why you should question everything

As a health care provider, I'm accustomed to dispensing advice. I tell my patients how they can lower their cholesterol levels. How much exercise they should get. Why they should definitely get the Covid-19 vaccine. And colon cancer screening. Patients, even friends and relatives, expect it.

"If it's free, it's advice.

If you pay for it, it's counseling."

~Jack Adams~

Now that I'm older and wiser, I have one more piece of advice to impart:

Save your money,

and invest it wisely so you can retire early. 

Why? Because it can take a long time to unlearn what you were taught that has become obsolete, or been proven wrong, or was outright false to begin with. It isn't easy to undo all that contradicts your sense of what is compassionate, fair, and true. It isn't easy. There's a lot to do, and it takes time.

Think about it. We now have access to information we couldn't imagine when we first entered medical practice. We didn't have MRIs or PET scans. We were just learning about the applications of radioactive isotopes in diagnosis and treatment. Laparoscopic and cryosurgery weren't options. Immunotherapy wasn't even on the horizon back then.

It's disconcerting to realize that the care we thought was top-notch proved to be ineffective, or worse, harmful to our patients. We know now that we were doing CPR all wrong. We were abusing antibiotics. We didn't recognize the existence of the human biome and its role in health and illness. Our understanding of epigenetics has changed the way we view the transmission and inheritance of DNA. We dismissed the importance of the mind-body-spirit connection in illness and health. 

The fact that we know better now...that we have learned over time...is a good thing. But this is the point:

"The important thing is

never to stop questioning."

~Albert Einstein~

This pertains to everything in life...to all we have been taught, or want to believe, or have been coerced into accepting as truth...about evolution, about the natural world, about cultural norms, about religion, and about science itself.

Question everything...and then,

when you think you have it figured out,

question yourself. 

As the Buddha put it:

"Believe nothing,

no matter where you read it

or who has said it, not even if I have said it,

unless it agrees with your own reason

and your own common sense."

~Buddha~

jan

 

how to play "stop the clock"

 

I retired after thirty years practicing Family Medicine out of fear.

I didn’t leave because of the long hours, or the fact that I’d been running hopelessly behind schedule all day, every day for three decades. I didn’t leave to take an easier position or to make more money. I didn’t ask to be excused because of fatigue, or forgetfulness, or ill health.

 

What scared me was the inevitability that I would miss a critical diagnosis, and because of it, I would subject the patient to unnecessary and inappropriate testing and treatments...all because I didn't get the patient's full history. I didn't know the whole story. Who had time to listen? Who had time to search for hidden clues to the diagnosis?

 

"I think of my patients as

body AND mind;

the more I understand about both of these,

the easier it is for me to help."

~Dr. McKenzie Mescon~

 

This fear reflected, in part, the trend toward productivity requirements that link complexity with compensation. Briefly...a doctor generates more money by seeing more complicated patients in less time, and by utilizing fewer diagnostic resources in their care. This is a sure recipe for disaster.

 

Let's say a patient presents with a sore throat and fever. His health care provider checks his throat and ears, and feels around for swollen submandibular lymph nodes. A throat swab is negative for Strep. But because he's running behind schedule, and only has ten minutes to see the patient in the first place, the provider fails to palpate the enlarged supraclavicular node that would have tipped him off to the real diagnosis...the lymphoma that was simmering out of sight. The lymphoma that was causing the patient's night sweats, fatigue and weight loss that no one asked about. It has happened. 

 

"The important thing is

not to stop questioning."

~Albert Einstein~

Details go missing all the time. 

Health care providers have to deal with time constraints. There simply is not enough time in the schedule to invite every patient to elaborate on the details of his medical history or symptoms. The provider gets the basics down, but then he is left to jump to conclusions or to dismiss further input that might otherwise affect the patient's treatment and prognosis. For example, it's bad enough when a patient presents with a broken arm after falling off a ladder at work...but it gets complicated if the patient fell because he was drinking on the job. That's a whole different problem.

The provider is also tethered to a coding and reimbursement system that doesn't compensate him for the time he takes with his patients. The EMR does not reflect psychosocial, emotional, or relational complications of illness or injury, all of which affect the patient's ability to heal.

In addition, people are busy. They're in a hurry. They may have to squeeze in a quick visit to the doctor between meetings or other commitments. To save time, they may minimize or dismiss their symptoms. For example, the patient may not want to stick around while you run an EKG for what he wants to believe is a case of indigestion. If the doctor has taken the time to explore the symptom, though, he may suspect angina...it gets worse when the patient climbs a flight of stairs, or he sometimes feels it in his jaw, or it makes him dizzy. It's not just a little heartburn.

 

Another problem is the fact that the patient may not have the language to describe his symptoms. To a doctor, there is a difference between lightheadedness and dizziness, episodic pain and steady pain, fatigue and weakness. They mean different things and imply different illnesses, and that may take some sorting out.

 

"It can be argued that

the largest yet most neglected

health care resource, worldwide,

is the patient."

