Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Read, read and read some more!

As a practicing physician (and research scientist), I am a regular journal reader. I read about 30 journals per week as part of my regular reading. Early in my medical career, as a medical student, I learned to evaluate medical and basic science literature. This is more important for practice today than ever before.

Many of my colleagues do not regularly read many journals, especially research, because they just don’t have the time. Practice today is very demanding with the push to see more patients and do more procedures. They rely on the industry, pharmaceutical, and medical device, within their specialty to keep them updated on the latest science out there. This is problematic for many reasons.

The pharmaceutical and medical device industries want to have you sell their products. They go to great lengths and expense to make sure that you get the most positive information on what they are selling or presenting. They are not as closely regulated these days by government agencies (FDA) as in previous times. A clear understanding of how many people who were formerly heads of pharmaceutical and medical device industries are now in charge of the FDA is a huge warning signal for me.

I am forced to evaluate all research on any device or pharmaceutical that is used in my patients. I look at all studies, not just the studies that the industry reps present with their products. Yes, there are new innovations coming at quantum speed but I have to make sure that I have all sides of the equation before using (or implanting) something in a patient.

I made sure that I thoroughly learned to evaluate studies and that I agree or disagree with the conclusions of the studies. I ask for alternatives; doesn’t make me popular with the reps who are often not medical professionals but salespeople with little clinical knowledge. It’s cool to look at displays at conventions but I take the literature, do my own research and call colleagues who might be using the devices.

We owe our patients our best knowledge and good faith. Their trust is in us which is part of the magic of medicine. This is also why medicine is the toughest and greatest profession that anyone can practice. In today’s world of instant access to scientific literature (from a remote computer), it’s overwhelming but we have to learn to take the time to do our own research rather than rely on the industry.

Much of what makes medicine difficult for me these days has to do with the profit margin that my hospital and healthcare system administration pushes in my direction. I am pressured to do cases faster than ever and get patients home as fast as possible. My social workers are burdened with making sure a patient has adequate care at home or in a non-acute facility for recovery as hospital stays are shorter and shorter with sicker patients.

Medical device innovation and development are expensive for companies with millions and millions done in research before the device gets into clinical practice. I am charged with making sure that the studies cover all of the bases and that I am thoroughly aware of the consequences (side-effects) and safe uses of devices and pharmaceuticals. Often my patients will have seen an advertisement for a new product and want the latest done or prescribed for them.

I have to have good information and explain all the risks and benefits of anything that I prescribe or use in my patients. This takes time, diligence and reading the literature. I am happy to do this and even happier if a new device/pharmaceutical helps my patients. Thus, at any stage in your practice, read, read and then READ more. There is much at stake for all of us.

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2 August, 2018 Posted by | academics, medical school, practice of medicine | | 2 Comments

Human Sexuality/Well-Being Part One

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In working with my medical students in the Physical Diagnosis course of the past semester, I discovered that there was more than the usual amount of discomfort with the discussion of human sexuality and sexual history-taking. Certainly, my students have studied anatomy, behavioral aspects, and physiology of the genital organs. They are quite comfortable with what is there but having conversations, connecting and explaining human sexuality is something novel for them.

In the past, I was prone to explain my students’ reluctance of sexual conversations with patients as a product of their lack of personal understanding but there are far more aspects than pure lack of understanding. The first item that I needed to introduce is that one does not have to have had a particular sexual experience in order to understand what a patient is attempting to communicate. One simply has to have an open, non-judgemental attitude with conveyed willingness to listen and hear what is said. If one does not understand, then one has to be willing to make the attempt to understand what the patient is saying.

Our patients come to us for problem-solving ultimately.  Patients bring their sexual experiences, which may include shame, guilt, embarrassment along with lack of knowledge. They seek reassurance that what they have experienced is “normal” or why something that they have read about or constantly seen on modern media is uncomfortable from the standpoint of behavior or physical experience. In short, we as physicians, regardless of specialty, need to explain and educate in some cases.

In this country, sexuality is intermingled with advertising, entertainment and the promise of personal achievement. How many times have we been bombarded with images (check out fragrance commercials) of young people in quasi-sexual situations that promise if you wear this fragrance, you too, will have this same situation. The same experiences are with the alcoholic beverage commercials where attractive people hint of increased attractiveness if one drinks a particular beverage.

