It is crucial that the musician practice and memorize the piece in such a way that the performance can be done almost automatically, with the fingers of each hand playing the proper notes with little or no conscious direction from the pianist; On the other hand, the pianist must have a certain amount of spontaneity in order to connect and communicate with the audience. Imreh did this by using her mental map of the piece. She would play much of the piece just as she always practiced it, with her fingers going through well-rehearsed motions, but she always knew exactly where she was in the piece because she'd identified various points that served as landmarks. Some of these were performance landmarks that would signal to Imreh that, for example, a change in fingering was approaching, while others were what Chaffin called expressive landmarks. These indicated places where she could vary her playing to capture a particular emotion, depending on how she felt and how the audience was responding. Here is where I am, who is a good doctor? This is my friend who is in an emergency, how do I help them? I have a family member who refuses to seek any help, how do I help them? And it's just the same questions, over and over and over again. There are no answers for these mostly because there are no services available in so many places and people have rigid mindsets quite often about what kind of help they are willing to seek, what kind of modalities they are willing to use to accept therapy. It's a difficult one to crack so I hope you can make some sense of that. AMRITA: Who did you turn to for help? PARAS SHARMA: I went to a therapist and when things looked like I needed medication, I went to a psychiatrist that I have closely worked with. So for me, the journey was pretty simple, because I knew and I really believed that therapy works and I also do believe that medication works when you need it. So I don't really identify with this entire thing that, Oh, we should always be anti-medicine'. <a href=''>No</a> wonder that the listener, as well as feeling exhausted, will often feel manipulated or controlled. <a href=''>This</a> is exactly what distinguishes manic-depression from other forms of psychosis, where the person may construct a virtual, distant or internal addressee. <a href=''>There</a> has to be a real listener right there in front of them. <a href=''>And</a> yet there is something tenuous, desperate even, about how the manic person maintains their interlocutor, as if they had to have them there at all costs, like a nightclub entertainer who has to keep his audience focused on himself at all times. <br /><br /><a href=''>Is</a> it an accident that manic-depression is so common in the world of comedians? <a href=''>As</a> Freud saw, to study mania means thinking about how jokes work. <a href=''>The</a> explosion into punning and wit described so frequently by manic subjects shows how a bond with another person is created through words. <a href=''>When</a> we tell a joke or employ wit, it is usually in situations of unease or threat. <a href=''>Alone</a> and isolated with another person, what better tool do we have to win them over or to make them less threatening? <a href=''>Jokes</a> unite and bond, creating a connection between two people generally at the expense of a third party, the butt of the joke. <a href=''>Preventive</a> Care <a href=''>Some</a> preventive services--including vaccinations, general health exams, and cancer screenings for at-risk populations--are delivered by primary care physicians and specialists. <a href=''>These</a> are paid for under mandatory health insurance. <a href=''>Since</a> the 1980s the Confederation has introduced population-based prevention programs for AIDS, drug abuse, tobacco, and alcohol. <a href=''>Cantons,</a> however, are responsible for implementing these prevention efforts. <a href=''>This</a> decentralized and diffuse responsibility, characteristic of the Swiss health care system, has limited the effectiveness of national prevention strategies. <a href=''>Quality</a> Controls <a href=''>The</a> Confederation's Health 2020 strategy has made expanding the measurement and quality of care a top priority. <a href=''>In</a> 2008, the Swiss Inpatient Quality Indicators were introduced to monitor and evaluate the quality of acute care hospitals. <a href=''>In</a> 2012, the FOPH and the Foundation for Patient Safety initiated 2 national quality programs to reduce surgical and medication errors. <a href=''>They</a> decided to get a dog, thinking it would be good training for the future responsibility of having children. <a href=''>They</a> got a beautiful golden retriever, along with all the fixin's--the toys, the brushes, the food, and a beautiful bed. <a href=''>They</a> came home and placed the dog's bed in the corner of their bedroom so they could all sleep safely together. <a href=''>Unfortunately,</a> the Relationship corner was where the dog's bed landed. <br /><br /><a href=''>Suddenly,</a> everything was about the dog. <a href=''>It</a> didn't take long for it to start coming between them--literally, in their bed. <a href=''>They</a> thought it was cute at first--he was so small and cuddly. <a href=''>But</a> then they noticed they didn't have the time or energy to even think of raising kids, what with all this dog stuff. <a href=''>After</a> all, he was going to school now! <a href=''>I</a> asked Marty one day about having children and he said he and Sara were working on their relationship first. <a href=''>That</a> allowed her to maintain spontaneity within the demanding constraints of performing a complicated piece before a live audience. <a href=''>PHYSICAL</a> ACTIVITIES ARE MENTAL TOO <a href='[]=<a+href=http://></a>'>As</a> we've just seen from several studies, musicians rely on mental representations to improve both the physical and cognitive aspects of their specialties. <a href='[]=<a+href=http://></a>'>And</a> mental representations are essential to activities we see as almost purely physical. <a href=''>Indeed,</a> any expert in any field can be rightly seen as a high-achieving intellectual where that field is concerned. <a href=''>This</a> applies to pretty much