WHY WRITE?

I forgot why I started to write in the first place
It was simply to see what I think
You don’t really know until
You put it down
Outside yourself
Is that what’s going on
Inside my head?
Is it OK to release the Gorgon
Is Pandora ready to
Open her box?

WISDOM COMES FROM DIVERGENT PLACES — Eckhart Tolle & Mick Jagger

Remember, if you are old enough, the British musical invasion of the 60s and 70s. One group that stood out and shockingly has stood the test of time (physically, not just their music) was/is the Rolling Stones.

The mind remains a black hole of wonder and mystery. How else can I explain how the lyrics from The Stones song You Can’t Always Get What You Want surged into my consciousness?  But it did. So please recall the following:  ….Oh you can’t always get what you want. You can’t always get what you want. You can’t always get what you want. But if you try sometime you find you get what you need.…. ( Let It Bleed, 1969)

Now I am not assuming or even speculating the source or influence of those lyrics but it seems to me, now more than ever, that there is wisdom to be found within them.  The notion that life brings what we need to evolve spiritually is derived from ancient wisdom traditions, often from Eastern religions but sometimes that which we have “heard” many times in the past becomes “heard” again, as if new, at a much deeper level.  In effect, we finally “get it”.

And then there is Tolle’s statement, once again a restating of ancient truths:  Life will give you whatever experience is most helpful for the evolution of your consciousness. How do you know this is the experience you need? Because this is the experience you are having at the moment.

 Will these statements of wisdom change your life? Perhaps, perhaps not. But if the message does resonate with you then consider the possibility that your attitude about what is occurring in your life will change. Adversity will not be regarded as some cosmic punishment. You will be able to discard the victim role you have been playing (which doesn’t work anyhow).  It may offer you the courage to move on with life and to accept what cannot be changed and remain grateful for the opportunity to learn from it.

MANAGING EXPECTATIONS — A Guide to Serenity

We all seek more serenity in our lives. Whether we refer to this as “peace of mind”, “contentment” or “happiness” or any of a dozen other similar terms.  As The Buddha noted centuries ago, life is about suffering and the end to suffering.  Of course there are many reasons why we suffer but I will address one in particular here– unrealized expectations.

We live in a time and place where we are exposed to the desires and lives of others. We constantly meet people who seem to be happy with their life circumstances.  We continuously compare our own lives with theirs. Difficulties arise. Who ever coined the term “compare and despair” was not far off the mark.  

We have developed expectations of what our lives should be like from our personal connections and the media which surrounds us 24/7.  This may explain why we secretly relish the suffering of celebrities, billionaires, the rich and famous who we previously envied. Unfortunately we may even do the same for those friends and family who we otherwise love and appreciate.

 The “why me” response seems primal and reflexive.  “Why not me” is its corollary.  Expectations are particularly problematic for us because they involve circumstances beyond our individual control.  Why doesn’t my boss appreciate  me?  Why doesn’t my brother step up to the plate and assume responsibility? Why don’t my friends value my opinion? Why does my spouse seem disinterested? Why do I struggle with less money, less fame, a weaker marriage, a child who isn’t living up their own potential? Etc. ad infinitum.

And what about our expectations for our own lives, even those to which we have influence.  We may take note of what we are grateful for but fixate on past dreams which crashed and burned or remain unrealized.  Why am I not in a committed relationship? Why isn’t my health as good as my neighbors?  Why do I covet my friend’s spouse? Why didn’t my career progress as far it should have?

 Letting go of expecations is extremely difficult.  That doesn’t mean we shouldn’t have them.  It doesn’t mean we need to doubt our own feelings.  It has to do with releasing our attachment to our expectations.  We need to stop ruminating on them, revisiting them over and over.

We need to seek a larger perspective on our individual lives.   We need to recognize that to pick and choose what we envy from the lives of others is not reality. We must realize that life, every life is a totality. Be careful what we wish for.  The unknown aspects of the life of others might be quite different from what we fantasizse.

We must recognize that we are both totally insignificant in the span of eternity while paradoxically undeniably important.  Our smallest gestures of kindness and compassion move the cosmos as much as any president’s directive. The value of each individual life remains undeniable and unexpected. And there may be unrecognized karmic factors which make each individual life unique.  Despite our best efforts to control the chaos around us, to micromanage our own lives and the lives of others, this is not only impossible but a further blow to our expectations.

 Perhaps catch and release is an apt metaphor. Feel free to examine your expectations of yourself and others, then let them go.  They are only your perception of your life which can change in a heartbeat. To paraphrase the Serenity Prayer—accept what you can’t change, change what you can and let go of any burdens that remain.

