Posts filed under ‘life thoughts’

While speaking of fossils

Just over 26 years ago I was fresh out of Residency, ready to start my new practice, full of an arrogance to which only youth can do justice. In my defense it was not a personal arrogance but more of a training arrogance. I had just completed 7 grueling years of training (post grad school) in which I worked up to 100 weeks and the amount of material I knew was phenomenal.
So when I was introduced to one of the more established Family Doctors in the area, who had been part of the vanguard that established Family Practice as a Specialty of its own, I remember thinking how nice and laid back he was, but also how much of a fossil he was. How could someone that old have kept up all these years; with the massive amounts of evolving medical knowledge and technology?
So, just the other day I was reviewing a resume of an applicant for a receptionist position and it mentioned that she had worked for this old MD.
And it hit me, I am at this point the same age as he was when I thought him a fossil!
Actually, I looked him up and it turns out I am four years older than he was at the time.
So that is what young, newly minted docs think of me now.–Wow.
Karma waited a quarter century to send that thought boomeranging back to me.
I told my office manager that she could call me Dyno from now on, in an effort to keep me a bit more grounded.


03/03/2015 at 8:04 AM Leave a comment

laughter a multi-pronged tool

I will admit that I not only love to laugh, I particularlly love making others laugh. Specially a deep, gut, unexpected laugh. And its value in creating a good doctor patient atmosphere would be hard to overstate. However, unbeknownst to most of my patients is the  many other uses to which I put such a common human reaction. 1. humor is complicated, it requires the brain to make unexpected associations and in many cases to keep several items in memory. In this way I find it useful to determine how a patient’s brain is functioning; usually in the evaluation of dementia, depression but also post concussion and severe illness. 2. It requires lots of air to laugh which makes this very useful in my younger patients, say 2 or 3 years of age. they won’t take a deep breath on command with a stethoscope on their backs but get them giggling or laughing and you can hear how they are breathing. Going forward I find that children are not as scared of coming back if they expect ‘the silly doctor’ to interact with them. 3. If you are depressed, particularly significantly so, or if you are feeling quite miserable it takes too much energy to laugh, although by looking at their face I can tell if they ‘got’ the humor. It helps me sort out who is hurting much more than they are saying and also the opposite. 4. it is a huge distraction from whatever the current complaint is and timed appropriately it allows me to examine a joint, or belly or lump without them anticipating pain, or in other cases from amplifying the pain. 5. It makes the time that we spend together more pleasant and perceived as longer or at least as more connected (IMHO) and further compensates for any waiting time they had. 6. It softens patients perception of me in my role as a doctor with all that comes implied with that. Makes me much more approachable by both adults, elderly and as mentioned above, children. Approachableness is hard to overestimate, it allows for a much better interaction, better data collection, better patient recollection, and more willingness in the patient to remember and follow directions.

02/28/2015 at 11:56 AM Leave a comment

To be a Hero

I tell students and young providers that one of the greatest things about being in Family Medicine is that one gets to be a ‘hero’ on a daily basis.
I don’t mean ‘hero’ like: running into a burning building and rescuing a kitten-hero, but more like: significantly improving peoples daily lives-hero.
Sure, occasionally we can catch a deadly issue in time to prevent something, but more often it is convincing someone to pay attention to their diabetes, or to try an antidepressant, to give them ‘permission’ to put their health above their work, or to create an atmosphere where they patient feels comfortable enough to tell you the truth.
We occupy a place of trust and it is an amazing opportunity that sometimes I forget because it is all I know. I get to see a side of people that is not shown to others. Most of the time it is a very endearing side, occasionally a dark side, either way they allow me in to their worlds and in many cases be a minor hero in their lives.
On days that I am particularly stressed, tired, frustrated. I try reminding myself of the privilege that is given me on an hourly basis. It nearly always perks me up.

02/22/2015 at 2:57 PM Leave a comment

Surgery awaits

It has been a quarter century since I severely injured my knee during a soccer game and it will no longer be put off. Despite a significant amount of weight loss the knee is now worn out and has been impeding my exercise; now it is getting in the way of some of my daily activities. So I am now in the role of patient awaiting surgery.

It is a remarkably uncomfortable role and I find myself second guessing my decision to have a knee replacement. By all logic i have let it go far too long but I keep wondering whether I could/should put up with the pain and instability another year. I find this patient perspective rather educational. I am not worried about a poor outcome, or the anesthesia or the recovery; rather a vague fear of being vulnerable and obtusely being absent from work for the such a long time. I have not missed work for more than three weeks since I was a young man, and the prospect of being out for over a month is terrifying. I am not sure whether I am more scared of being bored or of enjoying my time off.

Being in the patient role helps me understand my patients better; there is a lot to be learned by going through the process; thing that i can use when my patients exhibit the same feelings. Nevertheless it is six weeks until the knife and I find myself conveniently ‘forgetting’ it is looming on the horizon.

Then there are the multitude of logistical issues to handle: informing patients I will be out for a month, setting up a system to run the office while I am away, making sure that patients have sufficient refills on medicines, reassuring patients that the covering doctors are just as capable, etc.

