Thursday, March 31, 2016

RIP Zaha Hadid




Zaha Hadid has sadly died. She recently wrote a postcard to her younger self for BBC Arts with these words of wisdom
http://www.zaha-hadid.com/

'

ZAHA HADID 1950-2016

It is with great sadness that Zaha Hadid Architects have confirmed that Dame Zaha Hadid, DBE died suddenly in Miami in the early hours of this morning. She had contracted bronchitis earlier this week and suffered a sudden heart attack while being treated in hospital.

Zaha Hadid was widely regarded to be the greatest female architect in the world today. Born in Baghdad in 1950, she studied mathematics at the American University of Beirut before starting her architectural journey in 1972 at the Architectural Association in London.
By 1979 she had established her own practice in London – Zaha Hadid Architects – garnering a reputation across the world for her ground-breaking theoretical works including The Peak in Hong Kong (1983), the Kurfürstendamm in Berlin (1986) and the Cardiff Bay Opera House in Wales (1994).

Working with office partner Patrik Schumacher, her interest was in the interface between architecture, landscape, and geology; which her practice integrates with the use of innovative technologies often resulting in unexpected and dynamic architectural forms.
Zaha Hadid’s first major built commission, one that affirmed her international recognition, was the Vitra Fire Station in Weil Am Rhein, Germany (1993); subsequent notable projects including the MAXXI: Italian National Museum of 21st Century Arts in Rome (2009), the London Aquatics Centre for the 2012 Olympic Games (2011) and the Heydar Aliyev Centre in Baku (2013) illustrate her quest for complex, fluid space. Buildings such as the Rosenthal Center for Contemporary Art in Cincinnati (2003) and the Guangzhou Opera House in China (2010) have also been hailed as architecture that transforms our ideas of the future with visionary spatial concepts defined by advanced design, material and construction processes.

In 2004, Zaha Hadid became the first woman to be awarded the Pritzker Architecture Prize. She twice won the UK’s most prestigious architecture award, the RIBA Stirling Prize: in 2010 for the MAXXI Museum in Rome, a building for the staging of 21st century art, the distillation of years of experimentation, a mature piece of architecture conveying a calmness that belies the complexities of its form and organisation; and the Evelyn Grace Academy, a unique design, expertly inserted into an extremely tight site, that shows the students, staff and local residents they are valued and celebrates the school’s specialism throughout its fabric, with views of student participation at every turn.

Zaha Hadid’s other awards included the Republic of France’s Commandeur de l’Ordre des Arts et des Lettres, Japan’s Praemium Imperiale and in 2012, Zaha Hadid was made a Dame Commander of the Order of the British Empire.  She was made Honorary Member of the American Academy of Arts and Letters and Fellow of the American Institute of Architecture.

She held various academic roles including the Kenzo Tange Chair at the Graduate School of Design, Harvard University; the Sullivan Chair at the University of Illinois, School of Architecture. Hadid also taught studios at Columbia University, Yale University and the University of Applied Arts in Vienna.

Zaha Hadid was recently awarded the RIBA’s 2016 Royal Gold Medal, the first woman to be awarded the prestigious honour in her own right. Sir Peter Cook wrote the following citation:
"In our current culture of ticking every box, surely Zaha Hadid succeeds, since (to quote the Royal Gold Medal criteria) she is someone “who has made a significant contribution to the theory or practice of architecture…. for a substantial body of work rather than for work which is currently fashionable.”  Indeed her work, though full of form, style and unstoppable mannerism, possesses a quality that some of us might refer to as an impeccable ‘eye’: which we would claim is a fundamental in the consideration of special architecture and is rarely satisfied by mere ‘fashion’.

And surely her work is special. For three decades now, she has ventured where few would dare: if Paul Klee took a line for a walk, then Zaha took the surfaces that were driven by that line out for a virtual dance and then deftly folded them over and then took them out for a journey into space. In her earlier, ‘spiky’ period there was already a sense of vigour that she shared with her admired Russian Suprematists and Constructivists – attempting with them to capture that elusive dynamic of movement at the end of the machine age.
Necessarily having to disperse effort through a studio production, rather than being a lone artist, she cottoned–on to the potential of the computer to turn space upon itself. Indeed there is an Urban Myth that suggests that the very early Apple Mac ‘boxes’ were still crude enough to plot the mathematically unlikely – and so Zaha with her mathematics background seized upon this and made those flying machine projections of the Hong Kong Peak project and the like. Meanwhile, with paintings and special small drawings Zaha continued to lead from the front. She has also been smart enough to pull in some formidable computational talent without being phased by its ways.

