Collaboration Versus Competition

The other day my wife and I were attending a parent information night at our daughters’ school. Our girls attend a small private school that utilizes a well-known alternative teaching method. During the course of the presentation, the teacher spent some time outlining the guiding principles of this alternative method. On this list of teaching philosophies was a bullet point that caught my attention. It read “collaboration versus competition.”

As a medical educator, this struck me. I’ve been reading a lot lately about what is wrong with medical education these days. It seems there are many who  feel there needs to be more emphasis placed upon “soft skills” rather than hard science. It is felt that enhancing these skills trains better physicians with greater ability to relate to patients.

I cannot say that I completely disagree with this idea. Having come up through a traditional medical school model and post-graduate medical training, I can see in my own self the changes that occurred  which can more or less be attributed to the system. This system breeds an ultra-competitive environment. As college undergrads we compete fiercely for GPA and MCAT scores to gain entrance to medical school. While in medical school we compete with our classmates to gain acceptance to coveted residency programs. While in residency, we work hard to distinguish ourselves among the group so that we can gain access to highly sought after fellowship training programs or practice opportunities.

It would be nice to say that the competition is limited to the educational and postgraduate training years but unfortunately it is not. Practicing physicians having gone through years of competition cannot shed this attribute easily. They often go into practice and continue to compete only this time for development of patient panels, income/compensation and now the increasingly important patient satisfaction scores.

Now more so than ever the practice of medicine has truly evolved into a team sport. Delivery of care that is compassionate, high quality and cost efficient will require adherence to the other “C – words.” These are communication, connectivity and collaboration. In order for the healthcare team to function effectively, the individual needs to be de-emphasized and the collective team approach should be championed. The good of the patient needs to be put in front of everything and failure to meet the needs of the patient should constitute a failure of the entire healthcare team.

I am fortunate in that I have the ability to participate in the development of a brand-new medical school campus. As a medical educator this is perhaps the most exciting prospect of my career. I see this as an opportunity to help create a new environment that rewards collaboration over competition. This would only make sense as this medical school is being born out of the collaboration between a major University and a private hospital. Furthermore, this new medical school, much like my daughter’s elementary school, will be an alternative educational venue. The school will be developed to marry the disciplines of medicine and engineering. The concept of collaboration is at the very crux of the development of this new institution. I can only hope that this spirit carries forward into the teaching methodologies of its future students.

I’ve been in practice for nearly 13 years. During this time I’ve seen rapid changes occur in the practice of medicine. It is essential that medical schools and postgraduate training programs adapt quickly to these changes. It is important that we are equipping the young men and women who carry our profession forward with the right tools to succeed.

I am not naïve enough to think that we can completely eliminate the competitive nature of medical education. There will always be some element of it being a “numbers game.” However, I don’t believe that there is a medical educator out there who can refute the idea that we all can do a better job of preparing our students to function as effective members of the healthcare team. This means more emphasis on developing communication and interpersonal skills. Perhaps medical students need to participate in more group project type activities like business school students. However,  it is incumbent upon us as the educators to lead by example. We ourselves need to change. We as educators and practicing physicians need to model the type of behavior that we expect in our students.

In closing, think about this. Many times when the healthcare system fails a patient, it is not based upon a cognitive or technical error. Often times is the result of a poorly functioning team and lack of effective communication. We’ve done a reasonable job over the years in teaching our students the hard skills needed to become physicians. However, we now need to expand this, to foster an environment of cooperation and collaboration. This will ensure that our students will thrive in the profession throughout the years to come.

Top 5 Reasons Why The Beach Is Better Than Disney World

The bulk of my vacation time is spent in Florida either at Walt Disney World or on the beaches of South Walton.  I am just going to come out and say that I hate Disney.  I only indulge a WDW vacation for the sake of my wife and kids who are Disney aficionados…not Disney Geeks…but aficionados.  But I feel the need to back up my disdain for the swampy resortland that is WDW.  As I sit on my balcony with a cool gulf breeze tickling my head stubble, sipping a pomegranate-citrus mojito I have had a chance to organize my thoughts as to why this is the case.  SO….here are my top five reasons (in no particular order) of why the beach is better than Disney.

1.  COST.  I don’t care whose mouse butt you’ve been kissing, there is no such thing as an affordable Disney vacation.  Whether it is lodging, meals, park tickets or all the extra crap, a WDW vacation will be sure to send you into debt snowball hell and cause Dave Ramsey to vomit incessantly on your behalf.  Forget all the talk of special deals, meal plans, etc., WDW vacations are expensive beyond belief and I honestly don’t know how most people afford them.  The beach on the other hand is about simple pleasures.  The only parades you will see at the beach are of cosmetically enhanced southern women trying to be sexier than their teenage daughters.  But I digress.  We don’t need theme parks or nightly firework/lightshow displays to be happy.  Give us the crashing waves and a nice walk on the beach.  The other day we rode a roller coaster that had to be pushed by the attendant by hand to get started.  No joke!  The scariest thing was wondering whether the whole thing was going to come crashing down.  The only castles you will see are built by hand…by children.  Nobody is a princess (except for those southern women) or prince…everyone is a dude.  That is what is good for the soul…and the bank account.

Hunting For Shells on the Emerald Coast-SIMPLICITY

2.  LINES.  I am admittedly one of THE most impatient beings in the entire world.  If I had to wait in line to get into Heaven I would opt for purgatory or Hell just to avoid the line.  That said, WDW is a special kind of hell for me.  Where else can you spend ridiculous amounts of money to spend probably a third of the time waiting in line.  It’s egregious.  Sorry folks, the Haunted Mansion ain’t worth a 90 minute wait!  And FASTPASS my ASS!  These are not the answer.  They are too restrictive.  What WDW really needs is a VIP pass that gets one to the front of the line ALL DAY LONG- no restrictions.  I would actually pay good money for this as I would actually be able to get my money’s worth out of the theme park instead of waiting in line all damned day.

