Seeing the doughnut instead of the hole #WILTW

This is the 111th #WILTW

It has been an interesting week.

To be honest as a supporter of both Europe and the England Football team it’s actually been quite a painful one. England’s performance was so abject you wonder if we need a referendum on whether they should play in football championships in the future.

With the widespread negativity resulting from the political events you may have thought a discussion on “Paediatric end of life care in the ED” would not have been something to lift spirits. However this thoughtfully delivered teaching session by one of our Paediatric Intensive Care Consultants, Dr. Peter Barry, provided a great deal of food for thought. Judgements on  quality of life always cause a great deal of introspection. The outcomes of this weeks events put into some context when compared with the dilemmas  parents, carers and health care professionals face when making decisions about children with severe life limiting or modifying conditions.

Peter shared a piece of writing which I had not seen before. “The Median isn’t the Message” is the personal story of how Stephen Jay Gould makes sense of being diagnosed with cancer.

“Mesothelioma is incurable, with a median mortality of only eight months after discovery

It is an eloquent description of how statistics can potentially be used inappropriately if just presented at face value. What does a median mortality mean to you? It isn’t a mean, so the average time isn’t 8 months, it is the central, or half-way point time that is 8 months.

A politician in power might say with pride, “The mean income of our citizens is $15,000 per year.” The leader of the opposition might retort, “But half our citizens make less than $10,000 per year.” Both are right, but neither cites a statistic with impassive objectivity. The first invokes a mean, the second a median. (Means are higher than medians in such cases because one millionaire may outweigh hundreds of poor people in setting a mean; but he can balance only one mendicant in calculating a median).

While in many scenarios the median and mean are close numerically the choice of measurement can result in considerable variation around that value. In Stephen’s case there is a very large right skewed distribution around the 8 month point i.e. people can live for far longer than 8 months than less than it. Furthermore as a young man, diagnosed relatively early and having access to the best care he was much more likely to be on the right side of skew.


Having analysed what the variation around the median might be Stephen adopts a very proactive and positive attitude to his situation and lives for a further 20 years. The impact of his attitude on his survival a discussion, and controversial, point in itself. Stephen felt his optimism as someone who tends to see the doughnut instead of the hole allowed him to look at the the statistics of his cancer differently and as a result look at his cancer differently. Clearly this situation is specific to the individual and difficult to generalise a whole cancer population.

Donught WILTW

However while a thorough evaluation of the economic impact of Brexit is unlikely to find us a surplus of cash, and analysing the England match will not reveal hidden talents in our players, there are times when taking a deeper look at uncomfortable news may have a more positive impact than you might think.

What did you learn this week? #WILTW

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