Sunday, May 30, 2021

Memorial Day and America First

 I’ve never served in the armed forces.  Therefore, I can’t possibly grasp the depth of meaning that Memorial Day holds for families who know what service and sacrifice really mean.

My father served for 39 months during World War II, but was fortunate to have been kept from harm’s way.  He was part of a generation, perhaps the greatest generation, that was not preoccupied with self.  The trite phrase, ‘we are all in this together’, was a touchstone of that time.  No more.  Back then we crossed oceans to serve not only our nation’s interests, but also to preserve world peace.  Now, we have become much more self-oriented, both as a nation and as individuals.  America First has captured the sensibilities of tens of millions of Americans, a phrase that harkens back to Charles Lindbergh who was a speaker and supporter for the America First Committee.  Lindbergh was an American hero who was also an anti-Semite who received the Service Cross of the German Eagle by Hitler’s government.  

Charles Lindbergh - Champion of America First

I’ve thought a lot about freedom this past year. I’ve seen it championed and exploited and attacked and misunderstood.  Indeed, it has been downright weaponized.  Heretofore, it has been a unique and unifying American concept that has bound us together.  I fear now that it is often wielded to strike and divide us. Consider a few examples.

No mask for me.  I won’t let you attack my freedom.

Freedom of speech?  We found your tweet from 10 years ago.  The security guards will now escort you to your car.

You expressed a contrary view on college admission processes with the intent of engaging in civil discourse.  Our response?  You are a racist.

A free nation accepts the results of fair elections.  Consider the conspiratorial chaos we have witnessed since Election Day 2020.  Is this coming attractions?

A new interpretation of Freedom of Assembly is to storm the Capitol wreaking destruction and death.

Freedom of the press does not support tendentious and slanted coverage in print and on the airways.  I have seen too much of this and lament the lack of accountability and contrition by the journalism profession.

There is no conscription now which was a patriotic and unifying experience for young citizens.  If today's generation faced the existential challenge that my dad's generation faced, what would we do?  While I do not advocate for a return of the draft, I do wish there were a year or two of required national service.  I can think of a dozen reasons why it’s a great idea.  Why haven’t we done this?

To those of you who have served, and to your families, I honor you all.  Continue to set an example for the rest of us of what freedom truly means and why we must so zealously protect it.

Sunday, May 23, 2021

Job Interviewing Techniques in Medicine and Beyond

It would seem self-evident that an applicant for a job should be scrupulously honest.  First, it is the right thing to do.  Secondly, in our digital era, one’s academic record can be accessed back to kindergarten.  Yet, many applicants will embellish their credentials or claim a skill level that may exceed reality.  Thirty years ago, I was applying for my first job in New Jersey after completing my 2 year gastroenterology (GI) fellowship.  I was not competent to perform ERCP, a complex scope examination that GI practices desperately still want to add to their practices' skill sets.  Yet, I was advised by a practicing GI physician to simply claim that I could do the procedure.  Otherwise, he said, they would simply pass me by.  I queried the practitioner on my proposed course of action after being hired if I were summoned to perform an ERCP.  Decades later, I do not recall his response.   I can imagine what my new employer’s response might have been upon discovering that I had misrepresented my skills.. 

Should Applicants or Employers Take a Polygraph?

How honest should an interviewer be with a job applicant?   On the day that I wrote this, I read of a technique where an interviewer who is meeting a job applicant at a restaurant, secretly arranges for the applicant’s meal to be messed up in some way.  The justification is to see how the applicant reacts in real time to an unforeseen and unfavorable event.   It reminds me of my initial interview at NYU School of Medicine, when the interviewer, among other slippery questions, asked me “what is the death rate?”   The correct answer, which I luckily knew, is 100%.  Perhaps, this demonstration of my nimble intellect explains why they accepted me. 

I do not support subterfuge in a job interview to gauge applicants’ behaviors.   It’s certainly fair game to present hypotheticals, but outright trickery should be out of bounds.  And, if an interviewer is overtly dishonest, can this person be trusted after the hire?  If we sanction employer legerdemain, then should we not permit the applicant to play tricks on the interviewer to gauge his or her behavior and the company’s culture? 

I’ve always played it straight.  It’s all I know.  As for the position in New Jersey referenced above,  I didn't get the job.  And, so my life in Cleveland began.

Sunday, May 16, 2021

Is Your Physician a 'Spin Doctor"?

Recently, I read about a judge’s decision on a legal dispute.  The facts aren’t important here.  As I read my newspaper’s summary of the decision, it was clear to me that one side won and the other side lost.  Yet, both sides claimed victory.  This is commonplace in the public square where a clear loser boasts of a victory that even a casual observer recognizes to be magical thinking.  In the case above, the loser who claimed victory wasn’t a corporate PR spinner, but was the county prosecutor.

Folks seem to have such a difficult time admitting error, poor judgment or failure. 

Here’s a hypothetical.  A man sues a company alleging wrongful termination.  In addition to demanding that he be re-hired, he has asked for an apology, a public clearing of his name in boldface on the weekly company newsletter, back pay with benefits, and $5,000 to cover medical and psychological expenses incurred as a direct result of his firing.

