All in all, they have always been in the majority. Although not very big and not very visible, they have made their marks on world history. Unlike human kind who generally takes itself very seriously, wearing tie and suit to a room full of plush to discuss the seriousness of the situation, viruses need less words. For the better. After all, words are only the harbinger of what really matters: deeds.

And so it happens that this small group of particles as a collective suddenly pulls the emergency brake to solve a problem that has been daunting above our heads for years. With the development of our brains, we seem to divide problems into four quadrants. In increasing degrees of difficulty, we have short-term problems that are concrete (a broken leg or a flooded kitchen), short-term problems that are abstract (extremely high blood pressure or burnout), long-term problems that are concrete (incurable cancer or litter in the forest) and long-term problems that are abstract (smoking or climate change). The latter category often has the greatest consequences because we don’t notice much if we don’t do anything about it. And that is exactly where the hivemind of the family of Coronoviridae has found a gap in the market.

People, including myself, are hardly aware of the danger of pleasure trips to Rome and Paris with Easyjet. At least, there is a group that is busy, including a bunch of young people, that try to awaken us. But it seems we don’t really want to be woken up. As something for your own good, you never feel like it. We sometimes think about drowning in the reality of the day with urgency as a magic word. Current political leaders even insist: vision won’t get you anywhere, the pragmatist finds a solution for every problem in the here and now and works together with whom it suits him.

There you have it as a white rhino, platypus or summer bee. You live in a time when one species has enough brains to do strip-mine the earth, but has too little neocortex to transcend itself. Our tendency to pragmatically let the problems of today and tomorrow prevail, thereby accepting the massive impoverishment of biodiversity, is worrying to say the least.

But those who are not visible must be creative in their ability to assert themselves. Using the power of the opponent is the best weapon. A pandemic, the outbreak of an infectious virus; a concrete problem with short-term consequences that will hold the ruling species in front of a mirror and force it to humble its fellow inhabitants on this earth. A counterattack from nature that goes viral faster than any fragment of Kim Kardashian.

Air quality over China has never been better, according to NASA. In the operating rooms, our stocks of gauzes, masks and surgical gowns could run out steadily. For the first time, our sustainability project to think about smarter forms of reuse is taking off. If the latest versions of our iPhones can no longer be delivered, we might start talking to each other again.

It is sometimes said that fear is not a good counselor. Unfortunately, the belief in merciful empathy is already a vain hope today. This requires sensory connection. Anyone who shoots a duck out of the air and removes the warm body of organs will eat it later with more respect than who puts a tame copy neatly packed in a blue tray with the self-scanner in his shopping bag. The less something looks like us, the less likely we are to sacrifice our own comfort for the other party. Nature has become a bothersome phenomenon that causes traffic jams with slippery road surfaces and leaves on the train tracks. Nature also seems to understand this, driven solely by the urge to survive. Fear, on the other hand, is the only advisor to somewhat dampen our downplaying spirits.

Since the Enlightenment, a word that only the human species could have come up with, it is the most obvious thing for many people that I think I am therefore and that the preservation of the ego is also the highest attainable in this society. Selfie sticks, Uber and Insta want to give you the feeling that you are a unique creature in this world where it pays to be autonomous, independent and independent. It is almost a Cassandra-like prophecy that the collective (the rubber tree, the chain saw, the Amazon programmer) might be crucial to the creation of your selfie stick that you ordered via an anonymous digital platform.

Viruses are not organisms, they need a host to spread their own genetic material. They are pre-programmed to act according to their environment. They are not consciously aware of this, but nature has determined it so. They also last a little longer on this earth than we do and chances are they will see us perish too. At least, if we think we don’t need them. The corona, literally the crown in Latin, was handed over to someone in the Roman Empire for his services rendered. On behalf of the panda and the summer bee, that name seems entirely appropriate.

This article was published in Dutch newspaper NRC Handelsblad 6th of march 2020.

