OUR CHILDREN — ORCHID OR DANDELION ? — Why It Makes A Difference

In today’s WSJ article by Alison Gopnik http://online.wsj.com/article/SB10001424127887324637504578567640169906564.html?mod=WSJ_hps_LEFTTopStories  she discusses the is issue of resilience in children.  How they survive adversity, how they develop in the face of poverty, social upheaval, family and economic chaos speaks to all of us about how we navigate the stormy seas of our own lives. 

Pediatricians speak of two types of children–orchids and dandelions.  As one would imagine, orchids literally blossomed as individuals under ideal conditions and whithered when life experiences were difficult.  Dandelions were more resistant, tending to survive and do OK regardless of social and family environmental conditions. 

They seemed to find physiologic correlates by measuring RSA (respiratory sinus arrhythmia) in five month olds.  These were felt to correlate with temperament.  Follow – up studies demonstrated that lower-RSA children (dandelions) seemed to survive personal adversity better– while higher-RSAs (orchids) exhibited more difficulties as they got older. 

Can we learn anything from this article?  Are we surprised by the notion that temperaments are innate and that we are all the products of nature and nurture?  Doubtful.  We need to address the issues of poverty, parenting, family structure, educational support etc. etc. regardless of the “flower types” but it may be important to target those who are at higher risk of withering on the vine.

THE SAGE OF WAWA

Its strange. 

Wisdom can come from the most unusual people and places.  Like the words from a random fortune cookie, they can resonate with us on such a deep, intimate level that we are blown away by their relevance to our most personal life conundrums. 

A recent visit to a WAWA one early weekend morning had the same effect on me. 

I was standing in line with a newspaper (yes the Sunday NYTimes still works for me on paper) and coffee pondering some personal issues.  I was a bit “down” and perhaps feeling a bit sorry for myself (I try to minimize these feelings but we are human afterall).  The issues were not all that significant in the scheme of things,  but tell that to our ever rambling minds.

Next to me was a large, middle aged man with tattoos, a shaved head and a few earrings.  Deep into my own thoughts, I barely noticed him but his gravely voice got my attention.  The young woman who returned his change said to him “have a good day”.  He turned to me and as he spoke to the few assembled WAWA customers that early morning.   “I woke up this morning.  It’s a good day”.  His face was weathered, his voice perhaps the product of cartons of smokes and six-packs of beer.   A wry smile cracked his gruff demeanor.  I smiled back. 

Like a Buddhist koan which ignites enlightenment with its simplicity, it woke me from my self-indulgent gloom. Not a bad piece of wisdom from an unlikely source, in an unlikely place. 

A guess its all about recognizing truths when we need to hear them. 

Not that much different from finding inspiration from the Bible…..or a fortune cookie.

THE FEELINGS OF THE HEALER — A Personal Response

The New York Times recently reviewed a book by Dr. Danielle Ofri “What Doctors Feel” exploring the universe of physician’s emotions and their implication for the world of health care.  Would anyone be shocked to learn that we are human beings with powerfully human reactions to the pain and suffering we experience as part of our daily rounds? 

Ofri points to the particular experience of being sued for malpractice.  As someone who has personally been the recipient of such actions it is not an understatement to underline the power that such an experience has on the practitioner and their overall emotional well-being.  It is a life altering trauma.  It causes even the most competent and well-balanced physician to question their own abilities and to rage at a system which actually encourages such actions.  Ofri apparently (I have not read the book yet) writes of her own bitterness and despair over being sued and the sense of betrayal (yes, betrayal). 

It results from the consequence of deeply committing oneself to the healing process and being blamed when outcomes are imperfect.  She offers the analogy to a death and the healer’s subsequent grieving of a loss of innocence–one based on a naive belief that best intentions and efforts should rule the day. 

The physician’s response to being sued are often downplayed.  “They should be used to it by now” or “that’s why they have malpractice insurance” or “they’re rich and arrogant anyway”…..  The reality is quite different.  It changes the healer in a profound way.  Trust is lost in the process.  Compliments from patients are not viewed as trustworthy.  Thoughts of leaving the profession are abundant. 

 There are ways of dealing with patient dissatisfaction and poor outcomes.  They can take into account the litigious nature of American society and yet de-traumatize the experience for physician/healers.  If not don’t be shocked if your healer is in need of healing. 

How does that make you feel now?

GLOBAL WARMING POLITICS AND SCIENCE–An Unfortunate Mix

Is there anyone on the planet who is pro-air pollution?  Is there anyone who does not favor reduction in CO2 emissions?  Let’s grant that as a desirable goal that should  be pursued.  Yet somehow  the left’s agenda cannot help but politicize the debate.

