Sunday, October 18, 2020

Portland Protesters Topple Statues of Lincoln and Roosevelt.

To note that our nation is seething with anger – although deeply disturbing – is certainly not Breaking News, except on CNN where Breaking News flashes even when they are breaking for a commercial.  It is not that the nation is angry over a handful of controversial issues; we are angry over every issue.  Indeed, part of my dismay and fascination is how even a trivial event or utterance can provoke rage.  A few decades ago, if a person provoked or insulted someone, an argument might ensue.  Today the same provocation can have a fatal outcome. 

Let me offer a very bold pronouncement.  I do so under my own name and stand ready to accept a searing rebuke.  Ready? 

Humans are not perfect.

Yet, when we judge current political leaders, historical figures, athletes, law enforcement personnel, writers, musicians, educators and the rest of us, any flaw discovered may generate outrage.  The paradigm is not to consider any surrounding circumstances or the context of the time that might distract us from our search and destroy missions.   Ready! Fire! Aim!

Here’s an interesting twist that the search & destroy folks routinely employ.  A flaw found in one of their allies is overlooked while the same flaw in an adversary is magnified to gigantic proportions.  There is a very fancy term for this – hypocrisy.

This past week, protesters in Portland, Oregon toppled statues of Abraham Lincoln and Theodore Roosevelt over charges of racism and unjust actions against Native Americans.  I am not a historian who can judge these men, but I do know that our nation was considerably less enlightened and tolerant during their times than we are today.  Slavery during Lincoln’s presidency – while immoral and abhorrent – was lawful.  And Roosevelt served during the Jim Crow era.  They were both great men and great leaders who deserve to be honored.  I completely accept and encourage that their flaws and immoral thoughts and actions be scrutinized and studied. Give the context and judge accordingly.  But we should not allow our current sensibilities and anger to view their flaws through a modern lens as we diminish their accomplishments to justify current outrage.  We must reject this revisionism.   Isn't this how we would hope the next generation will judge us?

Should we dynamite Mount Rushmore?  In addition to taking out Roosevelt and Lincoln, we could also cleanse the landscape of two additional flawed figures, Thomas Jefferson and George Washington.


Should we blow it up and use the granite to make some woke statues?


With a demand for 100% purity, which has a very elastic definition, what statue will be left standing?

Many of the famed suffragettes whom we celebrate were racists.  Margaret Sanger, a pioneer and champion of women’s rights, had a permissive view on eugenics.  Many of our colleges and universities practiced racism and anti-Semitism.  Several universities had direct ties to slavery.  Yes, they are making amends in recent years, but why did it take them a century or so to come clean? 

We are imperfect people in a flawed nation in a defective world.  Blotting out, redacting and destroying recklessly won’t improve us.  Conversely, it will widen the gaping divide.  Surely, decent and tolerant people can forge alternative pathways to address raw disputes.

Who will be left standing after the statue police clear our parks and public squares? Would Gandhi, Mother Theresa or even the Almighty make the cut?

Sunday, October 11, 2020

Dr. Sean Conley - White House Physician - a National Mentor

 In one’s profession and in life, we strive to improve our performance.  There are so many pathways available to progress on this journey.  One of the best ways is to emulate others.  Athletes, artists, musicians, writers, parents, tradesmen, educators, clergy, law enforcement personnel and even physicians can better their performance by imitating others.  And while it might seem axiomatic that our best role model is one who is more proficient than we, this is not necessarily the case .  The team captain can learn much from a rookie.  The Jewish Talmud expresses the truth more eloquently. 


                                               Who is wise?  One who learns from every man.


Over my career, I have tried to improve my practice of medicine from watching other physicians and nurses in action.  As an example, I have heard medical professionals having difficult conversations with patients which taught me how to do this better.

So, when President Trump’s doctor recently led several news conferences to discuss the president’s COVID-19 status, flanked by the an expansive medical team, of course I was rapt.  At his level of the profession, I knew he would have much to offer me, an unknown community gastroenterologist.  After studying his speech pattern, facial expressions, clarity, humility and truthfulness, I was anxious to emulate this national medical mentor to take my own professional performance into a higher orbit.

Based on what I learned from Dr. Sean Conley, here’s an example of how I hope to communicate with patients and their families henceforth.


Doctor Whistleblower:    I’m here to update you on your evaluation for abdominal pain.

Patient:  I’m so glad you’re here, doctor.  What’s causing this stomach pain?