On social media sites such as Facebook and Snapchat, we share our experiences of connection where some constantly compare our lives (sexual and non-sexual) with our friends without remembering that people only post what they want you to see. Few of us tend to post that we are depressed or confused about aspects of our lives. We tend to post what we are proud of or what we want others to see. The constant comparison with others can cause anxiety in other aspects of our lives.

Sexuality for many of our patients (and us) came from experiences as teenagers, often with or without explanation or discussion. Knowledge may have come from religion, which introduced shame when sexuality is a normal, strong behavioral aspect of the life of a human being. Experiences from youth, coupled with lack of knowledge, can often produce feelings that need to be explored and explained. There is no hesitation in explaining a fracture or diabetes but there is hesitation or even non-discussion when a patient may have a behavioral/sexual issue.

The first step in any behavioral standpoint clinically is understanding our feelings and attitudes. Our attitudes have to step aside so that the patient feels acceptance and feels free to tell us what they need for us to know. We do not have to have experienced something to listen to the experience of our patients. We need only listen, ask questions if we don’t understand and convey an atmosphere of comfort. These conversations may take place over a couple of encounters but they should take place if necessary.

An example from my experience is a 50-year-old gentleman who had symptomatic peripheral vascular disease. He was diabetic, had moderate-to-severe atherosclerosis, was a heavy smoker, and experienced erectile dysfunction. He wanted to discuss his erectile dysfunction and could not find a physician willing to listen to this important aspect of his life. As a surgeon, I made sure that I listened to what he needed to say.

My first task was to allow him to tell me why this aspect of his life was important. For him, it was more important than the pain and limitations his disease has produced in terms of walking from his car into a grocery store. He felt, understandably for a 50-year-old person, that his life was over and that there was no use in seeking treatment for his health problems. His sexuality was important to his sense of well-being and his perception of himself as a man.

My point in this little essay is to remind those who read it, that we as physicians have to allow our patients to tell us everything and anything that they need to tell us without judgment or criticism. Our patients have to feel the freedom to allow us to know all aspects of their lives that may influence future therapeutic interventions. With pressure from healthcare administration to speed clinical encounters along quickly, we have to be aware that some encounters won’t be quick but are necessary over the long-term.

If I don’t have the time to explore something that my patient needs to discuss, I make sure that I note that a sensitive conversation has taken place and schedule them for another encounter as soon as possible. I strive to allow my patients to feel that I have listened even though I am pressured to “move them along”. I listen and accept what they need to say without judgment but with openness, one human being to another.

Human sexuality and sexual behavior are important to all of us. In this country, it’s the one behavioral aspect of life that is shrouded in mystery for many people regardless of educational level or background. Over my years of life and clinical practice, I constantly inventory my feelings and knowledge. I am learning new aspects of sexuality and behavior daily, the magic of medicine for me.

Explore your feelings, seek knowledge and seek to be open to your patients for sensitive discussions. I will be writing other posts about some of my learning experiences in human sexuality as I go forward. My findings are that if I speak openly of my learning experiences, my students feel open to listening and learning, a gift for their future patients and for themselves without discomfort.

14 July, 2018 Posted by | life in medicine, medical school, practice of medicine | | Leave a comment

Starting a Running Plan

2018-04-01 21.17.00 I have been a runner since my days at University.  I was a varsity tennis player who needed something for conditioning in the offseason. Since our coach would not allow any racket sports like squash or racketball, I decided to do some running and weight-lifting to keep my aerobic base intact. I became a 10K specialist loving the middle distance.

In graduate school, I didn’t play much tennis other than the occasional club tournament but kept my running plan. I ran from 2-3 miles daily; my time for relaxation between my teaching duties and research experiments. I used the time to think about problems, angles and write my dissertation in my head. My running helped my research more than anything else.

I didn’t run in medical school; devoting my time to intense study. The volume of material  I mastered for each exam was overwhelming. My stress level was maximal with weight gain and essentially a sedentary lifestyle dictated by needing to produce excellent work in my courses, my exam and board study. My academics soared but my physical conditioning suffered. This was a huge mistake.

