The last 5yrs has led to society embracing short cutting.
The “hack” has been synonymous with lifestyle change.
Everyone wants the 7 figures, millions of followers and immediate reversal of suffering but no one wants the arduous task of investing in learning.
In my time it was Cliff Notes night before a big final exam.
Now it’s stacked steroids, tummy tucks, testosterone, credit cards, catered food and a prescription dependant population.
Being active was exercise and organized sports during school years followed by work force labor for the rest of life. Now exercise has been substituted with computer time and hard labor is considered hallmark of lower class and minimum wage.
Exercise has been relinquished as a luxury and true dedication to sweat is just given during the month of January for a few weeks of attempting to get back to “high school weight” till an injury kicks you back to the reality of being overweight and out of shape.
Exercise SHOULD begin with an experienced coach, guru, mentor to evaluate goals, experience, short comings and resources. The usual excuse that is coughed up immediately is I don’t need a coach-I know what to do / I just have to do it!
WRONG!
If one truly knew what their circumstances needed to course correct from the abyss of hospitalization and medical procedures...it would have been engaged and continued in sustainable ritual. What most people think is that running like a Kenyan or lifting like an NFL Lineman is the outcome of exercise.
That is the sexy part of achievement but what most New Years resolution promises do NOT afford is to witness the 10-20 years of slinging mud, crying with frustration, packing in the gym clothes for rehab visits, watching friends eat without remorse .... and being very very hungry!!!
No one will engage the unsexy part AND most will attempt to “Cliff Note” their way to hollywood lifestyles.
When I analyze the excuses, I tell people it’s human to give up on an outcome...(I’m 58 yrs old and always wanted to be an Olympian) but we should never give up on hope (I may never get to the Olympics but I can talk to my God, figure out what my motivation is in real-time and put all hands on deck for a course correction). We always have a choice, agency, karma...the person who takes-on suffering...will hopefully see that there is EM-POWER-MENTin trying. (It’s ok to never being Olympic material OR being a physician that will never fit into the status quo of a prescription pusher OR being a yoga studio owner who is being kicked off the cliff of being a business owner by the universe)
I do not feel it’s in my best interest or the health of my patients to follow the vehemently enforced medical standard but I maintain HOPE and reconfigure my direction with faith that my destination will show up if I maintain dedication to healing all that I meet.
There are a lot of dead ends in the rat maze and depending on where you are it may seem like you should give up but just know there is an exit somewhere. Whether its injury or failure to maintain a business...(plan on not having six pack abs or 7 figure salaries but still show up to the gym floor, work or the unemployment line) keep moving, it’s ok to accept the reality of the situation we are in,trust the universe has something it needs you for, and ask what can I do with this- DON’T GIVE UP, THE WORLD NEEDS YOU!
October 24th Evening under the stars roll call / October 25th Full Hike around Devils Lake
Rally Point prior to hike will be The Concession Stand on the North Shore of the Lake 7:00AM Oct 25th (if no rain)
Accommodations Suggestions:
1-Tent/ RV campgrounds http://www.devilslakewisconsin.com/camping/ NO LONGER AVAILABLE
2-Best Western Baraboo Inn https://www.bestwestern.com/en_US/book/hotel-rooms.50092.html (but be prepared to cancel week of hike IF rain is forecasted as rock face very slippery with moisture)
3-Wisconsin Dells
4-Drive morning of event (note rally time at northern lake short meeting cabin is 7am!!!
Map and Link to AllTrails https://www.alltrails.com/trail/us/wisconsin/devils-lake-via-west-bluff-trail
Hiking Schedule:
Every Sunday 2-3 hours, 5 mile hike with back packs
September 27th Mallard Lake to Hawk Hollow 7.4 miles DONE!
October 4th Morton Arboretum to Big Rock 5.9 miles https://www.alltrails.com/trail/us/illinois/morton-arboretum-and-big-rock-trail
October 11th Sag Valley Yellow Tan trail loop +/- Swallow Cliff Stairs https://www.alltrails.com/trail/us/illinois/sag-valley-yellow-and-tan-loop
October 18th St James Farm +/- Mt Hoy at Blackwell Forest Preserve https://www.alltrails.com/explore/trail/us/illinois/saint-james-farm?mobileMap=false&ref=sidebar-static-map&ref=sidebar-view-full-map
Rain Alternative to be declared week of October 20th (Starved Rock State Park alternative)
Training Schedule:
During the week before each meet up, leg work with trainers, core work with trainers, flexibility with yoga teachers nutrition work with DrRic
In youth I used to dream of being an athlete. Growing up I was fast, I would carry the 8th grade guys on my back when we played “kill the man with the ball”. (Think of me walking one step at a time with a dog pile of guys trying to weigh me down to drop the ball) I was amused that my legs could carry a lot of weight but just went with it hoping no one would figure out to grab my legs. In youth I used to dream of a lot of things so why is it we stop dreaming? You only hear of the rare human like Steve Jobs or Elon Musk or even earlier scientists like Einstein or inventors like Edison coming up with a concept that “sticks” for the rest of time. I submit to you its all based in day dreaming.
Currently best visions come at 430-500am when ideas overflow (if I allow them). I wake do my 478 breath exercise, go downstairs sit overlooking my backyard while waiting for kettle to boil then sit more while brewing my gyokuro tea anticipating the first taste all the while imbibing nature therapy. Ideas flow like a fire hose opened full force.
This wasn’t so about 18 months ago; I would wake anticipating the tasks of the day and open my computer, log into the electronic medical records and start preloading patient data while downing a pot of coffee. I remember my wife coming down one morning asking me something and I remember snapping at her as she was interrupting my flow and I only had 40 more minutes to do these charts as the ones from the day before were not complete and as soon as I entered the gauntlet of the office every second would be accounted for.