Doctor Whistleblower:  Well, one thing for sure; it’s not athlete’s foot.  We’ve ruled that out.

Patient:  Whaddya mean athlete’s foot?  We’re talking about my stomach.

Doctor Whistleblower:  Exactly my point. 

Patient:  Did the CAT scan show anything?

Doctor Whistleblower:  Only the usual expected findings.

Patient:  What findings?

Doctor Whistleblower:  Like I said, the usual.

Patient:  Did I have appendicitis or something else?

Doctor Whistleblower:  I really can’t say.

Family:  What’s going on here?

Doctor Whistleblower:  Please don’t interrupt the patient and me or I’ll have to contact security.

Patient: Can you please tell me what’s wrong with me?

Doctor Whistleblower: I wish I could, but I can’t violate patient confidentiality.  You know that HIPAA stuff?

Patient:  But, I’m the patient!

Doctor Whistleblower:  Exactly my point!  You’re finally catching on.  My hands are tied here

Patient:  Can I be discharged home please?

Doctor Whistleblower:  Sure, but it will be against medical advice.  So, if things head south at home, it’s on you.  I'm so glad though that you're feeling better and are ready to go home.  


With all that I've learned, I hope that I can serve as a mentor for younger doctors and pay it forward.  

 

 

 

 

Sunday, October 4, 2020

Trump has COVID-19: Our Year of Disaster Marches Onward

The year 2020 has been an annus horribilis and it's not over yet.  Seemingly out of nowhere a virus, heretofore unknown, has seeped over the globe like hot molten lava leaving a wake of destruction and despair.  The fatalities here in the U.S. have been staggering and the death count continues to rise.  Millions here have been infected and have suffered greatly with severe illness, hospitalizations and intensive care unit treatment.  Those who have so far escaped infection are anxious that their fate might change at any moment.  All of us have been affected.

And, we have had a catastrophic economic melt down from which we may never fully recover.  Furloughs, layoffs, bankruptcies and permanent closures have affected nearly every sector of our economy.  The airline industry – the nation’s circulatory system – now has a very weak pulse, as one of countless industry examples.  Job losses have crippled much of the nation which has caused consequences to real people and families far beyond their economic losses.

As we struggled through the pandemic, the nation witnessed and participated in protests throughout the nation decrying racial injustice and demanding change.  While we tried to focus on this movement, we were distracted by those who engaged in looting, vandalism and other criminal actions.  One section of Seattle, Washington aimed to create an autonomous zone free of law enforcement.  Police became vilified by many which widened existing and raw fissures.

Reminiscent of Newton’s Third Law of Motion, where an action generates an opposite reaction, the violence that occurred in many of our cities led to a Law and Order counter-movement, which only served to further infame and divide us from each other.  It was as if the entire nation was talking past each other.


Sir Isaac Newton Offers Guidance

Then, we mourned, however briefly, the passing of Justice Ruth Bader Ginsburg, as a replacement was offered just days later who is slated to be confirmed by the Senate in record time.  Democrats howled and threatened to retaliate if they recapture the Senate in the upcoming election.  Do we really need a judicial cage fight on top of everything else?

We were not reassured that there would be peaceful transfer of power or that the election results would be accepted.  Might this supposition contribute to the national angst?

And, then the nation watched the first ‘debate’ between the 2 presidential candidates which took place just 20 minutes from my home.  The performance largely served to further demoralize us about the nation’s current mood and psyche.  We are not well, and we agree on nothing. 

And the nation and the world felt a collective frisson when we learned that President Trump has COVID-19 and was hospitalized.    

And, we haven’t even had the election yet.

Certainly, in my lifetime, I have never seen so much pain, anger, despair and anxiety packed into such a short period of time.   Where’s the way out?  Returning to Newton for guidance, his First Law of Motion states that an object in motion will not change unless some external force acts upon it.  Will you be part of that external force?

 

 

Sunday, September 27, 2020

Ruth Bader Ginsburg Lights the Fuse

Before Justice Ruth Bader Ginsburg’s death certificate was signed, Judicial Warfare commenced.

Both sides, of course, were prepared for this moment.  Justice Ginsburg, seemingly indefatigable, was well into her ninth decade and had numerous collisions with cancer.  It’s cruel, but entirely expected, that the nation was not given a proper opportunity to honor her legacy and accomplishments which should command admiration from all Americans.  One need not agree with her judicial philosophy or her opinions to admire the breadth of her accomplishments, her work ethic, her intellect, her vision and her humanity.  Indeed, her storied friendship with the late Justice Antonin Scalia shows a nation overflowing with anger what is possible.