Through the stress of surgical residency, I tried to walk the stairs and meditate when I could. Since I had a good muscle base from university and graduate school, I stayed in average shape but didn’t run very much. I carried the excess weight from medical school hating the way I felt and looked. I hid in scrubs and in my professional duties moving to attending physician and professor.

Today, I am a long-distance runner; shedding the weight of medical school at last. I am thin,  powerful and serene. Achieving my goals was not an overnight process but a process necessary for my health and mental acumen. I started out brisk walking 15 minutes out and 15 minutes back every day of the week. My walk became a run and my runs stretched longer and longer.

My running forced cleaning my food intake to fresh fruit and vegetables with lean protein. My trainer added weight-training to my long distance running. Today, I run at 3:00 AM for a minimum of 1 1/2 hours most days of the week; longer distances on the weekends when I am not on call. I am strong, setting personal records and loving the Half Marathon distance as much as I loved the 10 K distance runs of my past.

My hospital has 14 floors that I climb at least twice daily loving the view from the roof in the early morning after a night on call. I enjoy running through the empty streets of my city; greeting the policemen who keep me safe in the early hours. I meditate and pray; gratitude for my excellent health and conditioning. My resting heart rate is in the mid-40s; my body very thin and very strong.

I tell my story because the summer is a good time to start the journey of getting in good physical condition. The weather is warm in most of the country which makes the process easier. Trust me, it’s hard for me to face 2F temperatures and snow of the winters in my Midwest city but I do face them for my early morning runs. Desire and planning pushed me out the door at first but habit now keeps me going.

I lost the tired feelings after a 16-20-hour day; now replaced with the energy to give my best. My physical strength allows me to finish 6-10-hour cases without a second thought. Good physical conditioning lets me park my car in the most remote parking place and dash into the hospital with stratospheric energy. Today, my energy is my most positive characteristic as I can run to an emergency faster than most of my residents with a smile on my face.

The public health part of being in sound physical condition is that in my Midwestern city, three-fourths of the population is overweight or obese. I am 5’8″ tall and wear a US Size 2 which is smaller than 99% of the US population. Even at this thin size, I take no medications other than a multi-vitamin and a calcium/Vitamin D supplement-the hazard of working indoors in rooms without windows to the outside.

I can counsel my patients about weight loss and increasing physical activity as an example of what they might accomplish at any age. I don’t admonish them but stress the importance of taking small steps; changing eating habits replacing them with things that can become a part of an active, healthy lifestyle. Too many obese people look to strategies such as gastric bypass which is a valuable tool but is beyond the reach of many who are without health insurance.

Take the summer to do one or small steps that will benefit your health and career now. While I regret not keeping up with my running in medical school, I am grateful that I did realize how making small changes led me to excellent health now. Learn good nutrition and leave the hospital cafeteria/ fast food/junk food alone. I have not had even a cold in the past 5 years because my physical conditioning keeps my immune system strong.  Be strong and be the example that your patients need.

23 May, 2018 Posted by | academics, life in medicine, medical school | | Leave a comment

Well, Spring is Here! Good Time to Make Some Changes.

DSCN1772    I live in the Midwest where Spring took a long time to arrive. I have been training for an upcoming Half-Marathon but the cold temperatures put a damper on my quest for chewing up a good mileage base for my upcoming race. Still, the warm temperatures arrive with rain (the bane of my existence on the asphalt) which forced me into more resolve to get my running done.

My solution has been to run very early in the morning (3:00AM) and late in the evening after dark. My mind figured that if I didn’t see the pouring rain, it wouldn’t bother me as much as watching the downpour by daylight. My strategy worked a bit but the warmer temperature did come and I have a decent base of training.

As I watched my resting heart rate drop into the 50s, I watched my body become extremely thin. I worried a bit about losing muscle mass but one of my colleagues in Sports Medicine encouraged upping my protein intake. Following her advice, I did up my dietary protein while cutting back on carbohydrate intake. I have also found that I just can eat large quantities of food thus my weight loss continues while my speed is increasing along with my endurance.

My mind is peaceful, organized and disciplined which serve me well in medicine/surgery. My early morning runs are a chance to let my thoughts go in any direction and I tread along the empty streets of my Midwestern suburban town. I don’t have to worry about dogs or kids in the very early morning. The police officers on duty are now on a first-name basis with me with one presenting me with a light-reflecting vest that can be seen for miles under the street lights.

