Sent on behalf of Dr. M. Luterman
Procrastination is a complex psychological behavior that affects everyone to some degree or another. With some it can be a minor problem; with others it is a source of considerable stress and anxiety.
Procrastination is only remotely related to time management, (procrastinators often know exactly what they should be doing, even if they cannot do it), which is why very detailed schedules usually are no help.
The procrastinator is often remarkably optimistic about his ability to complete a task on a tight deadline; this is usually accompanied by expressions of reassurance that everything is under control.
(Therefore, there is no need to start.) For example, he may estimate that a paper will take only five days to write; he has fifteen days; there is plenty of time; no need to start. Lulled by a false sense of security, time passes. At some point, he crosses over an imaginary starting time and suddenly realizes, "Oh no! - I am not in control! There isn't enough time!”
At this point, considerable effort is directed towards completing the task, and work progresses. This sudden spurt of energy is the source of the erroneous feeling that “I only work well under pressure.” Actually, at this point you are making progress only because you haven't any choice. Your back is against the wall and there are no alternatives. Progress is being made, but you have lost your freedom.
Barely completed in time, the paper may actually earn a fairly good grade; whereupon the student experiences mixed feelings: pride of accomplishment (sort-of), scorn for the professor who cannot recognize substandard work, and guilt for getting an undeserved grade. But the net result is reinforcement: the procrastinator is rewarded positively for his poor behavior. (“Look what a decent grade I got after all!”) As a result, the counterproductive behavior is repeated over and over again.
Positive reinforcement for delay (a good grade) is a principal contributor to continued procrastination.
Other Characteristics:
Low Self-Confidence - The procrastinator may struggle with feelings of low self-confidence and low self-esteem. He may insist upon a high level of performance even though he may feel inadequate or incapable of actually achieving that level.
I'm Too Busy - Procrastination may be used to call attention to how busy he is. “Obviously I cannot do such and such because my affairs are so complicated and so demanding. That is why I am late, etc.” The procrastinator may even spend considerable time justifying his reasons, time that could be spent doing the work.
Stubbornness - Procrastination may be used as an expression of stubbornness or pride: “Don't think you can push me around. I will do it when I'm good and ready.”
Manipulation - Procrastination may be used to control or manipulate the behavior of others.
“They cannot start if I am not there.” Let's face it: deliberate delay drives others crazy. Coping with Pressures - Procrastination is often truly difficult to eradicate since the delay behavior has become a method of coping with day-to-day pressures and experiences. Obviously if one is cured, others will put new demands and expectations upon you. It's easier to have an excuse, to delay, to put off.
A Frustrated Victim - The procrastinator often feels like a victim: he cannot understand his behavior or why he cannot get work done like others. The whole thing is a frustrating mystery. The reasons for his behavior are hidden from him.
Bottom line....if you identify these behaviors in a student, talk to Karl or myself. After discussing it we may want to seek out some help if it is adversely affecting the student's performance.
Monday, December 14, 2009
Clinical Skills Pearl Vol 2 (#16): Adrenal Insufficiency Part 1
Sent on behalf of Dr. M. Luterman
Topic is Adrenal Insufficiency.
Who was Addisson?
What is his disease?
Which is more common primary or secondary disease?
What are the symptoms?
Dr Thomas Addison was a the British physician who first described the condition in his 1855 publication On the Constitutional and Local Effects of Disease of the Suprarenal Capsules. The adjective"Addisonian" is used for features of the condition, as well as patients with Addison's disease.
Adrenal insufficiency leads to a reduction in the output of adrenal hormones i.e. glucocorticoids and/or mineralocorticoids. There are two types of adrenal insufficiency:
1) Primary insufficiency - there is an inability of the adrenal glands to produce enough steroid hormones (Addison's disease is the name given to the autoimmune cause of this insufficiency). Glucocorticoid and often mineralocorticoid hormones are lost.
2) Secondary insufficiency - there is inadequate pituitary or hypothalamic stimulation of the adrenal glands.
Epidemiology
Primary insufficiency - rare 0.8 per 100,000; affects both sexes equally and can occur at any age.
Secondary insufficiency - relatively common compared to the primary type as exogenous steroid use is frequent leading to suppression of the hypothalamic-pituitary axis.
Presentation:
Note: Advanced adrenal insufficiency is more easier to diagnose but recognition of early cases is more difficult.
Presentation in part depends on the rapidity of adrenal hypofunction Acute - e.g. Waterhouse-Friderichsen syndrome (infarction secondary to septicaemia e.g. meningococcal); presents with collapse and shock 2 Chronic - symptoms develop insidiously and may be mild.
Symptoms
Fatigue and weakness
Anorexia
Nausea
Vomiting
Weight loss
Abdominal pain
Diarrhoea
Constipation
Syncope
Dizziness
Confusion
Personality change
Irritability
Amenorrhoea
Signs
Cutaneous and mucosal pigmentation - look at mucosa and in new scars
Hypotension
Postural hypotension
http://www.patient.co.uk/showdoc/40024894/
Topic is Adrenal Insufficiency.