any activity in which the positioning and movement of a person's body is evaluated for artistic expression by human judges. <a href=''>Think</a> of gymnastics, diving, figure skating, or dancing. <a href=''>Performers</a> in these areas must develop clear mental representations of how their bodies are supposed to move to generate the artistic appearance of their performance routines. <a href=''>But</a> even in areas where artistic form is not explicitly judged, it is still important to train the body to move in particularly efficient ways. <a href=''>Swimmers</a> learn to perform their strokes in ways that maximize thrust and minimize drag. <a href=''>Medicines</a> are needed when people need them, and they work for people who need them, so I really don't endorse a view that says you shouldn't ever go on medicines and I also don't endorse a view that medication should be the first thing that you go to. <a href=''>So</a> simply put, I went to therapy and I continue to go for therapy, and when I realised it was time for me to go on medication, I went on medication. <a href=''>I</a> still think it is time for me to stay on medication, so I continue. <a href=''>The</a> time when my therapist, my doctor and I feel that I'm ready to go off of it, we will start tapering it, and we will see how that goes. <br /><br /><a href=''>AMRITA:</a> What are myths you want to bust or a wider message you would like to spread further? <a href=''>PARAS</a> SHARMA: The last bit -- that it's not the case that medication is always bad and it's not that medication is always the answer. <a href=''>There's</a> a lot of grey area in between and we should respect people's opinions, choices. <a href=''>But</a> I really don't believe in those who actively dissuade people from seeking therapy or seeking medication. <a href=''>I</a> wholly respect my client's agency to use faith, use alternative medication, or use alternative healing practices, as long as they also continue seeking therapy and seeking medication if they need it. <a href=''>But</a> I don't appreciate mental health professionals or medical professionals for not doing that, and I also don't appreciate alternative healers or spiritual practitioners or leaders who dissuade people from seeking counselling or seeking medication, calling these Western concepts. <a href=''>They</a> also involve guilt. <a href=''>If</a> we feel guilty about something, perhaps a sexual or a violent thought in ourselves, wrapping it up as wit allows the temporary experience of release, as if we could redistribute the burden that we feel. <a href=''>Isn't</a> that why the most common initial reaction to hearing a joke is first of all the thought of who one will tell it to next? <a href=''>And</a> for the teller of the joke, it is a feeling of relief, of a split-second success, perhaps followed by the warm sensation of being loved. <a href=''>A</a> joke involves the idea of its transmission, of passing it around, whether in person or through an email or phone call. <a href=''>That's</a> why if you observe the audience during a comedy film, they keep looking not just at the screen but at each other, whereas if it's a tragedy the gaze remains fixed to the screen. <a href=''>Jokes</a> always involve a third party, as if our affect of laughter both depends on someone else laughing and is sanctioned by them. <a href=''>Describing</a> his first manic episode, a businessman explained howI found it intoxicating to be able to make people laugh in the office. I could even make people on the tube laugh. Jokes and punchlines just kept coming naturally. The National Association for Quality Improvement in Hospitals and Clinics (ANQ) publishes quality indicators for inpatient, psychiatric, rehabilitative, and geriatric facilities. In 2011, ANQ members signed a national quality contract that created financial incentives for adhering to ANQ quality initiatives. Hospitals that join the contract must provide data to an ANQ database for performance evaluation. By 2013, almost all hospitals in Switzerland had joined the contract and were participating in quality initiatives.

Physicians are not routinely evaluated on their quality of care. The fact that many physicians have no electronic records for data collection further challenges evaluations. For instance, in Geneva 30% of physicians keep only handwritten records. However, an ongoing project called BAGSAN is exploring the possibility of using routine ambulatory care data to develop quality indicators for providers. grassroots initiative to improve the quality of care is Smarter Medicine, a program based on the Choosing Wisely campaign in the United States. Because the current fee-for-service payment system for physicians incentivizes high-volume care, nearly 25% of all care is deemed inappropriate. I was shocked. I had to take a look around. Upon inspecting the Relationship corner, I quickly told him about how important this corner was to their relationship and that they had created a threesome with the dog. He said it felt that way, and now he had a new determination to get his wife back. The dog's bed moved, and so did the energy. They are happily working on having those kids they said they always wanted. Whatever resides in the Relationship corner besides you and your partner may falsely seem more important than your relationship. At a minimum, it may wiggle its way between the two of you, looking for equal attention. Perhaps you are in a relationship but are looking to spice up your sex life. Maybe you are single and want to get a little more than you have been lately. Runners learn to stride in ways that maximize speed and endurance while conserving energy. Pole-vaulters, tennis players, martial artists, golfers, hitters in baseball, three-point shooters in basketball, weightlifters, skeet shooters, and downhill skiers--for all of these athletes proper form is key to good performance, and the performers with the best mental representations will have an advantage over the rest. In these areas too, the virtuous circle rules: honing the skill improves mental representation, and mental representation helps hone the skill. There is a bit of a chicken-and-egg component to this.