Without a doubt. It is Monday morning. My mood is quite below temperature as I try to put the rigid wheels of the ‘hypermodern’ cow (computer on wheels) towards the hallway. Two surgical interns follow me like young ducklings in a pond. It is time for a daily ritual doctors have been practising for centuries: rounds. Anyone who ever attended one or happened to be the patient; you know what I mean. A white wind of medical personnel talking about you in words that might well be Russian or Chinese. For all parties, not in the least the patient, this ritual can be quite uneasy. As if you were a rare creature in the wild, the group gathers around you. This feeling of inappropriate voyeurism is also felt by those wearing the white. And in an age of safe and distant digitalisation, young doctors tend to seek comfort behing the safe computer screen. On this screen, the patient is a clean and emotionless collection of data. No unexpected questions, no tears or other body fluids. However, this ‘unnatural’ round of dialogues, remains one of the cornerstones of good health care.

Before we enter the room, I face the interns. It is their first day. They look at me wandering if I will be wat they expect of surgery. “You don’t know the patients in this room. Your first reflex will be to grab a computer, if you haven’t done so already, and to gather as much information in order to think you can limit the chances of not knowing. But please, I only ask one thing of you today. Look at the patient not as a doctor in training, but as a biologist.” Their state of confusion is visibly increasing. “Don’t diagnose, just observe.” Like my hero sir Arthur Conan Doyle, writer of the stories of Sherlock Holmes, would state: “It is a capital mistake to theorise before you have all the evidence.” We enter the room and walk towards the bed of an old man who has many tubes surrounding hem that he might well be a Christmas tree.

For centuries, medicine has been a job making ultimate use of the senses. Observation was a way to understand and treat the suffering of others, long before we understood the mechanics of the heart or the liver. We looked, listened, smelled and felt. The famous peewatchers held the urine production of a patient high in the sky to diagnose the origin of pain or sickness; they even tasted it. Diabetes mellitus literally means ‘sweet pee’, caused by the glucose that the body has not absorbed and is thus excreted. Red urine often contains blood caused by kidney stones that caused damage to our renal tubes. And these are only a few examples.

While my colleague is talking to the patient, I stand back and ask the interns: “What do you see?” Quietly the first utters: “But uhm, what can we see if we don’t know what his diagnose is?” I wait and look at the other intern. “What do you see?” She turns to the patient and whispers: “A pole with a bag of fluids?” “Indeed”, I answer, “Very good.” “What does it contain and where is it going?” The other intern walks closer to the pole and reads the name of the antibiotic written on the bag. “Might he have an infection?” What else do you see?” The wall behind is bed is full of postcards. “Maybe he has been here for a long time; but he also has a lot people that care about him.” I smile. On the little table next to his bed lie an insulin pen and a book about birds. At the side of his bed a big bag with yellow fluid can be spotted. The interns look at me, surprised by the amount of information the could deduce only by means of observation.

Once a week we have a so called grand round. It is amazing to follow the footsteps of an ‘old doctor’. His eyes, his ears, his nose and his fingers have experienced so much that he walks the ward as an old hunter in the Amazon rain forest. He can tell the honey like smell produced by pseudomonas bacteria in a wound and hears the unbalanced pace of a patient suffering from a difference in leg length after an operation.

Might it be a romantic mistake to rely too much on our senses? The 21st century is characterised by increasing evidence illustrating that our senses can be tricked and lead to irrational and wrong decisions. Daniel Kahneman and many others warn us to think slow carefully. Might we be better of te leave the diagnosis of abdominal pain to an algorithm?

As a young surgical resident, I might underestimate the power of artificial intelligence because it might take over my job one day. However, I also feel that doctors are little algorithms themselves. Our senses our amazing wearables that can learn and adapt. Even more so, our capacities to integrate the information of different senses is a product of decades of human evolution. So, if you are sitting at a cosy Christmas dinner the coming days and you get involved in medical discussion. Before you swipe or ask Google, try your own senses for a change. They might surprise you.

