Attaboy

Tonight, Renee and I dined at a friend’s house. I was talking about my ideas for this article when my friend asked me the following question?  How many “Attaboys” does it take to cancel one “Oh Shit.”  It was an excellent question and we debated what the right answer should be.  My opinion was that it was highly dependent on what the “Oh shit” was.  His was that one “Oh shit” did not cancel any “Attaboys.”

If you think I’ve lost my mind, read on.  As a practicing physician, I’ve seen many thousands of individuals over the years.  While many have loved me, there have been those that did not.  (A good guess places my career visit count near 400,000 patient visits).  The “did nots” tended to be a very vocal group using the internet to slash out at me.

There are multiple internet sites that rank physicians.  Most physicians simply ignore these sites.  I never could.  What angry people post becomes reality in many reader’s minds.  Unfortunately, the situation is complicated by two things:

  1.  Happy patients rarely ever go to the internet to give you an “Attaboy.”
  2. For a multitude of reasons, physicians cannot respond and defend themselves.

Let me give you an example.  One of the most viscous attacks I sustained as a practicing physician came from a person I never saw as a patient.  The individual came to the office with a friend and several textbooks and articles printed from the internet.  The person’s intent was to be the patient’s advocate.  What ensued was ludicrous, with the “advocate” reading from the text and articles and demanding that certain tests be run on my patient and certain medications prescribed.  Ultimately, I had to demand that this individual leave.

The next day, there was a scathing review of me on the internet by a “patient” that I had never treated.  I could not respond as responses often lead to further unjustified garbage being printed or worse, physical threats.  Responses also take the chance of unwittingly releasing patient information.  Notice that I have been very careful not to mention whether my attacker was male or female or anything about my ex-patient even now that I am no longer practicing. 

In my youth, I did in fact respond.  I defended myself against a liar and was shocked when the Chief of Police showed up in my office.  He proceeded to tell me that the person I had angered was known to the police and very dangerous.  He stated he would have patrol cars in front of the office in the morning and evening and I needed to watch my back.  I wore a Kevlar vest for months.  I learned to walk away from angry people.

So, what does a physician do?  Some choose to ignore the internet altogether.  In my case, my patients formed an “Attaboy” call tree; and, if someone attacked my online persona, the call tree triggered and published gobs of real “Attaboys’” were posted. Some physicians hire outside firms whose jobs are to monitor, clean and enhance their online personas.  Now you know how a physician consistently scores a 5 out of 5 without even one blemish.

There is a moral to this story.  If your physician (or any body else) takes good care of you, they deserve an “Attaboy.”  Go on the internet and praise them.  Nobody can tell me exactly how many “Attaboys” it takes to get rid of one “Oh, Shit” but the more “Attaboys” one has, the better.

By the way, if you’re pissed off, take a breather and cool down before you attack.  Then call or write your doc and present your case.  You may well get an answer.  You may even get an apology.  You may get an explanation that makes you happy.  Once you go public, all lines of communication stop, leaving you and your doc in a lousy place.

Free Medicine

October 4, 2019

I woke up this am in pain with a very stiff back.  My Parkinson’s symptoms were marked, making it difficult to walk.  I took my meds and tried to convince myself that I should get into my lift chair and try to go back to sleep.  I failed.  The only thing I wanted to do was to go to the office and get ready to see my patients.  The problem with that is the office is gone.  There are no patients. 

Actually, I’m a patient.  I don’t like being a patient.  I want to find a way to reconnect with those I’ve cared for over the years.  Now that I’m a patient/doc I have a lot to offer.  Being ill has given me a new perspective in life.

My phone beeps notifying me that I have a text message. The message reads, “32 years ago today you were just leaving Good Shepherd Hospital after spending 3 hours with Ted and me and baby Bob, giving us a foundation on how to be parents and care for a baby, thank you!”  I smile from ear to ear.  

That message is just what I needed.  It made me realize that the connections to my patients are still there and, in many cases, will be there for my lifetime.  Now, if I can only figure out how I can use those connections to improve the health, happiness and “wellth” of my former patients, I’ll be complete again.

This blog will serve to keep the lines of communication open and provide an educational platform for my readers.  Unfortunately, I’ve not been able to get the comment section running which leaves me able to reach out to you but no way for you to contact me.  Until I can figure out how to fix that issue, you can reach me at ssegal@lzftc.com.