Thus the evolution of the ‘flowing’ rather than spikey architecture crept up upon us in stages, as did the scale of her commissions, but in most cases, they remained clear in identity and control. When you entered the Fire Station at Vitra, you were conscious of being inside one of those early drawings and yes, it could be done. Yet at perhaps its highest, those of us lucky enough to see the Heydar Aliyev Center in Baku in the flesh, can surely never have been in such a dream-like space, with its totality, its enormous internal ramp and dart-like lights seeming to have come from a vocabulary that lies so far beyond the normal architecture that we assess or rationalize.

So we are presenting her with this Medal as a British Institution: and as a Dame Commander of the Order of the British Empire: thus she might seem to be a member of our British Establishment. Yet in reality, many of our chattering classes and not a few fellow architects have treated her with characteristic faint praise, and when she heroically won the Cardiff Opera House competition, blocking the scheme. Or when we awarded her the RIBA Stirling Prize for the school in South London – her second win in a row - we, the jury, were loudly derided by a number of distinguished architects. Of course, in our culture of circumspection and modesty her work is certainly not modest, and she herself is the opposite of modest. Indeed her vociferous criticism of poor work or stupidity recalls the line-side comments of the tennis player John McEnroe. Yet this is surely characteristic of the seriousness with which she takes the whole business: sloppiness and waywardness pain her and she cannot play the comfy British game of platitudinous waffle that is the preferred cushion adopted by many people of achievement or power. Her methods and perhaps much of her psychology remain Mesopotamian and not a little scary: but certainly clear.
As a result, it is perhaps a little lonely there up at the top, surrounded now by some very considerable talent in the office, but feared somewhat and distanced from the young. Yet in private Zaha is gossipy and amusing, genuinely interested in the work of talented colleagues who do very different architecture such as Steven Holl, and she was the first to bring to London talent such as Lebbeus Woods or Stanley Saiotowitz. She is exceptionally loyal to her old friends: many of whom came from the Alvin Boyarsky period of the Architectural Association:  which seems to remain as her comfort zone and golden period of friendship. Encouraged and promoted at an early age by Boyarsky, she has rewarded the AA with an unremitting loyalty and fondness for it.

The history of the Gold Medal must surely include many major figures who commanded a big ship and one ponders upon the operation involved that gets such strong concepts as the MAXXI in Rome – in which the power of organization is so clear - or the Bergisel Ski Jump in Innsbruck where dynamic is at last captured – or the Aquatics Centre for the London Olympics where the lines diving boards were as fluid as the motion of the divers - made into reality. And she has done it time and time again in Vienna, Marseilles, Beijing and Guangzhou. Never has she been so prolific, so consistent. We realize that Kenzo Tange and Frank Lloyd Wright could not have drawn every line or checked every joint, yet Zaha shares with them the precious role of towering, distinctive and relentless influence upon all around her that sets the results apart from the norm. Such self-confidence is easily accepted in film-makers and football managers, but causes some architects to feel uncomfortable, maybe they’re secretly jealous of her unquestionable talent. Let’s face it, we might have awarded the medal to a worthy, comfortable character. We didn’t, we awarded it to Zaha: larger than life, bold as brass and certainly on the case.

Our Heroine.

How lucky we are to have her in London."'

Monday, March 28, 2016

The breakdown of a council estate

http://www.bbc.co.uk/iplayer/episode/b00t0ydd/the-estate-were-in
http://bbc.in/1psJE4j

£12 million of public land sold for £3 to a developer in Barnet.
Break down of existing communities, and the invisible links that bind and elevate.

Sunday, March 27, 2016

A little told part of history...


http://www.amazon.co.uk/The-Grand-Mosque-Paris-Holocaust/dp/0823423042

http://thechildrenswar.blogspot.co.uk/2010/09/grand-mosque-of-paris-story-of-how.html

http://www.jewishbookcouncil.org/book/the-grand-mosque-of-paris-a-story-of-how-muslims-saved-jews-during-the-holocaust

some of the reviews from Amazon...

