To those new to my blog, welcome!  To those longtime followers, after one year of blogging, I want to thank you for your support.  I started this blog with no purpose other than to communicate to my patients the developments within my fledgling practice.  But as I started to write, I found myself driven to explore broader topics that relate to health, and our delivery system. 

What does it mean to be healthy?  I’ve come to believe that the answer to this question is different for each individual, but the answer definitely does not lie in physical health alone.  To me, “healthy” is a state of mind and is going to look very different from one person to another.  I watched one of my “healthiest” patients die of ovarian cancer this year.  Unfortunately, I also see many patients every day with no true physical ailments, but who are very unwell.  So in our quest for health, what areas do we have to consider?  I have framed my ideas around the book Wellbeing written by Tom Rath and Jim Harter http://www.wbfinder.com/home.aspx but have added one additional category that I think they missed – spirituality.

·        Physical Wellbeing – Do you have health and enough energy to do what you want to do every day?  Do you fuel your body with healthy nutrition, exercise, sleep, and keep toxins to a minimum?

·        Emotional Wellbeing – Do you have strong relationships and love in your life?  Are there unresolved tensions with your spouse, parents, children, friends, or work colleagues?

·        Financial Wellbeing – Do you feel secure in your ability to cover the basic needs of food, shelter, clothing, and education?  Does the way you use your non-essential income bring you joy?

·        Community Wellbeing – Do you take pride in your community?  Do you contribute in some way that helps others in your world to thrive because you care?

·        Career Wellbeing – Do you like what you do every day, be it at home or in an official work place?  Do you wake up every day excited to take on the next challenge in your “job”?

·        Spirituality – How do you refuel yourself?  What feeds your soul?  This can come from an official place of worship, or from another activity that brings joy and re-energizes your spirit like nature, music, writing, etc.

When I’m inspired to write, it’s with these categories in mind.  Sometimes I also explore how our broken healthcare system can change to better serve the wellbeing of the community as a whole, without going bankrupt.  So after my infancy as a blogger, I think I’ve finally figured out what I’m about and what the theme of my social platform will be – How To Be Healthy.

Careful readers of my blog may pick up that I’m mimicking my social media idol, Baratunde Thurston, author of How To Be Black. http://howtobeblack.me/htbborder  In reading his book, I realized that although we have different platforms and objectives, we share the common idea that there is no one way to “be” anything.  Although one may assume that his book prescribes a certain ideal for “blackness”, his thesis is actually that “blackness” is whatever a black person wants it to be.  In his very funny way, Baratunde satirically puts forth a few models of “blackness”, but he ultimately admits that his book is really about “How To Be Human”.  

Similarly, there is no one model for successfully navigating the path of “wellbeing”.  Our physical health can dramatically change in a moment due to illness or injury, but we can always strive to achieve our own maximal fitness.  One can be emotionally well within all sorts of different frameworks – married, single, childless, with kids, large friend networks, a closely held few.  In addition, every relationship looks different.  What matters is the degree of connection and the love that is felt.  Financial wellbeing will look different depending on the community one chooses to live in.  Spirituality can take innumerable forms, and so on.  What matters is that a person lives their life authentically, with their own inner voice as their guide.

So welcome to HowToBeHealthyMD.  I hope my readers will appreciate that my strong science background and training in evidenced based medicine enables me to judge new medical and nutrition information and provide a reliable interpretation of the implications.  But I also hope my followers appreciate that I am a “radical academic” (also coined by Baratunde on that roof top bar in Austin) that isn’t afraid to stand in the face of commonly held beliefs if they just “don’t make sense”.  I feel well poised to talk about issues of balance and wellbeing, because as a mother and an American, I’m struggling with the same issues you are.  So here’s to being healthy!  I hope you’ll continue the journey with me to higher and higher levels of personal fulfillment.

