survey The growing labours of the lengthen'd way, Th' increasing prospects tire our wand'ring eyes, Hills peep o'er hills, and Alps on Alps arise!"

24. Eugen Herrigel, German philosopher and author (Zen and the Art of Archery) "practice, repetition and repetition of the repeated with ever increasing intensity are its distinctive features for long stretches of the way.“ This brings mastery and understanding of self and the art.

25. George Leonard • Mastery comes from the process of getting there. Mastery is practice. Mastery is staying on the path. Masters don’t devote themselves to their particular skill just to get better at it. The truth is, they love to practice—and because of this, they do get better • One becomes so engrossed in the process that everything else falls away. Time of best work. During this time (the flow) enjoyment comes from the practice itself. Enjoyment is an intrinsic value. Pleasure is extrinsic. Enjoyment is active; pleasure is passive.

26. Malcolm Gladwell in his book Outliers highlighted the notion that become expert if anything, you must devote at least 10,000 hours to it. Robert Greene said 20,000 hours. Fuse The Intuitive With The Rational: Mastery

27. "The moment is the hard work. It is the simple joy of being absorbed us something use of doing; forgetting about everything but the task at hand; and one day, to your surprise, discovering that you are better at it then used to be, even if you still have a long way to go"

28. Mihaly Csikszentmihalyi "Repression is not the way to virtue. When people restrain themselves out of fear, their lives are by necessity diminished. Only through freely chosen discipline can life be enjoyed and still kept within the bounds of reason."

29. Enjoyment is intrinsic; pleasure is extrinsic. This is at the heart of mastering anything. If you do not learn to love practice, you will not get very far--or if you do, it will be more of a forced march than a rewarding journey

30. Mental state in terms of challenge level and skill level,

31. We have talked about: The nature of practice The illusion of knowledge Mastery The flow with matching of skills and challenge So, how does this apply to me? I’m a doctor and treat and heal my patients. I know what I am doing.

32. In the case of lumbar fusion, there was nearly a 20-fold range in ratesSpine. 2006 Nov 1;31(23):2707-14.United States' trends and regional variations in lumbar spine surgery: 1992-2003.

33. There was a nearly 8-fold variation in regional rates of lumbar discectomy and laminectomy Spine, 2006 Nov 1;31(23):2707-14.United States' trends and regional variations in lumbar spine surgery: 1992-2003.

34. A murderer is condemned to death. He has to choose between three rooms. The first is full of raging fires, the second is full of assassins with loaded guns, and the third is full of lions that haven't eaten in 3 years. Which room is safest for him? A woman shoots her husband. Then she holds him under water for over 5 minutes. Finally, she hangs him. But 5 minutes later they both go out together and enjoy a wonderful dinner together. How can this be? Can you name three consecutive days without using the words Wednesday, Friday, or Sunday?

37. Whoa dude, I came here to learn about this guideline stuff.

39. The Guidelines of Colorado

45. OK, bucks saved, but how can I practice using these things.

46. Amenhotep I 1500 BC

47. Ebers papyrus Bricks and herbs for asthma treatment of cancer.

48. Edwin Smith papyrus

49. Edwin Smith papyrus • The world's earliest known medical document • 17th century BCE, • describes anatomical observations and the examination, diagnosis, treatment, and prognosis of numerous injuries in exquisite detail. • Imhotep is credited as the founder of Egyptian medicine and the original author of the papyrus, although internal evidence suggests it was written and edited by at least three different authors, the last of which stopped mid-word. It is a compilationof 48 battlefield injury cases and the treatments that the victims had received. • The treatments are rational, and magic is resorted to in only one case. • The document lists 48 traumatic injury cases and its treatments. The document starts with the injuries on the head and then works its way down the body all the way to the feet, as in any modern medical document. • It predates Hippocrates by over a thousand years.

50. Hippocrates 460 to 370 BC