Sunday, December 26, 2021

COVID Divides a Divided Country

For millions of Americans, the pandemic has been disastrous.  We have lost an uncountable number of Americans. We cannot even grasp the magnitude of the loss.  Have you ever stood at the Vietnam Veterans Memorial on the mall in Washington, DC and scanned through the uncountable number of names etched into the Wall?   We have lost well over ten times this number of Americans in the pandemic.  And it’s not over yet.  Beyond those who have died, we have to contemplate family members and friends who have been left behind.  And those who have become seriously ill or even hospitalized or even spent time in an ICU have been changed forever.   And many who escaped the virus were scared that they might become the next victim, particularly before the release of the vaccines.  And now Omicron has swept onto our shores reminding us that the pandemic still lives.  Will we go through the entire Greek alphabet?

Similarly, we cannot even calculate the economic devastation and disruption that the pandemic has wrought. And, we have all witnessed the Great Resignation, a phenomenon that we still do not entirely understand.  It appears that many Americans simply do not want to return to the grinding jobs that they had become accustomed to.  Many have resisted the lure of substantial wage increases and astronomical signing bonuses.  At first, many speculated that folks were staying home as they were enjoying government subsidies.  These payments have largely ended but there has been no migration back to the work force. Clearly, something deeper is occurring here. 

COVID-19 - Uniter or Divider?

I shudder when I contemplate the consequences of having kept our kids home for a year.  Some are still ‘learning’ virtually.  The damage has extended far beyond the educational realm and reaches into mental health, economic, nutritional and social spheres.  Did we really have sufficient scientific evidence to justify such a draconian measure?  I wonder.

And sadly, a plague that in an earlier time would have bound us together has only further divided a separating nation.  Everything seems to be a fight.  Test yourself on my thesis.  Consider half a dozen or so issues of the day and if they are uniting or fracturing the nation.  Now, test yourself again.  Can you identify a issue that is bringing us together?

Any reader who is inclined to leave an uplifting comment is strongly urged to do so.

Sunday, December 19, 2021

Whistleblower Holiday Cheer 2021!


Twas the night before Christmas

And all through the House,

Progressives were screaming,

‘Are you a man or a mouse?’


They wanted it all.

No matter the cost.

They wanted it now.

So much would be lost.


The voted for Biden,

Who now is their tool,

And dream of ‘reforming’

The filibuster rule.


Pelosi’s been smacked,

And Schumer’s been bruised.

Does Biden realize

That he’s being used?


And while Biden is napping

In the White House mansion,

The man of the moment,

Is Senator Joe Manchin.


And while mainstream Dems

Fight with the ‘Squad’,

The real threat they face?

A circular firing squad!

GOP are no better.

They have no spines.

Trump is their leader.

He is divine!


Liz Cheney is out

For telling the truth.

While others are praised

For being uncouth.


How do Republicans

The few decent legislators,

Run in a primary

When they’ll be called ‘Traitors!’?


Kevin McCarthy

Unhinged and unraveled,

Dreams every night

Of the Speaker’s gavel. 


On January 6th,

As criminals crashed,

Now called Patriots

By the GOP unabashed.


Health is now politics.

What a crazy scene!

When folks can oppose

An amazing vaccine.


Who would have thought

That folks would believe,

That Anthony Fauci

Should be relieved.


So who will emerge

Who’s got the roar

To whack away Trump

In 2024?


Tom Cotton? DeSantis?

Who else might lose?

Marjorie or Nikki?

How ‘bout Ted Cruz?


One thing I know,

One thing for sure

We all know what ails us,

But what is the cure?













Sunday, December 12, 2021

Is the Physical Examination Still Useful?

Medical students, please read no further.

I am going to challenge one of the bedrock beliefs in medical training – the value of the physical examination.  Indeed, I was taught of the primacy of the physical exam as a young pup during my 4 years of medical education in New York City.  I believed it and did my best to acquire these skills from master diagnosticians.  Indeed, this was one of the thrills of being a medical student – learning what those clicks and clacks meant when we listened to hearts with our stethoscopes, seeing changes of diabetes and other diseases when we peered into your eyes with an ophthalmoscope or palpating a pulsating aneurysm that was lurking in your abdomen.