In the NYTimes article http://www.nytimes.com/2013/0http://www.nytimes.com/2013/05/11/science/earth/carbon-dioxide-level-passes-long-feared-milestone.html?pagewanted=print There is a warning about a “long-feared milestone” of CO2 emissions that has been breached.  The guilt for this catastrophe  which will clearly contribute to global warming is laid at the feet of human activity. 

Yet the article also offers a confusing scenario—it clearly states that the last time such CO2 levels were experienced on Earth was the Pliocene period, three million years ago and prior to human occupation of this planet.  So unless I am missing some profound twist of logic–why is this time different? Aren’t the scientific facts more consistent with natural cyclical changes that occur by virtue of geologic and astronomic factors beyond human control?

Again, don’t misinterpret this piece as in anyway advocating ignoring CO2 emissions.  Nor should the clear dangers of global warming, rising sea levels, increasingly severe storm activity be ignored either.  The consequences of global warning should be clear enough to everyone, regardless of political persuasion.

 Let’s just addresses  the issue without political posturing and fear-mongering.  This will only diminish the validity of continuing to reduce unnecessary polluting of our planet.

STEPHEN HAWKINGS / THE INTEL CORE i7 / and Anti-Israel Protests

Certainly anyone is free to protest the policies of any country of individiual.  And clearly there are many in this world who disagree with certain Israeli political actions particularly involving the Palestinian issue. 

To my thinking the leftists of the world see Israel as the top dog, the Palestinians as the underdog.  This is all they care to examine.  The failure of any Palestinian leader to accept the essential nature of the country as a Jewish state will forever deter Israelis from further concessions of land won by the sacrifice of their own soldiers in battle. 

Witness Stephen Hawkings refusal to attend a scientific conference in Israel.  The irony/hypocrisy of this action should be exposed.  Because of his horrific ALS his very life is dependent upon the Intel Core i7 chip, designed and produced by Israel. 

Although it is not possible to know the true feelings of the anti-Israel protestor, it is not far-fetched to believe that Jew-hatred may contribute to some proportion of it.  This festering wound on the moral conscience of the last 2000 years of Western civilization is itself complex and complicated.  But there is a common theme here. 

Jew-haters and Israeli -haters somehow ignore the enormous contributions that both Jews and Israelis have given the world through science/literature/medical  technology/ the arts/ Nobel Prize winners etc. etc. 

It is an interesting example of selective amnesia.  Would they refuse the benefits of such contributions?  They should if they are not hypocrites.  But like Hawkings they will happily benefit from what Jews/Israelis have contributed to the entirety of humanity.  Or would he rather wait for the first Palestinian chip?

I guess he can’t hold his breath that long.

UPLOADING THE EXCUSES FOR THE OBAMACARE DEBACLE

What a surprise. 

Ezekiel Emmanuel MD (of the uber frenetic brothers Emmanuel and a named conspirator of Obamacare)  is already preparing us for the fiasco that it will surely reign down upon us all.  In his Wall Street Journal message http://online.wsj.com/article/SB10001424127887324326504578467560106322692.html?mod=hp_opinion#articleTabs%3Darticle  he is setting us up (as his boss Obama) for the utter chaos that will ensue when Obamacare is rolled-out. 

The bottom-line is simply– it will not work.  It will continue to escalate health-care costs, premiums, co-pays and deductibles among those Americans who do work and who do care about their health care.  For those who  can’t afford insurance (the majority of those who elected Obama) what sense does it make to “mandate” them to buy any? 

And clearly there will be exploding administrative costs, new layers of government mandated bureaucrats who will continue to devour dollars that are needed to provide the healthcare we are all supposed to be seeking.  The new system (if it survives its own birthing) will end up like a giant medicaid anyway.  Long waits in doctors offices/clinics for short visits will only proliferate.  A system which promises everything but can pay for nothing cannot survive. 

Perhaps the cynics are right after all: Obama (and Zeke) know the outcome will be the collapse of private healthcare and the eventual emergence of a government sponsored single payer system. It is the socialist dream.  It will be VA medicine for us all. 

Can’t wait.

PATIENT CHOICE & THE ETHICS OF HEALING

In this Sunday’s NY Times oncologist Mikkael A. Sekeres describes his dealings with a Jehovah’s Witness patient, dying from leukemia and with profound anemia, who refused blood transfusions. 