This is my first time to visit Japan. Strangely so, I feel a sense of recognition during the visit of one of the shrines in Tokyo. As if I have been here before. The philosopher Friedrich Nietzsche wrote religions are often successful due to their opportunity to be the first to indoctrinate the blank sheets of children’s brains. Suddenly I get it. The Torii gates, the little buildings and even the decorations at the roof were the scenery of the endless levels of Pokémon, Super Mario and Kirby. As a child, I spend long road trips to France and rainy Sunday afternoons in Japan. Nintendo was my religion, the Gameboy my bible.

Two days later, I am standing in the operating room of surgeon Umezawa. “Mesu.”, she asks, holding up her gloved hand to the theater nurse. Just as I had gotten used to the endless stream of unknown words and characters, this word sounds very familiar. It does indeed mean ‘knife’ (mes in Dutch). Though, it shouldn’t have been a surprise to me. About 250 years prior to the introduction first Nintendo game computer in The Netherlands, the VOC (Dutch Easti-India Company, a shipping multinational founded in the 16th century) obtained a bonus level at the coasts of Nippon. During a 200 year-period (1633–1853) of so called sakoku or isolationist foreign policy of Japan, the Dutch received an exclusive trading post in Dejima, a small island in the bay of Nagasaki.

But it wasn’t only trading that took place. During this period, Dejima was the only window towards the West regarding science and was of great importance in medicine. As performance of post mortem dissections was still illegal in Japan, the works of Vesalius with detailed sketches of anatomical structures of the human body circulated all over Europe. The surgery of the Dutch was known as Komo-ryu geka (surgery of the red haired) and soon came to be known as a service of good quality. Japan is a country where the art of cutting seems to be deeply engrained in its culture. Therefore, it was striking that these blunt Dutch with their sharp knifes set the surgical standard.

Conversely, the knife remains merely an object of detail in the operating room. While I hold the camera, dr Umezawa carefully dissects the plane between the gallbladder and the liver. Her precision and attention to detail are impressive. She is one of the most renowned surgeon in Japan regarding laparoscopic cholecystectomies, the removal of the gallbladder through a minimal invasive procedure.

The concept of a laparoscopic operation has a striking amount of similarities with a computer game. Through several tiny incisions of only millimeters, a camera and two or three operating instruments are introduced in the abdomen. They are a type of long sticks with little scissors, a grasper or a coagulator at the tip. You can see what you do on the monitor.

The next morning, we bow for the patient, doing fine by the way she is happily slurping her miso-soup for breakfast. The modern surgeon and the modern patient tend to prefer minimal invasive surgery. The precision and the techniques of the East and the anatomical knowledge of the West have joint in to a hybrid form of modern surgery. The result gets near to what Hippocrates one day stated in his oath: Primum non nocere (First, do no harm). So next time when you see your 8-year old being infatuated by a digital world, don’t forget: he might be learning new languages, new countries and new skills.
梅澤博士ありがとう!

However, it was in Dutch. And as I can imagine, our language is only spoken by a few wandering around. Therefore, the full text in English underneath.

What I would like to become when I grow up? Somewhere between the moment that our general practitioner gave me a pair of tweezers and that one night I got to assist in a big operation, I choose that I would like to become a surgeon. Why? Because when I put on scrubs, I feel a bit like a kid that is going to bed the night before his birthday.

However, sometimes nowadays, I am lost. I get the feeling that I choose a utopic dream: a craft that no longer exists. Sometimes, it is truly frustrating to be a young doctor. When politicians are debating the millions being spent on health care while I am running on my old clogs towards a telephone to answer my pager. Or when a pharmaceutical company is presenting its yearly revenues from an expensive terrace in St Tropez while I have been trying to arrange a bed in another hospital for 7-year old boy with acute appendicitis because all our beds are taken. Sometimes, it feels as if our society has drifted far away from the original purpose of health care.pager

Health should play a key role in our lives. However, the health care sector seems to have adapted a profit model based on disease. Insurance companies, pharmaceutical companies and even hospitals benefit from an increasing number of patients. If more people are sick, more money is being made.