An Ophthalmoscope and Otoscope
The Eyes and Ears of Medicine

I was in awe of these seasoned physicians who could make a diagnosis just by watching a patient walk across the room.

While I still think the physical examination is useful, I have found over the years that it is less valuable than I was originally taught.  Years ago, such a statement would be considered heresy and might risk excommunication from the profession.  But yesterday’s heresy has become today’s dogma.
In general, physicians consider data from 3 separate tranches when evaluating patients:

  • The Medical History – the patient’s narrative
  • The Physical Examination
  • Objective Date including Laboratory and Radiology Reports

Medical students have been taught for generations to rely upon this triad and to regard them as coequal branches of medicine.  But they are not.  If physicians were asked which of the 3 is least helpful, I surmise that most would choose to forego the physical examination.  I would be among them.  Indeed, it is my view that the patient’s history is paramount.  In most cases, I can assemble accurate diagnostic considerations after hearing only the patient’s story.  Of course, the history must be detailed, and the patient given sufficient time to relate it.  Interrupting a patient in mid-sentence or not following the narrative path that a patient creates will not yield a full and useful history.   While less important, I do find that the Objective Data can be useful in narrowing the list of diagnostic possibilities or suggesting other considerations.   For example, abnormal blood test results might point to pancreatitis, a condition I might not have suspected as a cause of a patient’s abdominal pain. 

The reason the physical examination is the shortest leg of the 3-legged stool is because it is either normal or has abnormalities that are not relevant to the current issue.  For example, the vast majority of patients I see in my office with abdominal pain have normal abdominal physical examinations.
I am not counseling that we abandon the physical examination. And there are certainly cases when the exam is a game changer.  But these instances are less common than you might think.

Sunday, December 5, 2021

Should There Be A COVID-19 Vaccine Mandate?

It is easy to opine on issues that don’t personally affect us.  We’ve all seen folks on television or in our own lives who righteously stake out positions when they are far beyond the reach of their effects.  Conversely, we’ve seen the irony and the hypocrisy of individuals who ‘evolve’ almost instantly when a controversial issue becomes relevant to their personal circumstances.  Senator Rob Portman of my state of Ohio, for example, was against same sex marriage until he wasn’t.  Readers are encouraged to look up what led to a reversal in Senator Portman’s view.

Charles Darwin didn't realize that politicians can evolve.

The pandemic has also exposed much public (and private) pontification from individuals, businesses, organizations, government agencies – all of whom may have agendas that extend beyond any actual public health concerns.  One issue that has created raw fissures among us is the concept of mandating vaccines.  There are spirited arguments on various sides of this issue.  There’s the public health angle.  There’s the personal freedom argument.  There are business concerns regarding worker retention.  It’s now a legal issue.  It permeates commerce, education, travel, politics and nearly every sphere of our lives.

As of this writing, it has yet to be determined if the Occupational Safety and Health Administration’s (OSHA) Emergency Temporary Standard (ETS) requiring vaccinations of businesses who employ more than 100 workers is lawful.  The ETS has been stayed by the courts.

But here’s my point.  Assume that every business of any size must have all employees fully vaccinated. I have no doubt that tens of millions of Americans would support this from a public health standpoint.  This mandate would protect employees as well as customers.  In addition, the more of us who are vaccinated the closer we are to overpowering the pandemic before new variants emerge.  Can you say, 'Omicron'?

So, how does one oppose a measure that seems to have no legitimate counter-argument?

Think of it from a small business’s point of view.  Say you run a small retail shop, perhaps in a rural area or a part of the country where there is vaccine reluctance.  You have 7 employees and 5 of them have decided against the vaccine and would sooner quit than submit to the mandate.  The prospect for hiring new employees is non-existent, even though you have raised wages substantially and have offered a hiring bonus.  

What would a vaccine mandate do to this business and millions of similar businesses?  While the employer might favor a vaccine mandate in principle, do we expect that he or she would support a measure that would incinerate his livelihood?   And, are the folks who are arguing for a broad vaccine mandate at risk of losing their livelihoods if they prevail?

It’s quite different to argue a position when you’re not in the line of fire.