The efforts to recall her legacy were soon subsumed in partisan warfare.  The Democrats accused the GOP of monumental hypocrisy as they juxtapose their statements in 2016 when Judge Merrick Garland was nominated to their current proclamations that confirmation must now go forward.  The GOP, brushed this flip flop aside with some slight of hand claiming justification to proceed now since the Senate and the president are of the same political party.  I can barely grasp their point even after engaging in rhetorical contortions followed by linguistic acrobatics. 



Senators McConnell and Schumer Sharing Love

So, what’s next?  The GOP are poised to achieve confirmation prior to the presidential election.  Perhaps, this effort should be called Operation Warp Speed, instead of the COVID-19 vaccine development.   The Democrats can’t stop it but they won't soon forget this power grab!  If they capture the Senate, particularly with the rise of the political left wing, they will be pressured to consider adding justice seats or curtailing the justices’ lifetime appointments with shorter terms.  They will demand measures to ‘balance’ the court.  (Read:  install justices who will likely make rulings that Democrats want.)   Democrats are also understandably fueled by the shameless stiff-arming of Judge Merrick Garland 4 years ago.  If Biden wins, Judge Garland's Supreme Court opportunity may be rejuvenated.

And, then what happens when in the future the GOP recaptures the Senate?  For a hint, consider the words payback, retaliation and revenge.

But, let’s remember that the judicial fuse was first lit by Democratic Senator and Streetfighter Harry Reid who abolished the filibuster for confirming judges at all levels of the judiciary below the Supremes. 

Look, each side blames the other and crafts their own supportive narrative.  Here’s what I think.  If the Democrats retake the Senate, they should restore the filibuster for all judges at every level of the judiciary.  Our best chance to lower the hyperpartisan temperature, to foster collegiality and to achieve more balanced courts is to restore the status quo ante when both parties had to cooperate.  With the filibuster, neither side will be able to install extreme candidates as 60 votes will be needed for confirmation.  Indeed, the filibuster is a deep senate tradition that gives the minority party influence.  If the Democrats take over the senate, they might eliminate the filibuster entirely - a true nuclear legislative option - that would create more enmity between the parties, if this is even possible.

What is the probability that the Democrats would pursue my high road strategy if they take over the Senate?  Probably as likely as Senator Mitch McConnell inviting Senator Chuck Schumer to his porch on a lazy Sunday afternoon to shoot the breeze as they sip Kentucky bourbon. 

No, the Democrats will be out for blood.  And so the cycle will be perpetuated.  And who will be the real losers here?

 

Sunday, September 20, 2020

Stopping Coronavirus on College Campuses

Perhaps, October 31st will be an inflection point in the pandemic since more folks will be wearing masks on Halloween.

I assume that the annual ritual of trick or treating will be suspended this year, as have so many of our performances, celebrations, concerts and athletic event spectating.   It has been my observation in Ohio that more folks are masking up, although there are exceptions everywhere.  Our governor has directed concern for some rising case numbers toward college youth, who astonishingly haven’t followed the rules.  Just because one is a college student doesn’t guarantee that his decisions will be graced with wisdom.  And, if there is to be any chance that college kids who are drawn toward campus parties like iron filings are attracted to a strong magnet, there will need to be sure and certain enforcement.  What if a college made students aware that violating public health rules would result in expulsion with no refund of monies spent?   Yes, I know this sounds draconian, and it may not always be clear when an actual violation has occurred, but if we expect students to resist all of their impulses, then proper incentives and accountability need to be in place.



News Flash!  College Kids are not Saints!

Let’s recognize that not everyone does the right thing for the right reasons.   As an example, let me offer three reasons why people do not shoplift.

  1. It is wrong to steal property.
  2. It is wrong to commit an illegal act.
  3. Fear of getting caught and facing the consequences.

Once again, if we were all saintly, then laws against theft wouldn’t be necessary.

We have all seen these past months how many folks reject mask wearing and maintaining adequate physical distancing rejecting the advice of health experts and government officials.  I suggest that more rigorous and certain enforcement would have increased compliance.   Remember, we are discussing an issue that has life and death consequences.  A person who prances about maskless and mingles freely with others can cause a death or serious illness of someone downstream who he does not know.  Since the stakes are high, our tolerance for non-compliance should be low. 