The article raised important moral/ethical/medical and spiritual issues.  What is the role of the physician/medical establishment in advising and administering treatments to someone who refuses them? It was clearly a difficult time for the medical and nursing staff who cared for the patient as well as for the patient and his family of devout believers.  Dr Sekeres respected his patient’s wishes, tried to work around his refusal to be transfused, and ultimately witnessed his death. Afterwards there were discussions regarding whether or not more could have been done to save him.  Sekeres ultimately concludes that “our responsibility must be to our patient’s goal more than to our own…”  I agree. 

The difficulty arising from these issues is that not all physicians and medical teams do agree with this assertion.  On a daily basis we see physicians and family members forcibly take charge of medical decision making despite the expressed wishes of patients.   We see living wills, advanced directives continuously being ignored.

All this is complicated by patients themselves in a clearly weakened mental and physical state,  who seem to “change their mind” when it appears that their lives are imminently threatened by disease and death. 

Many bioethical issues arise from these real life situations.  Why should patients be the ultimate arbiters of their own fate? What about withholding medical treatment of treatable disease states? What about euthanasia either passive or active? At what point do we accept a patient’s decisions? And when (if ever) is it OK to override them?  How do family emotions and disagreements play into last minute alterations in end of life planning? 

Would professional teams of medical staff/ ethicist / spiritual leaders etc offer a sounding board for such difficult times?  The impact of such personal decisions have profound economic implications for the totality of health care as well.  When nearly half of all ICU/CCU patients in any given hospital should probably not be there (according to independent physician/nursing assessments)  the financial burden of health care costs loom large.  As stated I applaud Dr. Sekeres approach and attitude in this patient’s case.  While we are trained to save lives at “all costs” it should remain in the hands of individuals how they live and ultimately how they die.

THEY HATED THE WARS IN IRAQ & AFGANISTAN — Is This The New Excuse For Radical Islamic Barbarity?

Forgive me if I don’t get it. 

The Chechnian brothers who committed the Boston Marathon atrocities  ( I choose not to name them once again ) have been analyzed by the liberal media as being outraged by US wars against Iraq and Afghanistan.  Their actions at the Boston marathon somehow become “undertandable” by those who seek rationality in the barbaric actions of Islamic fundamentalists.  If only we “understood” them better then these religious fanatics would desist from a their heinous acts of maniacal slaughter.  ( An Obama policy).  If only we realized how distressed they were by our political support of Israel.  If only we understood that attacks on Iraq and Afghanistan would trigger such a response.  If only… if only….    But why should we?  I personally believe our involvement in both of these wars was utter folly.  I shudder to ponder the next time our military leaders decide to send our best young men and women into harms way for some inane and insane military venture without an exit strategy. 

Yet I strongly reject any attempt to “understand” or somehow “justify” jihadist attitudes and actions in this 21st  century.  There is NO JUSTIFICATION FOR THE SLAUGHTER OF INNOCENTS.  Do I need to restate this?  When Americans or Israelis kill innocent civilians in the prosecution of military actions theiy immediately apologize.  It is never their intention to do so.  Do we not understand the profound ethical/moral/spiritual/metaphysical distinction here? 

INTENTION IS EVERYTHING!!

The purposeful destruction/ wounding/ killing of innocent civilians can NEVER be justified.  To even suggest that there is any legitimacy to these jihadist claims is horrific and reprehensible. To even offer an explanation is to infer that we should understand the reasons or motivations for such actions.  Civillized people disagree with each other– passionately and frequently.  Do we ever excuse such barbaric behavior?  Never. 

And God forbid we ever do so.

THE TRANSFORMATION OF HEALTH CARE — A Difficult Transition

The status quo in health care is changing.  That is painfully obvious to both patient (ie everyone) and healthcare providers (formerly known as “doctor”).  It has to do with both economics and  the philosophy of health care in this country. 

Everyone understands that the cost of health care has been rising for many years now.  Ironically that rate of increase may have stabilized somewhat.  But the causes are often misunderstood. 

Healthcare technology is always changing, evolving and hopefully improving.  Innovation costs money.  Is that a shocking revelation to anyone?  New drugs are expensive to bring to market.  Our aging population is surviving with chronic diseases longer than ever.  There are millions of poor citizens who cannot contribute to these costs and yet are never refused the health care that they need. 

Enter the beaurocrats/ politicians/ PhDs in social planning/ economists etc. etc.  Each has their own solution for fixing the problem. 

What may ultimately be the greatest casualty in this health care debate  is the time-honored patient-doctor relationship.  Some cynics will claim this was always an illusion.  Some will claim that physicians were always interested in generating income on the backs of those who relied on them. 