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Two weeks ago I broke out of my comfort zone and attended an amazing conference in Austin called South by Southwest (SXSW).  Although this conference is better known for its film and music components, there is also an “interactive” session which brings together 15,000 of the most amazing social media, entrepreneurial, and IT minds in the country from every industry.  As the picture above suggests, this festival of creativity is quite a scene!  During these five days, innovators from every realm take the city of Austin by storm.  Everywhere you looked, people engaged every imaginable piece of technology to blog, tweet, post, or link the latest information hitting the scene.   

I chose to attend this conference because of a confluence of several interests that all emerge from my desire to understand why people do what they do.  Through my work, I strive to influence others to make choices that promote both their own wellbeing, as well as the physical and psychological health of the community as a whole.  I went to Austin with the hopes of discovering tools to encourage positive behavioral changes in both my weight management and general medicine patients which I found in the work of Noreen Kamal @noreenkamal at Vivospace. http://www.magic.ubc.ca/pmwiki.php?n=Projects.E-HealthCare  Through my experience in health IT, I know that mobile health will play an increasingly large role in facilitating and improving patient care.  

The Mobile Health Revolution

In my affluent community in the northwest Chicago suburbs it seems that almost everyone owns a smartphone.  In a few short years, this perception will be the reality.  In fact, sixty-five percent of the population is predicted to own a smart phone by the year 2015.  The power of this vehicle to collect data and influence people has the attention of every industry, including healthcare.  In collaboration with Technical Doctor http://www.technicaldr.com/tdr/, Dr. Blodgett of the Thompson Memory Center http://thomsonmemory.com/, and Dr. Arora @Futuredocs of the University of Chicago, I have spent the past two months developing two unique mobile health solutions.  One application will enable us to evaluate therapies for Alzheimer’s and link caregivers and patients into a support network.  The other application will support better transitions from the hospital to the outpatient setting for patients with chronic diseases requiring frequent hospitalizations.  Today fifteen billion dollars is spent on patients who are readmitted to the hospital within 30 days of their discharge.  Twelve billion of this is thought to be preventable with better follow up care in the outpatient setting.

In this photo you see me at SXSW with a few of the most inspiring people I’ve come across in the mobile health scene.  The two gentlemen in the photo, Steven Krein @stevenkrein and Unity Stoakes @unitystoakes, are the two co-founders of StartUpHealth. http://www.startuphealth.com/  This company’s mission is to improve healthcare in America by providing health and wellness entrepreneurs with inspiration, education, and access to customers, capital, and other critical resources.  With this help, startups can innovate more quickly and build new solutions that will improve care and reduce out of control healthcare costs.  I’m excited to share that I may apply to their StartUpHealth Academy to facilitate the promotion of my unique ideas. 

The woman in the photo is Dr. Jennifer Dyer who is a pediatric endocrinologist and social media queen better known as the @Endogoddess.  Love it! http://endogoddess.blogspot.com/  This inspiring woman has developed several mobile health apps to improve care for diabetics and is a fashionista to boot!  I am so honored to have both her friendship and her mentorship as I explore the world of mobile health and social media, but I’ve told her to give up on me in terms of high-end fashion! J 

Behavioral Genetics

As a student of molecular biology, neuroscience, and human behavior, I have come to believe that each of us is a walking clinical trial in regards to our genetics, physique, lifestyle, consumption, location, and relationships.  At SXSW I was somewhat alarmed to learn that corporations are gathering data on every purchase we make, giving them insight into very personal areas of our lives http://www.dailymail.co.uk/news/article-2102859/How-Target-knows-shoppers-pregnant--figured-teen-father-did.html.  My Facebook friends may also be surprised to know that CEO Mark Zuckerberg can determine by a person’s Facebook postings with 33% accuracy when a couple will break up!  Also shocking was that the popular app Foursquare can actually predict with amazing accuracy where a person will go next.

I’m currently reading Thinking Fast and Slow http://www.amazon.com/Thinking-Fast-Slow-Daniel-Kahneman/dp/0374275637 by the brilliant Princeton psychology professor Daniel Kahneman.  This book describes the “instinctual” part of our nature (System 1) which drives most of what we do.  On some level, the entire concept of “free will” is questioned.  In a prior post http://karanancemd.posterous.com/its-the-little-things-that-matter I wrote about how the trait of “altruism” is actually genetic.