Who was Addisson?
What is his disease?
Which is more common primary or secondary disease?
What are the symptoms?
Dr Thomas Addison was a the British physician who first described the condition in his 1855 publication On the Constitutional and Local Effects of Disease of the Suprarenal Capsules. The adjective"Addisonian" is used for features of the condition, as well as patients with Addison's disease.
Adrenal insufficiency leads to a reduction in the output of adrenal hormones i.e. glucocorticoids and/or mineralocorticoids. There are two types of adrenal insufficiency:
1) Primary insufficiency - there is an inability of the adrenal glands to produce enough steroid hormones (Addison's disease is the name given to the autoimmune cause of this insufficiency). Glucocorticoid and often mineralocorticoid hormones are lost.
2) Secondary insufficiency - there is inadequate pituitary or hypothalamic stimulation of the adrenal glands.
Epidemiology
Primary insufficiency - rare 0.8 per 100,000; affects both sexes equally and can occur at any age.
Secondary insufficiency - relatively common compared to the primary type as exogenous steroid use is frequent leading to suppression of the hypothalamic-pituitary axis.
Presentation:
Note: Advanced adrenal insufficiency is more easier to diagnose but recognition of early cases is more difficult.
Presentation in part depends on the rapidity of adrenal hypofunction Acute - e.g. Waterhouse-Friderichsen syndrome (infarction secondary to septicaemia e.g. meningococcal); presents with collapse and shock 2 Chronic - symptoms develop insidiously and may be mild.
Symptoms
Fatigue and weakness
Anorexia
Nausea
Vomiting
Weight loss
Abdominal pain
Diarrhoea
Constipation
Syncope
Dizziness
Confusion
Personality change
Irritability
Amenorrhoea
Signs
Cutaneous and mucosal pigmentation - look at mucosa and in new scars
Hypotension
Postural hypotension
http://www.patient.co.uk/showdoc/40024894/
Monday, December 7, 2009
PBL Pearl Vol 2 (#15): Feedback Part 2 -- How to give it
Last week we discussed receiving feedback.....this week the tips are on how to give it....remember giving it incorrectly can be quite harmful as can not giving it....yin and yang.....some tips (from the University of Waterloo)....
Dr. Luterman
*******************************************************
Giving Effective Feedback:
• Prioritize your ideas. Limit your feedback to the most important issues. Consider the feedback’s potential value to the receiver and how you would respond – could you act on the feedback? As well, too much feedback provided at a single time can be overwhelming to the recipient.
• Concentrate on the behavior, not the person. One strategy is to open by stating the behavior in question, then describing how you feel about it, and ending with what you want. This model enables you to avoid sounding accusatory by using “I” and focusing on behaviors, instead of assumed interpretations.
Example: “I haven’t seen you in class in for a week. I’m worried that you are missing important information. Can we meet soon to discuss it?”
Instead of: “You obviously don’t care about this course!”
• Balance the content. Use the “sandwich approach.” Begin by providing comments on specific strengths. This provides reinforcement and identifies the things the recipient should keep doing. Then identify specific areas of improvement and ways to make changes.
Conclude with a positive comment. This model helps to bolster confidence and keep the weak areas in perspective.
Example: “Your presentation was great. You made good eye contact, and were well prepared. You were a little hard to hear at the back of the room, but with some practice you can overcome this. Keep up the good work!”
Instead of: “You didn’t speak loudly enough. However, the presentation went well.”
• Be specific. Avoid general comments that may be of limited use to the receiver. Try to include examples to illustrate your statement. As well, offering alternatives rather than just giving advice allows the receiver to decide what to do with your feedback.
• Be realistic. Feedback should focus on what can be changed. It is useless and frustrating for recipients to get comments on something over which they have no control. Also, remember to avoid using the words “always” and “never.” People’s behavior is rarely that consistent.
• Own the feedback. When offering evaluative comments, use the pronoun “I” rather than “they” or “one,” which would imply that your opinion is universally agreed on. Remember that feedback is merely your opinion.
• Be timely. Seek an appropriate time to communicate your feedback.
Being prompt is key since feedback loses its impact if delayed too long. Delayed feedback can also cause feelings of guilt and resentment in the recipient if the opportunity for improvement has passed. As well, if your feedback is primarily negative, take time to prepare what you will say or write.
• Offer continuing support. Feedback should be a continuous process, not a one-time event.
After offering feedback, make a conscious effort to follow up. Let recipients know you are available if they have questions, and, if appropriate, ask for another opportunity to provide more feedback in the future.