This sounds blown out of proportion BUT its true. One would think its should be easy to type, in prose style as the patient is speaking; come up with a diagnosis and a treatment plan all on the fly BUT it is not! What overshadows the time spent with patient is the arduous “CI’s” (clinical integration?) that is required for all doctor offices employed by hospital to fulfill in order to assure you get all the requirements for clinic site to get bonus. The “CI’s” go into asking about recent vaccines, Pap smears, colonoscopy, prescription meds, blood pressure... ALL not what the patient is presenting for the day of BUT are necessary as a “by the way” while you are here can we get our bonus. AND those questions and key strokes take seconds to minutes in an office visit to accomplish. (If your doctor is running 15 minutes behind and In addition now has to go through those CI questions; then enter data by checking boxes-this will take an extra 5 minutes (IT JUST FURTHER DELAYS AN ALREADY DELAYED DAY!!!) And that is just second patient of a 25+ patient day. 15 minutes behind x 25 patients = extra 375 minutes end of day (6 hours delayed to go home and eat dinner). 20 minutes behind x 25 patients = extra 500 minutes (8.3 hours delayed to go home). Now for the rare doctor running on time, adding an extra 5 minutes per patient for average 25 patients = extra 125 minutes (2 hours delayed to go home). THIS IS ONLY PATIENT CHARTING AND DOES NOT INCLUDE THE PATIENT THAT IS CALLING IN WITH A NEW PROBLEM, OR TO FIND OUT ABOUT RESULTS OR CALLING FOR REFILL OF MEDS OR CALLING FOR A 4 PAGE DISABILITY FORM TO BE FILLED OUT (all these things mentioned are hourly occurrences!!!)
So if I would be a slave to the task-master of the day (the electronic medical record) then even adding a few extra key strokes adds up. GOD FORBID IF A PATIENT HAD AN AFTER THOUGHT QUESTION AND I HAD TO LEAVE THE NEXT PATIENT ROOM TO REENTER THE ONE I ALREADY LEFT. No wonder I hear some docs are answering questions while walking out the door or literally doctor “spent 5 minutes in the room” is a common occurrence. My wife would wonder why I wouldn’t check my text messages and its because I just wanted to run out the back door after I finished the most crucial work (leaving some unfinished questions to be answered on next days schedule) and get to the sanctuary of my home. This gauntlet would occur 5 days a week and infect my “time to day dream”. In fact it induced a stress response that would wake me up at 420 for fear that I didn’t preload the charts in time to be out the door in the am to drive my son to school. No wonder heart attacks occur across the world mostly on Monday!
Turning on the stress response can be useful for getting out of life threatening situations. It’s not like you have to manifest full fight or flight and carry a machete In the clinic but the rapidity of the tasks demands you think fast and use algorithms to survive the day. Here is the rub, average patient doesn’t give a shit what the doctor has to go through, the patient is suffering and just wants it to stop. Patient demands attention from the provider and demands focused problem solving to come up with answers and a plan of action. The average corporate paid doctor WILL provide that BUT it will be in algorithm form. To survive the day, every patient’s verbalized symptoms will be keyword focused. Front desk and clinic area will be focused on listening for keywords of symptoms IN ORDER to lump patient into a treatment algorithm and produce a rapid solution. The more rapid the solution, the more on time clinic runs, the MORE CI gets accounted for and the faster staff leaves to get home and spend time with family.
Unfortunately, every person notes a common symptom but the rest of what they are feeling may not be understood by a layman thus its not divulged to staff when making the appointment or at check-in on the visit day. Typically the doctor is supposed to question further (“outside the box questioning”) to make sure the symptoms are not from a deeper root cause. BUT WHO HAS TIME!!?
Patient: “...but doc its my 4th bladder infection this year”. Doctor: “...its ok as women are allowed to have UTI’s frequently...any other final questions?”
When doc is thinking in stress response 5 days a week, it doesn’t allow for “dream time”. This time is when you think “outside the box” to become inventive. More importantly become inquisitive. When patient is coming in over and over again with bladder infection symptoms ...is there something else lurking in the body that is starting to express itself? Naaa... if it was important it’ll declare itself and we can get the specialist to cut it out, burning it out or melt it out! Or more appropriately if it keeps coming back, it probably needs a prescription thrown to keep it from recurring again.
Doesn’t seem like a fulfilling career, or a great work schedule BUT nice paycheck!!! (Average primary care salary in Illinois is $181,000 annually.) BUT that’s the guaranteed base salary as you are “starting out” working as an employee. As you get established in 3 years your paycheck gets smaller and smaller as a “reverse incentive” to make you work faster and get back to the huge paycheck like the “protected” first year of working. The only way to stream line everything mentioned above in the daily schedule is to treat the whole week as an algorithm. Assume most patients will be sick from infection or sick from over eating or stressed out from life. Preload all the days of the week with the typical algorithm answer of antibiotic, diabetes pill, or mood altering drug. In fact, may as well just preload the entire month and year for figuring most patients you see will fit into the usual categories so anyone that calls with the smallest of symptoms or the beginning of a disease on recent blood test results should be placed on the most rapid medicine for the general population.
When docs don’t have time to think in abstract and go into personalized-time-consuming-problem-solving, all patients are treated like cattle and branded to end up same way. THIS IS CALLED THE ECOLOGICAL FALLACY. It is assumed the data from the individual is treated as the research outcome data coming from a larger group. Does this sound familiar? Patient Lives Matter!!! Medical community should not assume all patients coming in with symptoms will be successfully treated based on the data of the general population. If I was to give metformin to anyone overweight with an elevated glucose and assume they are not going to lose weight or change lifestyle, you pigeon hole those patients that would otherwise have committed to change and reversed their disease. BUT WHO HAS TIME TO DIVE INTO PERSONAL INVESTIGATION TO FIGURE OUT WHO THE OWNER OF THE SYMPTOMS IS AND WHAT IS THE ROOT CAUSE OF ALL THIS!?!
When I do lifestyle coaching online, I can sometimes spend 1.5-2 hours trying to figure who this person is...the proverbial meet the client where they stand. However ask the hospital you work for if you can spend 1.5-2.0 hours and just see a fraction of patients daily as compared to the ‘average” and you will be laughed away pointing out you are “not keeping up”. There is a saying in social work to meet the client where they are / instead of being prescriptive, try to improvise to co create a plan of action PERSONALIZED to the individual. Going right back to where I started this blog, improvising is a learned talent... or should I say its a natural talent from youth displayed in day dreaming. It’s a natural talent that in adulthood that is “unlearned” to allow algorithm medicine and the ecological fallacy to anchor.
I had an grounding conversation with Dr Pat Massey. For those of you who know me, I followed Pat from the 90's forward when I came across Alexian Brothers article about a doc that taught Tai Chi to patients with "Failed Back Syndrome" and got them off their medicines feeling no pain. This syndrome is when a patient goes through major surgery to correct an acquired defect and either; has persistent symptoms or suffers more than before surgery. I had just finished my Sports Medicine Fellowship in 1995 and felt very empowered as a primary care physician with "extra training" to have a more tools in my toolbox for problem solving disease manifestation in patients (see Annual Sickness Visit post).
