Thursday, June 27, 2013

HOW TO THINK LIKE A DOCTOR

It's 3 am Thursday morning and I just finished my first book with the above title! Who should buy this book when it is published? Anyone who has ever been a patient. Anyone who has never been a patient. All med students, NP's, PA's, EMT's, Paramedics, and MA students. And those scared of doctors like children and hospital administrators.
Also for anyone who has walked into a clinic, saw the doctor, then walked out thinking "what the hell just happened?
If you think in your own mind that you "know better" than your physician, then read this book and show her the error of her ways.
Read this book then begin to use it like a medical journal of your own health and wellness. Did Dr. Pitel do all the things a good physician does as explored in the book or did he leave something out that Dr. Mangold said should have been done? Or did the medication Dr. Poofandsmoker from Hartford Hospital give you match up with your story and his six minute exam? Did he explain side-effects and med interactions with you or did he punt that off to the pharmacy tech instead?
So please pass on the word. It will only be published as an eBook available at amazon.com for a very reasonable rate. Click on the amazon link to the right to take you there.
Comments and criticisms are welcome but may make me cry.
Thanks all. Get out the word.

Thursday, June 20, 2013

PARACHUTING IN CIRCLES

   Stream of consciousness tonight. Watched "The Hobbit" with the Young Padawan, the Cowboy, Blair Corbett of Ark of Hope fame, and Gimli, son of Gloin. The Cheshire Cat would pounce in and out of the viewing area while the Cowboy seemed to think that the chair and his bed were interchangeable living arrangements.
   Gandalf healed Thorin with prayer. In my practice, that occurred 10% of the time. Can I prove it? No. Prove I'm wrong.
   Angie once bragged that her brother was a great photographer because he had a lot of great photography equipment. I still won't let her live that one down. In photography as in medicine, there are paths of knowledge where critical factors overlap. My own father was a professional photographer. One of my best friends was the photographer extraordinaire Dan Harris. They both trained on high-tech equipment (the more they learned, the techier it became. Did I invent another word?).They could also take outdated equipment and playfully create works of art.
Using whatever equipment you have available and trying to make a diagnosis is similar. It CAN be done with the most expensive toys found in any hospital. Trust me, they won't be in your local clinic. It can also be done through listening to a patient carefully and doing a thorough physical examination. The use of extra tests usually serves to verify a good physician's suspicions. A bad physician will run batteries of tests to arrive at something, anything. There is an old saying in medicine that if you run enough tests, eventually you will find something abnormal.
Abnormal. What if there was a test that created "abnormals" that were ill-defined and vague. How do you interpret that and how do you treat that? Aurora Health Care in Southeast Wisconsin discovered how to do that AND make money doing it: http://m.jsonline.com/features/health/113541984.html?dc=smart&c=y&ua=blackberry. We heard of these tricks Aurora was pulling when an ostracized cardiologist came to our clinic and repeated to us what he saw with his own eyes. When he complained about it, he was let go unceremoniously and lives with the bitterness of knowing that there is no "Employer Retaliation" protection against whistleblowers in the state of Wisconsin. The state brags there is. Believe me, there isn't.
   I will be parachuting for the first time next week. No, I will not have a Golden Parachute like the ex-CEO of Aurora whose termination package amounted to more than $20 million. Ironically, the company stopped construction recently of one facility because they were $20 million behind in projected costs.
   So the take home message today is this: hospitals are not the hospitals our grandparents and even parents knew when they were younger. They are hospital systems and their bottom line is profit. Second in line, image. Third, helping people get better. A physician's and nurse's bottom line is making people better. Profit should come second. Sometimes job security or the security of a steady paycheck has more pull than pure profit. Sometimes profit wins but really, it is patient care.
   Say a prayer for me on the 23rd when I sky dive for the first time in my life. I hope my knees can take it.

Wednesday, June 19, 2013

CRAZY IS AS CRAZY DOES

Charles Knotbrite came to our first garage sale and introduced himself as a Christian who was interested in our mission work. For everyone's reference, we consider ourselves on a mission from God to bring quality health care to underserved areas of the world. Our primary purpose is to serve, not necessarily to "convert." This runs counter to what many in evangelical circles consider "mission work." Our drive comes straight out of Matthew 25 (NIV):
                                
34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’
37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? 38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?’
40 “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’

Asides aside, Charles wanted to know where our mission work was taking us. "Well, Nicaragua for starters" I replied. "Nicaragua? Good luck with that. Ortega is a crazy man." Which was a conversation-stopper.

Unlike Jenny Wai, at least Charles Knotbrite knew where Nicaragua is. I worry though that he is not only making political judgments based on listening to radio commentators but also making medical diagnoses without enough real information. Part of my training was in psychiatry and the two top diagnoses during my clinic years were psychiatric diagnoses. Yet I would not dare make a diagnosis of Ortega's mental status based on what I read in newspapers or hear on the radio. Mountain-making out of molehills? Maybe a little but I really resent having my dreams belittled by people who have never even left their home states. At some post in the future, I will go over psychiatric diagnoses and the importance of the neurological basis for psychiatric disorders. For now, I want to take the bible quote above and show you how we tried to follow Christ's commandments when it was easier to donate money than it was to physically serve.