*******************************************************
Dr. Luterman
*******************************************************
Giving Effective Feedback:
• Prioritize your ideas. Limit your feedback to the most important issues. Consider the feedback’s potential value to the receiver and how you would respond – could you act on the feedback? As well, too much feedback provided at a single time can be overwhelming to the recipient.
• Concentrate on the behavior, not the person. One strategy is to open by stating the behavior in question, then describing how you feel about it, and ending with what you want. This model enables you to avoid sounding accusatory by using “I” and focusing on behaviors, instead of assumed interpretations.
Example: “I haven’t seen you in class in for a week. I’m worried that you are missing important information. Can we meet soon to discuss it?”
Instead of: “You obviously don’t care about this course!”
• Balance the content. Use the “sandwich approach.” Begin by providing comments on specific strengths. This provides reinforcement and identifies the things the recipient should keep doing. Then identify specific areas of improvement and ways to make changes.
Conclude with a positive comment. This model helps to bolster confidence and keep the weak areas in perspective.
Example: “Your presentation was great. You made good eye contact, and were well prepared. You were a little hard to hear at the back of the room, but with some practice you can overcome this. Keep up the good work!”
Instead of: “You didn’t speak loudly enough. However, the presentation went well.”
• Be specific. Avoid general comments that may be of limited use to the receiver. Try to include examples to illustrate your statement. As well, offering alternatives rather than just giving advice allows the receiver to decide what to do with your feedback.
• Be realistic. Feedback should focus on what can be changed. It is useless and frustrating for recipients to get comments on something over which they have no control. Also, remember to avoid using the words “always” and “never.” People’s behavior is rarely that consistent.
• Own the feedback. When offering evaluative comments, use the pronoun “I” rather than “they” or “one,” which would imply that your opinion is universally agreed on. Remember that feedback is merely your opinion.
• Be timely. Seek an appropriate time to communicate your feedback.
Being prompt is key since feedback loses its impact if delayed too long. Delayed feedback can also cause feelings of guilt and resentment in the recipient if the opportunity for improvement has passed. As well, if your feedback is primarily negative, take time to prepare what you will say or write.
• Offer continuing support. Feedback should be a continuous process, not a one-time event.
After offering feedback, make a conscious effort to follow up. Let recipients know you are available if they have questions, and, if appropriate, ask for another opportunity to provide more feedback in the future.
*******************************************************
Clinical Skills Pearl Vol 2 (#15): Thyroid Nodules
Sent on behalf of Dr. M. Luterman
The American Association of Clinical Endocrinologists (AACE) released medical guidelines for the diagnosis and management of thyroid nodules. The new guidelines were developed by a panel of experts who encompassdifferent disciplines, including endocrinology, nuclear medicine.
The guidelines emphasize the importance of thyroid nodules in clinical practice. Thyroid nodules are common in the general population and they are typically discovered by palpation in 3% to 7% and by ultrasound (US) examination in 20% to 75%. "Extra" nodules are detected by ultrasound in up to 50% of patients with a single palpable thyroid
nodule.
The estimated annual incidence rate of 0.1% translates into approximately 300,000 new nodules that will be discovered in the U.S. this year. The overall frequency of malignancy in thyroid nodules is approximately 5%, requiring careful selection of patients for surgical treatment.
The panel agreed that all patients with palpable nodules should undergothyroid US examination and FNA. Ultrasound-guided FNA biopsy is suggested for a nodule yielding unsatisfactory aspirate on initial palpation-guided FNA; micronodules <1 cm; impalpable nodules; and for alcohol ablative therapy. The guidelines recommend that micronodules should be selected for biopsy primarily by history and ultrasound characteristics, rather than by size alone.
Click here for a link to the article (requires McMaster login).
The American Association of Clinical Endocrinologists (AACE) released medical guidelines for the diagnosis and management of thyroid nodules. The new guidelines were developed by a panel of experts who encompassdifferent disciplines, including endocrinology, nuclear medicine.
The guidelines emphasize the importance of thyroid nodules in clinical practice. Thyroid nodules are common in the general population and they are typically discovered by palpation in 3% to 7% and by ultrasound (US) examination in 20% to 75%. "Extra" nodules are detected by ultrasound in up to 50% of patients with a single palpable thyroid
nodule.
The estimated annual incidence rate of 0.1% translates into approximately 300,000 new nodules that will be discovered in the U.S. this year. The overall frequency of malignancy in thyroid nodules is approximately 5%, requiring careful selection of patients for surgical treatment.
The panel agreed that all patients with palpable nodules should undergothyroid US examination and FNA. Ultrasound-guided FNA biopsy is suggested for a nodule yielding unsatisfactory aspirate on initial palpation-guided FNA; micronodules <1 cm; impalpable nodules; and for alcohol ablative therapy. The guidelines recommend that micronodules should be selected for biopsy primarily by history and ultrasound characteristics, rather than by size alone.
Click here for a link to the article (requires McMaster login).
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