02/18/2015 at 12:18 PM Leave a comment

Parenting and baby birds

In my position as a Family Doc I get to see a lot of parenting. Some is just so awful it does not bear repeating. Some is average and unspectacular- sad in so many ways, because with a little extra effort the next generation would be so much more prepared and well adjusted. There is good parenting, although not as much as you would think; where parents are making use of the huge knowledge base to do better than their own parents. And on occasion there is exceptional parenting.

But across all of these parents one of the major pitfalls is the last stage of parenting. What I call- Kicking the bird out of the nest. As opposed to letting it stay so it can shit all over itself. Not every kid is itching for the moment they can leave the house, to be on their own , figure life’s issues in their own particular way. But that is what the goal of parenting is, to mold these kids into self supporting well adjusted members of society. Otherwise you are left with a bunch of dependent parasites.

This part of parenting is so counter to everything else we do, that it is no surprise how many parents mess it up. We are used to taking care of them, watching over them, supporting them.  Over the late teens we should be giving them more responsibility with their increased freedoms but then there comes a time when it is important that they take the training wheels off and go on their own. Whether it be advanced studies, advanced training, or work, they need to learn how to be on their own and eventually to support themselves ( and find out how hard it really is).

Yet time and time again, I will have a parent with a 28 yr old or 32 year old or 22 yr old at home that is doing nothing, going no where, responding to no amount of reason. I must admit I do not understand why a kid would do that ( I was out and gone before the ink was dry on my HS diploma) or why a parent would put up with that, my father pushed my brother out of the house (gently)–He got his Masters in Engineering because of it.

My daughter is leaving for college in a few weeks. It is already difficult to contemplate and it will be very hard and sad. But the idea of hobbling her and enfeebling her by keeping her at home is not acceptable. She needs to fly. So who are the parents looking out for when they do not push their baby birds out of the nest?

The kid may not do well on their own, who knows? But if they stay home we know that will not turn out well.  For reasons that are not clear it does seem that my generation has raised a significant group of dependent, helpless young adults.


I neglected to post this when I wrote it and my daughter has graduated, taught for a year in China and is now settling down with her husband  in Minneapolis. All good things, but I do wish she had found her place in the world closer to home. thanks to the internet and modern communication it sometimes feels like she is just around the corner.

01/01/2015 at 3:18 AM Leave a comment

It’s much more complex than you think

It is not that I am surprised that people don’t know that medicine is complicated, but that they don’t seem to even have any suspicion that there may be alot more to it than they can appreciate.

After all, people do seem to know that med school is long and arduous, yet feel that with even a trivial effort that they can hope to figure out the workings of the body. I see this same effect in many places. It is a denial that the world could possibly be so complicated as to defy understanding or control.

As Isaac Newton famously said ( or was attributed to him) that despite being one of the most brilliant and accomplished minds of his time that he had barely examined one grain of sand on the beach of knowledge.

The levels of complexity boggle even me. The actual knowledge that has already been discovered is so vast as to be humbling if not overwhelming. Much of the time the body’s workings are counterintuitive and inconsistent.

The patient is the undeniable expert on what is happening to him/her as long as they stick to reporting what has happened. When they try to explain why it is so, is where the problems start.


as an example: Many times a patient will say something like, I have a headache some mornings, what is it? Sort of like my telling my mechanic, ‘my car makes a noise what is wrong with it?’

It will take me many, specific questions to even hazard a guess.

12/23/2014 at 5:05 AM Leave a comment

Natural, schmatural

What is it with this ‘Natural’ thing anyway? I have so many people simply assuming that natural must be better, as if it is a given, nothing to question, as fixed as ‘breathing is good’. This despite the overwhelming evidence against it. Furthermore, people are totally willing to believe that if it said to be ‘natural’ it therefore must be.
Nobody in this money driven society would ever consider lying about such a thing, surely that is taboo.
These are intelligent, educated thoughtful people. People that would never even hesitate to delete an email from a Nigerian prince. So why swallow such a bunch of hooey about ‘natural’?
The best answer I have heard in thirty years is that it is a holdover from the ’60’s back to nature movement and perhaps it is, but it sure should be wearing thin by now.
After all, consider the following:

Natural encompasses:

a hard difficult life full of tragedy ( think many childhood deaths) followed by an early death

Small Pox, Typhus, Malaria, Polio, Tetanus– the scourges and killers of untold millions before ‘unnatural medicines/ vaccines’ came to the forefront.

Performing labor manually, living by ‘the sweat of ones brow’ if you will, being hot in summer, cold in winter. No way cars and electricity are ‘natural’

Natural vegetables and staples before they were augmented/domesticated provided meager sustenance and did not allow for much storage, which meant cycles of famine.

Going to the bathroom in the open, the world smelling of a toilet.

Give me engineering and human modernity anytime. Certainly i won’t be the first to try something new but hey, were are a very bright and curious race and I enjoy and fully take advantage of all the fruits of scientists’ labor, whether it be transportation, Air conditioning (!!!), a robust infrastructure or advanced medicines.

A year ago I was routinely tested for immunity to a variety of diseases (Hep B, Polio, etc.) and was found to have no immunity to ChickenPox. How in the world is that possible ? I don’t know but I can tell you, I could not wait to get to the office and get a shot followed by a second one in six weeks.

12/13/2014 at 3:22 PM Leave a comment

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