Secondly, I do not have a list of former patients and therefore have no way of spreading the word that I’m writing again.  I need your help.  Spread the word that www.livewellthy.org is the place to go for medical education on the internet.  You don’t have to be a former patient of mine to use this site.   That brings me to problems number three.

I stink as a web developer.  My home page does not catch your attention and therefore most readers who find my site move on immediately.  Yes, Google monitors everything and lets me know how many pages are read, by how many visitors.  If any of you are web developers and can help me improve this blog, please contact me.

Once again, as I read my old blog, I find answers to my own questions.  In 2013, while I was fed up with the outside constraint that had been placed on my medical practice by the government and insurers, I could still dream.

Many of you have asked me who they should transfer their care to.  That’s a hard question to answer.  Having had a hybrid practice that offered a Concierge Choice option, I can tell you that concierge medicine is as close to “free medicine” as you can get.  Perhaps, you should look for a concierge doc.  

Dinosaurs still exist.  Dinosaurs tend to be older docs who remember a pre-computer world and strive to give their patients the individualized care they need regardless of the insurer’s edicts or the computer’s algorithm.  Some dinosaurs even see patients in the hospital.  Perhaps you should look for a physician who will care for you in the hospital, as well as in the office.

Yes, the idealist in me dreamed of being able to provide the individualized care my patients both needed and deserved without artificial constraints, prior authorizations, codes, etc.  Look for a doc who has similar dreams.

October 23, 2013

When I grow up, I want to practice “Free Medicine!”  You may be asking yourself, “What is free medicine?  Does he mean he wants to run a free clinic or give out free pills?”  “Free Medicine (FM)” is a concept I just created in response to a comment from a reader on yesterday’s article.  My reader is a brilliant doc, educator and writer who serves both as mentor and colleague.

Dr M’s comment pointed out the fact that primary care docs are already a medical bargain.  While the world clamors over the ever-rising cost of medical care, Dr. M reminded me that the cost of seeing a primary care doc is miniscule in comparison to the cost of chemotherapy, surgery or going to the Emergency Room.

“Free Medicine” is an old idea whose time has come.  FM means being able to practice medicine as it was meant to be practiced, unencumbered by governmental and insurer rules and regulations.  Yes, I dream of being able to provide the individualized care my patients both need and deserve without artificial constraints, prior authorizations, codes, etc.  

FM means the ability to shelter my patients’ most private problems from the intrusion of modern day medicine’s fixation on sharing virtually everything with insurers, government workers and statisticians.  While their intent may be laudable, the information amassed in “The Cloud” may be used to destroy the very health we are pledged to preserve (witness the anxiety and depression of those whose data was recently stolen from a large hospital chain).

FM opens a physician’s mind, allowing him/her to be creative in coming up with difficult to make diagnoses and treatment plans.  “Best Practices” close the physicians mind, stressing compliance with “established” protocols.  Heed my warning, cookbook medicine, better known as evidenced based medicine, has infested my profession and stolen our freedom to think and act as highly educated professionals.

“Free Medicine” means being a DOCTOR, not a provider, gatekeeper or service technician.  FM means working for you, my patient; not corporate America.  Yes, I dream of being free.  I also have nightmares.  In my nightmare, I am being sucked into a huge vortex, falling uncontrollably into the world of ACO bondage.  I know there has to be a way out:  I just can’t see it!  Finally, it’s there; the door to freedom opens.

What is cost of freedom?  What’s it worth to you?  Will you be sucked into a world where your healthcare is provided in accordance with protocols created by insurers and Medicare or will you break free?  Will I survive long enough to find my door to freedom?  I pray so!

My door to freedom lies in cutting the tether that binds me to the accursed computer and its EMR.  Breaking off from Medicare and insurers and starting a fee for service/cash only practice of medicine is freedom.  Once again, proudly hanging out my shingle and opening my door to all that would want to come in, all that cherish their freedom, is freedom.

Primary care accounts for a miniscule amount of the cost of medicine in this country.  If we were free from filing insurance and Medicare claims and free from coding and accumulating meaningless reams of data, we primary care docs could  reduce our fees and do what we love best:  care for you, the patient, who places your life in our hands.