Nutrition wasn't sexy in the 90's and physical medicine was booming. Rehab, trigger point understanding, exercise (marathon training and working out at Bally's) was the rage as some folks were able to take a non doctor modality (fitness) and apply it to alleviate some key deficiencies in American lifestyle. Just by adapting this available form of exercise, a small percentage of people were bitten by the running bug and reversed the onset of hypertension, high cholesterol and heavier weight. I don't mention Bally's memberships as only a sliver of gymrats have grandfathered into the newer expressions of working out at all in one 24 hour gyms. In fact the average person that jogs will run year round, the average person that exercises in a gym will weight training for a few weeks after Holiday eating. So by default, weight training on your own will be a temporary modality pulled out when inspired to attack new years resolutions.
My theory is that the runners high (endorphine and enkephalin secretion) makes people feel euphoric, is addicting and DOES NOT require vast knowledge on what to do. No matter what speed you run (even hike) the feeling from the event;
-keeps you in the moment (erasing the need to ruminate on the laundry list of things to do that day),
-gives you a bump of invincible-hormone (as our genetic code rewards the endeavor with the neurotransmitters to solidify that this habit will preserve the species so do said act again),
-moves stretches and perfuses muscle with oxygen to take away muscle stiffness, lower blood glucose and increase sex hormone,
-reinforces circadian rhythm to induce a deeper refreshing sleep (resulting in repairing trained muscle and reinforcing neural tracts to adapt new coping skills learned during the day)
The post work-out high:
-gives you a bump of invincible-hormone
-sometimes reinforces circadian rhythm (but highly depends on what stimulant you use to get through the work out -ie caffeine, red bull sugar, metallica ...)
...thus the high quit rate with working out UNLESS YOU GET SOMEONE TO DESIGN/REDESIGN and keep you on task!!!
Now that nutrition has: multiple authors, weight loss centers, patented box diets and supplement companies that have the newest Dr Oz vitamin for slimming waist line, the American public has kinda made nutrition education a needed modality to build up. Since the hospital systems do not acknowledge personal nutrition design as a domain they control...the Nutraceutical/fitness industry has taken it over. Note I said “kinda” as most Americans will not read a text cover to cover and just adapt the cliff notes on a nutrition practice from watching a YouTube video. (Super biased and sometimes poorly interpreted by vloggers that may or may not have a nutrition background).
So now the average citizen has 3 modalities that can be used to reverse/prevent disease manifestation. One roadblock is that for the power of nutrition change to take effect, its not as easy to find your groove as putting on a pair of running shoes and going outside.
-Nutrition has to be personally designed
-Weight training has to be personally designed
-Running can be initiated and fine tuned even by a high school runner
Insurance based medicine doesn't cover nutrition counseling unless you have crossed over and been rewarded with the label of diabetic or heart stent candidate or cancer patient!!!
Insurance based medicine doesn't cover exercise unless you have acquired an acl tear, back spasm, shoulder impingement or an overuse injury from work.
Medical insurance was supposed to be used "just in case" a catastrophic event occurs, that way you are ‘insured‘ to not go bankrupt or get turned away by a hospital. Now a days patients rely on medical insurance to cover an annual wellness visit (see Annual Sickness Visit) at which point the laundry list of issues are brought to the doctor to address and inevitably either doc says "don't worry about that one-trust me" or s/he proceeds to give a pill/referal to address the remainder of the complaints. My theory is medical school and residency is jam packed with curriculum now with the advent of electronic medical records and there is no time to teach lifesaving nutrition, exercise prescription (even some orthopedic specialists) or cultivation of mindful practice. These 3 key components are how blue zone citizens reach the age of 100+ while maintaining independence, bladder function and memory.
Luckily these modalities can be undertaken without a doctor BUT the more efficient way to engage change is to have investment in a coach to teach, apply, adapt and refine to the individual. If you have a favorite author then you may be able to try on the practice IF you read cover to cover and have a good fund of knowledge. As I alluded to earlier America has become fixated on social media and watching a book is easier than reading one. Condensing long concepts are like cherry picking your data to invent a new law of thermodynamics.
This brings me right back to my original sentence, my conversation with Dr Massey. He preceded me to develop a footprint in the area for "a different type of medical practice". He also confided in me that he took a lot of bumps in attempting to intertwine successful life changing protocols to the confines of a hospital system (JUST LIKE MY LIFESTYLE CLINIC BLUE PRINTS WHICH I WAS TOLD WOULDN’T WORK THEN SUDDENLY THERES A WEIGHT LOSS CLINIC?!!) I am now convinced if you try to sell a screw driver user a new tool called a hammer, they will look at you like you're speaking a foreign language. I have finished the gauntlet of learning to use the screwdriver, the hammer, the flash light the prybar and the glue stick (and will continue to adapt newer tools as the horizon demands) and I feel penalized when I wield these tools like a martial artist of lifestyle design. I guess it was inevitable to butt heads with "standard practice" when I embraced "alternative and complimentary approaches. I was hoping to just maintain a regular paycheck and do what I feel was right (on the down low) as my contemporaries still look at me like I'm speaking a foreign language when I speak of energy medicine, yoga breath, supplement effects, gut microbiota, medical cannabis application and "hand holding".
Looking back to last week, if felt so wrong in taking care of my patients and:
-NOT going over the allotted time for a visit
-NOT suggesting weaning down on pain meds/weaning up on medical cannabis
-NOT providing lifestyle coaching outside of insurance reimbursement
-NOT suggesting looking at my youtube tutorials to educate
The root word of doctor is “docere” which means To Teach.
The root word of patient is “patiens” which means To Suffer or Bear
The root word of heal means To Make Whole...I do not agree with a drug or a surgery to make you Whole (drugs/procedures maybe necessary to stop severity of suffering but the next step should always be taught!)...there are a few primary care docs who practice from the heart but its only a matter of time before comparison is made to the performance of all other US docs with speed medicine (lazy medicine)...at which point you “eat what you kill”...(if you dont want to see high volume-then you will need to moonlight to pay the bills)
The true healers I am collaborating with are good at what they do since they can’t rely on screwdrivers. I am sharing my tools with my new team to develop a parallel option to the embedded disease care system (see Annual Sickness Visit). Looking forward to the future, I feel so RIGHT to dive 110% into all things NOT suggested within the walls of a hospital system. I am now unemployed (which is not the first time -thanks to medical insurance reimbursement!!!) but I am unafraid as the warriors that have reversed there suffering under my care are sending out threads of compassion to sew my proverbial parachute.
