The following year, a senior student introduced me to the idea of creating a blog, which at that time, was still an unheard of medium for creating web content (and who had ever heard of “content”?).  Finally, by the end of my intern year, while sitting in the ICU trying to keep a twenty year old race car driver alive, I wrote my first blog post.   Then I wrote another and another. I documented my revelations about learning medicine, the journey that my own patients revealed to me.

Daily as my sleep deprived mind both memorized standard practice and absorbed new journal articles, I was constantly writing.  I’d care for a sick child and in my mind I was blogging about it.   I performed my first trauma resuscitation and in my mind I was blogging.  When the Amish family of a dying man sang in the ICU…I blogged about it.

At that point, my blog was one of the most popular medical blogs and the first emergency medical blog that I know of. As popularity increased I tried hard to both capture my thoughts, emotions and experiences while remaining anonymous. I shared my journey of becoming a physician with my readers..through the cold clinical discoveries, to saving my first life, to learning (again) that patients are people…my thoughts were all open.  All of these things I shared publicly, with the world, with anyone who had an internet connection.

Interview requests from medical writers came and I declined.  I did not want anyone to know who I was, I feared that I had shared too much about myself.  But at the same time, my family felt closer to me than they ever had. My father still recounts stories from that time…stories I’d never told him personally, yet he’s got the words nearly memorized. My grandmother kept a printed stack of my stories on her reading table. When I miss my grandfather…I can just revisit my blog and the memories come flooding back (and I usually shed a tear or two).

Through my anonymous blogging life I made friends, grieved for friends, watched friends rise to (relative fame) and yet I retreated.  At points in my life my blog was my solace, my retreat and my joy. My blog sits now docile for the most part, a series of a thousand or so tiny milestones in the process of becoming a physician. It will always be  a part of  who I’ve become, who I was then and who I’ll be tomorrow.

Blogging is a powerful tool.

I texted this  line to a friend while sitting in the “introductory” session of the Landmark educational meeting. A  friend had invited me, after telling me some of the good experiences she’d had.  When she described it, it sounded like a combination of motivational coaching, business coaching and personal development. All good things I thought, and I’m always interested in “bettering” myself.

From the moment I walked in, I knew that this was not what I was expecting. I had brought work to do, planning to simply listen in on their meeting and get my work done (it still remains undone as I type this).   The room was laid out like a church with pulpit almost, and as people strolled in the greetings were similar. Warm hugs, arm squeezes, even a tear or two.

I was quickly spotted as a visitor and many people came up to greet me.  I began getting uncomfortable almost immediately and sent of the above text to my friend.

After introdcutions, the “guests” were whisked off to a separate room for a separate session.  I was a little dissapointned as I’d come to sit in on the interesting information that my friend said they’d be covering (Brain science).

There were only 2 of us, plus a nice man with a nametag that read “Introduction Leader”, and an “introduction leader in training”.  Wow…whatever this thing is…to need to have introduction leader’s in-trianing  means that they’ve got a pretty big funnel of educational training for their “leaders”.

In the tiny room, our leader sat with a book stand next to him and his 3 ring binder with all the information he was supposed to cover with us.   He led us through a not-uninteresting exercise, but clearly one with an specific motive…to get you to see how messed up you really are inside.

I am currently going through some business buildign activities, and I’ve been very proactive and trying to launch a new branch of my small business…making phone calls, gathering market information, etc.   I picked this activity as my item to work on for the session.  But this didn’t fit his model at all…the leader’s example of “what I’m already doing”, “what I already have”, and “what I’m already being”, were all negatives….his was also a business situation…what he was already doing was letting sales leads slip by, not closing calls and spending his time doing efforst that were not buildign the bottom line.  What he was already being was…”selfish, irresponsible and close minded”.  He said that the point of the last part was to really “tell one on yourself”.

HUH?  What I was already being was forward thinking, proactive, seeking new education and opportunities…all good stuff…I just need to complete the last pieces of the puzzle to make it all a go.