I also take a run around my hospital grounds to lose tension when things seem to interfere with my rest. On those shorter hospital runs, I plan lectures and work out pesky problems. I meditate and pray a prayer of thanks on many of my runs as I am grateful for good joints and a healthy body. As I seem, my patients who are often sick from years of smoking, unhealthy eating, and diabetes, I know that every step keeps me healthy and serene.

I changed my eating habits; no more cafeteria food in the middle of the night replaced with fresh cut vegetables and fresh fruits. Though I love my black French Roast coffee, I limit myself to two cups freshly brewed and savored. I eat nuts, a few raisins for sweetness and drink plenty of water to keep hydrated. Keeping hydrated in the HVAC air of my university and hospital is a challenge for me.

I now live one day at a time because my training for my long-distance races has forced me to do this. I don’t make the excuse that I am too tired or too busy to cook a good healthy meal (chop vegetables on the weekend and keep them in the freezer). I try not to sit for hours on end reading journals and completing records but move or stand when I do these necessities of my profession. I park in the furthest parking space and enjoy the brisk walk into the building. I shop in the outer aisles of the grocery store where I can find fresh fruit and vegetables; limiting my access to processed foods.

My complexion is glowing; my mind is aware and quicker these days based on a few changes to my diet and exercise. I used the changing weather to change how I take care of myself. I felt that I couldn’t counsel my patients in terms of a healthy lifestyle if I wasn’t living healthy myself. I also enjoy shopping (get many of my dresses from Costco) and love that I now wear Size Small scrubs (cuter than the Large ones).

I told myself that I would change one day at a time. If I could do one day, I could stretch my one day to two. Making the changes was difficult at first but now they are my normal routine. I sleep better, move better and get my work done better. There are times when I run the 14 floors of my hospital just because I know that I can do this now. What a difference making a change even at my advanced age can do and mean.

Take the time to make some small changes that will lead to a healthier mind and body. It’s very difficult for me to be depressed and angry when I am running in the wind (and occasional rain) with the world moving by me. I find that I smile more and enjoy greeting the world in the darkness as I head out at 3:00AM. I also find that the phone doesn’t ring at that hour either.

Spend some time taking care of yourself and appreciating what your body can do and how it can change. Be good to yourself and appreciate how powerful self-love and appreciation can become infectious to all around you. Wear brighter colors or change the color of your lipstick. Do anything that makes you feel good about this amazing world where you will help others and allow them to help you.

Spring is here soon to be followed by summer with warm days, beautiful flowers and trees. The smell of freshly cut grass or charcoal burning on the evening grills is a sheer pleasure. The early morning fog, quiet as the sun comes up and hearing an occasional alarm sounding as my neighbors start their days is great too. It’s a bit of a spiritual experience but it’s a good one!

5 May, 2018 Posted by | medical school, medicine, relaxation | , | Leave a comment

Using Every Tool

As all of us in academics (professors, students) enter the final stages before the semester/quarter ends, we make the push to finish strong. If you have been struggling with your studies, now is the time, just like tax time, to get your work shored up for that strong finish. It also a good time to take and inventory of sorts, in your thinking about why and how you master your studies to have the best outcome in your classes.

We finished our spring breaks with the hope of resting perhaps getting away from our studies in order to come back with renewed energy. Depending on how you spend your break-some catching up, some getting away, some planning for the next steps, you may be feeling that the “break” was not a break at all. If that was the case, then take this weekend to put some strategies into place to finish this term/semester/school year as best you can.

I always advise my students at the beginning of the year, that regular planning/study is the key to mastery of your subject matter. Making schedules and sticking to them is as important to success as my daily workouts are key to my training for an upcoming marathon. I have to work out regularly in order to complete my distance race. I can’t arrive on race day and run a marathon, half-marathon or even a 10-kilometer race without doing some daily training/conditioning work.

Like anything that I have to train for, there are days when I don’t feel like putting in the time. Sometimes, I just want to take a break but I can’t take too many breaks. My training runs, like your daily study periods are a time to work on those little details to develop the strength and tools to complete my goals. If I don’t put in that time regularly (do something) I won’t be ready for my long-distance race.