At SXSW I attended many talks that highlighted other behaviors that we think of as “choices” that actually have a genetic basis or are very predictable when you use data to determine what a person, or certain demographic of the population will prefer.  Most inspiring was the talk by Dr. Ravi Iyer @ Ravi_polipsych, the Founder and Data Scientist of www.YourMorals.org with whom I was lucky enough to share a margarita and some conversation with as pictured below.

Dr. Iyer gave a compelling presentation that highlighted why emotional profiles are more important than demographic profiles, and astutely pointed out that we live in an age where consumption is about values (e.g. Whole Foods) and happiness (e.g. Zappos) rather than survival.  I encourage each of you to contribute to his research and better understand your own moral psychology by participating in the free surveys on his website.  Most interesting from his talk for me, though, was how we can use social networks to form moral agreement amongst people from different cultural backgrounds and ideologies.  This tied right in with my other new SXSW discovery, the politically-active, technology-loving comedian and Director of Digital for The Onion http://www.theonion.com/, Baratunde Thurston.  Baratunde gave an inspiring keynote speech about the role of technology, comedy, and satire in transforming the world around us.  An audio link to his talk is available at http://schedule.sxsw.com/2012/events/event_IAP992055. 

Born into a “neighborhood just like The Wire” in Washington DC, Baratunde grew up surrounded by drug dealing, police brutality, and murders.  Despite living “in a black neighborhood under siege” Baratunde was blessed with an amazing mother, Arnita Thurston, who as a widow provided her son the opportunities and structure to ultimately lead to his graduation from Harvard University in 1999.  In his book, How To Be Black http://howtobeblack.me/htbborder, Baratunde thanks his mother for helping him to survive his childhood.  As a result of her efforts and tutelage, Baratunde describes himself at twelve years old as “a bass-playing, tofu-eating, weekend-camping, karate-chopping, apartheid-hating, top-grade-getting, generally trouble-avoiding, agent of blackness.”  LOL!

Through a random twist of fate, I was lucky enough to engage this thoughtful, fun “agent of blackness” in a conversation at an Austin rooftop bar. 

After a freewheeling exchange of ideas that included Obama’s Accountable Care Act, race relations, and social media, I downloaded his book and have been enjoying every minute!  I think Baratunde’s book is a “must read” for every white person that doesn’t interact with the black community on a regular basis.  It’s one thing to study African American history, but yet another to understand the misperceptions between races that can lead to strain and even violence, as highlighted by the Trayvon Martin tragedy.  After reading Baratunde's light-hearted but poignant book, I’m proud to report that I’m much “blacker” than I was a month ago! ;)

So those are the SXSW highlights I’ve finally found the time to share.  Although I was initially intimidated by the size and intensity of this fast moving scene, I'm happy that I strayed from my typical “doctor” conferences to learn some completely new things.  I’ll close with my favorite (and only!) Japanese Proverb brought to my attention in one of @DrHelenFisher’s books (another personal idol I met at SXSW!) “Let us not follow where the path may lead.  Let us go instead where there is no path, and leave a trail.”

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So as our children played board games, cards, and pool in the community room, I talked to Grandad about his life story.  Born in Ellsworth, Kansas, Grandad attended the University of Missouri where he excelled in ROTC.  He remembers a certain army captain that he admired and respected, who encouraged him to make a career in the service.  After a few years in the army Grandad was stationed in Fort Des Moines, Iowa, where he met and fell in love with Colin's grandmother, Margaret “Dusty” Wallace.  Their relationship was a true romance.  Although I only knew Grandmaloo for a short time before Alzheimer's set in and she died in 2007, I remember how lovingly she and Grandad treated each other.  They had one daughter before Grandad had to leave his family for three years when he served in Europe during World War II.  Upon his return they had two more daughters and raised a lovely family.