If disease is the incentive for profit, how do we create a cost model for health? An example. A man visits his general practitioner. He his blood pressure is increased. He smokes cigarettes and is slightly obese. Any doctor who would take the time to design a long-term lifestyle plan, would be a thieve of his own wallet. We are nudged to prescribe a pill: quick and profitable.

This problem already starts at the base of our health care system: research. It is almost impossible to investigate the benefits of doing less instead of doing more. A pharmaceutical company does not gain profit from prescribing less.

This consumerism is deeply rooted in our health care system. Both doctors and patients have good intentions, I don’t doubt that for a second. But the current costs of health care in The Netherlands, about 96 billion euro, are largely spent on pharmaceutical companies and real estate partners. But they are also not the only ones to blame, they just profit from a system in which disease is the model for profit.

Our system is sick. Its condition is so critical that we are only busy resuscitating rather than taking a step back to investigate the true cause. If a profit model for disease persists, insurance companies and pharmaceutical companies will stay in the lead. Doctors and other even patients will remain marionettes in this game.

I would like to become surgeon. A good surgeon knows when she should cut but even more so, when not to cut. It is time for us all, politicians, health care companies and all others to change for the better. Because in the end, it is your health that matters most.

Do you use WhatsApp? How many of the social groups you belong to have a digital version on this app? What do you share? And how often do you scroll down just to have no unread messages? Our social connectedness can sometimes be a burden nowadays. But, it can also serve a purpose. Today a good friend and colleague of mine quit smoking for 100 days! Mostly thanks to WhatsApp.

Let me introduce you to Goos Huijzer (1964). She has been working as an expert taking care of the animals and facilities of the laboratory of experimental surgery in the Academic Medical Center in Amsterdam. She has witnessed the rise of exemplary surgeons introducing novel techniques such as laparoscopy. Like no other, she knows how to take care of animals in the lab and has been delivering quality work for over 20 years.

As an aspiring surgical resident, I love to stroll with her through the lab and watch her experienced hands work like a good doctor would do: effective but minimally invasive.

There was only one small down side. Several times a day, she had to go outside to smoke. When she was sick for two weeks with a lung infection and afraid to go see a doctor who might diagnose lung cancer, I decided two initiate an experiment.

Goos started smoking when she was 12 years old and a package a day was not an exception. The habit was engraved deeply in her daily life and although she was not unwilling to stop, it would be hard. However, her phone was almost as precious to her as one thing that was as her lighter and pack of her cigarettes. Goos is concerned not only with animals, but also with other human beings making her social network very important to her.

After reading the book ‘Hooked’ of Nir Eyal, I realized social support and a reward might contribute to the solution.

On the fifth of May, I started a group WhatsApp with Goos, Eva (another colleague) and I, called: “Goos quits smoking day 1”. Every morning, the subject title of the WhatsApp group would be changed to the amount of days.

Every day we would post a little #reddit movie of an animal doing something funny or extraordinary as a form of motivational support.

We often met for coffee at work and Goos stated that the chat group offered her both support but also served as watchful eye that she didn’t want to let down. The fact that she didn’t only tell herself she would quit but also promised us, created an additional incentive.

Today, Goos has quit smoking for 100 days and we are exceptionally proud of her and are hoping to continue for the next!

The gathering of researchers spending their working life to understand the behaviour of a cancer cell should be focused and serious. One could argue that inviting a world-famous pianist and a historian all the way from Oxford to contribute to this scientific meeting dedicated to the devastating effects of tumors, would be rather strange. However, it happened yesterday at the meeting of the Cancer Center Amsterdam, the collaborative institute of the Academic Medical Center and the VU Medical Center in Amsterdam. A brief report.

It is difficult not to encounter information about cancer on a daily base when you work in the medical field. Our abundant amount of information is scattered, ranging from confetti platforms to super specialised ivory towers. One can find everything, varying from little diamonds to complete rubbish on Twitter or, for that matter, Pubmed. On the other end of the spectrum, there is an endless list of medical congresses all over the world, each discussing their own strategies to understand and combat the killer of our times. There is so much to know that one might realise that we do not know it all. However, subconsciously, we hope to at least look in the right direction.