Release your attachment to your expectations  and be grateful for the opportunity to live this life.  There will be other lives to live.  Stay tuned. 

PATIENT PORTALS — Unintended Consequences

Everything new brings with its introduction unintended consequences.

Patient advocacy, access to our own medical records, the concept that we need to take ownership of our health care–all resonates as true and laudable.  What happens in the real world, however, is often chaos and unnecessary suffering.

Please allow me to offter real world examples of this notion.  Patients are able to access their radiology reports, blood work, endoscopy and surgical reports with their associated pathology reports even before their attending physicians.  Sounds great?  Not really. What immediately occurs is a frantic Google search for any medical terms which are unfamilar to the patient.  What often follows is sheer panic and misery when uncertainty and confusion ensue.  This is understandable.  Even the most intellectually gifted layman (my patients, of course) do not understand the  clinical significance or relevance of what occurs on a lab, XRay or pathology report.  

Traditionally (in past days) the patient would receive the initial information while in the presence of their doctors.  Immediate discussions would occur. Analysis of the real consequences of a radiology report which might recommend a follow-up procedure based upon some vague and usually benign finding could be quickly and easily placed in perspective. ” Yes, let’s order another study just to confirm that these findings are probably nothing.”  That would often assuage the patient’s fears and avoid unnecessary panic.

The situations is quite different now.  I find myself dealing with borderline hysterical (or nearly) patients who have convinced themselves via the internet that they are absolutely dying from what may be a totally innocuous condition.  

My plea to my patients and to the patients of other physicians is to bring your reports to your doctors and, in persons, review every line of the report itself.  Frankly, most of this interaction cannot adequately be performed over the telephone (sorry about that).  Often the emotional content of the discussion can only be dealt with on a person to person basis.  Often I rely on diagrams to elucidate the results.  That is the way to promote the best in doctor/patient connections and to alleviate unnecessary chaos and distress.

The system is assuredly changing. Let’s all take a deep breath and try to make it work to everyone’s benefit.

WHY SCIENCE IS STILL NECESSARY

Read another article today from Science Daily selections regarding the status of happiness in ‘old age’.  This one contradicted some earlier studies which implied that we generally become happier as we get older.

 Such confusion exists among claims made on the internet on a daily basis. There are outrageous  assertions made continuously about the benefits of this treatmenet versus another. Recently I’ve seen postings regarding the old claims of the health benefits of coffee enemas. On their face, many might seem reasonable to some, ridiculous to others.

What willl ultimately determine “truth” is the scientific method. Now we all understand that science is imperfect. Its liability, its weakness is that not all science is ultimately accurate. Because scientists are human they may be prone to falsifying data for a variety of personal reasons. Of course this is reprehensible. But what makes science invaluable as a tool for ascertaining truth is its ability to correct itself over time. This is crucial. Studies need to be repeated, over and over. In this way what we deem to be truth is essentially a consensus of scientific studies (which need to be examined as to their own reliability) which is always open to revision. In this sense, scientific truth ( as opposed to religious truth) is always uncertain.  But it is in this uncertainty, this insistence that results be confirmed over and over that we can rely on its veracity.

 Is science ALL we need to understand the nature of reality?  I would submit the answer is NO.  We need the humanities– philosophy, literature, the study of consciousness, spirituality. Some of these aspects of human experience may NOT be open to scientific study.  But when it comes to understanding the physical universe and its manifestations, we absolutely need it.

THE TWIRLING RING ANECDOTE — a follow-up

Before relating the following anecdote I should offer some caveats.

 If you are convinced that consciousness ends at the time of physical death then you shouldn’t bother reading further.  If you are totally convinced that those who claim to communicate with souls who have crossed-over are complete and utter frauds, read no further.  If you are brainwashed by certain religious dogmas and doctrines and believe that alternative experiences are the work of the devil, read no further.

 But……if you are open minded, curious or have had your own intuitive experiences that lead you to seek more, then stay tuned.  The initial “twirling ring” anecdote was described in my book META-PHYSICIAN ON CALL… (p 77)

 The key to what I refer to as the credibility quotient regarding these anecdotes is knowing the individual who has had them.  There must be no question of their credibility, reliability and honesty.  What helps is their unattachment financially or professionally to the content of their story.  In other words, they have nothing to gain (and perhaps much to lose if someone regards them as a bit “off” by telling what they know.)  