Grandad reflected happily on his many years in the service.  He appreciated the "congenial" community, where newcomers were always welcomed with social calls within 24 hours of arriving to base.  He enjoyed the "exactness and challenge" of the army and the rigid demands of military life did not bother him.  Towards the end of our visit I asked Grandad what he felt the biggest factor to a life well lived was.  Without a moment's hesitation he answered with one word - love.  In addition to having a great love in his life, Grandad was blessed with a loving family, loving friends, and a loving community within the military.

As I celebrated yesterday's holiday devoted to love, I found myself reflecting on why some people accrue so much love in their lives, while others leave this world very alone.  I think many of the answers are described in Dr. John Townsend's book, "Loving People".   To have good relationships a person must know both how to give, and how to receive love.  When someone grows up surrounded by love, these behaviors can come quite naturally.  But for those that haven't been loved well, both learning how to love others and learning how to let oneself be loved may require conscious effort.

A true human connection is at the core of a loving relationship.  Dr. Townsend breaks human connection into the following essential elements.

1. Feelings - The ability to share the emotions we experience about things and people, both pleasant and painful.

2. Dreams and Desires - Loving people can share their deepest longings and wishes with those they love, especially the things we keep protected and may even have a hard time acknowledging ourselves.

3. Fears - When we are connected we feel safe to share our fears openly.

4. Failures - No one is without mistakes, and when we connect, we let others in on the darker parts of our lives.

5. Our Past - When we connect with someone we bring them into our personal history, sharing both our losses and joys.

6. The Other Person - Loving people have the ability to honestly communicate to the other person how they feel about their interactions with each other in a way that does not threaten, but rather strengthens the relationship.

One of the most rewarding aspects of my job is the opportunity to connect with so many wonderful people through the art of medicine.  I know I'm doing my job well when patients share their feelings and fears regarding their current health issues with me.  When people open up to me, I know I've made them feel safe.  My weight management program has resulted in particularly satisfying connections.  By meeting weekly with people struggling with the very sensitive and emotionally complicated issues relating to obesity, we have the opportunity to develop a safe platform from which to discuss past failures, desires and dreams, and can develop the good communication skills required for a productive patient-coach relationship.  

Dr. Townsend points out that “the best connectors are the ones that have been on the receiving end of connection.”  I feel very blessed that I have been loved so well in my life.  When I encounter someone who is selfish, unkind, or hurtful, I try to react with empathy instead of anger, because that person is most likely acting “unlovable” because they are nursing an emotional wound from some prior relationship.  These are the people most in need of grace, acceptance, and understanding. 

Grace can best be defined as an undeserved favor.  Forgiving a person for behavior that they are not proud of is the most wonderful gift you can give a person.  Just yesterday I had a tearful patient in my office because she returned three months later than instructed because she was ashamed at her inability to meet her weight loss and exercise goals.  Her relief when I reached out and hugged her and said those magic words “it’s ok” was palpable.  I often hear from patients, “I was afraid you would be mad/yell at me”.  I always find this statement shocking because why would I scold when I know we all live with the most merciless critic of all - ourselves.  What people really need when they act in self destructive ways is support and forgiveness.  A person can break through the iciest shell with these methods!

So in this week devoted to celebrating love I will close with my favorite paragraph from Dr. Townsend’s book.  “Connected people are people who are grateful for what they have taken in and do not want to waste it.  When we use our connections good things happen.  Spouses feel like less of a failure, people take career risks that are fulfilling, kids move on from sports defeats, lovers develop closer bonds, single people resolve fears, and books get written.  Connection requires movement and response when we experience it.  Connection takes time and energy from someone you care about, even if it is freely given.  That is not a guilt motive; it is a reality motive.  Take ownership over connecting with others, and help it help you to be a better and more whole person.” - John Townsend

Please feel free to reach out to Grandad by email martys@satx.rr.com 

He's always open to making a new friend!