Sometimes, I do take a very short break from my training but at the end of the day, my tool is that I do something more intense so that I get a small benefit of even not running on that particular break day. These are my mini-spring breaks away from training. This strategy, I apply to studies (yes, even as a professor, I am constantly learning, honing and refining). That short break is the tool to remind me to get back onto my regular schedule as soon as possible.

I have used preparation for a long distance race because when I made the change from short-distance running to long-distance running, many other items in my life became easier and better. My studies, like your studies whether you are an undergraduate, graduate or medical student require daily work and refinement; in other words, daily training. We are all preparing and using the tools of preparation for finishing strong in our endeavors.

Consistent work is always key to academic success. In today’s world of electronic delivery of materials, one still has to devote regular study time for complete mastery of subject matter. We have millions of bits of information at our fingertips, online and even on our thumb drives, that we must master for our programs of study. Organization and regular consistent study of our academic materials is more relevant today than back when I was in medical school and graduate school.

Organize your materials, plan your study schedule and take short breaks over the course of the day but be consistent in your study. As I have written in other pieces on this blog, my tools of organization have been to review the previous material, study the present material and prepare for what will come next. These are your tools for making sure that this period before finals and before the semester/year ends are in place so that you may finish strong.

Just as I want to complete my upcoming distance race as strong as possible, I want to complete the race. Use your time wisely, take short breaks away from your studies but make those breaks matter. Don’t give up at this point because you are overwhelmed. When those feelings of being overwhelmed enter your mind, take a short minute, jot down that you are feeling overwhelmed and write out only the next small thing that you will complete.

As you complete many small things, they always add up to completion of the big items. Completing those small items also keeps procrastination from derailing your studies at this time. Until you have taken that final exam, nothing is lost and you can keep preparing but if you stop, give up and allow feelings of “everyone is doing the better that I am” to enter your strategies, you won’t be see any success. Fight the feelings to make comparison to those around you; only compare you with you yesterday.

You can’t change the passage of time and you can’t change the past but you can decide in the next minute to change your thinking about how you deal with the present to affect the future. This is the most valuable tool for anything. I can’t change how I ran my last race but I can keep preparing for the one that is coming up. This is what I tell myself as I head out the door to the gym to do a bit of speed work and lift some weights. Every weight I life, every step I take is moving forward. Use those tools and adapt as you make adjustments to finish strong but don’t forget a tiny break/ reward for keeping things going.

14 April, 2018 Posted by | academics, medical school | , | Leave a comment

Why Don’t We Feel Safe?

Today, March 24, 2018, many high school students and teachers are marching/assembling in major cities to bring attention to their increased feelings of not being safe in their educational settings. I would add my support to them as everyone should feel safe in their homes, schools, places of employment and places of recreation. Safety is a right of every individual in any environment. When individuals don’t feel safe, they experience increased stress far above what is expected in their day-to-day lives.

Even in hospitals, safety has always been of importance both in how we treat patients and the patient environment. We always pay very close attention to situations that potentially put individuals at risk but of recent, safety issues for those of us who are just going about our jobs in emergency departments, hallways and classrooms have come under scrutiny. In short, physicians, professors, students, and patients have been harm’s way because of disgruntled employees and colleagues who seek revenge for perceived wrongs.

It’s persons who feel the need to inflict harm on those who have no role in their perceived situation that is most troubling for the public at large. When guns are fired, even with intended targets, others get hurt and killed. When mentally ill individuals have access to weapons (guns, cars, knives, explosives), individuals without warning, are subjected to random violence. When the electronic and television news media spends hours and hours attempting to find motives and uncover a “story” in these random acts of violence; creating stress in individuals.

Perhaps this 24-hour scrutiny is a product of the electronic information age but there is nothing that prohibits us from turning off the news and disconnecting from social and other media. From the time I first acquired a pager as a medical student, I became acutely aware of the need to just “turn the thing off” in order to reconnect with a world that doesn’t need access to my attention at all times. I never want to be the person walking along staring at my smartphone and ignoring the world around me. Yes, I look at it when I must but certainly, I strive to look around; be aware of those around me.