And that could well be the core of the problem. Peter Frankopan, writer of the New York Times bestseller Silk Roads, delivers an uncomfortable first ten minutes of his lecture. “You are all very much unaware of the striking lack of dimension regarding the things you think matter in the world.” After showing some pictures of Western world leaders who all pass our timeline on a daily base, our complete lack of knowledge of the ten world leaders representing the majority of the world population is shamefully unmasking.

“You are all very much unaware of the striking lack of dimension regarding the things you think matter in the world.”

“Even scientists are very prone to amplify the so-called undeniable facts of others and themselves. We are afraid to look beyond our field of expertise and to connect dots in new ways.” The similarities between our narcissistic obsession with the Western world and the ability to look at the origin and the spread of diseases such as cancer. During the 30 minute lecture, as a young doctor and researcher, I realised the continuous struggle of the vain drive to strive towards a point to obtain some sort of territory of knowledge or the need to create borders in order to produce versus the fearless and open mind needed to dive into unknown territories of knowledge and to question all that has been stated as the truth so far.

The second guest of the evening puts our ability to stretch our mind to open up to new ways of thinking and observing even further. Michiel Borstlap, a renowned piano player famous for his improvisational work, delivers various on the spot responses on the facts delivered on stage. The way how a successful CRISPR experiment would sounds, and even more invigorating, an ad hoc composition of a failed CRISPR experiment, which combines dark jazzy notes with a trembling impatience of DNA structures wanting to be detangled.

It might not have been the evening at which one was given a more precise explanation on the molecular subtype of one rare form of liver cancer, nor was there a direct therapy at hand that would save thousands of innocent lives. The evening illustrated how it is possible to get the human mind to perform at its best: cross-linking in uncoded ways, to find new ways to approach a problem by allowing to question them again. It reminded me of the bold ways Alexander von Humboldt once revolutionised the sciences of nature which were completely segregated and divided in taxonomic cubicles of species by connecting all patterns together in his Naturgemälde and also organising congresses in a similar way.

Hopefully, the future of medical and other congresses will reinvent to concept of hybrid thinking by inviting other scientists and artists not to entertain but to disrupt or ivory towers and rigid thoughts.

See you next time?

The silk roads of cancer was originally published in Healthcare in America on Medium, where people are continuing the conversation by highlighting and responding to this story.

Mr D, from New York

The sky was grey. The raindrops scattered amongst the medieval buildings in the old town of Zutphen in the east of The Netherlands. My student and I carried two heavy bags with groceries and a backpack full of equipment to be installed at the home of our first patient.

At noon precisely, we rang his doorbell. His wife opened the door and warmheartedly welcomed us. We mounted the stairs and entered a house completely stacked with paintings, pencils and canvasses.

While she was making tea, he ensured us to make ourselves comfortable. Mr D, 80 years old, quietly sat in a flowered chair. He wore thick rain trousers, two fleece sweaters and a hoodie with some paint spots here and there. Although his mouth missed half of its teeth, the words coming out of it were as bright as his eyes.

It was about 1,5 years ago, I started my PhD in surgery. The major question to investigate: how to define whether patients with cancer of the intestines are fit enough to operate? We started out with a traditional approach, investigating cohorts of previously operated patients and looking at what had been done before by other research groups. The conclusion so far: we don’t really know what’s best for the frail elderly patient.

In order to put our concepts into a clinical experiment, we sought to combine the scientific evidence and the growing market of addictive online products such as Facebook and Instagram. First, we asked physiotherapists and dietary specialists what kind of exercise and diet would be best to prepare a cancer patient for an operation: in short, daily bouts of strength training and a portion of around 40 grams of protein. Second, we assessed the most important motivational triggers for elderly people: social support and having a purpose while preferably maintaining daily habits and routines. After profound research and dialogue both with experts and patients, we developed a small, user-friendly old fashioned television that could be installed at home.