If I didn’t already feel uncomfortable this was really starting to seem like an ill-intended, misguided effort at getting vulnarable people to sign up for an expensive course in self-help and common sense.  Not that those are bad things, but having gone through a number of small business coaching sessions that were all quite helpful, as well as being in a business that helps others achieve things they never dreamed possible (completing a triathlon), I was very dissapointed at the Introduction Leader’s approach to “discovering possibilities”.

None of the introductory session was aimed at finding solutions…and I certainly wouldn’t expect to find a solution in 90 minutes to a large problem.  Instead, it was devoted to giving you “carrots”, with examples of personal breakthroughs due to realizations of childhood traumas that have defined your personality to adulthood. (Things like being told by your school-age crush that you’re ugly, not being able to make final ammends with a deceased loved one, etc).

The suggestion taht every one has some childhood trauma causing limiting behaviors in adulthood I find very insulting. I live an examined life. I’ve overcome innumberable obstacles to get into medical school, become a  physician, invest profitably, start a small business and help other people reach their goals.  I constantly read business books looking for new,  different and better ways to accomplish my goals.

At intermission, I tried to leave, by politely telling him that I was just going to wait in the lobby until my friend’s session was done.   He turned bright read and got very fidgety.  He said, “Before you decide to leave, can we have another conversation about this?” Man, was he desperate to have me stay in the room.   I already knew that I was not interested in this thing, whatever it was (I still don’t know).

I took a break and did some pushups, handstands and planks in the hallway (I was missing valuable exercise time!!), and checked my cell phone.  Not only did my friend text me back, but her boyfriend too. There on my blackberry, two texts one right above the other simply said, “CULT!”  I laughed about it, knowing that somehow my instincts of “this just doesn’t feel right” were correct.

During the second portion ( I did decide to stay), we opened up a new pamphet, and I took the registration card out and obnoxiously tossed it in the air behind my chair, making a statement that yes, I am interested in being a better person…no, I am not going to sign up for the landmark forum tonight.  Now what do you have to tell me?

I could paraphrase what he talked about in the 2nd half, and there was nothign inherently good or bad about the content…but I failed to see the connecting of how signing up for the landmark forum TONIGHT was going to be the only way I’d slove the puzzle of letting my past limit my future.

In the end…it was 3 hours wasted, and my work is still not done.  But I felt compelled to share this with my readers and whomever else my stumble across it.

Reactions around the blogosphere range from the ridiculous to the absurd.  Former wanna-be football players are basically saying that the player should “suck it up” and that coaches hazing football players is a rite of passage.  It reminds me just a little bit of surgeons and docs (like me) trained pre “residency work hour restrictions” and post.

Those of us trained pre were of the opinion that “it’s just part of the training”, “you’ll be a better doctor for it”.  And I’m sure that many of these former football players feel the same way.

What I can’t understand though, is how anyone can think that they know the best way to treat and diagnose a concussion when they have no medical background or concept of what real head injury is.

In my previous post on Concussion Rules Stir Controversy, I commented that were I a sideline coach, I’d pull every “mildly concussed” player from the game.   The standard of care at one point was that if any syptoms were present, that the player should not return to contact sports until at least 7 days have passed without any sypmtoms of a concussion.

Since many concussions result in a “post concussive syndrome” that can persist for days to months, there’s no way to predict when I player can return to play.

It’s a sticky situation, and if you have an abusive or belittling coach, it can really put the player in a tug of war between phsyicians and coaches.

Regarding the suspension of Texas Tech Coach Mike Leach, whatever the truth is, it highlights that every school, be it high school or collegiate, needs to adopt a policy on concussion management for players.  Remove the head coach from the decision as he should not be involved…let him coach football.