Yes, I dream of the day I am part of the “Free Medicine” movement.  The question is, will you join me?  I can’t do it unless you think freedom is worth paying for.  I cannot exit the vortex and leave all those souls I am currently responsible for to be sucked into the depths of illness without me.  I am truly torn! Captains are supposed to go down with their ship, aren’t they?  

“Attention on deck.  The ship is sinking!  All hands man the lifeboats!”

YouTube

October 1, 2019

Awakening at 3 am is a killer!  Yes, we don’t have to worry about Parkinson’s killing me, sleep deprivation will get me first!  I’m being a good patient and wearing my CPAP.  It’s not helping.  I go to roll over and the pain in back hits.  If I stay in one position long enough, I get stiff and can’t move.

At some point I get up, come downstairs and try to be constructive.  It’s 4 am and the dishwasher has been emptied, a load of clothes has been run and I’ve straightened up the house. Time to write but nothing comes to mind.

I’ve discovered YouTube.  It’s been helpful in occupying my time.  I’ve blown through the Parkinson’s content.  This morning I discover “TEDx.” I watched “The Magic of Not Giving a F***, “How To Stop Screwing Yourself Over,” and “No Sex Marriage-Masturbation, Loneliness, Cheating.”

What a morning.  I learned about destressing your life by being honest and saying “NO” to what you don’t really want to do.  Sometime ago, I developed my Fuck It List and have done well with it.  Number one on my list is I will no longer put a noose (necktie) around my neck and go out pretending to have a good time.

I learned how to stop “screwing myself.”  The speaker states I can have anything I want. (Renee, I want …)  The speaker further states getting what you want is simple (but not easy).  She talks about “activation energy,” self- parenting and forcing yourself to get what you want.  Her video was actually helpful.  She used dieting as an example and I’ve been miserable at dieting since my surgery. While I need to lose weight, I want to eat the Danish!  Time to parent myself and force myself not to eat the Danish or anything not on my diet.

In “No Sex Marriage,” I learned I’m doing pretty good!  Whew!!  If you’re not, watch Maureen McGrath’s TEDx.  The best news today is threefold.  One is that sex exists well into the 90s.  Two is that sexercise should be done daily.  Three is that all marital arguments should be settled in the bedroom, naked.  I like this therapist.  I think I’ll be argumentative and see what happens.

BELIEVING

October 1, 2019

A recent article dealt with the importance of listening. Today, I want to address the importance of believing what you hear. One of the most important diagnostic tools is a trained ear. Another important diagnostic tool is your brain!  Once a physician hears his patient’s story, he has the choice of believing it, even if it is illogical, or dismissing it in favor of a more conventional interpretation.

Yes, patients often tell you what’s wrong with them and, often, their diagnosis is highly unlikely or even impossible.  Thirty five years of practicing medicine has taught me that the “impossible” is possible and some of my best diagnoses have been made because I choose to believe what my patient told me!

In my second year of residency, I received a call from the floor nurse telling me that Patient Y was asking for Last Rights.  Patient Y was scheduled to go home in the next few days and had no reason to die.  I went to the floor and reviewed her records and then examined my patient.  Patient Y was resolute in her opinion that she would not see the sun rise despite my confident reassurance.  Patient Y died that night.  Her autopsy revealed a tiny cerebral aneurysm rupture as the cause of her death.  I never forgot how incredulous I was at Patient Y’s insistence that she was dying and how healthy she was at the time of her death.

Choosing to believe your patients when their concerns are unrealistic is not easy.  Yes, I’ve run a great deal of tests that turned out to be unnecessary in order to disprove my patients’ diagnoses; and the majority of time, my patients concerns turned out to be truly unfounded.  When my patients’ seemingly unfounded concerns turned out to be real, it reinforced my ability to believe in the impossible and often saved a life.

“Doc, there is something wrong in my head!  No, I don’t have a headache.  No, my memory and speech are ok.”   “No” was her answer to every question, yet she firmly stated there was something she could not describe that was in her head.  She was not crazy!  Choosing to believe her, I sent her for a CT.  She, too, had an aneurysm and it was successfully clipped.  Thirty-five years, later she is doing fine.  Believing what your patient tells you may be hard, but it is vital to good care.

In today’s cost-conscious world, believing is discouraged.  If the patient above walked into my office tomorrow morning, I would have had to convince an insurance clerk to authorize her CT and would probably have been refused authorization.  Trying to meet the requirements of a computer-driven algorithm in order to diagnose a disease process requires more than a belief.  And that, my friends, is the problem with today’s healthcare system.