I go to the township board meeting letting them know with my “special care plan”, my neighbors lawns are healthy my neighbors houses are strong and my neighborhood is safe.
I want to offer a wider template for the whole town to reap the same rewards. I offer my services at a discount as it pleases me to see neighborhoods thrive but the board says they have seen these programs in the past and don't want to invest as past experience says its not worth it.
I accept that perhaps My “special care plan’ may not be for everyone and maybe its by-chance a few properties are finding great benefit.
I keep it to myself but share it with close neighbors, and friends of neighbors as word is getting around that I can get grass to grow, houses to withstand Mother Nature, I take their success and feel good about giving and doing my small part with a small subset making a small but important impact.
THEN I find out one of the board members retires and goes on to become the first head of a “special care plan” clinic to change the town by making lawns healthy, town homes strong and the town and country safe!? And all the other board members are congratulating him stating he will make a great impact with this needed investment?!
WTF!!!
My house is smaller than the other township board members,
My neighbors houses don’t need big hammers and nails to repair what needs fixing,
My title according to the township is “average towny” with average experience in rebuilding neighborhoods,
My neighborhood impact is farther reaching and more sustainable than multimillion dollar infrastructure planning blueprints the board suggests to revamp neighbors,
My personal design takes a house at its face value and creates peace, longevity and blending with the landscape by embracing individual strengths and acknowledging weaknesses (not all houses will adapt into a one size fits all blueprint).
I have personal investment as I have rebuilt my own “average” house from the point of demolition to the current warm, resistant, and forever lasting.
Gonna have to find a new town but this time I’m taking my tools with me and building a city.
From a March 2019 Deepak and Oprah 21 Day Meditation Challenge-
"when you feel struggle... pause... try to take a step back...give yourself a moments time to find your center...that struggle is a gift a whisper your true self tapping yourself on the shoulder ever so gently to look again cause you always get to choose. Do you react to an obstacle as a negative or do you embrace it as an opportunity with the open hearted knowledge that ... All Will Be Well"
My Dad a gynecologic surgeon used to tell me stories when operating on someone and critical life and death didn't seem like it was going the patients way... he would pause, take a step outside the operating room take a deep breath and open his heart and mind to find the answer OUTSIDE the turmoil of forces trying to make him take the easy way out and "call it".
I usually will tell new patients with insurmountable lists of ailments if we go back in time and think about what happened during the time period before shit hit the fan...we can find the answer of what to reverse. It seems too simplistic BUT I believe if we act to reverse the biggest root cause...all the other subordinate roots will fall into place like a wack a mole game allowing you to see all the moles to hit.
I have made every excuse not to take the proverbial step off the staircase and have dis-empowered myself. My ego gets in the way ruminating on every unlikely scenario that might occur if I go the route of starting my own brick and mortar clinic but honestly with all the complaints I hear from docs who have started and survived without having to be financially rescued by a major health care system...I'M NOT LIKE THEM!!!
I have always had a passion to nurture the human body, fine tune the muscular system, support the digestive system, embrace the spiritual practice of ancient cultures push human performance (both athletic and regular Joe/Jane) to it maximum. I kept on telling Mama I wanted to be an athlete but she reiterated that being a physician would guarantee financial security anywhere in the world. (don't think she would have fathomed how google reviews could make or break even a Harvard graduate). I so appreciate her pushing me into this direction but look where I am:
-sports medicine trained
-integrative medicine fellowship (nutrition)
-yoga instructor and middle aged athlete/coach
When a complicated patient comes in for help, I like listening to their story as I will always try to find the answer they are looking for in the words and language they use. I feel most of use can heal ourselves but just refuse to see the way out of the pit as it is seemingly so difficult to initiate the first step. We have become accustomed to existing in the level of daily suffering and soaking in waves of sympathy every time someone asks "are you OK?" I'm not belittling chronic disease and admit wholeheartedly that I am a fibromyalgia sufferer IN REMISSION but I am not using this as an excuse for not moving on. I've worn the concrete suit that disease gives us and recognize that it is just a chore to get through a single day let alone see a higher calling. My own stumbling feet are intentionally getting in the way of finding the next milestone of aging called wisdom.
I painfully wish my Dad was around just to bounce my ideas off of but I know he gave me the answer to my query a long time ago ... I just have to extract it from his many late night lessons sitting a the kitchen table with a few beers talking about "medicine". I'm taking a moment, finding my center knowing that throughout this struggle I have your spirit behind my shoulder pushing me forward.
I miss you so much but I know what I have to do.
So my goal with medical practice is to help patients define a goal. In creating my annual DrRic's Hiking Excursions....it started as a goal for me to keep activity as top priority. Modern lifestyle keeps activity and exercise on the bottom of the "totem pole" regarding multitasking. When we keep shoveling other tasks atop the required daily move count, before you know it January first rolls around and your 5-10lb heavier, still tired, and planning a check up with doc to most likely get started another medicine since nothing changed from the previous visit. That is why I find it easier to daisy change small tasks and have mini successes so life isn't overwhelmed with ONE BIG GOAL OF LOSING 50 POUNDS BY SPRING. (...individual goals may vary but you get the picture about procrastinating on health)
During the dreaded annual wellness exam (15-20 minutes max as allowed by medical insurance reimbursement)...when I hear "I know what to do I just have to do it"....I immediately retort "please don't rely on failed routines as if your technique failed to give long term success then if will fail you again" and we don' want to have the same conversation next year.
A common benchmark for success or failure is levels of glucose, cholesterol, and vitamins. If your deductible is too high to invest in getting blood tests or fancy imaging studies ...then we go old school.
-new school = test blood levels and get xrays or ct scans and determine if change has occurred.
-old school = measure waist line, weight, level of fitness, blood pressure, diet or number of meds (the more medicine prescriptions you have accumulated / the more health has "left the building")
So the inherent problem with doctors of functional medicine is they follow numbers not the person.
If you feel good now after fixing the lab values....okay but you have just accumulated more vitamins and herbs instead of medicine prescriptions!!! If there was a way to add old school guidance to new school measuring....that would be perfect. Using old school ways will change the basic ways of eating sleeping activity and stress tolerance....it should be recognized as a 360 degree change but that takes motivation (in your face accountability every day during the weakest times of the day.) A coach for keeping eyes on your activity and making you aware of goals short and long term, a nutrition expert to remind you BEFORE the crave kicks in on what is expected by end of day and a mindful coach to design and redesign do-able routines to keep a stress neutralizing routine on your daily accomplishments. If I act as head-coach one to twice a year during your visits....I need these coaches in your back pocket with day to day/week to week motivation.
