HAHAHAHAHAHAH!!!

The motherfucking Cowboys fans booed the shit out of TO when he ran onto the field! HAHAHAHAHAHAHAHAH!!!!!!!

I hate to say this, but “GO GIANTS!!!!!!!!”

UPDATE: First Romo pass went to TO, perfect pass, and TO dropped it. The fans booed him mercilessly!!! HAHAHAHAHAHAHAH!!!!!!!!!!!!!!!!!!!!!!

Korean Airline Pilots, Arrogant Physicians, and Life-Or-Death Decisionmaking

Malcolm Gladwell’s new book, Outliers: The Story of Success (Little Brown), contains a very interesting discussion of the reasons for plane crashes. It turns out that very few plane crashes involve unsurmountable catastrophic mechanical failure. Rather, most plane crashes occur as the consequence of a chain of small human decision-making errors compounded by poor communication between pilots in the cockpit.

Up until a few years ago, Korean Air Lines was plagued by a much higher crash rate than other airlines. Analysis of cockpit voice recorder data from a number of Korean plane crashes revealed that the god-like status of captains and the relative subordination of their second officers frequently led to situations where the captain was fucking up, the second officer was clearly aware of the fuckup, but the second officer was either unwilling or unable to communicate to the captain the fact that he was fucking up.

In one horrifying case, the transcript reveals that just before their plane plowed into the side of a hill, the second officer was saying something to the captain like, “sometimes it is not so easy in bad weather at this airport to see the runway”, when it was clear that he knew they were headed for the hill and should have been shouting, “Dude! Pull up!!! We’re about to crash into the motherfucking hill!! PULL UP!!!”

Turns out that this is consistent with the strongly hierarchical nature of Korean culture, and that once Korean Airlines realized what was going on, they were able to train their Korean pilots to not behave hierarchically in the cockpit. Their crash rate immediately declined to typical industry-wide levels.

A recent New York Times article, Arrogant, Abusive and Disruptive — and a Doctor, recounts the following harrowing situation (h/t PalMD at Denialism):

It was the middle of the night, and Laura Silverthorn, a nurse at a hospital in Washington, knew her patient was in danger.

The boy had a shunt in his brain to drain fluid, but he was vomiting and had an extreme headache, two signs that the shunt was blocked and fluid was building up. When she paged the on-call resident, who was asleep in the hospital, he told her not to worry.

After a second page, Ms. Silverthorn said, “he became arrogant and said, ‘You don’t know what to look for — you’re not a doctor.’ ”

He ignored her third page, and after another harrowing hour she called the attending physician at home. The child was rushed into surgery.

“He could have died or had serious brain injury,” Ms. Silverthorn said, “but I was treated like a pest for calling in the middle of the night.”

Just like the second officer in the plane heading for the hill, this nurse was in possession of absolutely critical information in a life-or-death situation. And just like in the Korean Airlines cockpit, a culture of strict hierarchy resulted in a failure of essential communication of that information.

Many features of the medical training system reinforce the status of physicians as not only different from the other participants in the medical care system–nurses, physician assistants, technicians, etc–but superior, and to be deferred to. This is bad for patient care.

The fact of the matter is that physicians are, on average, no more intelligent, perceptive, or experienced than nurses, PAs, technicians, etc. They are, of course, in possession of specialized information and skills that other participants in the medical care system are not.

These communication breakdowns appear not to just be isolated incidents, as the Times article notes:

[A] survey by the Institute for Safe Medication Practices, a nonprofit organization, found that 40 percent of hospital staff members reported having been so intimidated by a doctor that they did not share their concerns about orders for medication that appeared to be incorrect. As a result, 7 percent said they contributed to a medication error.

Just as Korean Airlines was able to train its pilots to overcome the naturally hierarchical nature of Korean society, we should be able to train medical care providers to overcome the naturally hierarchical nature of the medical care system. This will lead to improvements in treatment outcome, and reduce suffering and premature death.

UPDATE: Check out my colleague PalMD’s post on this topic.