As those who march in the streets today want to emphasize,  all individuals have a fundamental right to pursue their lives not only in freedom but in safety. As a physician, I don’t want to take care of even one more innocent individual who has become a victim of random violence. My stress is worrying about those I love and whether or not they will come home. The stress is palpable across many in my environment which include where I work and study. There is simply no reason in a civilized society for this to happen.

My answer is to be vigilant and to be aware of those around me at all times. My answer is not to lock-down hospitals and campuses but to pay attention to people around me who may be suffering. My answer is to not look to electronic and television media to examine what I as a physician, must examine for myself. My answer is to treat all people, even those who are struggling academically and personally, with dignity and compassion.

Just recently, more than a few of the medical students that I have taught, found out that they didn’t match into a residency position. The stress of finding employment for next year is gut-wrenching for them and for me as well. The lack of post-graduate positions coupled with a system that is in dire need of an overhaul is necessary. The feelings of despair were very deep for those who didn’t find a match when those around one are celebrating. I found more than one person who is derailed by the process.

Disappointment, anger, and despair when one does not obtain the end result of work and study or any other desired outcome is often a trigger for actions that are uncharacteristic. Even more disturbing is that those who are successful may be perceived as “bragging” on social media when they are just celebrating the next step in their training. My answer to those who didn’t match is that it’s not a personal failing and my answer to those who did is well-done but have compassion for those who are struggling.  My answer is to do everything within my power to allow my students to feel safe as they study and work. As a human being, I can do no less but I can do more.

24 March, 2018 Posted by | academics, medical school | Leave a comment

Spring Break

Whenever the hype for March Madness comes around, my thoughts go toward Spring Break for undergraduates. For many in the Northeastern United States, a nor’easter has dumped enough snow (continues to dump snow/ice) that the prospect of heading to a warmer climate most attractive. Even if one heads to the ski slopes, it’s important to take this time, if available, to get away from your academics to recharge and see new scenery.

Some students will use the time to catch up or write papers that may be due towards the end of the semester but don’t use the entire break to work on academic matters. Go to a movie (check out the Oscar nominees for Best Picture) or see a musical, hear a concert or attend a play. In short, do something outside of your normal routine that expands your mind. Even exploring a new cuisine or reading a fiction novel is a great way to break out of the academic world for even 24 hours.

Rest, relaxation and breaks are as important as hard work in the pursuit of excellence. One can argue that if one “breaks” every weekend, one does not need much of a vacation but if those weekend breaks are your routine, do something different over Spring Break. It’s the different activity that allows the mind to recharge and sets new neural networks for use as you need them. Humans were never “wired” for routine and do best with change.

Knowing that one needs a break in routine is a useful characteristic to hone at the undergraduate level. Pursuit of medicine is stressful, long and can be all-consuming which isn’t good for mental health. Taking a break, even those weekend breaks is as important as disciplined, dedicated study during the week. Planning and executing plans are great but not planning, especially during a break is good too.

As a physician/surgeon, I took pride in not taking vacations as I built up my practice and research. Fast forward to today and I recognize the value of doing something different, interacting with colleagues outside of medicine/science and enjoying nature, sporting events and travel. I need my vacations now more than ever but I needed them as I started my career too. There is no pride in having a stress level that is on the verge of causing mental/physical breakdown.

In medicine, we often place our patients ahead of our families and ourselves. I can recall countless times, my father left the dinner table for an emergency or left a family gathering to take care of a patient. I have left graduations, dinners, weddings and other events because I was called into the hospital. At this point, I realize the toll that “being too available” has taken on my relationships and mental health. Today, I head out of town for my Spring Break to catch up on my reading (novels), watch those Oscar nominees and lie in the West Coast sunshine because I will return a better physician and professor for doing so.

8 March, 2018 Posted by | academics, stress reduction | Leave a comment

In Service, In Reality

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I found out a short time ago, that I am a match for donating a kidney to a colleague. The reality of my choice has been weighing on my mind as I perform my early morning runs through my little mid-western suburban town. I will donate one of my kidneys to help a colleague who is suffering on hemodialysis with many complications. It turns out that his son is also a match but refuses to donate to his father. I can’t refuse being of service to those who need something I can provide.