While I was installing the small device that would help him to get fit the coming weeks prior to surgery, my colleague asked him some questions about his daily diet and physical performance. Surrounded amongst the most surreal but craftsmen’s worthy paintings, the nature of medicine to assess the pure rational and pragmatic perspective felt rather one-dimensional.

“Did you feel desperate or depressed the last month?” It was another question of the so called ‘geriatric depression scale’. The contrast of an intelligent artist who has travelled and lived and the blunt question summarising the interpretation of daily life into a yes or no question, was a precise reflection of the current struggle of daily medicine. The human scale at which we try to deliver care is caught in forced systems of randomised controlled trials and precisely standardised protocols.

More than once he paused, partly to catch a breath due to some serious restrictive lung function, partly to look at us and to say something important. My own tendency to keep busy betrayed the uneasily awareness of that it had been a long time since I had had the possibility to truly listen to a patient. A patient, though not yet weakened by a hospital bed or sedative medicines which apparently always makes me take their words more like those of a poor child than of an equal human being.

Meanwhile, with serious dedication, he performed the hand grip strength test and spelled the word bacon backwards to ensure his cognitive functioning. In between, we talked about art, love and other matters of more importance than whether or not he experienced a bloated feeling due to his tumor.

He spoke without ego, embraced emotion without the dramatic sauce: he was real. And likewise, he complimented his treating surgeon, my boss, for the same straightforwardness. After I was done installing all that had to be measured the coming weeks, I sat down in front of him.

He looked at me and said: “You are a doctor? And you want to be a surgeon?” I nodded. He paused. “The thing is. I admire the Dutch painters: Van Gogh, Mondriaan, Vermeer.” He looked out of the window. The rain had stopped and a typical Dutch sky presented itself, clouds mixed with the brightest of lights. “Your boss is like the Dutch painters. Not woozy, straight forward, sticking to the topic. His trust gives me trust.” Again, there was a silence. “However, do not mistake clarity with bluntness, it’s all a matter of subtlety.”

The 2-hour visit vanished as if they were mere moments. I left the apartment as if somebody had just given me a new pair of eyes. We walked back to the train station. We were unsure what to say. But if it were like Hippocrates once said: “Medicine is entertaining the patient while he is getting better.” Than today I would have to add to that: “The patient can teach the doctor while he is being entertained.”

Precisely 7.30am, room G4–123, Academic Medical Center, Amsterdam. “Good morning. This is the handover of Tuesday 3rd of January 2017.” These are the final words of the doctor on call. In a verbiage of 30 minutes, she elaborates on the events of the last 12 hours. The room is filled with surgeons, residents and interns. She is standing in front of two enormous screens, visualising the names, imaging and lab results of the patients. Now and then a remark is made. The setting resembles an episode of the evening news: informative but seldomely relevant. Communication is a crucial aspect in health care, but is the use of words increasingly becoming a burden?

Curing disease is an age-old profession. Medicine has always been a sensory occupation. Sir Arthur Conan Doyle, a doctor and creator of Sherlock Holmes, was renowned for his observing capacities. Without having spoken a word, Doyle could deduce numerous facts about his or her private life. The so called ‘clinical eye’, stretching far beyond the visual image, is a valuable and threatened instrument in medicine. Let me ask you about the last time you visited your doctor. Did he take the time to shake hands and observe you from head to toe or was his computer screen more interesting?

Verbal language is not an age-old instrument. There were times we existed without communicating through spoken words. Our mind consisted mainly of sensory memories. The shape and color of eatable fruits, tracks of dangerous animals, the smell of fermenting or poisonous things, the sound of an approaching thunderstorm. Gradually, we deduced patterns out of these observations leading to a more profound understanding of the world around us. We developed concepts such as landscape orientation, positioning according to the sun and a sense of time due to cyclic periods of seasons, tides and moonrise.

