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.


Sunday, November 28, 2021

Thanksgiving 2022


This has been a tough year for America and the world.  For many folks and families, it may be challenging to find reasons to feel thankful.  But we must try.  When you’re in a dark room, you might not see a way to let the light in.  Try to find a window that you can crack open.  Or, one of us will do our best to open it from the outside.

Wishing blessings, contentment and peace to all.

Hoping for a lot more light in the year to come.

Sunday, November 21, 2021

Calling Your Doctor's Office - Frustration #1

There are joys and satisfactions in the practice of medicine.  Indeed, they have sustained me for the past few decades.  I enjoy the work and I continue to be honored that my long-term patients as well as new ones place their trust in me.  Despite my best efforts to deliver perfect advice to every patient every time, I confess that I am a member of the imperfect human species.  I have reminded patients that while I try to offer sound medical advice, I am neither omniscient nor clairvoyant.   If I knew, for example, that the medicine I am prescribing wouldn’t work, or would cause you an unpleasant side effect, then I would not have prescribed it. If you become a ill a week after you have been discharged from the hospital, it does not mean that you were thrown out prematurely.   Excellent medical judgement doesn’t guarantee an excellent outcome.  Conversely, a favorable medical result may occur after mediocre medical care. 

There are also frustrations in the everyday medical world.  Assuming that you can even decode your medical bills, try rectifying an error with your insurance company.  If you didn’t have high blood pressure when you called them to inquire, you will surely have it before the end of the conversation, that is if you actually reach a living and breathing human.  When your doctor’s prescription is denied by your insurance company, does this restore your faith that the insurance company cares deeply about your health?   Have you had the experience of trying to make an appointment to see your doctor to be told he or she is booked out for months?  

I think that the most frustrating experience for patients and us in the medical universe is the labyrinthine telephonic chamber of horrors.  This dwarfs every other frustration and seems to defy any solution.  This can test the mettle of a battle-hardened Marine.  It can bring an athlete to her knees.  It can make a stoic Philistine weep.  After 30 years of medical practice, my staff and I have been unable to crack the code on this. 

Alexander Graham Bell Trying to Reach His Doctor

In each of the 3 jobs I have had as a gastroenterologist, the telephone Theater of the Absurd was there. Of course, this vexes patients who can get through several chapters of War and Peace as they are left hanging on the line.  The lucky ones will ultimately reach a helpful human.  The rest may end up being cut off or simply left dangling on hold for a few months or so.  I suspect that many patients, who hit the jackpot and reach a live human after an interminable wait, have forgotten the reason for the call – yet another frustration!

Trust me, dear patients, that this issue is just as frustrating for us.  Our phones ring constantly which forces our staff to put most of you on hold as they juggle this onslaught.  And, try managing this while they are supposed to be checking in patients, arranging diagnostic tests and responding to impatient physicians who are waving their arms at them.  Sound like fun?

The reality, at least for smaller practices, is they cannot afford to hire a team of dedicated phone answerers.  And, even if they could, would these folks have enough training to handle the calls, or would they simply route the call to another staff member?

So, now you understand better the need for the obnoxious phone menu that greets you.
‘Please listen carefully as our options have changed.’   This is a lie.  The options haven’t changed and I doubt they will. 

Sunday, November 14, 2021

Why I Oppose Medical Marijuana

I don't really oppose medical marijuana, only the process that has brought it to market.

In general, I hew to the philosophy of  ‘leaving it to the professionals’.   Yes, I support all of us engaging in some measure of due diligence, but I try to select advisors and professionals whom I trust. If they have knowledge and experience that I lack, shouldn't their views carry more weight than mine?

In my own life, and probably yours, there are many areas in which I simply am not capable of any due diligence. If a car mechanic, for example, recommends that an expensive part needs to be replaced, I can only hope that this is truly necessary.  If the folks we deal with are honest and experienced, then things will tend to fall into place as they should.  Obviously, for this to work out well, several assumptions need to be true.

Many people today soundly reject the ‘leave it to the professionals’ philosophy.  For most of my life, the curricula in our public schools was dictated by education professionals.  When I was a student in grade school through high school, I don’t recall any protests or objections to our courses of study.  Yes, I’m sure that if our assignments, book reports, reading materials and classroom discussions were viewed through today’s prisms, that there would be many legitimate issues to criticize.  But, the zeitgeist today seems to be to criticize and protest everything.  Dialogue is neither encouraged nor practiced.

Indeed, there’s a benefit today to reject professionals' advice.  Candidates today are buoyed by championing the rights of parents to have a real voice in what their kids are being taught in public schools.  Police departments are being monitored by citizens who do not have formal training or experience in law enforcement.   I’m not weighing in on these issues, only pointing out how the situation has flipped. 

Medical Marijuana Approved by Legislators!
(What Have They Been Smoking?)

Here in Ohio, a bill has recently been sponsored that would add various medical indications for medical marijuana use including autism, muscle spasms, headaches, arthritis and other conditions.  In my view this is ridiculous.  I’ve written before and continue to be believe that elected legislators should not be making medical decisions.  Not only do they have no requisite training and experience, but their mere involvement politicizes the process.  It’s axiomatic that politicians support stuff in order to get folks to vote for them.  How is such a process defensible with regard to medical care?  (Hint, it isn’t.)  And to those who defend it, why not then have lawmakers decide on drugs or treatments for heart disease, Alzheimer’s disease or cancer?  Do you think that lobbyists or corporate donors might be able to influence legislators on adding a disease or two to the medical marijuana list?  (Hint, answer 'yes' here.)

Sure, there are medical studies out there that show medical benefits of marijuana.  But, this is not sufficient.  Medical marijuana, like any proposed medical treatment, must be subjected to rigorous and impartial scientific inquiry with final approval or rejection falling to the FDA, where this authority resides.  

There are spheres of society where professionals must remain in charge, even though others voices should be heard.  If you want medical advice, then ask a doctor.  If there’s a rattle in your car, then don’t ask me.