Loving People, John Townsend, 2007, Thomas Nelson Publishing

 

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Ten days ago I returned from Washington DC where I attended the first Care Innovation Summit sponsored by the Center for Medicareand Medicaid Innovation. http://innovations.cms.gov/

I recognize we are living in tough political and economic times.  The national debt, unemployment, partisan conflict, struggling schools, and disenfranchised groups all come to mind when I think of serious political concerns.  But the problems in the healthcare system feed into many of the larger issues our country is facing.  Healthcare as it exists today is destroying American prosperity and the American dream.  With 17.9% of the GDP spent on healthcare, it is imperative that we jail break the health care system at a price we can afford.  We need to change the system so that value is incentivized over volume (i.e. how many patients are seen, how many tests are ordered, etc.) while keeping the patient’s personal experience at the center of all we do.

For such big problems there are obviously no easy answers.  The political gridlock we’ve seen in Washington in recent years contributes to the perception that everyone on Capitol Hill is motivated by personal agendas with little concern for the greater good.  But today I want to show you another side of what’s going on in Washington.  I want to familiarize my readers with the innovators in this country committed to reforming the healthcare delivery system, fixing the SGR, and reforming the way payments are made to reward quality and innovation.

The list of speakers that I had the privilege of listening to is much too extensive to cover here, so I’m choosing to highlight two amazing voices on the healthcare scene that left the strongest impression on me.  The first is Susan Dentzer, the Editor-in-Chief of Health Affairs http://www.healthaffairs.org/ which is the nation’s leading peer-reviewed journal focused on the intersection of health, health care and health policy in the US and internationally.  Susan used the words of the renowned writer from Stanford’s MBA school, Jim Collins, to talk about how we need a healthcare system that is built to last.¹ 

America is full of many corporate successes.  This is because our capitalist culture generously rewards true innovation that is successfully implemented.  Financial incentive encourages risk takers with boundless optimism and extraordinary creativity to come up with solutions to some of our toughest problems.  This drive to innovate is rooted in the American spirit.  Susan Dentzer pointed out that we need a partnership between the private and public sectors to come up with the best answers for the healthcare crisis.  By taking this approach we should be able to step away from the in-fighting in Washington because “innovation is not a partisan issue.  It comes in purple, not blue or red.”

The second speaker whose words I want to spread is Atul Gawande, MD, MPH who is a surgeon at the Harvard Medical School as well as a writer of three New York Times bestselling books^2,3,4 and a public health researcher. Dr. Gawande contrasted the medical system in the pre-penicillin era⁵ to today’s much more complex environment.  One hundred years ago healthcare was cheap, but completely ineffective.  Dr. Gawande pointed out that today we have 13,600 unique diagnoses for human diseases, and 6000 different medications we can prescribe or operations we can perform.  Per his count we have 13,600 service lines that we are trying to roll out to every person in every community!

Dr. Gawande astutely concludes that the reason healthcare costs are so out of control is that innovations in delivery systems have not kept pace with the scientific and medical discoveries we can now leverage.  The old system rewarded the cowboys, physicians who could enter a room, take control, and do it all.  But the paradigm of individual clinicians trying to do it all on their own isn’t working.  Instead of cowboys, Dr. Gawande eloquently explained that we now need highly effective pit crews where humility, accountability, and self-discipline are what’s valued.

But how do we know if the pit crew is doing a good job or not?  How can the struggling crews identify the more effective teams and implement their secrets of success?  The answer lies in the ability to capture, analyze and report the DATA!!!  Without data we have no ability to recognize success and failure.  Dr. Gawande pointed out that at the turn of the century the American people were facing a crisis in the ability to produce and deliver enough food to its citizens.  At that point in history 40% of the family budget was going to food costs.  To address this serious problem the government collected data in the form of comparative effectiveness research and created regulations and incentives to encourage farmers to use processes that were proven to work.  The government also created the national weather service, which provided the farmers with important information to protect their crops.  Over the course of 20 years the percentage of the family budget that went towards food dropped from 40% to only 20%.  We need to do this in healthcare today.

The widespread adoption of electronic medical record systems (EMRs) by physicians has us on our way, but simply having a system doesn’t mean it’s being used in a way that provides structured data that can be studied.  CMS is trying to make this possible by demanding that physicians adopt CCHIT (Certified Commision for Health Information Technology) certified EMRs which use HL7 CCD (Health Level 7 Continuity of Care Document) programming to promote the exchange of health information between providers and facilities involved in a patient’s care.  This will lead to a profound reduction in healthcare spending because test results will be accessible, and expensive imaging studies will not need to be repeated.  Having access to the patient’s complete medical history will also help physicians to make accurate diagnoses and appropriate treatment plans.