Sunday Forum: Suck it up, America

We have become a nation of whining hypochondriacs, and the only way to fix a broken health-care system is for all of us to get a grip, says DR. THOMAS A. DOYLE

Sunday, October 11, 2009

Pittsburgh Post-Gazette

Emergency departments are distilleries that boil complex blends of trauma, stress and emotion down to the essence of immediacy: What needs to be done, right now, to fix the problem. Working the past 20 years in such environments has shown me with great clarity what is wrong (and right) with our nation’s medical system.

It’s obvious to me that despite all the furor and rancor, what is being debated in Washington currently is not health-care reform. It’s only health-care insurance reform. It addresses the undeniably important issues of who is going to pay and how, but completely misses the point of why.

Health care costs too much in our country because we deliver too much health care. We deliver too much because we demand too much. And we demand it for all the wrong reasons. We’re turning into a nation of anxious wimps.

I still love my job; very few things are as emotionally rewarding as relieving true pain and suffering, sharing compassionate care and actually saving lives. Illness and injury will always require the best efforts our medical system can provide. But emergency departments nationwide are being overwhelmed by the non-emergent, and doctors in general are asked to treat what doesn’t need treatment.

In a single night I had patients come in to our emergency department, most brought by ambulance, for the following complaints: I smoked marijuana and got dizzy; I got stung by a bee and it hurts; I got drunk and have a hangover; I sat out in the sun and got sunburn; I ate Mexican food and threw up; I picked my nose and it bled, but now it stopped; I just had sex and want to know if I’m pregnant.

Since all my colleagues and I have worked our shifts while suffering from worse symptoms than these (well, not the marijuana, I hope), we have understandably lost some of our natural empathy for such patients. When working with a cold, flu or headache, I often feel I am like one of those cute little animal signs in amusement parks that say “you must be taller than me to ride this ride” only mine should read “you must be sicker than me to come to our emergency department.” You’d be surprised how many patients wouldn’t qualify.

At a time when we have an unprecedented obsession with health (Dr. Oz, “The Doctors,” Oprah and a host of daytime talk shows make the smallest issues seem like apocalyptic pandemics) we have substandard national wellness. This is largely because the media focuses on the exotic and the sensational and ignores the mundane.

Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes and breast implants when we really should worry about smoking, drug abuse, obesity, cars and basic hygiene. If you go by pharmaceutical advertisement budgets, our most critical health needs are to have sex and fall asleep.

Somehow we have developed an expectation that our health should always be perfect, and if it isn’t, there should be a pill to fix it. With every ache and sniffle we run to the doctor or purchase useless quackery such as the dietary supplement Airborne or homeopathic cures (to the tune of tens of billions of dollars a year). We demand unnecessary diagnostic testing, narcotics for bruises and sprains, antibiotics for our viruses (which do absolutely no good). And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.

Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better.

The human body is exquisitely talented at healing. If bodies didn’t heal by themselves, we’d be up the creek. Even in an intensive care unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you give it plenty of gas, oil and brake fluid and that transmission should fix itself in no time.

The bottom line is that most conditions are self-limited. This doesn’t mesh well with our immediate-gratification, instant-action society. But usually that bronchitis or back ache or poison ivy or stomach flu just needs time to get better. Take two aspirin and call me in the morning wasn’t your doctor being lazy in the middle of the night; it was sound medical practice. As a wise pediatrician colleague of mine once told me, “Our best medicines are Tincture of Time and Elixir of Neglect.” Taking drugs for things that go away on their own is rarely helpful and often harmful.

We’ve become a nation of hypochondriacs. Every sneeze is swine flu, every headache a tumor. And at great expense, we deliver fantastically prompt, thorough and largely unnecessary care.

There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix.

A good physician needs to have the guts to stand up to people and tell them that their baby gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat. Unfortunately, this type of advice rarely leads to high patient satisfaction scores.

Modern medicine is a blessing which improves all our lives. But until we start educating the general populace about what really affects health and what a doctor is capable (and more importantly, incapable) of fixing, we will continue to waste a large portion of our health-care dollar on treatments which just don’t make any difference.