Don’t Ignore Your Gut Feelings

“Doc, last week, I thought I was having a stroke.  My vision went from wavy to black then came back slowly.  I just thought I would mention it while I’m here.”

“Doc, last Sunday I had severe chest pain.  I thought I was having a heart attack.  It lasted 2 hours and then went away.  I’ve been achy and have not felt right since.”

“Doc, for the last few months I’ve noticed blood in my stool.  Sometimes it turns the water red.  Should I be worried?”

I’ve heard some form of the above statements on a regular basis and I was always amazed that my patients respond to such potentially life-threatening symptoms in so nonchalant a manner.  While they obviously survived to tell their story, many don’t.

Unfortunately, people die at home while pondering the question, “Am I having a stroke, heart attack or gastrointestinal bleed.”  Their loved ones find them slumped over the kitchen table or lying on the floor.  Others are found in time, only to end up in a nursing home or as a cardiac cripple.  It’s the sad truth.

There is a golden period in which to salvage heart and brain from the ravages of stroke and heart attack, a time to stop the bleeding before you exsanguinate.  Why do people wait at home, pondering such an important question?  Sometimes, it’s simply denial.  “I exercise every day.  It can’t be my heart!  No one in my family has ever had a heart attack.”  Sometimes patients tell me, “I didn’t call because I didn’t want to bother you,” or “I felt foolish.  I was just being a nervous ninny.”  There are dozens of excuses for not acting on their concerns.

“I figured I would wait a while and see what happened,” is my favorite.  I want to respond with, “That’s a great idea!  Wait to see if you can lose your ability to speak, start dropping things or simply die with extreme chest pain.”  Yes, waiting to see what happens is a gamble.  It’s like rolling the dice.  Sooner or later, you crap out!

If you are alone and think you are having a heart attack, stroke, or start to hemorrhage, dial 911 while you can.  If you wait too long, dialing the phone may become an impossibility.  What have you got to lose?  Afraid you’ll look foolish by calling 911 when it’s really nothing?  Don’t be!  Be happy you are alive!

Doc to spouse of patient currently fighting for his life in the ER – “Why didn’t you call the paramedics?”

Spouse – He/she said “If you call the paramedics, I will never speak to you again!”

Doctor – “Didn’t it dawn on you that if he/she dies, he/she would never speak to you again?”

I can’t count how many times a loved one has told me that they did not call 911 because of the above statement. Remember my answer and if your stubborn spouse gives you trouble, ignore them. Call for help. If he/she lives and never speaks to you again, at least they are alive.

By the way, in my experience, 7 out of 10 times your intuition is accurate.  If you think you could be in trouble, you are!  As I always like to say, the life you save may be your own.  Be happy and “Wellthy!”

The Question Nobody Will Ask

September 29, 2019

Promise me you won’t freak out.  I’ve been debating an issue for years.  It’s one of those issues that you can’t talk about because people freak out.  It’s really a debate best held between physicians.  In time I suspect religious authorities and the legal profession will chime in.

Before I go on, let me tell you a little story.  Tonight is the beginning of the Jewish New Year.  As is our custom, Renee prepared a holiday meal and we had family and friends over. Renee out did herself.  It wasn’t a meal; it was a feast.  After dinner, Renee stated that she wanted the meal to be special because it probably will be the last holiday we celebrate in our home.  We are moving to North Carolina in the spring.

As my readers know, I’ve been depressed over my physical circumstances.  The idea that tonight is a “last time” event is depressing.  Renee started me thinking about all the “last time” events we will be celebrating in the months to come.  

As we plan to sell our home and establish our North Carolina life, I am forced to think of all the friends and patients I’ll be leaving in Illinois.  So, I sat down to write an email to Dr. Pamela Wible which led to this blog.

First, let me state that, while moving can be depressing, leading to a lot of last times, it can also be exhilarating.  Moving can be full of new chances, new joys.  Moving can be full of joy.

Now, drum roll, I’ll get to the point.  Dr Wible is an expert on physician suicide.  I told you not to freak!  I’m not committing suicide, I’m just moving to North Carolina (my UVa. friends may think so).  The question I’ve been debating for years is, “If a terminally ill patient or one with a progressive neurological disease decides to end his/her life when life is no longer worth living, is that called suicide?”