Either way, if you are headed to and early coffin or worse, a label of "disabled" due to stent, numerous medications, physical pain or emotional imbalance has been adopted...someone has to design a template for lifestyle change. In taking care of lowering blood sugar, I usually like to add psyllium (fiber), timing of meals, volume of meals, ingredients of meals and level of satiety (satisfying feeling of fullness). In Toms story of lowering sugar, the odd thing is he gained weight since his last visit which doesn't make sense as his sugar level dropped down?!... In the Q&A that ensued, I found out his sleep was being interrupted!!! AH HA!!! but poor sleep would cause sugar to go up? Then he revealed the answer. Tom got a puppy and he has been the one caring for the new family member. The little guy wakes Tom at 3 am to pee but even with this seemingly frustrating info...Tom was smiling while talking about his new best friend. To me this is the typical result found when people participate in laughter yoga. Small studies have been used to check pain tolerance during duchenne type laughter and it was speculated that there may be an endorphine mediated response that changed the way damage to the body was handled. Being in love can cause the heart and mind to be bulletproof to damage / the opposite is true too. Maximum stress can cause a normal heart to undergo anatomic changes resulting in the heart attack.
This is where my hypothesis on love and inflammation. Tom gains weight=sugar goes higher. Tom loses weight=sugar goes lower. Tom finds happiness=metabolism changes. Tom finds puppy=sugar lowers JUST LIKE HE LOST WEIGHT!!! and the test for my theory is his weight gain should have increased sugar but actually reversed it. Now there is alot more to test, control for variables, check the lab reliability, scale accuracy...but who cares. Tom found a friend, puppy found a home, doctor got a reason to blog, one less medicine the insurance has to pay for.
When I was growing up in the 70's : (
... the waiting room was where dad's would wait while babies were being born.
The stereotypical scene was several dad's pacing back and forth anticipating the
good news. Now the dreaded waiting room associated with western medicine
is where you wait for hours, read outdated magazines (that sick people have leafed
through) with a sign that says no phone use. In this culture of immediate reward,
it rubs everyone the wrong way to have to deal with waiting.
So even before I see anyone in the exam room, an unsatisfactory review is brewing.
One wonder why a doctor would care about reading reviews when they all should be
focused on patient care ....but.... salaries are dependent on satisfaction. The current
design structure for getting paid by a hospital has efficiency and patient satisfaction
built into the formula (RVU's). It was started in the early millennium when large hospital
organizations had to be accountable to medical insurance payers to be efficient (and
not order too many expensive tests) but insurance companies also wanted their
clients to get the "best" health care. One parameter of measurement was patient
satisfaction surveys. Reviewing wasn't as hot a tool in 2000 as it is now. Additionally around
1999...there were a still primary care doctors that owned their own medical practice paying
attention to utilities, salaries, billing, malpractice insurance...even answering their own
phones and pagers at night. (I remember someone paging me at 2am just to say they
couldn't sleep!!!) With medicare reimbursement decreasing back then about 3% every
year.....it was only a matter of time before being a small business owner of a medical practice
would cave in to being a salaried employee.
I left medicine totally disgusted in 2005 and moved from Illinois to Florida where I was
going to start over and just be a dad. The last thing I remember was being told by
administration that the hospital paying my salary was changing and if I didn't get
on board with the new salary structure (less pay more hours because I wasn't producing
the same as other primary care docs in rest of the country) then I should leave. But in theory I couldn't leave even if I wanted to, there was a restrictive covenant in place that would bar me
from opening my own practice within a 15 mile radius and I would have to pay for a malpractice
insurance "tail" to cover any potential law suits filed against me for the prior 10 yrs.
-most patients don't see primary care docs > 15 minutes from their homes
-tail coverage costs about $10,000-20,000 to be paid all at once
-new malpractice insurance would have cost me $50,000 before I even opened my doors
-electronic medical records were being pushed by the government as an attempt to decrease
paper waste and have efficient doctor to doctor communication (more like doctor to insurance billing efficiency)
-offering medical insurance to future employees as a small business owner was impossible to afford (and still is)
But I had work to pay mortgage, kids education, medical insurance.....(I didn't have medical insurance
for about 2 yrs as I couldn't afford it...prayed every day to stay injury free). So I signed up to be an immediate care doc. See patients that I didn't have attachment to, finish work right on time and hand
off the the next doc. No phone calls middle of the night. "Treat em and Street em" was the motto. That was not why I stayed in school until the "21st grade" (I am now on my 24th grade / year of study). I was disillusioned from medicine due to the harsh words of an administrator saying that my practice style of medicine didn't make a difference in the community as compared to the national average "I was below average"....until the phone call.
I remember being okay with life in Florida, payed hourly for immediate care coughs colds sutures injuries....then I got a call from an old patient from Illinois. They were looking for my help as all the docs they were assigned to didn't give many options. He was dying slowly of cancer. With the acupuncture training I finished before leaving for Florida, I remember designing a few options no one else thought of. He died eventually but I hope my suggestions gave a small sigh of relief for at least his family. This is the part of the movie where the hero thinks back in time and pieces together the keys to conquering the the big Boss bad guy. I re-awakened my core thinking ..."I wasn't below average and all the weird things I invested in -acupuncture, breath, yoga, nutrition, exercise...gave options no other doc was offering. They made a difference to my old patients who looked across north America for me, they made a difference for me during the time I had no medical insurance, I had to make major lifestyle changes to stay out of the hospital! So I came back albeit slow, I still worked my way back into private practice (kinda) still holding onto my style of medicine.
So how does this pertain to the waiting room? I learned from Andy Weil, Herb Benson, Deepak Chopra and Joseph Helms that the answer to the disease manifestation is in the patient. Getting the answer out will take more than a blood pressure reading, a throat swab or blood testing. There is a gentle teasing out of information from the human sitting in the exam room with you. An exam is not just a physical exam...it should be a bio, psycho, social, nutritional, educational, introspective interaction between healer and patient. Look at the word 'patient'....connoted the need to take time for healing. Done properly, the time spent in close proximity to a good healer will reveal the most direct path to heal-ing. When we truncate the time spent in planning out the journey on our path to being disease free, there is more chance for error. Making a mistake means back tracking and starting again. This time loop of only inquiring about the biggest symptom and then treating with a temporary medicine till another symptom pops up to be repeated again...doesn't get anyone (doctor or patient closer to "healthy". In fact this stutter stepping pushes healing farther away and brings chronic suffering into younger ages. The answer is in the patient, to know the patient inside and out will be the best way an architect can design change, empowering change will beat disease.