HASH(0x8f499228) out of 5 stars The Grand Mosque of Paris 28 Dec. 2009
By Jewish Book World Magazine Published on Amazon.com
Format: Hardcover
The Grand Mosque of Paris is the story of the Muslim community of Paris during the Nazi occupation of World War II and their efforts to rescue Jews. The mosque constructed in 1926 had space for a community center, library, restaurant, clinic and apartments for the functionaries. It was built upon a labyrinth of subterranean tunnels and rooms, areas that had been excavated for building stones for the city of Paris. These underground passages and catacombs served as hiding places and escape routes for those hunted by the French police and Gestapo. The rescue and escape of Jews was under the leadership of the Rector, Si Kaddour Benghabrit, a sophisticated Algerian-born diplomat, who was considered the most powerful Muslim in France at the time. The clerics provided sanctuary, certificates of Muslim identity and safe passage for those who sought their help. This well written, concise history is enhanced by the beautiful double page oil paintings, which are most effective in conveying setting and mood. There is no personal narrative although this historical story has all the elements for a compelling novel as evidenced by the few examples given. It is noted that at least 100 Jews, downed Allied airmen, Resistance fighters and escaped prisoners of war, were also spirited to safety. These righteous saviors deserve to be honored and their deeds told. This book is appropriate for elementary school students who are studying WWII and/or the Holocaust, but would also interest older students and adults. An afterword, glossary and extensive bibliography is very informative and sheds light upon this important and little known story of the Holocaust. For ages 10 and up. Naomi Kramer
14 of 15 people found the following review helpful
HASH(0x8f0969e4) out of 5 stars A Beautiful Book, An Essential Story 24 Dec. 2009
By Señor Joel Published on Amazon.com
Format: Hardcover
Gorgeously illustrated, the book tells the story of how Muslims at the Grand Mosque saved Jews from the holocaust. Both authors speak French and did extensive interviewing in France; this follows on the heels of their much more ambitious joint undertaking, "Hidden On The Mountain: Stories Of Children Sheltered From The Nazis In Le Chambon".
This book is impressive on many levels. It is intended as a children's picture book, but to me this only adds to its power and beauty. The essential lesson of "The Grand Mosque" is the fact that Jews and Muslims in recent history worked together for survival and considered each other brothers--a story much in need of remembrance in today's world. The authors went to great effort to seek out documentation that is many cases almost impossible to find. At one point they bring the reader into the detective process regarding an old letter found recently in a Paris café:
-Was this letter read out in the café? Did it circulate among the Kabyle workers of Paris...?
These anecdotes that Ruelle and DeSaix have helped resuscitate from near oblivion are a moving tribute to humanity's capacity for compassion and valor, especially in the worst possible circumstances.
The book celebrates the Mosque itself, in addition to the kind acts of its World War II Rector, Si Kaddour Benghabrit, and his congregation. Each illustration in "The Grand Mosque" is in itself a work of art, and many of them are a respectful tribute to the beauty of Islamic architecture. A glossary of Islamic terms helps to further the author's goal of bettering our understanding of what is sacred to Muslims.
In the back with the bibliography is an annotated list of recommended books and films related to this subject. First among these is Derri Berkani's documentary, "Une Résiistance Oubliée", which inspired the book and is also used in anti-racism education across Europe. The film comes highly recommended by the authors.
11 of 12 people found the following review helpful
HASH(0x8f3a7948) out of 5 stars Should Be Required Reading for Upper Elementary and Tweens 30 Mar. 2010
By Portianay Published on Amazon.com
Format: Hardcover
This is a heart-wrenching, truly beautiful account of Muslims who put themselves in harm's way in order to rescue Jews during the Holocaust. The pictures are stunning, but the story goes far beyond anything I have read in this age category on this topic to date.

The Afterword is almost more fascinating than the books itself. Every public and school library needs this book.



An article on a film based on true events - some extracts from the article - 

'In doing research for the film, Mr. Ferroukhi and even Mr. Stora learned new stories. At one screening a woman asked him why the film did not mention the Ashkenazi Jews of Eastern European origin who had been saved by the mosque. Mr. Stora said he explained that the mosque didn’t intervene on behalf of Ashkenazi Jews, who did not speak Arabic or know Arab culture.