Open Letter To Keith Olbermann

Dude, Comrade PhysioProf loves you, and he hates George Bush as much as the next non-deranged American. But we are getting a little concerned about your continued single-minded focus on Bush and his sick-fuck right-wing supporters. Bush is a powerless lame duck. Power is beginning to nucleate arround Obama. Comrade PhysioProf demands that you hold Obama’s feet to the fire with the same critical rigor that you have Bush’s. If you do not, you will establish yourself as nothing but a political hackfuck just as bad as Bill Kristol.

Twelve Months Of Comrade PhysioProf

I got the idea from DoucheMonkey and think this is kind of a cool meme, so here we go with the first sentence of the first post of each of the months of 2008. (Comrade PhysioProf has exercised a mild editorial license in interpreting the terms “first sentence” and “first post”.)

January: This is my shiny new blog; still smells like that new car smell.

February: Jon Swift has the full story, but the bottom line is that this is the first anniversary of Blogroll Amnesty Day, a day that now is commemorated by smaller blogs who link to blogs even smaller than them.

March: I am so fucking pissed off right now, my eyes are crossing.

April: PhysioProf has been giving a lot of thought lately to the issue of foul language and civility.

May: The Reverend Wright foofaraw is just an inevitable consequence of the fact that in the United States we incorporate into our political discourse–indeed elevate to the highest level of importance–the delusional views of wackaloon religious assholes and the relationships of political candidates to those assholes.

June: I have noticed a few very confused ideas floating around blogtopia (anybody have any fucking clue who coined that word?) concerning the intrinsic nature of the depraved sick-fuck right-wing faction that has controlled the Republican Party for the last 40 years.

July: Commenter Terry had the following to say about news reports that Barack Obama is sucking religious wackaloon dick:

You know, it would really be great if a true liberal presidential candidate were available, one that would say, “Fuck You!” to the press, to the republicans, to the believers in some daddy sky fairy that will save them all by destroying the world.

August: When are you motherfucking dipwads gonna wake the fuck up and realize that there is no “reaching across the aisle” or “building bridges” with people who hate you, your values, your families, and everything you care about in life, and would like to see all of that destroyed?

September: Republican electoral success rests on a three-legged stool of depraved sick-fuck extreme far-right-wing factions.

October: The Democratic Party is the sober responsible spouse who continually cleans up after the out-of-control drunken asshole Republican Party spouse who crashes the car, fucks the babysitter, blows out all the credit cards, and then cries: “It wasn’t my fault; you should have stopped me!”

November: It is a very good thing that the Republican Party has been soundly defeated in the Presidential election yesterday.

December: “Hard-Working American” is right-wing scumspeak for “not a nigger or a spic”.

Question For Comrade PhysioProf’s Readers

Why is an opened bottle of amontillado sherry that has been sitting on my counter for months with an EtOH concentration of 18.5% still perfectly good, while a bottle of Ridge zinfandel that is 15.9% EtOH spoils within a few days of opening? Is it that small difference in EtOH that makes the difference, or something else? And why does an opened bottle of fruit juice last for weeks in the refrigerator, but not wine?

Mentoring Writers

One of the most important roles academics play as mentors is teaching their trainees how to write effectively, whether in science, the humanities, or whatthefuckever discipline. As soon as I see the first piece of writing produced by a new trainee in my lab, within seconds I either breathe a tremendous sigh of relief, or begin to cry forlornly.

It’s all about being able to write a decent sentence. If a trainee can write a decent English sentence that means what they want it to mean, then they can be taught to structure sentences into paragraphs, and paragraphs into papers, grants, etc. But if they can’t write a decent English sentence, I know to get ready for some serious hand-wringing and pulling out of my own hair. Because by the time people have graduated college, if they don’t know how to write a decent English sentence, there is little hope that they can learn.

I have read sentences written by some of my trainees that literally suck meaning out of the universe. They have negative information content. On one occasion, I crossed out an entire paragraph written by one of my trainees and commented beside it, “This is so wrong in so many different ways, I don’t even know what to say.”