This take more than the standard 20 minute visit (15 minutes actually but I have 20 years of experience!!!) so when I run behind by 45+ minutes, it is usually to accommodate for the 20 minute slot given for a "wellness check up" that turned out to be a multi-system, multi-symptom chronic presentation that needs fixing now. I'm not blaming patients, they don't know that the majority of medical insurance payers are following the state's reimbursement of 49.95 for the most complex of visits (that usually takes about 45-60 minutes of face to face time to listen to plan out and diagnose. Tag that onto a 6-9 month turn around on payment receipt...how is a business supposed to survive? Then at the same time I have to make sure service is with a smile or I wont get my "potential" annual salary. I am not embarrassed to say...I am getting the same salary I was paid during my first years of working for a hospital. (in 1995) I have the potential to make what the average primary care doc makes in the US but I would have to see more patient and practice medicine like everyone else...just contributing to the time loop, but I choose not to.
I know my body mind spirit won't tolerate practicing at this pace forever BUT for now:
-I take my salary as is (at least I have a job)
-continue to change lives (check my drricsaguil instagram posts)
-save up some money doing other things (like my youtube channel and maybe an acupuncture clinic on "days off")
-hit the lottery
-vote for change
-opt out of taking medical insurance BUT charge a reasonable fee
-continue to create a sense of calm in the "waiting room" so that patients are actually healing before I walk in to start the healing process.
My faith tells me if I provide the keys for people, the Universe will open the door for both of us.
Guess I have to take a seat in my own waiting room.
This is the second time within a few months I have visited this place to pay respects to people (younger than me),,,both dedicated their lives to helping others. Through the sorrow of the homily, I remember the words "its not how long you live but more importantly how you live life".
Last week I was throwing a diva tantrum in my brain thinking I have no time. I was working 12 hour days, missed hugging my son good night, listened to alot of unhappiness during doctor hospital contract meetings, hardly spoke with my best friend/partner for life, painfully documenting hours of patient encounters in a computer system that was updating its servers, unable to work out or hike...thank god I had Davidji and his newest guided meditations to help ground me. In fact, when I start to catch myself stepping onto the pedestal of ego to accept my diva award.....I just think back to the casket at the front of the funeral home carrying the lifeless remains of someone that was near and dear to humanity. A lifeless body with makeup, a favorite garment, a watch that stopped ticking....surrounded by pictures that celebrate joy, love, excitement beauty....the reason we get up everyday to a new sunrise ready to live life. I stimulate my frontal lobe to conjure up, what would it be like if I was there, would my pictures say I was happy, did I contribute to the universe, would my kids be able to fight back the tears with memories of spectacular experiences with me? Did I do my part to make the world a better place?
Passages in some of the oldest books of wisdom paint the picture that we are crude vessels that temporarily carry and express the energy/spirit/breath of the universe. Eventually we surrender the vessel back but the spirit rejoins the universe to continue existence as nature or a sunrise or an inspiration (inspire and spirit both come from the same root word of breath). Right about now some of my atheist readers will be rationalizing that nothing spiritual can be proven ...... but I am pretty sure even the most concrete thinking non believer will get to a point in their journey when they yearn for a higher power to help take the last walk. As a doctor I have been witness to it many times, the sense of calm that comes over the sufferer. Whether it is preceded by the most searing chest pain imaginable OR persistent difficulty in catching a breath to to point of passing out OR being wheeled away by the anesthesia guy into the operating room and saying the last goodbyes to family and friends OR being taken off life support just in time for family and friends to wish a bon voyage OR getting the last morphine dose...there is usually a point when the anguish and facial grimace are replaced by peace and a face that just resembles sleep. I believe that is the point when the universe fills our lungs with calm...we get to see the big picture that our lives are temporary expressions of the same energy on borrowed time. The crude material that makes up flesh and bone isn't important, what matters is the way the universe pumps life into the vessel to play the music that would only exist on paper.
When we go through life day by day, just to get a paycheck, or live for Friday when we can go out and get wasted, or refuse random acts of kindness assuming someone else will do it...we don't allow the expression of the music inside us. Its not that we are obliged to contribute to the universe and support life, it is in our DNA to express life and support the symphony with our individual musical notes. In ayurveda its called dharma, purpose in life. We cant find it in a formula or in a book, you just get this overwhelming feeling of peace when your doing what the universe created you for. I think its the same peace we can experience right before our last breath when you accept the universe back in and surrender the vessel back, well I feel in my heart that when you find your expression of energy/spirit/breath, a sense of calm and joy rewards your actions by unraveling DNA to give you such a natural high.
I think its easy for us to put the blinders on and just physically go through the motions of an 8 hour work day, get home, have a drink, watch mindless TV and go to sleep. The point to ponder is are you feeling fulfilled? Are you happy? Have you found your purpose in life? What will your homily be like...did you contribute? did you suffer? OR did you live your life hair on fire, driven to express yourself just living with an endless source of energy that seems to be a beacon for others to also search out for their individual expression. Aim to breath your last breath full of energy, creativity and peace....INSPIRE.
It’s so cool to witness when people / patients find a way out of suffering. Even if not labeled with an injury, infection or inflammation...when getting into a “good stride” - the eyes get brighter, shoulders go back, chest comes forward, belly gets flatter- even the voice gets full with power and creativity. All those Chakra / Energy points of the body LIGHT UP and I can see a change in the way a person is interfacing with the world. Most of us have witnessed when someone walks into a room and makes heads turn, (not even wearing expensive things, or being handsome, pretty, tall, loud...). It’s usually that person who is magically silent but charismatic and carrying an aura of confidence . You just want to take a few steps closer and listen in or investigate “who what and where” this person is about. Like wandering closer to a crackling campfire in the midst of a cold night.
It’s kinda what happens when you find a good diet, a rewarding exercise routine, a sleep-full night, or even a certain way to correct posture just enough so that annoying muscle ache can stop for a few seconds. What I find is universal with this “good stride” is that it is usually preceded by a stuck time in life followed by a “detox”. Detoxing the gut, detoxing the liver, detoxing the blood, the detox diet, rinsing the nose, clearing the breath, scrubbing the skin...we’ve all done our versions of this and felt a little better afterward. Sometimes to the point of feeling refreshed, sometimes to the magnitude of being “on fire” with energy. Alot of people forget to do the one part of our bodies that really need it the most...Detoxing the Brain.