“She told me: ‘That’s not true. My mother was protected and saved by a certificate from the mosque,’ ” Mr. Stora said.
On Wednesday, the day of the film’s release here, hundreds of students from three racially and ethnically mixed Paris-area high schools were invited to a special screening and question-and-answer session with Mr. Ferroukhi and some of his actors.
Some asked banal questions. Where did you find the old cars? (From an antique car rental agency.) Others reacted with curiosity and disbelief, wanting to know how much of the film was based on fact, and how it could have been possible that Jews mingled easily with Muslims. Some were stunned to hear that the Nazis persecuted only the Jews, and left the Muslims alone.

Reviews here were mixed on the film, which is to be released in the Netherlands, Switzerland and Belgium. (American rights have been sold as well.) The daily Le Figaro said it “reconstitutes an atmosphere and a period marvelously.” The weekly L’Express called it “ideal for a school outing, less for an evening at the movies.”

Mr. Ferroukhi does not care. He said he was lobbying the Culture and Education Ministries to get the film shown in schools. “It pays homage to the people of our history who have been invisible,” he said. “It shows another reality, that Muslims and Jews existed in peace. We have to remember that — with pride.”'

Saturday, March 26, 2016

Al-Qaeda separtists bomb and kill at least 32 in schoolboy football tournament.

http://www.bbc.co.uk/news/world-middle-east-35904425

Iraq violence: Victims of IS football match attack buried

Mourners attend the funeral of a victim killed by a suicide bombing at a soccer field in IskandariyaImage copyrightReuters
Image captionMany of the victims were aged between 10 and 16
Iraq has buried the victims of a suicide attack in a football match in the city of Iskandariya that killed at least 32 people.
Many of the dead were young boys who were in a trophy ceremony hit by the bomber, himself said to be a teenager.
So-called Islamic State (IS) said it carried out the attack.
IS is a mainly Sunni group which controls large swathes of northern and western Iraq, and has attacked numerous Shia targets in the country.
UN Secretary General Ban Ki-moon, in Iraq for talks with the government, expressed his condolences to the families of the victims.
"I would like to take this opportunity to express my deepest condolences to the people and government of Iraq, and particularly those members of the families affected by terrorist attacks yesterday," he told reporters in Baghdad.
Mr Ban urged Iraqi leaders to step up reconciliation efforts between Shias and Sunnis in order to defeat IS.
Friday's attack happened in Iskandariya, a mainly Shia town 40km (25 miles) south of the capital, Baghdad.
Video posted on social media showed the moment of the blast, as an official was speaking in front of a crowd of dozens of people, including the young players.
The footage cuts off with a big flash of yellow light. It then shows the chaos and screaming of people fleeing the area.
A medical official said 17 of the dead were boys aged between 10 and 16, AFP news agency reported.
Video posted on social media showed the moment of the explosionImage copyrightAP
Image captionVideo posted on social media showed the moment of the explosion
Mayor Ahmed Shaker was also killed, as was one of his bodyguards and at least five members of the security forces, it said.
Some 84 others were wounded, and 12 of them were said to be in critical condition.
People inspect the aftermath of a suicide bombing at a soccer field in IskandariyaImage copyrightAP
Image captionMany of those killed were teenagers - as was the bomber
Mourners attend the funeral of a victim killed by a suicide bombing at a soccer field in IskandariyaImage copyrightReuters
Image captionDozens of people took part in the funeral ceremonies in Iskandariya
Iskandariya is in a region that was once called "the triangle of death" and was badly affected by sectarian violence that followed the 2003 US-led invasion of Iraq.
In a statement, FIFA President Gianni Infantino said he was "shocked" by what he described as a "tragedy".