I did not make this choice lightly, to donate one of my kidneys. I am in robust good health, taking no medications as I run 6-8 miles each morning in the very early morning darkness. At my age, I am something of an anomaly with defying the odds; continuing to challenge myself physically and mentally. At a time when most of my colleagues contemplate retirement, I contemplate my next adventure be it sailing an ocean, flying cross country or running a marathon. In short, physical and mental challenges enrich my life and will continue to enrich my life.

I would be less than honest if I didn’t say that the timing of this transplant is worrisome for me. Minimally, I will be away from my running and teaching for a few weeks. Runners always worry about losing conditioning if we are not out crossing pavement but I can do other things such as swimming (need to work on my strokes) and biking as I recover. I plan another shot at the marathon distance in the late spring thus I know that this surgery will challenge my training for that run. This recovery will be problematic for me who strives on being as independent as possible.

My service to others is something that is part of me. I grew up in a family of physicians who always pushed me to give as much as I can. We were fortunate to have the advantages of good education and great guidance from our parents and extended family. “To those that much has been given, much is expected,” was ingrained in me as early as I can remember; much of why I chose medicine/surgery as a career. My service to other has recently extended to my study for the priesthood too. I have an opportunity to give a gift that will enable another human to live a high quality life.

While I intellectually understand the physical implications of my choice to donate an organ, I face the mental challenges of this donation with much trepidation. My feelings are not of “what if I need it later” but how can I minimize not being available for my students and patients at this time of the year. We are in the midst of epidemics and the start of a second semester which always bring challenges to those of us in academic medicine. I also didn’t have the wonderful luxury of input from those whose opinions I value most, my touchstones as both are busy with academic duties and so forth.

As I see my students, some now quite comfortable with their clinical duties and some who have made the adjustment to the rigors of the first-year curriculum, I am concerned that my brief absence from teaching may make an impact. Still, my duty to service forces me to recover as fast as possible and be present to guide those who are training under me. These are the thoughts that occupy my meditations on my distance runs these days.

In a time when many are quite self-absorbed, it is my duty as a human being and as a physician to help those who are in the direst of need.  Does that duty to help extend to organ donation? In my mind, it does extend to giving as much as I can for the good of another human being. The last thing that I consider is the effect on me physically as this will be minimal in the long-term scheme of my fortunate life.

My mentor for the priesthood suggested that I speak with the son of my colleague who because of choices made by the father, refuses to donate an organ. My mentor says that my best service extends to make another attempt to heal this family spiritually too. There is much merit to my priest mentor’s input here as there is still a small window of time but a challenge for this fledgling student of theology. In reality, I see many facets to this challenge which I meet as I meet all of my challenges.

My colleague is in need; his family needs him and I am honored to serve both this man and his family. He has much to live for and many depend on him.  In short, his life is very valuable to those who love him. It is those relationships of love and connection that must be preserved as long as possible. I am dedicated to organ donation both living and after death. Organ donation is one more aspect of my life of service to others. My reality is that through my service to others, my life has value and that my value is only through my service. I live a rich life of serenity that is a great gift given to me. I do this because I can do this and will do no less.

31 January, 2018 Posted by | life in medicine | , , | Leave a comment

Flu to You too!

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This year’s flu season is in full swing! Here in the Midwest where I live, there have been deaths from this strain of influenza, affecting people who are younger and apparently healthy before acquiring the virus. Along with this deadly strain comes the news media reports that the flu vaccine isn’t as effective as in previous years; related to me by my patients who complain that the vaccine “makes them sick” or that they don’t want to get the immunization.

My reply is that while the vaccine isn’t 100% effective, it does make any bouts with the flu, milder. I also remind them that along with the flu vaccine, good hand-washing is paramount. Wash hands often, don’t touch face and try to avoid those who are already sick with viral upper respiratory infections. Smokers are at increased risk for having a rough time this year because conventional cigarette/pipe/cigar smoke defeats the cilia in one’s respiratory tract allowing increased susceptibility to pathogens. In short, if you have folks who are smokers, this is a good time to either quit or move to nicotine patches, e-cigarettes/vapers or other smoking cessation-devices.

Grumbling that one does not want to be forced to receive the flu immunization or that one is going the “die from something” isn’t sound thinking for long-term health preservation in order to continue risky behavior. Along with getting proper rest, proper exercise and stress-reduction, one needs to eat properly. “I don’t have time to breathe, let alone work out”, is not going to help keep one healthy during these times when most of us are surrounded by patient’s suffering from viral illnesses.

