Grace

“Die, v.: To stop sinning suddenly.” – Elbert Hubbard

Perfection is impossible to attain. That was God’s point. You can never be good enough.

So stop trying.

Relax.

Grace has you covered.

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IT

“Never trust a computer you can’t throw out a window.” – Steve Wozniak

IT people that I work with kill me. I do not even fathom or comprehend what they do. They cannot fathom or comprehend what I do. We live in utterly dichotomous worlds that only overlap on the fringes. As a consequence, we are the bane of each other’s existence.

Truthfully, I don’t trust technology. It can be very, very helpful. Or really, really awful. The more helpful it is, the more awful it is when it doesn’t work.

It often doesn’t work.

The past two weeks have been awful from an IT standpoint at work. I won’t bore you with details that I barely understand. Suffice it to say, that I had very violent feelings about our IT people.

Often they like to use the phrase, “User error.” This is IT lingo for, “You Suck!” Unfortunately, there is not a phrase I can use back at them when it is actually their fault. If there were, I would have used it repeatedly this week.

In the end, I have realized, it is not all their fault. Maybe. They are carrying out bad policy from elsewhere. Meanwhile, my patients, my staff, and I get caught in the middle. Someone has to pay…

So I have said all of this to say that I pledge this week to say something nice to an IT person. They are people with feelings, too. And we are all part of the same team.

Magical

“Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic.” – Thomas Szasz

Everyday I encounter patients who have an unrealistic expectation of what I am capable of doing.

“I need for you to make me better by tomorrow, I am leaving on vacation!”

I can’t. I can’t fix you. And the drugs I prescribe might help, but not that fast. If you are better by tomorrow, it was your body that did you the favor, not your doctor.

There is also this perception that the more tests you do, the better you are. Acute care facilities do X-rays and blood tests so often not because it is evidence based or because they are providing better care. They do it because they can make more money off of you.

So bottom line: Medicine and doctors…we are mere tools. Be an educated consumer. Don’t be afraid to ask if something is really necessary and feel empowered to say no when it isn’t. There is no such thing as magic!

Artwork

“The art of being wise is the art of knowing what to overlook.” – William James

Lesson learned.

It is easier to overlook minutia when it comes to my kids. “You guys wanna make an ever loving mess in the kitchen? Aright! Let’s do it!” I have found that having kids has helped me to relax my OCD quite a bit. I bristle at people that have said, “She just needs to have a baby,” about me or female colleagues as I think it is fairly disrespectful (particularly because it is always men saying it in reference to legitimate complaints/concerns brought up by said women) but there is some level of truth here in that you cannot micromanage a child. You start stepping back and asking yourself if that is a battle that is worth fighting…will it make a difference in the long run?

Not so easy to ignore the minutia in my patients. “You didn’t check your blood sugar every single day for the past three months? (Cue stern look.)” Never mind that it really doesn’t change what I do with them most of the time. They didn’t do what I told them to!

But the art of medicine (and life) is motivating people. Give them realistic goals. Encourage instead of berate when they fall short. Not only do patients respond better, I feel happier too.

Rococo Sex

“Like the furtive collectors of stolen art, cell biologists are forced to be lonely admirers of spectacular architecture, exquisite symmetry, dramas of violence and death, mobility, self-sacrifice and, yes, rococo sex.”
– Lorraine Lee Cudmore

When you do prenatal care, deliver babies, or are pregnant yourself (especially if you are told there is something wrong with your baby) you realize how very amazing it is that such a complex organism comes regularly into being with so little imperfection. Bilions of cells and trillions of chemical processes and all of it occurring at the exact precise moment and place that it should. Why doesn’t the whole lot just go careening out of control into some unrecognizable biological goo?

It is a miracle.

Humiliation

“Life is a long lesson in humility.” James M. Barrie

If there is one thing to be said about pride, it is that the more boasting you do, the more certain it is that there will be humiliation.

It is inevitable.

There have been quite a lot of things I have taken pride in over the years. Purity. Snicker. That went a long time ago. Grades. There is always someone smarter than you. Good skin. Hellooooo, wrinkles! Fashion sense. The 80’s proved that I was wrong, but I didn’t realize it for another decade.

So, nowadays I generally keep my mouth shut. I do not want to invite trouble. Are my kids smart? Maybe. Do I have a nice house? Meh. Has my health been relatively good? Uh…. Is my sourdough bread to die for? Nah.

Let other people do the boasting for you. That is safer!

Bam!

So often in the clinic I treat women who have neglected themselves. We so often put everyone else’s needs and interests before ourselves.

Physicians are even worse. We don’t like to seek help at all. We are too busy to think about ourselves. We don’t want to seem stupid if our self diagnosis is incorrect or to be put in the helpless patient role or to be reminded that we are anything but invincible.

Get a female physician and the combo can be deadly.

So we ignore things until BAM! Life hits us and we end up against a wall.

Time to regroup and recuperate!