'National reconciliation'

The UN chief also urged politicians to foster reconciliation with the minority Sunni, who say they were marginalised under the Shia-led government.
Some discontented Sunnis have joined IS and other extremist groups.
"National reconciliation is an important part of the strategy to defeat Daesh, who have ruthlessly exploited divisions and targeted the marginalized and disenfranchised," he said, using another name for IS.
IS has been losing some territory of its self-declared caliphate that includes parts of neighbouring Syria, and Iraqi forces have started an operation to retake Mosul, the largest city under the group's control.
Followers of Shiite cleric Muqtada al-Sadr protest outside the heavily guarded Green Zone in BaghdadImage copyrightEPA
Image captionSupporters of Shia cleric Moqtada Sadr have protested outside Baghdad's Green Zone
Meanwhile, thousands of supporters of the powerful Shia cleric Moqtada Sadrcontinued their sit-in outside the gates of the heavily fortified Green Zone, an area of government offices and embassies in Baghdad.
They have urged Prime Minister Haider al-Abadi to announce a new-cabinet and fresh measures to fight corruption.
Mr Abadi said on Saturday a new cabinet would be announced within a week.

articles on cognitive error in EM

http://lifeinthefastlane.com/a-mortal-battle-with-four-hour-medicine/

http://lifeinthefastlane.com/to-err-is-human-003-2/

clinical reasoning toolkit

http://www.improvediagnosis.org/?page=ClinicalReasoning

Advice for new EM graduates

From the council of emergency medicine residency directors

http://www.cordem.org/i4a/pages/index.cfm?pageid=3634

Advice for Graduates

Preparing to Practice: Advice For New Graduates and Young Physicians: 
Avoiding the Pitfalls

Compiled by Stephen R. Hayden, MD
Professor of Clinical Emergency Medicine
Associate Dean for Graduate Medical Education UC San Diego
Acknowledgment: Thank you to all the members of the Council of Residency Directors (CORD) in
Emergency Medicine for your sage advice and invaluable contributions to this work!