Those who direct public policy have come down hard on physicians as the source of much of the problem.  They insist that we don’t practice according to established guidelines, that we order tests, call consultants and overdo everything out of greed.  They imply that defensive medicine is an excuse for lining our pockets with income generating tests and procedures.  They dismiss the impact that malpractice claims have on physician attitudes towards their patients or the overutilization of defensive practices. They refuse to consider binding arbitration approaches to medical malpractice disputes and deny the role of lawyer PACs and their influence on the process. They insist that electronic medical records leads to better health care for all.  They tout the benefits of electronic medical records while every physician and every patient understands the absurdity of such a claim.  They insist that patients do not need options in the medications we prescribe but that one generic per diagnosis will be sufficient.  They believe physicians need oversight when our clinical judgment impels us to order a test or call in a consultant when this does not conform to some their own templates of care.  They believe that salaried physicians will see as many patients and keep later hours than those who receive compensation for what they actually do.

They deny the power of the sacred place which is the relationship between patient and doctor behind the examination room door.  They insist that social media contacts and skype approaches will easily and cheaply substitute for such face to face encounters.  

The system awaits young physicians who are seeking full time 9 to 5 types of pracitices.  They have no interest in getting called at night or on weekends for their patient’s problems.  Those who get sick after “banker’s hours” will find themselves in ERs or medimerge facilities, essentially on their own.

In short they are forcefully molding the transformation of health care as we have known it.   To point out that this will  be a difficult transiton is an understatement.  

I will very likely leave practice a better and more knowledgeable physician than I was 5 years before, one year, before, even one day before I retire.  My experience and sense of awareness grows each day I stay around.

In other words I will be leaving before I should or need to.  Yet when I do (I am turning 65 next month) it will be out of a deep sadness and frustration about the state of affairs involving our health care system.

Sorry to inject such negativity but, let us pray for some infusion of sanity into a system bound for inferiority.

BACK-STABBING 101— Is That the Parental Teaching Paradigm?

A recent NYTimes article http://www.nytimes.com/2013/03/31/magazine/a-modest-proposal-for-more-back-stabbing-in-preschool.html?emc=eta1 explored the question of how to raise children in an age characterized by competitveness and a “back stabbing” social and economic milieu. 

This angst of parenting is a relatively recent social phenomenon. Only one or two generations ago parents of large families were too busy ensuring their basic survival to worry about whether their kids did their homework perfectly or had the appropriate “play dates” or should be schooled in self-defense classes and SAT prep courses.  Survival in a competitve world has always existed and will continue to be a reality no matter how carefully and how cautiously parents try to soften the blow of failure, disappointment and rejection. 

Parents can offer the wisdom derived from their own life experiences.  They can emphasize the possibilities of “success” by virtue of the individual’s determination and desire to achieve what an individual goal.  I have often thought about individual personalities and how much of it is an inborn phenomenon.  There are naturally driven, ambitious children who are self-motivated to achieve certain goals.  This may be associated with a basic intelligence and talent, to be sure, but their inner drive is a quality not easily instilled from the outside.  But this is not meant as a condemnation of someone who is more laid-back, less interested in material possessions, noteriety or fame.  It is merely a different style of living.  Discord and confusion arise when individuals fail to recognize that these patterns of behavior lead to different outcomes. 

Also, it is interesting to observe that the “best schools” do not guarrantee the “best outcomes”.  For instance, I have observed excellent physicians who failed to achieve admission in American medical schools but who have demonstrated enormous intelligence and drive in their careers.  Perhaps they were not great “test takers” or found their “calling” after the traditional pre-med trial by fire passed them by. 

It is should also be noted that finding a path in life that seems to align a child’s personal talents and interest may provide the determination and drive to follow their “dream” that could not be imposed from even the intrusive helicopter-parent. 

And finally a parent can express an attitude that does not extol aggresssive  competitiveness or back-stabbing at all.  Life is ultimately NOT a zero-sum game the way it is frequently portrayed.  There is always room for another player in any field of endeavor.  Individual success and achievement does not have to imply stepping over someone, or demeaming their achievements or attempting to diminish their accomplishments. 

Good karma follows good intention.  Hard work, drive and ambition do not have to been regarded in any negative sense whatsoever.  In fact Darwinian theory extols the virtues of cooperation, collaboration, altruism and kindness as forces for success as well. 

Providing a loving, supportive foundation which fosters a child’s realistic (not delusional) self-worth is pretty much all that is necessary.  The rest is their own life’s journey, something a parent cannot micromanage anway