Tough question, huh?  Physicians are committing suicide at a ridiculously high rate and Dr Wible is the expert, so I sent her this question.  I figured its time to seek her opinion.  Remember, I asked you to “not panic.”  I fully suspect that I will piss a lot of people off.  The reality is that the question needs an answer and will probably never have one.  

So why open this can of worms?  Over the years, I’ve had terminally ill patients, patients degraded by their diseases and in severe pain, take their own lives.  Their deaths were listed as “suicide” and suicide has an extremely negative connotation. It leaves a horrid legacy for the surviving family members.  When dealing with a life ending disease, it should not.

I am moving to North Carollina with my wife, daughter and son, granddaughter and future grandson.  I have four other children and 3 more grandchildren. I told you not to worry, I have a lot to live for and hopefully a long time before my Parkinson’s steals the quality and joys of life from me.

“All Natural”

“All natural” are two of the most abused words in the English language.  Advertising firms have successfully made “All Natural” synonymous with “healthy/good for you” and “safe!”  If only that was true.

Vitamins, minerals, herbals and homeopathic products are often touted as all natural and come with an assortment of miraculous promises and outlandish prices.  Rather than immediately recognize the obvious lie (pills don’t grow in nature; they are manufactured on a production line), patients fall for the premise behind the lie and spend a small fortune on questionable pills.

“All natural” vitamins, minerals and cofactors come in the fruits and vegetables you find in your local grocers or farm stands.  If you have money to burn, buy a Vitamix or Ninja and make delicious, “all natural” drinks.  You control the content and quality.

If you don’t have money to burn, eat the whole fruit or vegetable.  If your doc has diagnosed a true vitamin deficiency, he/she will often prescribe the specific vitamin at an appropriate dose, to be bought at a known and trusted vendor. 

Here’s an article from 2012 reviewing one specific product. In 2019 all you have to do is go to the internet and you will be bombarded by adds for products like the one described below.

May 25, 2012

Now I’ve seen everything.  I’m outraged and disgusted by the unscrupulous marketers that prey on my elderly and the unsuspecting patients who seek health in a bottle and instead pay good money for snake oil.

I’m equally frustrated by the fact that these same patients either shun conventional medicine or can’t afford the pills that have been proven to improve or even save lives.  Recently, I’ve written about the harm done by Pharma’s TV advertisement of their merchandise.  You’ve all seen the commercials proclaiming that product “X” can save your sex life, helping you be ready at a moment’s notice while warning of the dangers of a four hour erection, loss of vision, back pain, or worse.

The purveyors of snake oil have no such restrictions and make no mention of any negative associated with their products.  Today, my patient brought in the “dietary supplement” her father purchased at the cost of $70 FOR 64 OUNCES (my children tell me typing in all caps means I’m yelling).  Product “Y” claims to be full of trillions of “redox signaling molecules” essential to life.  Product “Y” claims to be natural.  It comes with very specific instructions and is to be taken 2 ounces once or twice a day ($2 – $4 a day).

This miraculous substance, cheap at about a dollar an ounce, is salt water.  Yes, the label lists the ingredients as distilled water and Sodium Chloride (salt).  The label also proclaims that the product may have a chlorine odor as the product has trace amounts of natural chlorine.  Yes, the miraculous product appears to be chlorinated, distilled and then salted water.

Salt water for a little over $1 an ounce.  What will they think of next?  By the way, this product is sold to all comers.  If the FDA had assessed this product, the product warnings would have alerted patients with heart disease and hypertension to the perils of taking salt water.  Yes, salt is essential to life; but too much salt can kill you if you have congestive heart failure.

A little (or a lot of) skepticism goes a long way!  Remember, the life you save be your own.

I’m Sorry You Had To Wait`

September 28. 2019

I just got off the phone with my buddy.  I went to Doerfler’s butcher shop to pick up dinner and tomorrow’s meals.  My buddy loves their hot dogs and I picked him up a few.  We both love lamb and they have lamb burgers.  I bought a few of them.

I’m back on a modified Keto Diet.  My friend stated that my problem was that I eat too fast.  I jokingly said that I eat fast because there is not enough time in the day to eat everything I wanted to eat.  His observation was accurate and started me thinking, analyzing why I rush through meals.  Afterall, I love food.  You’d think I would eat slowly and savor the taste.