How would you bring folks into line who threaten all of us?

 

 

Sunday, September 13, 2020

Dealing with Angry People - Better to Do Right than Be Right

 The nation’s racial upheaval, particularly vis a vis law enforcement, has shown us the value of the skill of de-escalation.   A situation arises and several outcomes are possible, although some are clearly preferred.  The specific technique and approach utilized may determine the end result.  A range of options are often available.  What can make these situations so difficult to unravel afterwards is that an option that may lead to escalation may be deemed to be acceptable, according to the training protocol.  In other words, even the approach taken was acceptable, there may have been a better way.

Obviously, we all endorse training and practices that has the highest probability of bringing calm to a potential combustible situation.   I expect law enforcement – the professionals – to pursue de-escalation as their default mode.  But, the citizenry can and should do its part to de-escalate.   If all parties share the desire for a calm denouement, then it is much more likely that this will be the result.

I realize that my views here may sound naïve and idealistic, particularly as the nation is a cauldron of anger and dispute, but we all have to try.



Even a face mask can light a fuse.

It seems to be that de-escalation has never been more important than it is now.  Who would have imagined that one would need de-escalatory expertise when confronting an individual in a store who is not wearing a mask?  We’ve all had the experience of inadvertently annoying another driver on the road who proceeds to either tailgate within a foot or two of our rear bumper or to display a well-known digital gesture of displeasure? 

Even in my own profession, I am facing a patient and their family who bring anger and frustration into the exam room.  While I may not be responsible for their state of mind, I am responsible in how I deal with it.  Do I want to win the argument or win the peace?

The reason why de-escalation is so critical is because we are suffering from an epidemic of anger.  Our current fractious and divided nation is in part the result of malignant escalation by our leaders, elective officials, interest groups and individuals.  What would life be like here if all of us served as fire extinguishers instead of arsonists?

 

Sunday, September 6, 2020

Labor Day 2020

Labor Day is a time to pause, reflect and to thank all those who keep this nation vibrant. You are the guts of the country.

Labor has battled many adversaries over the decades.  It has sparred with management.  It has railed against 'right to work' legislation.  It has struggled to compete against low wage workers in foreign countries.

But this year it has been sucker-punched by the most formidable adversary that has ever entered the arena. And Labor is still reeling.  And, so are the rest of us.



An enemy like no other

It will be a slow grind, but it will lumber forward.  Yes, we will reach the other side.  How will we get there?  Of course, we will need our medical and scientific community to put the virus in its place.  And everyone will have a role to play.  But, the grit, sweat and determination of Labor will be a major force leading us out of the abyss.



Sunday, August 30, 2020

Why I Don't Tell Alcoholics to Quit Drinking.

 

I have seen many alcoholics during my gastroenterology career.  It is likely in the majority of cases that I was not aware of their abuse history.  Patients often deny or minimize their alcohol history when queried. 

“Do you use alcohol regularly?”

“Only socially.”

At this point the physician and the patient engage in a linguistic tete-a-tete on the precise meaning of ‘socially’.

Patients are more forthright about their habits when they have a medical condition that has a clear an obvious connection to alcohol, such as jaundice or liver injury.  And, if family members are present, they often serve as fact checkers and truth tellers.

What is my approach to these patients?   Do I wave my arms and preach like an evangelist that they should throw their bottles away?   Do I tell them that they must quit or face medical damnation?  Do I threaten to sever them from my practice if they persist with their addiction?   I have adopted a rather different approach.  I do not advise alcoholic patients to quit their drinking.  Yes, I know that this may sound like an abdication of my responsibility to protect my patients’ health, but I do not see it that way. So before you report me to the state medical board, here me out.

I certainly do not endorse or otherwise support injurious addictions.  I wish that everyone could unshackle themselves from their suffocating tentacles.  And I conduct my personal life in a rather abstemious manner with regard to spirits and hard drink.  But, I do not directly implore patients to cease and desist as I believe that they must make this decision themselves as the very first step in their hoped for recovery.  In my experience, all successful recoveries start from within, not from without.  

I lay out the hard medical facts to these patients with clarity and candor.  I discuss the natural history of the disease and the dreadful and irreversible complications that they are at risk to suffer.  I review their available medical data emphasizing that their lab reports and imaging studies may not accurately reflect the depth of injury present in their liver and other organs.  For example, a patient with cirrhosis of the liver may paradoxically have completely normal liver blood tests.