3. FOOD.  Everywhere you go there is food and not the good kind.  My wife and I are fairly health conscious but ferchissakes one can only resist a Dole Whip or Mickey Ice Cream Bar for so long.  And don’t get me started on those turkey legs.  Damn!  They look and smell so friggin’ good but my wife has threatened me with divorce if I ever ate one in public….so.  WDW is not the place for healthy eating. At the beach it’s all about freshness.  We have twice weekly farmers’ markets, fresh seafood and fish tacos….I repeat… FISH. F&^%ING. TACOS.

4.  PHYSICAL ACTIVITY.  Not only am I eating like a king at WDW but I’m deprived of my most basic of human needs…a WORKOUT! I am a triathlete so I am pretty versatile in how I can exercise but WDW seems to have a way to prevent me from doing pretty much everything.  The resorts are land locked by insanely busy highways which make running or cycling outside difficult at best.  There is not a pool anywhere in the greater Orlando area that is remotely hospitable to lap swimming.  I suppose I could avail myself of a spin class at the resort health club but that’s about as lame on vacation as it is in real life.  I’ll pass.  In contrast, the beach begs me to be active.  I can run, ride my bike, swim in lap pools or the gulf.  Hell, just playing out in the surf with my kids for a few hours burns enough calories to entitle me to snow cone or two.

Me and Da Gubna

5. SCHEDULES.  I spend my entire working life getting up early, working late, tied to my desk. I have meetings, lectures and other commitments.  Oh and let’s not forget all the scheduled family activities such as sports, etc.  Vacation is supposed to be break from that.  So explain to me how getting up at 6am so I can be at a 7am character breakfast and in the park by 8am is the least bit relaxing.  I much prefer ‘beach time.’  You get up whenever.  Maybe you go to the beach.  Maybe you go to the pool. Maybe you ride your bike.  You wanna crack a Dale’s Pale Ale at 10am…go ahead.  There are no schedules at the beach.  It’s five o’clock somewhere…all….the…time…at the beach.

OK…so there it is.  Maybe you agree or disagree.  Maybe I secretly long for a ride on the Rockin Roller Coaster.  I’ll never tell.

A Real Pain in the Ass for Cyclists



My  legs have been pretty heavy this past week. My runs have been tough and my last road ride on Friday morning left me with some soreness that I’ve not experienced before. I knew I was going to be in the car all day Saturday so I was looking forward to a day of rest.

Apparently 14 hours in the car wasn’t exactly the kind of day off that my legs needed. I woke up Sunday morning with a terrible pain in my left hip, buttock  and shooting down my left leg. By now, most of you are probably thinking that I have a lumbar disc/ sciatica problem. While that is a good thought, I’m here to tell you about what I think the real problem is: Piriformis syndrome.

Piriformis Syndrome, or PS as I will heretofore refer to it as, is the condition usually afflicting athletes such as runners or people who sit a lot. I know…damned if you do….damned if you don’t!  It’s caused by inflammation of the piriformis muscle which is a hip stabilizer deep in the buttock region. When this muscle becomes inflamed it can actually impinge upon the sciatic nerve causing symptoms that are very similar to lumbar disc degeneration.

When I palpated my ass through my lycra spandex cycling kit this morning I could feel a knotted muscle and there was a definite trigger point that caused shooting pain down my leg.  Otherwise, most of the time the pain is nagging and seems to be aggravated by lateral hip and thigh movement.  Sunday afternoon I was out in some moderate surf playing with the kids at the beach and I could tell every time the waves shifted me to the left and required resistance.  It hurt.  Not terribly but noticeable.

So why am I pouring all this out in my blog.  Trust me, I’m NOT  looking for sympathy.  It’s more of a PSA.  Judging by the number of lumbar spine and hip films I read each week, these are common presenting complaints by patients to their doctors.  A suspicion of lumbar disc disease usually exists and an imaging workup will ensue.  This could involve xrays, CT scans and even MRIs.  This is expensive and involves radiation exposure.

I know, I know…I shouldn’t be discouraging medical imaging.  After all that is how I make my living.  But I actually care just a  little about you guys.  So here’s the deal.  If you are an active dude or dudette and have these symptoms keep this diagnosis in the back of your mind and mention it to your doctor.  If he/she is not a sports medicine physician, then they might not be keyed into it and will go down that path of lumbar radiculopathy.  That can lead to expensive diagnostics and treatment.

It seems the treatment for PS is actually pretty conservative.  It is recommended that the offending activity be curtailed first and foremost.  REST.  Ah…well….if you are reading this you might be an endurance athlete and we don’t do rest well, do we?  Anti-inflammatory medications might also help in acute flare ups.  Direct massage of the affected area can be helpful.  Sometimes the piriformis muscle can be palpated as an over-contracted ball of muscle in the buttock region.  Direct massage or using our great friend the foam roller could help.  There is also some stretching that can be done to alleviate the symptoms.  If you are not comfortable massaging your own ass you can always call this guy.



Otherwise some alternative forms of treatment such as osteopathic or chiropractic manipulation might be of use.  I can tell you that 5 minutes of self massage really provided me some relief before my ride this morning.  The point of the all this is that if PS is really what you are dealing with and not lumbar disc disease then you shouldn’t need a bunch of expensive tests and treatment.

Anyway, I hope my sore ass and thigh have helped you understand a little about the little known entity that is Piriformis Syndrome. Keep it mind (or your doctor’s mind) if you are having butt pain and shooting pain down your thigh and leg. Stay well my friends!