~WV Slack~



Patients may also withhold information out of shame, fear, or guilt. Alcohol, tobacco, and drug abuse are prime examples. STIs  are another. Any behavior, or practice, or habit that contributed to their illness, or heartbreak, or regret is part of the story that needs to be told before healing can begin.

 

It can be as much of a challenge for patients to tell their whole story as it is for physicians to ask about it. 

Some time ago I related the history of a patient who claimed her left orbital blowout fracture was the result of a fall causing her to strike the corner of her TV...when in fact, it was the result of a blow from her boyfriend's fist that required me to secure a PFA and to find safe shelter for her. That took time, but it may have saved her life.

 

Isn't that what physician productivity is really all about? Time constraints, reimbursement issues, and productivity aside...we are here to deliver high quality, compassionate, and complete health care to our patients...not to play "stop the clock" with them.

"You define what is important to you

by what you dedicate your time to."

~Vishwas Tiwari~

jan

 

the willing suspension of disbelief

If you write fiction, you know how careful you must be to include details that make your story believable. You are in charge of creating realistic characters. You have to build a world the reader can visualize and understand. What happens there must be consistent and plausible given the story line. Even so, you may be asking the reader to suspend disbelief...to accept the fact that dinosaurs can coexist with astronauts, for example, or that extinct creatures can come back to life, or that your hero's superpower is mental telepathy.

"A piece of writing has to seduce the reader.

It has to suspend disbelief and

earn the reader's trust."

~Po Bronson~

If, on the other hand, you write nonfiction, you need to focus on the facts, and communicate them with accuracy and clarity. This, too, may require the reader to suspend disbelief as you discuss new discoveries that challenge the old...for example, recent observations and speculation about the immensity and complexity of the Cosmos. How viruses mutate. How you can hear a multiplicity of sounds, including each one's volume and pitch, how you discern harmony and melody, and how you assign meaning to them, all at the same time. Beautiful music. Approaching storm. Childhood lullaby. When you pause to think about it, it's hard to believe. In fact, it's hard to believe much of what we are learning about how the human body functions.

Advances in modern medical technology have made it possible for us to observe and understand, for the first time, how the human body takes care of itself. How it fights off infection. How a bruise just fades away. How a broken bone heals. The fact that a patient recovers after a heart attack or stroke is enough to challenge anyone's concept of reality. Still, that's the easy part...

"The body is a remarkable mystery,

capable of untold feats

of self-preservation and healing."

~J. Upledger~

...because, every day, we're learning more about how the body sustains and heals itself without any conscious awareness, attention, or effort on our part. Meaning that much of what the body does to keep itself healthy, and what it takes to heal, is under subconscious control.

We have long recognized the "placebo effect": This takes place when, unbeknownst to the patient, he is "prescribed" a useless sugar pill by his physician, but he recovers just as he would had he been given a proven drug. This is believed to happen because the patient trusts his doctor, and believes he is getting a real medication that is known to work for his condition. He expects to get better. In other words, healing depends on the patient's conscious thoughts about it.

"Your body's ability to heal is greater

than anyone has permitted you to believe."

~Unknown~

But then, there's this: Diabetes has subsided, and skin lesions have disappeared under hypnosis, suggesting there is an unconscious component to healing. This has been shown to correlate with the patient's belief that healing is occurring because of the hypnotic suggestion that it is. Just the thought of it.

And this: Patients with Multiple Personality Disorder have been observed to change not only their voices and mannerisms as they morph into different personalities, but to change their eye color. Scars observed in one personality can disappear as another personality emerges. And their EEG changes, suggesting that the mind is intrinsically involved in the transformations that are observed. 

We don't know how that happens, yet...but in medicine, as in writing, it requires the willing suspension of disbelief to even imagine it.

"It is now life and not art

that requires the willing suspension

of disbelief."

~Po Bronson~

jan

the hardest thing about storytelling

 

The healing power of storytelling emerges when four conditions are met:

          --when we listen to what our body is trying to tell us

          --when we feel an insistent urge to put our story into words

          --when we find a safe place to share it

          --when our story is heard and understood by someone we trust 

 
I hear this from people over and over again:

“I’ve always wanted to write, but…”

This is usually followed by a litany of excuses for not writing:

         …but I'm not good enough.         

         …but I don’t have the time for it.
         …but I don’t have anything important to say.

"All you have to do is write

one true sentence. 

Write the truest sentence that you know."

~Ernest Hemingway~

 

If opening lines come to you when you’re driving to work, or a memory sometimes sneaks up on you while you’re mowing the lawn, or snatches of dialogue come to you in the middle of the night, your story may be begging you to please get started.

"The scariest moment

is always just before you start."

~Stephen King~

You know who you are. We've been over this before. Your voice has been silenced for too long. Perhaps it was the "C" you received on your term paper in seventh grade because your teacher was having a bad day. Maybe you're surrounded by cynics who insist you can't earn a living as a writer. It might be your own inner critic lying to you about how bad you are at spelling and grammar. All of them conspiring against the creative, wise, and eager writer you could be.

"The hardest thing about getting started

is getting started."

~Guy Kawasaki~

jan