1. Feed the hungry: local food pantries; Hunger Task Force (http://www.hungertaskforce.org/)
2. Give clean water to the thirsty: Water Missions International (http://www.watermissions.org/)
3. House the homeless: Habitat for Humanity (http://www.habitat.org/)
4. Clothe the naked: Salvation Army (http://www.salvationarmyusa.org/usn/www_usn_2.nsf)
5. Visit prisoners: Voice of the Martyrs (http://www.persecution.com/)

Although not listed in this part of Matthew, Jesus also commanded us to take care of orphans and widows which has also been a significant part of Judaism since Moses' time. Today I would like to give a shout out to Ark of Hope in Florida which has done one of the best jobs of taking care of neglected and (sadly) rejected kids that I have ever seen. Visit them at www.arkofhopeforchildren.org when you can.

Wednesday, June 12, 2013

THE UNBEARABLE BEING OF LIGHTNESS

I cannot understate the importance of lighting after dark in what the good people at mpowerd call "energy impoverished" areas of the world (https://www.mpowerd.com/luci-different). From the GravityLight (http://deciwatt.org) site:
"There are currently over 1.5 billion people in the World who have no reliable access to electricity. These people rely, instead, on biomass fuels (mostly kerosene) for lighting once the sun goes down.

The World Bank estimates that, as a result, 780 million women and children inhale smoke which is equivalent to smoking 2 packets of cigarettes every day. 60% of adult, female lung-cancer victims in developing nations are non-smokers. The fumes also cause eye infections and cataracts, but burning kerosene is also more immediately dangerous: 2.5 million people a year, in India alone, suffer severe burns from overturned kerosene lamps. Burning Kerosene also comes with a financial burden: kerosene for lighting ALONE can consume 10 to 20% of a household's income. This burden traps people in a permanent state of subsistence living, buying cupful’s of fuel for their daily needs, as and when they can.

The burning of Kerosene for lighting also produces 244 million tons of Carbon Dioxide annually."

Decent lighting impacts several areas of the SCANCAPS model of human needs: safe housing, clean air, and reliable means of power production. It also affects medical care, in some cases very dramatically. After witnessing births in Nigeria by "any light source available" (including cellphones) Laura Stachel and her husband Hal Aronson developed the "solar suitcase" to make lights available at all hours of the night. Their mission can be found at http://wecaresolar.org/.

This is just the beginning of my own mission to fill those human needs. Please visits these sites (and www.nokero.com) and do what you can to help. At the very least, spread the word that there are unmet needs and we have the resources to meet them. Thanks for any help you can give.

Thursday, June 6, 2013

LET THERE BE LIGHT

This post will be brief because of time-constraints (yes, even Minimalist Sojourners are pressured for time at times). I'll delve into this deeper later when I talk about basic human needs and SCANCAPS, but for now I'd like to introduce you to two companies that are working to bring light to what the good people at mpowerd call "energy impoverished" areas of the world. Their contribution is the Luci Light. We ran across it at an outfitter's in Boone, NC and fell in love with it immediately (https://www.mpowerd.com/). The other company is Nokero (www.nokero.com). We ran across them at the Global Health Initiative at Yale last year when they were just starting-up. We still have the solar-powered light they sold us then. We gave it to the Young Padawan and it has held up well under very strenuous conditions. I'm afraid growth or success may have gone to their heads, though: the responses to our last emails to them were stock "go to our website to make your online purchase" replies. Oh well.

I encourage everyone to do what they can to shine the light. Patients die in the dark; women give birth in the dark; horrendous crimes are committed in the dark.

Tuesday, June 4, 2013

THE VICTROLA WILL NOT SAVE THE DAY, The Wooden Calf

Way back in April during our first garage sale, we had an antique Victrola (that's the first green audio gear for those of you too young to know) appraised by an antique dealer for $1750. He unfortunately could not take it since he already had too many in his shop. He did advise us to take the first offer above $750 even if it felt painful.

It felt painful to let it go at any price. MY value for it was considerably higher than $750 so even an offer for that would've seemed like a jilt to me.
Now it's garage sale time and no offers over $150. What's preventing me from selling it at $150? Pride. How DARE anyone even consider that offer? This is an antique after all. This gorgeous piece of early 20th Century craftsmanship has adorned the living spaces of several homes and has lasted through two marriages and 7 children. No garage sale offer could come close to the value I placed on the Victrola.

So I am trying to figure out how my "desire" to have this piece of merchandise fits in with my true needs. I really valued it yet what was the driving force behind that?

I think we felt  the large amount of truly wothless stuff we accumulated was a form of insurance. Surely selling all this stuff would help propel us forward into the next chapter in our familys life. Selling this amazing stuff would help us financially meet our basic needs.