The brain weighs about 3 pounds, is composed of tissue that does not break down (compared to skin cells, blood cells, sperm, eggs......) and is the only organ that can continue to grow and evolve even into old age. Physically we cant’t really detox the the 100,000,000,000 neurons that make up the brain. BUT if you look at what those neurons do...they use chemical messengers to set up an electric charge and through that action, a thought is created and stored in the frontal lobe. This is what sets the human species as being on top of the evolutionary ladder compared to lower lifeforms. Unfortunately, this is also a disadvantage compared to other lifeforms in that some humans with ruminating thoughts, traumatic experiences, self defeating ideas can go through life suffering ,sorrowful, socially isolated. You have probably witnessed when someone with those qualities walks into a room. People will want to move away, look away, stop listening to or stop engaging that “bad karma” person.
This is the exact quality and thought pattern that you would want to Detox out of your Frontal Lobe. When we go on a great vacation, we push the reset button on our brains. When people go with me on hikes and we hit our summit, the eyes get brighter, shoulders go back, chest comes forward, belly gets flatter- even the voice gets full. We have effectively Detoxed our Brains. Richie Davidson out of University of Madison Wisconsin has found that certain types of mental training will improve the resilience of the brain when confronted with negative life events. Without a regular practice of mindfulness, the brain can be stuck in a rut (like that circle that appears on your screen when your computer is downloading a video stream so painfully slow). This practice can be achieved several ways, you can be like the monks Davidson studied (the Dalai Lama being the most well known), or getting out to nature (like Dr Eva Selhub wrote about in her book Your Brain on Nature), or going through a 5 days immersion at the Chopra Center (I took Seduction of Spirit and met Deepak Chopra when I started my “detox practice”), or something as easy as listening to Davidji with Guided Meditations for Awakening Your Spirit (one of the best voices for meditation I have ever heard). What ever technique you stumble across and adapt to practice...it is just that...a practice that should be done on a regular basis. The human brain has about 50,000 - 70.000 thoughts per day. Some of these thoughts can add to being stuck, some of these thoughts can propel us to being that person who walks into the room and turns heads.
The bottom line is that if you do not have a regular practice of Detoxing the Brain, at least twice a day for 5-30 minutes at a time, you are missing out on the one cheapest, simplest ways to reverse suffering for yourself and others around you. If you don’t get it on your own, try hiring coaches (psychologist, counselor, yoga teacher, energy healer...) to design a practice that’s sustainable. Be patient with the journey as it does get frustrating to turn off the thoughts that want to take you on a roller coaster ride of more thoughts and ideas and to-do lists. As my friend Davidji says while doing your mindful practice, when you notice you’re drifting away to thoughts sounds or physical sensations, ever so gently, drift back to the practice. Finding a way to “ignite” your detox practice will get you to be the biggest campfire you can be.
My Dad has always been a teacher. He taught me not to take crap from bullies. He showed me the value of embracing education. He inspired me to change lives. He showed me how to double clutch, heel toe the pedals, controlling the yaw of a car with tire speed. He encouraged me to work hard but shoot for a reward. He ultimately showed me that even when faced with death, you are still in control.
Fatherhood is more than just having kids and providing shelter and food. It is an honor bestowed to 1/2 of the planet to propel a species forward. There are some who do not support the position and drop the ball....(cant focus on them as it takes the beauty away from the title). We should honor the ones that really carve out a chunk of time in what seems a mountain of burden to act as a beacon for young people to emulate. The guys who "get it" have it hard wired in their DNA to put their arms around the ball, head down, and plow forward no matter what lies ahead. When I ask people to jot down a 2 week diet diary.....I try to get a snap shot of what they eat, how they vary food intake, what they crave. Some dads with come in the 14 days of food journalling where every day looks exactly the same. I look at them and wonder, "....this is ok with you?" Apparently there is satisfaction in mundane and repetition....when it supports an overarching goal. When the realization is- you have to "provide" even when the task requires the majority of your waking hours (starting at sunrise and ending at bedtime) to be actively supporting the family. I remember a birds nest outside my window where every spring, the mama bird would keep eggs warm and papa would spend his whole day searching for worms and bugs then bringing home the prize. It was in his DNA to fly out and provide no matter how cold dark or wet it was.
I appreciate dad's who take on the roll of fatherhood with pride and honor. It is too exhausting to listen to the stories of men who trash the honor and teach bad lessons. On the flip side, it is so empowering to see when dad's step up the the plate and hit home runs in the face of adversity.
My father is one of these men. He came over from a foreign country, established a foot hold for our family, taught and empowered the value of education, launched me and my siblings into the world, allowed my Mama to leave with family surrounding her and still seems to teach me lessons even though he isn't around anymore.
I miss you dearly Dad, I wish you where here to guide me .....thank you for being my inspiration.
I woke around 4, something was calling me to go downstairs. Even my faithful companion Perry was too sleepy to wake and follow me down. The slot blinds facing the pond were open and the night sky was glowing. I moved to the window and looked up to see a deep breath of the moon. Full and bright as a setting sun. I decided to meditate to a mantra guided by Deepak Chopra in an old 21 Day Meditation. Om Bhavam Namah = I am absolute existence: Cultivate Stillness and Commune with Nature. It just happened to come up in one of the guided meditations I have on my phone. After a few minutes of repetition....I became aware that the moon was moving. (okay....we all know it takes the same course along the night sky over and over again!!) but this was different. From my position on the couch, the silhouette of the moon was just small enough to "fit" between the slots on the blinds. As I continued my mantra repetition.....I could see the moon moving from one slot to the next. I thought: "that's weird" then returned back to meditation. But trying not to think too much into this occurrence....the moon was trying to distract me. Or was my mediation slowing down my perception so I could be a witness to the speed of the earth rotating - like riding on a carousel and pretending the carousel is standing still and the carnival grounds are all moving around you. I continued to just be mindful of the my current place on the couch, the position of the couch in the house, the direction of the windows to the sky, the geographic location of my house to the continent, the tilt of the earth in relation to the moon, the reflection of the sun rays on the moon /through the window onto my couch and into my eyes.....all causing a reaction to my retina stimulating a nerve impulse to by occipital brain creating an image and an emotional response of craving this moment.