Anita Dufalla/Post-Gazette

Dr. Thomas A. Doyle is a specialist in emergency medicine who practices in Sewickley (tomdoy@aol.com). This is an excerpt from a book he is writing called “Suck It Up, America: The Tough Choices Needed for Real Health-Care Reform.”

Read more: http://www.post-gazette.com/pg/09284/1004304-109.stm#ixzz0TgtnEINR

as anyone who’s ever seen a 12 year old wreck his bike into a barbed wire fence at 25 mph and not feel the need to cry until he realizes no one will wait up for him to hear his story, they are nearly invincible. My point is, that children are not real, they are simply a developing organism which will someday turn into a jumbled twine of conscious thought, buried emotions, and ever-mounting divorce papers

Read the rest of his entry here

As soon as he climbed out of the ambulance,  you couldn’t help but laugh. He had a smile from ear to ear and despite his bike touring vacation being potentially ruined by a ride ending injury, he was all about enjoying himself in the moment, no worries about the past or future.  But if appearances were everything, he might not be someone you’d want to admit you were friends with… or at least not take home to mother.

What would otherwise be called a sunshine smile revealed yellowed nubs of teeth barely long enough to chew a piece of bread.  When he laughed, a raspy smokey breath of air filled the space in front of him…you could almost see the years of cigarette smoke that had built  up in  his lungs.

His friends were equally as happy and easy going. I really can’t explain why this little man was so fascinating to me. I guess because in my role as an ER doc, I get to see all sides of people. Normally I wouldn’t have given this man and his friends the time of day. I mean, based on appearances alone, he was kind of gross.  And if you judged a man by the stickers on his black motorcycle skull cap, well, he was downright disgusting.  When he went to xray for his thumb, I took photos of the bumper stickers on his helmet.

“I was born with nothing, and still have plenty of it left”

“I’m looking for the perfect woman, a nymphomaniac who owns a liquor store”

“Could you drive any better if that phone was up your a**”

“I’ll be sober tomorrow, but you’ll still be ugly”

And perhaps the most disgusting of al and yet somehow amusing…

“9 out of 10 women are battered, but I’m still eatin’ mine plain”

After he returned from x-ray, he asked if he could go outside and have a cigarette while he waited for the results. So he and his buddies headed out to the ambulance bay and smoked and laughed and laughed and smoked.  I guess what was really intersting was that despite all the messages he carried around on his helmet and the tough persona he emulated in the motorcycle outfit and mannerisms, the whole group of them was just downright nice.

They were polite and thankful and optimistic about the rest of their trip to Sturgis. I placed a splint on his left hand, and he hopped on the back of his buddy’s motorcycle and they rode off into the mountains together, both of them wearing helmets even though not required by law.

While tragic, it made me realize how much time I spend idle and unfocused. I’ve been far more optimistic thinking to myself, What would Mikey do right now?  He wasn’t one to waste time with anything…always planning his next adventure.

Tonight I had a choice to race another crit or to do cyclocross practice.  Since I always finish last in the crits, and every single moment is painful, I thought, why flagellate myself? Cross is fun, fast, requires skill and technique and practice.

I was one of 5 women there and about 15 men. For the most part we held our own and for 2 of the women, it was their first cross experience ever. I think they are bike shopping now.

I worked the first four days upon arriving here, so it wasn’t until yesterday that I had a chance to go out for a ride.  I was all ready to hit the road when I looked at the fork on my bike, and it was a bit crooked. I pushed down and uh oh…Fork screwed. Headset broken. Head tube cracked. Damn.  On the way out, i had run into a metal “warning” bar while going through a drive through and heard an awful noise on the roof.   The mountain bike rolled backward over it’s front wheel holder and was simply thrown free of the impact with no frame damage to the bike that I can tell.  Teh road bike was not so lucky as the forks were securely locked into the fork mount carrier.

Damn.

I called my bike shop back home and  had them super-stat a new bike build that should be here by the weekend.   An expensive mistake all in the name of a quick breakfast. Guess I know where I”ll be spending this month’s paycheck.