The Opera

I recently attended Die Tote Stadt (The Dead City), an opera by Korngold. Don’t judge. I have been to the opera only twice in my life.

I sat next to a middle aged woman. She was perhaps in her early to mid fifties, beautiful. This woman was there by herself, which seemed odd as there was no empty seat beside her. The lead soprano’s agent, as it turned out (he was quite the talker and fairly well known by most everyone who was anyone…not me and not her) was sitting on the other side of her and did not know her. She was wearing black, which at the opera is not that odd but her shoes were unexpected… very worn compared to the rest of her. It was as if she was left at the last minute with the realization that she needed black shoes but did not have anything suitable to wear and no time to make a purchase. Her cell phone screen had a picture of her with an older gentleman in an embrace, clearly as lovers. She fidgeted between apps without any real purpose.

During “Marietta’s Lied”, an aria sung by a dying lover, this woman began to cry softly, wiping tears from her eyes with a tissue that she pulled from her clutch.

I have put a YouTube link here so you can hear this exquisite piece (close your eyes and let it wash over you):

A translation of this aria is given below. Maybe it was just her allergies giving her fits. But maybe this woman beside me had lost her lover to death. Maybe this opera was something they both loved and now it possessed new meaning.

The story line has a man who lives each day as a shrine to his dead wife. He falls in love with a woman that looks like his wife but who has slept with dozens of men, including his friend. She seduces him, he falls for her, and they make love only to realize that the other is not what they had hoped for. He strangles her then wakes to find that it was a dream, that he needs to get on with his life instead of living only for his dead wife’s memory.

As the woman cried, I wondered what I should do. Put my arm around her? Give her a pat? Should I ask her about it at intermission?

In the end, I said nothing. I let her have her moment of private mourning. I was terribly curious and it eats at me still. If the roles had been reversed I don’t know if I would want to leave the spell untouched by words or if I would want the opportunity to share the story and my love with a stranger.

The beauty of this music will forever haunt me now on a completely new level as I live in my own “temple of memories”.

English translation of “Marietta’s Lied”:

Joy, that near to me remains,
Come to me, my true love.
Night sinks into the grove
You are my light and day.
Anxiously beats heart on heart
Hope itself soars heavenward.

How true, a sad song.
The song of true love,
that must die.

I know the song.
I heard it often in younger, in better days.
It has yet another verse–
Do I know it still?

Though sorrow becomes dark,
Come to me, my true love.
Lean (to me) your pale face
Death will not separate us.
If you must leave me one day,
Believe, there is an afterlife.

(Translation by Lisa Lockhart, listed at the Aria Database. http://www.aria-database.com/search.php?individualAria=844 )

In Review

Have you checked out online physician reviews before you picked a new physician?

I used to monitor what was said about me online. I wanted to see what people were saying. Feedback from patients is often helpful.

I have learned a lot from listening to my patients.

But I stopped reading online reviews. Haven’t looked in a couple of years. I found that for every fifty glowing reviews that oneugly one negated everything. When something negative was left, it was never something constructive. It was pure venomous vitriol. Made me feel angry and helpless.

I could go back and trace the dates or use things that were said on the negative reviews and figure out who put it there. Generally they were drug seekers who did not get what they wanted or people who were fired from my practice because of abuse of my staff, which is fine. I don’t mind upsetting people like that but no one else knows that was the reason they said that I sucked. Confidentiality laws being what they are, I cannot respond to those reviews.

New patients come every day and more often than not they say that they picked me because of my reviews so there must be a lot of good stuff out there at this point.

But, I have often wondered how patients should decide on who is a good physician, who they should see. There is a fair degree of quackery and ignorance and personality disorders among physicians as anyone in medicine can tell you.

Quality ratings from insurance companies are not really all that telling. Generally they rate the physicians that cost them the least (spend less of their money) the highest. If they are using preventive care or disease management data (like did I strong arm you into getting your PAP and colonoscopy or do my patients have their diabetes under control) could mean I am good at treating my patients, or could mean that I fire anyone that does not do what I say (I know physicians who do this very thing).

Online patient reviews can tell you something, maybe. Perhaps I really am good and personable and conscientious. Maybe I just give everyone what they want even if it is not good medicine. (Here is an antibiotic for your viral infection…)

Word of mouth, friend referrals, can be good, but even horrible physicians have loyal followers.

Trying doctors out is a good way to see first hand the practice style, but copays get expensive!

You could check on pending lawsuits, but even that could give you a false sense of security. Maybe a doctor has never been sued because they are ordering CTs on everyone. Seems like a good idea until you realize that every CT you get increases your risk of cancer later. They are appropriate in certain circumstances but very often are not the right choice straight out of the box.

Celebrity endorsements are NOT a good way to choose a physician. That could be a whole other post.

In short, a combination of a lot of that is probably the right way to go. I am glad that there is more transparency in medicine and easier access to info for patients. That is a good thing for the profession, but be aware of the pitfalls. Most of all, when you post a review make it honest and constructive.