The reality struck me like a ton of bricks.  I HATE BEING LATE!  I hate it so much that for 35 years I ran a “no appointment necessary” medical practice.  My practice was busiest at lunch and dinner time as sick people tended to use their lunch break to see me or come in after their shift were done.

I HATE BEING LATE meant that, for 35 years, I inhaled my meals.  I’d see patients in room 1 and 3, order the test they needed and then run back into the kitchen to consume fuel (food).  Then I would hurry back to finish up rooms 1 and 3 and move on to the next patients.

Despite inhaling my food and literally running through the halls, patients still had significant waits.  As a physician, you can either give your patient the time he/she needs or treat by the clock, terminating the visit in 8 minutes and moving on. I actually had a physician employee who wanted an 8-minute alarm in each room.  He did not last long!

I can’t imagine working in an appointment practice. Determining how much time a patient needs is impossible.  There is an “Oh, by the way . . .” phenomena that turns a 15-minute appointment into a schedule buster.

Doctor – “Mr. B, you have a strep throat.  I want you to fill this prescription and take the antibiotic twice a day until its done.  Use Tylenol as needed, drink lots of fluids and call me if you have any problems.  Do you have any questions?  Stop at the desk for written instructions.”

As the doc is leaving the room:

Patient – “Oh, by the way doc, I’ve had several episodes of chest pain lasting up to fifteen minutes.  I forgot to tell the nurse.  I’m sure it’s indigestion.”

There goes your schedule.  Thirty minutes later the paramedics are pulling out of the lot and the patient’s heart attack is being treated.  Eight-minute visits just don’t work.

The next time your doc keeps you waiting, understand that most of the time he/she is treating patients who often have complex, time consuming problems.  Read a book, text a loved one and be happy your doc takes the time you need when addressing your health care needs.

I will work on eating my meals slowly, savoring the taste and allowing my satiety center to kick in and remind me that I’m full.  I will work on eating a more appropriate diet and get healthy.  I’ll continue to exercise every morning.  What do you need to do to enhance your health?

Parkinson’s will “pierce your heart”

September 27, 2019

It’s 4 am and I’m awake again.  This is crappy!  Occupying my time until the rest of the world awakens is not easy.  I read and write but sometimes that’s just not enough.  When the sun comes up, I take my first walk of the day.  Coffee, and breakfast and exercise fill some of my solo time.  Finally, Renee’s awake, and I have someone to talk to (and bug).  Retirement might be nice if I was well, although I doubt it.

Recently, one of my friends turned me on to the educational and entertainment attributes of YouTube.  This morning I discovered Dr Okun’s lecture on Parkinson’s.  He’s a professor of neurology and a Parkinson’s specialist in Florida.  One of his slides really hit home!  The slide stated:

“The four simple words, ‘you have Parkinson’s disease’ will pierce the heart and drain the dreams of 50,000+ people worldwide each year.

After I finished crying, I realized that Parkinson’s had done that to me!  My grandfather and father had Parkinson’s and the memories of how it affected them haunt me, much like a Steven King novel might.

Dr Okun takes a hopeful approach when he talks about Parkinson’s.  He quotes Ifeanyi Enoch Onuoha as saying “Every challenge you encounter in life is a fork in the road.  You have the choice to choose which way to go: backward, forward, breakdown or breakthrough.”

Well, I’ve been at the fork for years now and I’ve gone in 3 of the four directions.  Currently, I’m in breakdown.  To be more precise, I’m broken!  I’m also busting my ass trying to get up and “breakthrough” to the healthier side.

The gist of Dr. Okun’s lecture is that exercise is a critical component of treating Parkinson’s.  He recommends that exercise be started before the diagnosis is made and continued throughout the course of the disease.  THAT SUCKS!!  I HATE EXERCISE!!  I championed exercise for years, recommending it to pretty much all of my patients.  Unfortunately, I never made time for it.  Time to pay the piper.

The next lecture covered the genetic nature of Parkinson’s.  Yes, like my grandfather and father, I’ve possibly cursed my progeny.  Basically, the professor giving the lecture stated, “Genes load the gun and environment pulls the trigger.”  Listen kids!  Find time to exercise every day forever! (Erin, Jeremy, Lisa: pay attention) Unfortunately, the environment he talks about includes foods.  So now not only do I have to exercise but I need to clean up my diet.