The Victrola among other things had become a golden calf. I realized this clearly when selling it for far less than appraised value made me angry and upset. Instead of trusting in Gods provision, I had mistakenly placed all my bets on that Victrola. That Victrola should have paid for several plane tickets. It couldnt. It was just an old, decorative piece of wood.  It wasnt created or designed to support the heavy weight of all my needs and desires.

However God does promise us a future and a hope.  Our hope and faith had been mistakenly and momentarily misplaced.

All these idols get in the way of an incredible and intimate relationship not only with God but it also interferes with our relationship with other people. We are excited about living a life of simplicity, one that focuses on time-relishing relationships with people, not with stuff.

We can't wait to take all of you with us.  Imagine the places we will go!

PS: For those of you interested in what most professionals consider "true needs" you can continue reading here:

Recently, psychologists and cross-cultural anthropologists have generated lists of basic human needs. Notice there is no mention of a Victrola anywhere on the list.

From Wikipedia: " Doyal and Gough point to eleven broad categories of "intermediate needs" that define how the need for physical health and personal autonomy are fulfilled:
Adequate nutritional food and water
Adequate protective housing
A safe environment for working
A supply of clothing
A safe physical environment
Appropriate health care
Security in childhood
Significant primary relationships with others
Physical security
Economic security
Safe birth control and child-bearing
Appropriate basic and cross-cultural education.

More later.

Sunday, June 2, 2013

I LOVE MY EMPLOYER

We're at Lees-McRae College in Banner Elk, NC today (Sunday, June2) studying physics and biology through Landry Academy. Yesterday was whitewater rafting day on the Wautaga River (pics to follow as soon as we order them. I didn't bring my cellphone for obvious reasons). Within four days, Angie and I had two extremely opposite experiences with 20-somethings (Generation Y'ers) which illustrate our despair with this country and also our hopes for restoration.

But first, a few lessons from whitewater rafting day:
1. Never wear jeans if there is a chance of them getting wet. Jeans will get wet from rafting. I knew this from my one prior experience in Boseman, Montana and from being an avid ultralight backpacker (www.whiteblaze.net).
2. Wear scuba booties instead of athletic shoes.
3. Use waterproof sunscreen. Especially if you are white, balding, and haven't seen the sun in six months.
4. If the expedition leaders offer you a free t-shirt at the start of the trip, take it. Pride is cold.

Last Wednesday, the last day in our house, I took Angie out to eat at Uno's. While a corporate restaurant, you can find food that nourishes instead of fills. We met three Generation Y'ers working there: two females and our server who is male. For the sake of brevity, I am going to combine them into one umbrella person I will call "Jenny Wai." I know it's not nice to generalize especially while talking about negative aspects of a population, but I'm sure anyone who has to deal with them can relate. And every experience related here is true, word-for-word if in quotes.

When we explained to Jenny that we gave up almost everything intentionally and intended to tour the country before heading to Nicaragua, Jenny wanted to know if Nicaragua was a city or a country. We said it is a country and asked her if she knew where it was. "Europe," she replied. Really, it's not, Jenny. It's in Central America. "Well, I was close," she said as if we just kicked her in the head, holding her palms apart about 8 inches. Probably because on the last atlas she looked at, they WERE 8 inches apart.

Jenny graduated high school last year and is taking a year off before she heads to college. What does she intend to study? "I don't know. I like everything. Like maybe film making. Or computers. I'm having a hard time narrowing it down." How about cartography, I asked (heck, I am known for my sarcasm). "Oh yes, that's possible. I like everything." Do you like working here? "It's a job. I'm going to leave in a year to go to college."

Fast forward three days. After a great time on the Wautaga River, we were referred to a restaurant in Boone, NC by our raft guide Joshua. The restaurant is Hob Nob Farm Cafe (http://hobnobfarmcafe.com) and our server was a college student named Sophia. True name and very appropriate. That will be my nickname for all of the Gen Y'ers who have goals and some sense that there is a whole world out there that needs exploring and healing. She attends Appalachian State University. After high school and before starting college, she spent a year in the Peace Corps in Uganda. SHE knows where Nicaragua is. She understands that people there can live on $1 a day (she did it herself), and she knows that we can make things better for people. I will leave that "better" intentionally vague for now: first because it is dependent on each person's ability to interact with the world and second because I have my own concepts of to make the world better which I love and which I have developed over years of glorious and painful trial-and-error.

Sophia and her friend Emily (another server we talked to), renewed our hope for the future. The fertile ground for their growth was not the university but rather their employer, Hob Nob Cafe. When we asked Sophia if she liked working there, she replied with exuberance "I absolutely love my employer." Briefly, the owners grow most of their own food for the restaurant. For the rest, they buy from local organic farmers. Servers are limited to 8 so that each position is coveted by the local candidates. Employees are encouraged to make the cafe better and rewarded for their creative ideas. They are paid well since the cafe refuses to take credit or debit cards. The 2% fee they save goes back into the local economy instead of to the large banks that control the U.S. economy.

I'd like to thank Sameer, a college professor from Florida who was visiting here and who let Jon play on his tablet while I wrote this blog. I didn't even ask him: he just did it on his own. There is hope: http://wise.fau.edu/~hinduja/.