Outside Activities/Personal: Pitfall is not taking care of yourself; physically, mentally, and spiritually…
  • “Tell them to rediscover their passion outside medicine so that they can rely on it to de-stress and add dimension to their life. For me it is ballet, but many others do sports, music, church groups, community organizations, art, etc. The nice thing is that they get a circle of non-medical friends to add perspective to their lives. For most people, all these interests were suppressed during clinical training.”
  • Make time for yourself (separate from time for your family)...get back into that exercise routine that fell by the wayside during residency (or sport or instrument they used to play)
  • Find a balance between work and play, don’t forget to take care of yourself
  • Taking a job that they end up loathing for whatever reason, and then not having the courage to leave and find another one
Finances: Pitfall is getting in over your head
  • Start saving up during residency for the first year out.  “There are a LOT of expenses no one told me about.  Moving, security deposits, first and last month's rent, boards fee (both written and oral - plus travel and lodging to Chicago!), cost of licensure.  It adds up to several thousand dollars.”
  • Don't spend more than you earn.  Spending quickly rises to match income.  Don’t live beyond your means now that you are getting a real paycheck.  Don’t buy a house too soon or buy a very modest one initially.  Owning a home can get you in over your head faster that you can imagine. Don’t buy a $60K BMW right away!
  • “Do not underfund your savings plan, do not overpay for a car.  I see too many recently graduated residents buy a big ticket item as soon as they become attendings (usually some ridiculously expensive car) but not put money into savings.  They need to max out their 401k/403b from day one.  If they never see the money going into their savings plan, they never feel the hurt.”
  • Realize that you are immediately in a new tax bracket and plan accordingly
  • Pay off some debt, live like a resident financially for a while which allows for saving money so you can travel, change jobs if needed, etc.
  • Start saving for retirement as early as possible, and start college funds for your kids the minute they are born
  • Continue short term disability plans from residency if possible as they are often fairly inexpensive and not all groups offer short term disability (some policies allow this and this is particularly important for females who may get pregnant). Some companies offer a guaranteed issue disability policy to residency graduates; take advantage of it.
  • Many residents do not understand their contracts or sign ones that may get them into trouble, i.e., agreeing to restrictive covenants, etc.  Don’t feel like you won’t get the job if you don’t agree to all the provisions; in the end almost everything is negotiable.  Look to your specialty societies if you are not sure or have questions.
You are not Alone: Pitfall is being afraid to ask questions or ask for help
  • You can always call 'home'.  If you are out moonlighting or on your own and just want to bounce something off one of your colleagues from where you trained, you can always call.  Someone from your department is on 24/7.  Sometimes it just helps to think out loud and with another brain that knows your brain. Stay in communication with the mothership!
  • Never lose your humility or be too afraid / too proud to ask for help.  Just because you've graduated, doesn’t mean you know it all / can do it all. Medicine is the most humbling of professions; if you don't know the answer, ask!
  • If you're not sure about a patient case, ask your colleague who's working with you.  It's not a sign of weakness.  Your colleague has one thing that a new grad does not - experience.
  • First 5 years out of residency is a steep learning curve; you’ll see stuff you’ve never seen before, you may do procedures you’ve never done before, better to admit you’re not sure than make something up.
Compassionate Care: Pitfall is forgetting why you got into medicine in the first place
  • “Take the time to make a true connection with a minimum of ONE of your patients per day or shift.  Take the extra time and make the extra effort to create a connection and find out something about them as a person.  it helps you keep your humanism and remember why you got into this business - to help people.
  • Graduates must never lose their compassion; if they see themselves moving towards indifference, do something about it; compassion is the most important quality associated with a long and happy career.  And the obvious corollary… never forget your patient is an actual person and not a scientific problem.
  • In the first few years of practice most graduates end up making an important, but unconscious, choice between compassion and indifference toward their patients.  Young physicians who seem jaded and annoyed by their patients (or “hits”) frequently become bitter as the years go by.   Others who really take the time to listen and care for their patients seem to become more satisfied as they go on.
  • Consistently regarding your next patient as an opportunity to care, rather than a burden or an obstacle to getting home, is the best guarantee for long-term success.
  • Be nice to as many people as possible; “Kindness is contagious”.
Burn Out: Pitfall is succumbing to the pressures of clinical practice and burning out
  • “I see a certain curve in young physicians… nervous/uncertain at first, then they gain confidence and after a few years become a bit overconfident, until something bad happens; for the high performers particularly, as they expect more and more from themselves, often forgetting to maintain their private lives, there is a tendency to burn out in years 3-5 (loss of compassion/empathy, de-humanizing patients, judgmental, short tempered, hard on their colleagues, etc.).  This is a repetitive pattern and over the years I have come to look for it.  Noted early it can be readily reversed, but if allowed to progress it can become a crippling issue.  So I warn people about this and I have been told it helps.”
  • “One of the things I wish someone told me was to watch the amount of overtime I take on. New grads are seeing real money/pay checks for the first time. OT is real alluring because new grads think they need all this money to pay off bills and other debts they have accumulated. However, if they do too much OT they get burnt and cranky and they can't enjoy their new jobs/positions.
  • Remember what you enjoyed as a resident.
Treat Others Well: Pitfall is now that you are a real doctor thinking you are above your coworkers
  • Listen to your nurses and staff.  They will save your ass more than you know!  Scorn the nurses... look for a new job!
  • Not being a team player (you are the new guy that means watching more than talking).
  • Telling all the 'old' guys how to do it!
  • Get to know other medical staff and review a list of your consultants with the current staff to find out who is really helpful/unhelpful, who has a personality disorder, who you can call in a pinch even if they’re technically not on call, etc.  You need to feel you are part of the larger physician team of the hospital - even if you don’t like all of them. 