Whoopy!  Parkinson’s pulls you backward.  Going forward is going to be difficult and require the exercise I successfully avoided for 65 years.  Breakdown sucks.  Breakthrough is a pipe dream.  

Time to go exercise.  Yeh.

Are you listening?

Listening!  It’s not hard to listen, is it?  Most of us don’t need any special equipment.  You can listen anywhere.  You don’t have to get dressed in a suit and tie to listen.  So why don’t people listen?

Patients often don’t listen.  They feel pressure to tell their story or make their point.  Often, they have consulted Dr. Google and think they know the answer and what they want.  Others have emotionally bought into an idea and don’t want to discuss it.  They simply want a substance (or don’t want one) and there is no convincing them no matter how strong the data is.

Physicians often don’t listen.  Their excuse is often that they don’t have time, rushing from one patient to another.  One of the most dangerous problems in medicine is called “anchoring.”  When you anchor, you lock into the first item on the differential diagnosis list and fail to entertain the other less obvious diagnoses.

What’s a fellow to do?  I always told my patients that, if they felt I wasn’t listening, to call a time out and call my attention to what they were saying.  When I suspected that my patient was not listening to me or a consultant, I would ask them to repeat, in their own words, what they had heard.

Listening to each other is vital.  Listening with an open, non-anchored mind is essential to developing a healthy body, relationship and lifestyle.  Knowing who you are listening to is critical.  Listening to the static on the internet can be dangerous.  The scourge of measles, once eradicated, is back because people are listening to the wrong sources.

Below is an article published in 2012. Reading THE ART OF LISTENING has reinforced my need for exercise.  I need  endorphins and with persistent exercise, I’ll get them.  

Listen to me.  You want to do everything you can to stay healthy!  You want to clean up your act, eat an appropriate diet, exercise and take the time to enjoy life now, while you can.  Also, say a little prayer.  G-d may be listening.  Tell him chronic illness is not fun and ask for a little help for you, me and the rest of mankind.

The Art Of Listening

Posted on August 31, 2012 by livewellthy

August 31, 2012

Over the last two days, I have addressed the question, “As patients, which qualities in your physicians do you value most?” Yesterday’s article focused on the value of “time.”  Today, I want to focus on the value of listening.  One of the most important skills a physician can develop is the skill of listening to both what a patient says and doesn’t say.  Listening takes time but its value is immeasurable.

In prior articles I have strived to help my readers understand how doctors think.  One of my most popular articles reviewed the decision making process involved in formulating a “differential diagnosis.”  Recently, I was formulating a differential diagnosis for a patient suffering from a sleep disorder.  The diagnostic possibilities were many.  My patient, in typical teenager fashion, was a boy of few words.  When he did answer my questions, his answers were vague.  Luckily, his mother was present for his exam.

Mothers are great diagnosticians.  After all, they know their children better than anyone.  In my experience, once you get mothers engaged in the diagnostic process, they stand a good chance of coming up with an accurate diagnosis on their own.  This particular mother inspired today’s article.  Listening to her was a pleasure; and, sure enough, she made my job easy by coming up with the most likely diagnosis.

My patient’s sleep disorder stemmed from his exercise routine.  In today’s vernacular, my patient was “cut.”  He obviously spent a great deal of the time exercising.  The problem was that his hours of exercise occurred in between 7 -9:30 p.m.  Exercise stimulates endorphins.  Everyone knows about a “runner’s high.” 

According to Wikipedia, “Endorphins (“endogenous morphine”) are endogenous opioid peptides that function as neurotransmitters.[1] They are produced by the pituitary gland and the hypothalamus in vertebrates during exercise,[2] excitementpainconsumption of spicy foodlove and orgasm,[3][4]and they resemble the opiates in their abilities to produce analgesia and a feeling of well-being.”  They also will keep you awake!

Mom, without realizing it, led me to a diagnosis that might have taken many visits and tests to uncover.  She saved a lot of time, money, and hassle.  I’m glad my listening ears were on and functioning fully.

The takeaway message is clear:  listen long enough and you will find gems of value in every walk of life.  The true gems in this story are the endorphins.  If they can keep a young man awake, what can they do for you?  What are you willing to do to get them?  All it takes is a daily exercise routine and patience.  Just remember, you want your endorphins in the morning!