My final thoughts center around those who become ill. Please stay home, get some rest and don’t bring your viral illnesses to the hospital/clinic/school for sharing with others. Keep your children home even if you must stay with them. Rest and self-care are more important than ever with this year’s influenza strain. H3N2, the predominant strain (it’s a strain of Influenza A) is not trivial. I would rather err on the side of caution and care than put more at risk. This is not the time to “soldier through” or “tough it out” because many who consider themselves young and invincible are ending up with serious complications.

Your first step in taking good care of your patients is to take good care of yourself in this new year. Don’t start 2018 off  by adding to the patient population because you want to be a trooper. Yes, I have excused any of my students or trainees who have picked up the flu! Get that flu shot too!

13 January, 2018 Posted by | medical school, medicine | | Leave a comment

Challenges to Come in Medicine

As everyone takes a much-needed holiday break, it would be good to look at some of the challenges ahead, the greatest of which is adequate delivery of health services to all of our patients. We continue to hear that the wealthy have adequate access but numbers those who are in the world of adequate access  to good health care are getting smaller. Even two years ago, the solid middle-class had tools available for access to health care but those tools are getting scarce. This scarcity of health care resources will increase largely from increased costs for everyone. The wealthy will weather these changes but more and more of our patients will not.

What do these changes mean for us who are charged by profession, to deliver adequate health care? These changes mean that we must take valuable and scarce time to study the political consequences of closing clinics, increased cost of insurance premiums and the disappearance of the mandate for having health insurance. Mandates are only a tool but they were decreasing the numbers of the uninsured in this country. More patients who are uninsured has always translated into increased costs for facilities that must provide health care. Those increased costs are passed onto patients who are more and more on the fringes of not being able to afford increased premiums.

We are charged with increased efficiency in the delivery of health care in today’s world of practice. These efficiency mandates have resulted in increased pressure for us to see more patients in a shorter period of time. While decreasing the time I can spend with a patient, my patient’s problems haven’t changed. When one is attending to a patient problem with potential life-altering consequences, adequate time must be given to those problems.

Mid-level practitioners are physician extenders and not substitutes for physicians who have dedicated themselves to years of training and hours of continuing medical education post training. While there is a role for all of us, physicians by training will and must continue to remain at the helm of delivery of health care to all. In some locations the middle class and the poor have been priced out of being evaluated by a physician which is not a sound practice.

As we head home to celebrate holidays, we all have to strive at every level not to take shortcuts for efficiency. We all have to give our best and make sure that our patients receive the best care possible. Currently the health of patients in this country, while we are at the forefront of medical device and scientific discovery, lags behind other developed countries. If even one person comes into my clinic with Stage 4 cancer because of lack of access to even basic preventative services, our whole system suffers.

Most of us entered medicine with the compassion to work long hours for our patients without regard for social, insurance or financial status. A child from Appalachia who barely finds regular food deserves the best medical care that can be provided in this country. Families are under increased pressure to take valuable income resources to provide food and shelter by putting of much-needed preventive services; often the parents skip important screenings for their children.

If I sound as if I am a socialist, perhaps I am by the standards of this country. My belief is in a basic level of health care for all humans regardless of ability to pay. One’s health is key to one’s life, well-being and quality of life. When I see a patient with uncontrolled hypertension who doesn’t take inexpensive medication; which can result in permanent loss of renal function or stroke,  I am disappointed and sad.

As a physician, I can’t settle for allowing human beings, my patient’s to suffer because of lack of access to health care. I have challenged myself to be proactive in anticipating the affects of lack of health care funding on the health of my patients. I have challenged myself to find solutions and to keep finding solutions for my patients, all of my patients. For me, this is my holiday present to those I serve not because this will make my life easier but because it’s my challenge.

Read, evaluate and educate yourselves in the political aspects and the business of medicine. If you don’t have classes in medical school that offer this, form groups that can advocate this practice. I can’t say that it will be easy but I can say that your present and future patients will have better health because of you actions. It’s not too late to make a start and it won’t be easy or quick but this must be done by the greatest health care minds on the planet.

21 December, 2017 Posted by | medical school, practice of medicine | | Leave a comment