The connection with nature is soooo powerful and can cause a shift in the way we think and feel. The above conditions took place over 15-17 minutes of me just waking up and following an urge to move. There is no medication that can reproduce anything close to what I just experienced in that same speed with out side effects. I consequently had my morning Sencha green tea and proceded to create this blog -all because I paused and took notice to something in nature that we usually are too busy to marvel. This is what I love about feeling youthful, there seems to be a peace that young people carry as they have not been exposed to so many trials and daily life interactions. They dont get caught up in the thoughts of "how does this effect me/whats in it for me/what can I get out of this event". I think when you let go of an outcome, there is a freedom that allows clearer thinking, appreciation for here and now....ultimately being in the moment.
My adult parents, business owners, patients -sometimes are so caught up in worry and over planning the future, over thinking the past that they miss what is the awe of nature happening in front of them. Earth day isn't just an appreciation for this planet, its taking time to be in the moment, let the curiosity inside you come out again and be mesmerized like your first trip to the Grand Canyon or touching a horse, or hearing thunder, seeing an eagle or floating .....in the water, just the sun above, no worry about anything but where your are right now. aaahhh.
"Imagine a cliff where people keep falling off and dying. Instead of erecting a warning sign at the top of the cliff telling people not to approach, modern medicine just places ambulances at the bottom."
-Burkitt 1991
Saturday, October 31, 2015
I am witnessing a duality in creating my "ideal medical practice". Corporate medicine uses structure to design a healthy community.....reimbursement, budget, staff, department. building, campus. I am using anecdotal success to design......learned information applied in real time to my salaried position. (sounds like a watered down version of my practice but in the eyes of professional regulation, I am a family medicine doctor just like any other).
My experience with hospitals is when large hospital joins larger hospital system.....reputation brings volume (more doctors ask for privileges to practice, local business align with hospital, patients set allegiance with hospital name) and volume brings profit.
My experience with healing is all patients possess the appropriate way to improve suffering but it must be teased out of the tangled mess acquired over decades (spiritual, physical and nutritional baggage).
So can the medical model work to end suffering. No, it can control suffering... and in a few cases successfully reverse (like what you see with visits to Mayo Clinic....people sign up, get evaluated by intake doc, speciality doc, testing doc, summarizing doc.....in a few days to be send back to place of origin with homework for the local healers. In my opinion its nothing fancy, just the impeccable timing and focused communication among several aligned physicians with a captured audience. A well functioning local hospital can have the same success when large departments are cohesive, testing is not redundant and patient is willing to go from department to department in a single well designed plan.
The problem I experience with hospitals in the last 20 yrs is -there's poor communication between departments, between doctors, between testing facilities. It brings excessive testing, excessive prescription use, prolonged suffering and sick days at work....this all culminates in less energy by the patient to make the visits, and be engaged in being their own advocate for finding the endpoint. (we have all experienced this in calling the phone company to dispute a bill, getting an automated phone menu, repeating the voice commands then being switched to punch dial for a department, finally speak with a live representative describing the problems, being placed on hold to only repeat your autobiography to a fresh person who promptly forwards you to a manager extension that goes to voice mail.....kinda get the wind taken out of your sails by then right?!?! ) So imagine someone labeled with irritable bowel syndrome, fibromyalgia, non differentiated connective tissue disorder, chronic pain, obesity, metabolic syndrome........
The fix was supposed to be the primary care doctor role. In the 90's we were given the title of "gatekeepers" to arbitrate if and when a specialist was to be seen. Patients were very unhappy with being told, you can't go to him (not in network) or I do not believe you need that test yet (direct to consumer advertising pushes the most expensive test or pill with little to no benefit over standard). Insurance companies acquiesced to the masses and gave more options for patients and doctors. I remember in residency, to take care of all the insurance forms and call backs, an entire department had to be created to handle the paper chase man-hours....and this is from a speciality that receives the smallest reimbursement of all departments. I have worked for 6 hospital systems in 2 different states and I am always told by corporate that primary care offices "do not make money". So if you tally the budget and payments received, most primary care offices are in the red. But....hospitals can sustain primary care practices for the trickle down profit of blood tests, surgical procedures, imaging tests, rehab......when all these things per reimbursed properly, the hospital can justify keeping primary care doctors around.
Q-can the average primary care doctor be an advocate for the suffering patient with a tangled mess of acquired decades of baggage?
A-yes. If....the doc is well versed with using different tools to untangle. (Maslow's Hammer 1966, if all you have is a hammer, everything looks like a nail) Imperative is the ability of the doc to negotiate the truncated patient visit with the exact set of questions. If we all doctors had 60 minutes to do a quid pro quo, I believe even the untrained person could design a decent direction for patients to proceed to better health. We don't have 60 minutes, we have 10 (maybe 15 if you argue to the corporation that issues your salary.....you have a dedicated panel of patients that are satisfied!!!) What Can I do in 10-15minutes? Listen ...but interrupt if you give too much information ...all this so I can extract just enough story-line to justify writing a prescription to turn suffering temporarily down a bit. Disease management as my guru Andrew Weil calls it. So requirements to successfully be an advocate for creating a local Mayo Clinic experience is 1-visit time and 2-integrative medicine training. Neither of which we are afforded as a primary care doctor coming out of residency training.
In attempting to create an Integrative Patient Care Practice (a local Mayo Clinic type center), one would have to lay out a structure to "corporate" for allocating budget. It would have to be strategically placed in the hospital campus to anchor the new department as a destination medical specialty. It would have to hire talented ancillary care to help with lifestyle change. That's a lot of planning and proposal based on anecdotal evidence from a doc that "doesn't see as many patients as an average family medicine practitioner", "practices medicine but also does that cooky acupuncture (needles or something like that)" and "teaches yoga, eats organic veggies like a hippy". Sarcastically this is what I experienced as I went to corporate in the past, presented my vision of a Lifestyle Center and was immediately met with questions like what is the budget, is this viable for the economy of the area, who will we have to hire (even had one head walk out of the meeting early) Difficult questions to answer for a concept that doesn't exist. I don't blame them, this is the language they don't speak.
So for my patients who follow my blog, have no fear, I know what has been working for 20yrs and I have refined my personal life be healthier husband/father/son and it has afforded me a better spyglass to see into patients "tangled mess". All the cool experiences I have lived through helps me avoid Maslow's golden hammer law, just in the last 10 months of my return to working for a hospital, I have seen countless patients coming in with weight loss 20-40lbs. This as the result of educating new patients last spring about how to lower cholesterol medicine dose, wean off 1 of many blood pressure pills, or exercise with walking. The beauty of inspiring a "way out" is you fill the sails with wind by empowering change with knowledge. Ultimately my heart says to do whats right for my patients but my paycheck says I have to do what's right as a salaried Family Medicine provider. (I Got This!!!)