The judge awards the man all of his demands, but reduced the $5.000 demand to $3,500 as he felt that the larger amount was excessive.

Is there any doubt here who won this case?  Yet, here’s what we might expect the company’s PR magpie to crow in a press release.

All of us at Termination Enterprises are delighted with the judge’s decision to reject a disgruntled former employee’s demand for excessive payment.  In the spirit of reconciliation, we have decided to rehire the worker in accordance with the values of our company.


Spin is everywhere.  If a politician is queried about sagging poll numbers, here is what you won’t hear.

My poll numbers are down because my policies stink.

You are more likely to hear bromides such as the following:
  • I don’t pay attention to the polls.  Polls go up and down every day.
  • Considering how we are being outspent, it’s amazing how well we’re doing.
  • We’re exactly where we expected to be.
  • Our campaign doesn’t want to peak too early.
  • The only poll that matters is Election Day.
How does my profession handle the truth?  Now, I don’t regard myself and my medical colleagues to be liars, but we have been known to massage a phrase from time to time, as I have written in a prior post.   Similar to the hypothetical company referenced at the top of this post, physicians sometimes claim victory with irrational enthusiasm.

Claim: We are very pleased that the tumor has decreased in size. 
Truth:  This result will not change your life expectancy.

Claim: I recommend fiber supplements for your irritable bowel syndrome.
Truth:  Every doctor does this despite no proof of benefit.

Claim: I agree with you that an antibiotic makes sense here..
Truth: Antibiotics do nothing for colds except risk complications and cost money.

Claim: I’m sorry I’m late.  Something came up at the hospital.
Truth: I overslept.

Just because something is not true does not make it an outright lie.  Nevertheless, when your doctor makes a recommendation to you, ask about the medical evidence that supports the advice.  If the evidence is beyond a reasonable doubt, then you may decide the case accordingly.  If the evidence falls short, then you may decline the advice and claim victory.

Sunday, May 9, 2021

Taking a Moment to Say Thanks


If we are lucky, then we have someone in our lives who loves us no matter what, who makes us feel a little smarter than we are, who sees a resemblance between us and some swashbuckling actor who looks nothing like us, who laughs at our jokes, who delights when we call or visit, who takes great pride in our accomplishments, who overlooks our flaws and who reassures us that the obstacle that has unexpectedly confronted us can be overcome. 

Thanks, Mom!

(And to moms everywhere.)

Happy Mother's Day!

Sunday, May 2, 2021

Choosing the Right Doctor for You.

As my readers know, I have been a parsimonious practitioner during my entire career.  By this, I mean that I believe that less medical care leads to superior medical outcomes.  I have devoted several dozens of posts on this subject within this blog.  This is my medical philosophy.   Other physicians who see the world differently would challenge me suggesting that I deny patients necessary diagnostic tests and treatments.  Personally, I think that I have the better argument, but so do they.

Interestingly, over time patients tend to select and stay with physicians who share similar philosophies.  For example, a patient who believes that regular diagnostic testing, frequent labs, a CAT scan now and then, prescriptions for various symptoms is unlikely to remain my patient because of a philosophical gulf between us.   If that individual, for example, expects antibiotics – as his former physician obediently provided – for what the patient believes is ‘diverticulitis’, and I demur, then this patient will be dissatisfied.  Assuming that I am correct that antibiotics are not needed, it remains a difficult task to disabuse such a patient from his belief.   First of all, many patients want medication despite the absence of supportive medical evidence.  And, if a previous physician has prescribed medicine for the very same symptoms, it stands to reason that the patient expects a similar response from me.   What I regard to be overdiagnosis and overtreatment, is described by these patients as thorough and appropriate medical care.  

Sir William Osler
Physician, Teacher, Philosopher and Parsimonious Practitioner 

Conversely, if a patient is circumspect about exposing himself to the medical industrial complex – subjected to diagnostic tests, medications and specialist consultations – then he will not mesh with a doctor who uses the medical accelerator more than the brake.

These philosophical distinctions I raise can also cause tension within the medical team.  A gastroenterologist may believe that his patient should have surgery the next morning.  The gastroenterologist’s partner sees the same patient the next morning and has a different view, even though the patient’s status has not changed.  And, just add some seasoning to this stew, the surgeon on the case may disagree with both of them.

Individuals need to consider philosophy when hiring a physician, an attorney or a financial planner.   How comfortable are you with risk?   Are you action-oriented or more deliberative preferring to see how events play out?   Do you worry that failure to act risks a worse outcome?  How many opinions do you need to feel secure?    Do you prefer advisers who mirror your own view or do you welcome a challenge?

It takes time to gauge your doctor's medical philosophy and your comfort with it.  But it is an essential element of the doctor-patient relationship.  Most patients have accepted, with great assistance from the medical profession, that more tests and treatments define higher quality care.  I've spent a career trying to explain to my patients why I disagree so passionately.

One of the first duties of the physician is to educate the masses not to take medicine.
Sir William Osler, 1910.