In the book I refer to Marilyn (all names changed) who was gifted with medium/psychic ability since childhool.  She never charged for her services and actually desired them to vanish, which they did not.  She recalled learning of a nurse I called Janet whose daughter Sue died tragically in a car accident.  She knew Janet from working together at the hospital at which I was an Attending physician.  She had never met Sue but when she entered the family home for the wake she saw a picture of Sue and her sister Barbara.  Scanning the crowded room she saw Sue present there. She was translucent in appearance and she noted what she was wearing. It was clear that no one else in the room could perceive her.  She appeared anxious and confused and was vigorously twirling a ring on her finger. 

Months later she felt it was safe to approach Janet and describe the events of the wake.  Janet broke down in tears when she confirmed that, indeed, Sue would twirl the ring on her finger when upset.

 I have always considered this anecdote one of the most powerful I have ever heard and, quite frankly, highly suggestive of survival of consciousness after death.  But just the other day, nearly ten years later,  I had an amazing follow up.

 Janet brought her husband to me for a screening colonoscopy.  She then related a recent occurrence in the family.  They were on vacation and her remaining daughter Barbara describe having an extremely vivid dream in which her dead sister Sue appeared in specific clothing and affectionately stroked her face.  It was so realistic that she truly felt her presence.  But the next morning as she told her mother Janet, she felt almost foolish.  She rationalized that it must have been wishful thinking.

 The family returned home and Janet returned to work at the hospital.  To her surprise Marilyn greeted her and pulled her aside. “Your daughter Sue will not let me rest until I tell you and your daughter Barbara that she was really there– it was not a dream!”  Of course Janet was floored. How could Marilyn have known about the dream in the first place?  When Janet described the clothes that Barbara  had described, Marilyn stated– “Those were the exact clothes I saw her in at her wake.  She must have been wearing them at the time of her death.”  Janet confirmed the fact of the clothing, also that she was not wearing them when she was laid out at her wake.

 Now as Janet related this story to me she had a gently smile on her face.  This had been a powerful validation that Barbara’s experience with Sue was not a hallucination or dream.

 It gave her some small comfort to know that her daughter was gone from the physical realm but that her soul connection lives on.

o

METAPHYSICIAN On Call

I have been enamored of the relationship between a physician and metaphysician for years now.  My book is titled META-PHYSICIAN ON CALL.  My blog is PHYSICIAN TO META-PHYSICIAN.  I continue to believe deeply that the awareness of human beings as a composite being of body, mind and spirit is essential in the healing process.  

It was particularly gratifying to find a quote from Anatole Broyard, writer, literary critic and editor who stated Also, I would like a doctor who is not only a talented physician, but a bit of a metaphysician, too. Someone who can treat body and soul.  It would be presumptious of me to believe that I have reached that level of awareness. I do believe it is an ideal, one that I am striving to reach.

 I would point out that I have used the term METAPHYSICIAN and META-PHYSICIAN.  They are clearly related but not identical.  A metaphysican is someone who seeks to understand the nature of reality.  Metaphysics is a subcategory of philosophy. Using meta  hyphenated with physician also introduces the notion of meta as change or transformation.

  It represents a level of awareness among physicians that we need to transcend the weight of frustration, annoyance, outright rage that we experience from insurance companies and governmental bureacracy  that threatens our best efforts to appreciate the role we can play in our patients lives.  I must continuously remind myself that my better self can move beyond these hinderances and be the meta-physician I seek to be.

CAN TMI (too much information) BE A BAD THING FOR HEALTHCARE?

I can “hear” the groans right now wafting through cyberspace.  Here is an old school doctor bemoaning the “new patient” who is internet savvy and has done their homework. I must be one of those physicians who fears patient awareness and  their ability to come armed with reams of information by which they can mold and control their own healthcare decisions.  I am probably one of those who decry patient self-determination and their ability to possess ALL of their medical records.  

Well actually that is not entirely true. I do recommend my patients do their homework, their “due diligence” so to speak when it comes to their own health.  They are their own best advocate. But what has become a difficulty for me and my patients is exactly how to deal with the enormous volume of information which patients can obtain. I am concerned by what seems to be an almost adversarial approach that some patients now take towards physicans.

 One particular source of information has been generated by big Pharma in an attempt to bypass physicians go directly to consumers.  Ironically, I find that this practice has actually backfired to some extent.  Let me share one particular situation which I am attempting to deal with at the moment.  I am a gastroenterologist and I treat (among other conditions) Crohn’s disease.  This can be a very difficult, disabling condition with a variety of very unpleasant manifestations.  One of most horrific are fistulas.  They are “tracts” that can drain a mucus/pus like material from openings in the skin.  Unfortunately they often occur around the anus and genitourinary tract.  