During a normal day at the hospital, the handover is followed by ward rounds. A junior doctor and a team of nurses discuss the condition of the patients. In my hospital, a big part of this discussion is held in a room away from the patients, filled with a lot of computers. The computers give us a lot of information about the patients. The urine production, level of pain, results of blood tests and whether there is any growth of bacteria. Consequently, we make a plan and go to the patient to tell him. In some hospitals, it is even more modern. They have a so called ‘cow’, a computer on wheels’, which can be rolled into a the room of patient. The thing has the same effect as a smartphone on the table during an intimate conversation.

Language has the capacity to abstract information. It gives us the opportunity to communicate more efficiently with each other. For example, pneumonia is a word that comprises a set of symptoms (coughing, fever, shortness of breath) often caused by bacteria. At the same time, language alienates us from our real time observations. Even more so, language can limit us in our ability to observe. A doctor who as already read that a patient is familiar with urinary tract infections will be biased to take a shortcut towards that diagnosis when that patient presents with a similar set of symptoms rather than thinking in an open way.

This phenomena is infecting our society as a whole. Our lives are gradually shifting towards a more digital and abstract level. We rely on our smartphone rather than our senses. If you want to know whether it’s going to rain, you look down at your phone rather than up to the clouds. You don’t smell whether your milk is sour, you check the package for its durability limit. At the same time we long and admire sensory input more than ever. We want craftsmanship, authenticity and stories in our products and companies.

You might think that this is purely a romantic and nostalgic pledge for the old fashioned doctor. One that is so nicely depicted in doctor House: wandering in his own mind and without any aid diagnosing the patient on the spot. In an age of IBM Watson and big data, you must be kidding me right? Why should we let an biased and limited human mind such as that of an ordinary doctor get in the way of a computer that can deal a lot more structured with a clinical algorithm?

IBM Watson is in a way a superbrain that creates patterns based on the sensory input it is given. The input of IBM Watson however currently relies only on all data that was registered in our electronic medical records. Details such as the way somebody sits down, interacts with his wife, a change of voice or an emotional silence have not been recorded and consequently will not be a part of the algorithm of IBM Watson.

Should we therefore stop using language and continue our further communication purely in body language and emoticons? Quite the contrary. Nevertheless, we should think about our possibilities to expand our form of registering our observations. Visualisations can have a profound impact on our understanding of mechanisms and systems and could be of great importance in the understanding of disease.

It’s half past four. After a full day at the operating room, an older surgeon and I walk back to the wards. When the doors open he halts for a moment. He sniffs his nose loudly as if he were a hunting dog. He looks at a room of mister P, a patient with an open wound that has been in the hospital for weeks. “That sweat smell,”, he mutters, “must be pseudomonas.” A few minutes later I read the Wikipedia page: “Pseudomonas, a bacterium known for its sweet odour.” It’s about time we change the dressings.

A surgeon’s touch was originally published in Healthcare in America on Medium, where people are continuing the conversation by highlighting and responding to this story.

A significant amount of research in clinical medicine is performed by multicentre randomized controlled trials. The logistical challenges of follow-up can possibly harm the completeness of the results. As a MD-PhD candidate in the department of surgery, I would like to make this process more efficient for myself and others performing this kind of research. This manual explains how to automate the process of managing follow-up moments for included patients.

PART 1: BUILD EXCEL SHEET

1. Column 1: Follow-up dates based on inclusion/intervention

First cell: Date of inclusion

Further columns: Follow-up moments

e.g. Surgical trial
Date of inclusion: 21–07–2016 (cell A3)

Date of surgery: 08–08–2016 (cell A2)

Follow-up 1, preoperative day: cell A4

→ type in formula field =A2–1

Follow-up 2: postoperative day: cell A5

→ type in formula field =A2+1

2. Column 2/3: Start time

Type the time at which you want to be notified in your agenda.

3. Column 3: End time

Type the time at which event ends in your agenda.

4. Column 4: Location

Type at which centre the inclusion took place.