  • Bring food for everyone to your department/office for at least the first month (or longer).
  • Ask the nurses/techs what you can do to help out and clean up after yourself without being asked (I promise the return is greater than the effort!)
  • Not treating other physicians as if they were members of your own family, especially when one of them becomes ill.
  • Be the "yes" person.  If you can do it, and there is no reason to say no, then say "yes".  Be the dependable person others can count on. What goes around, comes around.
  • Your character is revealed by the manner in which you treat those least important to you…
  • “As my 9 year old daughter tells me often - Smile.”  It's contagious.  :) 
Clinical Practice: Pitfall is not doing what you know is right
  • Do not make a “fence decision” that you will lose sleep over. If you are second guessing yourself while the patient is still in the ED, office, or on your service, you WILL wake up in a sweat at 3 in the morning questioning why you did what you did (or didn’t!)
  • There are very few absolutes in medicine. Practice varies from hospital to hospital, region to region and by provider so learn the local standards. Be cognizant of this and be flexible. Don't sacrifice your training and principles but decide which battles to fight.
  • Forgetting to use their history and physical exam skills to diagnose their patients, not the CT scanner.
  • Be prepared for change: clinical practice will change and you must keep up with current medical knowledge.  Develop a regular reading plan. 
  • Becoming complacent in patient care; at graduation they are proficient but it will take many thousands of patients and many years to become a master.  Keep working at it; like the flight community says – complacency kills!
  • You will have to reinvent yourself – maybe several times, be open to it (protect yourself from tunnel vision).
  • Document scrupulously and honestly.  Always do the right thing, DESPITE: Managed care, cost-effectiveness and administrative pressures.
  • You are a professional, maintain professional standards at all times and in all situations.  Whether you like it or not everyone looks up to you.  Beware of social media – don’t post ANYTHING that is even remotely socially questionable, invariably your boss will end up seeing it and it could cost you your job.
  • Ask yourself; how would your mother feel about the way you conducted yourself if she read it in the newspaper?
Academics: Pitfall is not learning the art of saying both yes and no
  • Not going that extra mile if you are in academics because you are just starting out, e.g. reviewing, research, taking on the med student rotation, etc. 
  • Learning to say no is an art form; however, don’t say no too often early in your career because the offers may stop coming.  Rather learn to say yes to the right things and seek out something you can become passionate about and can take you places. That one random "yes" could lead to a niche you never would have thought possible.  Create a niche for yourself.
  • Talk to your chair early, ask for help getting involved in important departmental activities but at the same time limiting them so you can focus on becoming very comfortable with your new role as a clinical attending physician.
  • “We give people titles in academics too quickly. I think I ruined one of my best grads by making him an APD right out of residency. Now he’s stuck in a wrong path and not very successful. My new rule, no promotions for 2 years… awards, thanks, gifts, sure.  No titles.”
Professional Development: Pitfall is not placing a high enough priority on it
  • Forgetting that the first day after graduation is the beginning of a process in which you actually learn how to practice your specialty, not the end.
  • Get involved with hospital committees, county and state medical societies, etc. Get involved at a local/regional and national level.
  • Specifically getting on your departmental or hospital QA committee - it's a good way to learn your clinical  processes and what the standard of care is for your institution.  Also, always best to learn from others 'mistakes'.
  • Consider a leadership development program.
  • Find good mentors and continue mentor relationships from residency.
  • Give back to your specialty.
Passing Boards: Pitfall is not allowing enough time to prepare for them
  • Do not slack in studying - You are not really done until you pass your boards.
  • Seriously review for your board examination regardless of your last In-Service score. Every PD can relate a story about an excellent, competent resident with a great final In-Service Exam score that then flunked the written or oral certification examination!
Remember The Six C’s
Compassion
Remember why we do this in the first place
Be careful to avoid callousness, hardness & burn-out (“Easy to be hard…”)
Compulsiveness
Be compulsive in your:
Charting
Record completion
Filling out paperwork
Patient care
Life-long learning
Showing up on time
Caution (Conservatism)
“Be neither the first, nor the last, to adopt anything new”
Most new, pushed drugs are not necessary (Vioxx, Celebrex, Ketek)
First, do no harm
Conflict resolution
There will be lots of potential fights, with:
patients, privates, partners, boss, staff, RN’s, etc.
Learn to gracefully & diplomatically avoid or resolve real and potential conflicts
Prevent escalation
It usually isn’t really worth it, after all
Being right isn’t enough - to get ahead, you’ve got to get along
You don’t want to be the one that everyone thinks is “difficult to deal with”
Committees
Despite the hassle, be involved professionally at the:
Departmental level
Hospital level
Community level
Professional organizational level
The investment in time pays off multiple ways
But wait until after your boards!
Communication
In your documentation
With your patients and families
Always spend an extra minute or two
With ED staff
Learn their names
Show respect for them 
Rosen’s Troll Theory:
Trolls are everywhere; you know who they are and you have interacted with them.  They are in every clinical practice, office, and organization and their sole purpose is to frustrate  you and prevent you from getting what you want to get done.  In order to be successful you need to beat the trolls at their own game and there is a scoring system:
  • If you get the troll to do what you want, and don’t lose your temper you win; you get 1 point
  • If you get the troll to do what you want but lose your temper in the process; call it a draw
  • If you can’t get the troll to do what you want, but you don’t lose your temper the troll gets 1 point
  • If you can’t get the troll to do what you want, and you lose your temper the troll wins; they get 2 points!
As you can see the world favors trolls, and so the essence of career success and avoiding these pitfalls, is to get the trolls of the world to do what you want them to without losing your temper or better yet to make them think it was their idea in the first place. In this manner you will avoid being "betrolled".