One of the breakthrough treatments are drugs known as anti-TNFs.  Now I don’t want to expand in detail about exactly how they work and the brand names which many of you would recognize from TV and magazine ads.  Essentially they are very powerful with “potentially” serious side effects effecting the immune system.  On the other hand they can be tremendously beneficial for some patients with Crohn’s and other autoimmune diseases.  They problem is that the TV commercials are SO explicit in the risks and potential devasting consequences of bad reactions that even I would be loathe to try them.

 This has happened with my one young female patient with Crohn’s disease and perianal fistua who is reluctant to try this medication.  Ironically, she is willing to try an alternative drug which is chemically almost identical to the first but which does not advertize on TV and for which she is unaware of the same potential side effects.  And by the way, her insurance company will only pay for the one she is afraid to take.  So now my difficulty is to try to “sell” her on the necessity of trying the drug she is afraid to take.  And she is afraid because of TMI and her unwillingness (so far) to trust the experience and opinion of a physician.  I desperately want her to try the drug and have tried to communicate to her that thousands of patients have used it without difficulty or complication. And we can closely monitor in case issues arise.

In effect what I am calling for is a reasonable balance between information gleaned from a wide variety of sources, some of which are of questionable veracity, and guidance from a physician who really does have the patient’s best interest at heart as well as decades of experience and hopefully some wisdom as well.  An informed patient and a wise physician can, indeed, be on the same page. 

PHYSICIANS AS SALESMAN?

Is the notion that your physician is a salesman inherently disturbing? It is a question I have asked myself over the more than 35 years that I have been in practice.  I come from a family of salesmen.  My father and son are in fields traditionally viewed as sales. 

Yet I had never viewed what I did as sales–until I thought about it.  The truth is that we all salesmen but hopefully in the best sense of the word. In any field of endeavor, from businessman to artist to physician we are continuously “selling” ourselves to our clients, our colleagues, our patrons, our social contacts.

I am not talking about the stereotypical ” used car”  guy who uses high pressure, fast talk and disengenuous techniques to push you into a choice which may not be in your best interest. To my way of thinking sales is essentially demonstrating your best self.  It is about educating the client/patient about a product or service which will cost them financial resources but which will benefit them in someway (or not)  in the future. 

We all need to be good communicators, educators in effect.  A good salesman can explain the risks/benefits of that product/ssrvice is such a way as to make the decision easier.  If it is not a mutual consensus on what to do the, quite frankly, it should not be done. And yet there remains a strong element of uncertainty in any sales situation. Will the product or service be beneficial in the long run? Is there risk in consummating the sale or in not doing so? Of course.

 Is there an element of trust involved in such an interaction? Certainly.  The salesman almost always has the advantage in knowledge and experience regarding the product/service that are being negotiated. But that has been true and will always be true.  Ultimately, the leap of faith will prove to be mutually beneficial or not.  There will always be the element of uncertainty and risk that is inherent in any human interaction.Time will be the ultimate arbiter.

A “good” salesman, whether selling a dishwasher, car, insurance product or the need for a colonoscopy, will be vindicated in the long run.  Their client/patient will return to them, time and again.  They will recommend them to their friends and neighbors. It is as simple and complex as that.

THE DOCTOR / PATIENT ENCOUNTER–TECHNOLOGY  &  AND  ITS  LIMITS

American Psychological Association (APA). “Falling off the wagon with Facebook.” ScienceDaily. ScienceDaily, 6 August 2015. <www.sciencedaily.com/releases/2015/08/150806112510.htm>.

The American Psychological Association’s piece cited above points to an important phenomenon of which we should all be aware–namely technology has its limits. Of course this is not to demean or diminish the incredible benefits that computers and access to instantaneous information and communication has brought to society as we know it.  It is virtually impossible to recall just a few years back when we did not possess smart phones, or any portable means of communication for that matter.

The point of this study is to remind us that technology still has its limitations.  We are still inherently social beings who have evolved to interact with each other in close proximity. Body language, facial expressions, subtle emotional responses to close in dialogue represent a dance between who individuals. The give and take often occurs on a subliminal level. Our ability to “read” others is a gift that some of us possess to a higher degree than others.  Face to face encounters are different from computer based and I will openly  risk the wrath of my more technologically savvy colleagues to propose that they always will be so.

So will telemedicine ever replace the office visit? Will it be used as a less satisfying but potentially helpful supplement to the patient-doctor encounter?

 Perhaps I only fantasize that my personal encounter with patients within the sanctity of the closed exam room cannot be adequately duplicated by technology. Perhaps it is only withful thinking that some of my success in the practice of medicine is related as much to those interpersonal skills as to raw medical knowledge.

Perhaps I remain the Luddite in the white coat.  Or at least I remain skeptical of its ability to replace the personal encounter.  Only time will tell.