5. Column 5: Description

Type the patient identification number

Type what needs to be done at that date e.g. lab withdraw, questionnaire

YOU ONLY HAVE TO DO THIS ONCE. IF YOU HAVE A NEW INCLUSION, ONLY INSERT THE NEW DATE OF INCLUSION/INTERVENTION IN THE YELLOW CELLS AND DRAG PREVIOUS CELLS DOWN TO COPY FORMULAS.

PART 2: EXPORT TO CSV

1. Go to formulas at top of bar

Select all your data → Select define name → Make a name (doesn’t matter) → click ok

2. Check whether your computer uses comma as separation tool.

Go to Settings (Configuratiescherm) of Windows → Go to language, region (klok, taal en region) → Click on ‘change language user interface’ (change language user interface) → go to more settings (meer instellingen) → change separation sign (lijstscheidingsteken) to a comma and change decimal sign (decimal sign) to → ;

3. Go back to excel form.

Go to save document. Save document as csv with separator sign (met lijstscheidingstteken)

4. Close excel document.

PART 3: IMPORT TO OUTLOOK

1. In outlook, go to File (Bestand) → Open → Import

2. Click on ‘import data from another program’

3. Select your agenda

4. In screen of values, you should see the head of your columns. You can drag them to the right headers on the right.

5. Click OK

CONGRATULATIONS!

YOU JUST SAVED YOURSELF TWO HOURS OF WORK!

Questions? → e.r.bruns@amc.nl

During a week of night shift, I read Scott Belsky’s book “How to make ideas happen”. As a surgical resident and a PhD candidate at the Academic Medical Centre in Amsterdam, I often find myself divided between an overload of ideas to enhance health care issues in my hospital and a lack of time and specific knowledge to execute them. When Scott mentioned the 99U conference, a congress for creative developers about the 99% execution rather than the 1% inspiration, it seemed like a unique opportunity to learn something from experts from a different field.

Together with my friend and colleague Laura Kox, we smashed our piggy banks, applied for the conference and booked a flight to New York. The next evening, we stood somewhat uneasily at the welcome session. People with fancy glasses and fine shoes surrounded us. They were playing Ping-Pong on a foursquare table and drinking IPA’s. The creative atmosphere was miles away from the medical congresses we were used to. They are often situated far away from booming metropoles, Ping-Pong tables are replaced by enormous amounts of stands of the medical industry and almost every PowerPoint slide is in blue and yellow, with Arial fonts filling the page more than any listener can handle.

“No matter which professional field you are in; we recommend you to visit a congress of a completely different field at least once.”

Two days at the 99U conference, were a complete eye opener. Doctors often regard fancy slides, GIF’s and other technological feats as a way to disguise a lack of quality regarding the content of the story. Studying medicine is all about learning to get a grip on the slippery symptoms patient present themselves with. We try to objectivise symptoms and not let our minds being distracted by biases. Surely, this is a good aspect in becoming a good doctor, as I experienced working in Zambia myself. However, the fact that design truly decides whether content can be transferred to the user, has been greatly ignored in health care.

Besides Scott Belsky’s himself, who beautifully illustrated how we have to understand the less likeable side of the human mind to build a good product for it, many other speakers were truly inspiring. Most remarkable to us were executive producer Effie Brown and graphics editor Jennifer Daniel. By showing their vulnerable and sometimes less likeable side of themselves, they showed how to be a leader in a very authentic way.

Effie Brown clearly pointed out, becoming a leader consists of three steps:

1. KNOW THYSELF

2. WHAT & WHY you will do what you do

3. DBAD (don’t be a dick)

As a doctor, I find myself struggling every day to help patients without having all the knowledge to be completely sure that I can cure them. I try to learn from the values great inspirators like Atul Gawande, Abraham Verghese and Henry Marsh.

Besides the obvious advantages of great design of medical interfaces and products, the 99U conference taught us much more. Quoting Scott Belsky, “Empathy is more important than Passion.” In order to be empathetic, we must acknowledge that as doctors, we must remain human.

Thank you, 99U, hope to see you all next year.