In the words of Dr. Gawande, analyzing the data available to us today is like driving a car with a speedometer that tells us how fast everyone else on the road was going four years ago – not very helpful!  He pointed out that we know much more about how the crops and cows are doing in our country than the human beings.  We have a big problem in our healthcare system, and it needs to be fixed STAT!  Data is the oxygen for innovation, and right now we’re suffocating.  I feel strongly that patients should have a universal patient identifier (UPI) so that physicians don’t have to rely on having a conscious patient with a good memory and enough medical knowledge to understand what is or isn’t important regarding their past medical history.  I acknowledge that this is a controversial issue, and to see both sides of the story I invite you to read an article in the Wall Street Journal a couple of weeks ago that addresses both sides of the argument. http://online.wsj.com/article/SB20001424052970204124204577154661814932978.html?KEYWORDS=squaring+off+on+health+care

But I agree with Dr. Gawande that if we can’t access data on patient outcomes, it will be impossible to understand our current baseline.  Without this basic understanding, we will not be able to identify either problems we can fix in the current system, or opportunities to provide better delivery of healthcare to our citizens.  It is difficult if not impossible to set goals for improvement in medical delivery and quality of care without access to relevant and reliable data.  We also need data so that after implementing changes we can assess progress and identify teams who achieve superior outcomes at reasonable costs.

I share Dr. Gawande’s belief that we are fighting a war to preserve the soul of American medicine.  Regardless of political affiliation we all want people to survive and live their lives to their fullest potential.  I came home from Washington imbued with hope that if the citizens, the doctors, the innovators, and the politicians work together to capture the data floating around in our current healthcare system, we can achieve the goals of the three part aim - better health, better care, at reduced costs. 

¹Built to Last: Successful Habits of Visionary Companies, James C. Collins, Jerry I. Porras, 1997 A Harper Business Book

²The Checklist Manifesto, Atul Gawande, 2011, Metropolitan Books

³ Better: A Surgeon’s Notes on Performance, Atul Gawande, 2007 Metropolitan Books

⁴ Complications: A Surgeon’s Notes on an Imperfect Science, Atul Gawande, 2002 Picador

⁵The Youngest Science: Notes of a Medicine-Watcher, Lewis Thomas, 1983 Penguin Books

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As we prepare to celebrate the life of one of the greatest civil rights leaders of all time, Martin Luther King Jr, I find myself humbled as I reflect on the incredible sacrifices certain people have made on behalf of others.  As a student of human behavior, I find people that are free from the common human desire to hoard their resources for themselves or their families intriguing.  A few years ago I read a book about Greg Mortenson, Three Cups of Tea.  Now although there have been questions regarding some unethical use of the foundation's money on Greg's part in the last couple of years, at the time I was incredibly moved by the way this explorer devoted his entire life to building schools with the primary goal of educating young Pakistani girls.  I admired his goal of building literacy and peace, one school at a time.

Greg could build an entire school for $12,000.  At the time I read the book, we had just taken a trip to Disney World with the kids.  I remember thinking about the thousands of dollars we spent for 10 days of entertainment which were now over.  I felt incredibly selfish for spending so much money with no bigger purpose than nice memories for my family.  In that moment, I was driven towards making a personal sacrifice.  I decided to forgo one of my biggest addictions in life – my 3 pump, non-fat, no-foam grande vanilla latte from Starbucks.  I calculated that the $30 I spend most weeks at Starbucks equates to over $1500 a year!  Wow.  By forgoing my daily Starbucks and sending the money to Greg Mortenson, I could build a school for girls in 8 years.  I’m ashamed to say that my effort only lasted about 8 days.  Geneticists have actually identified a gene for altruism¹.  I evidently didn’t inherit it. L Like many Americans, my family and I continue to enjoy way more privileges than most other people around the world.

I often feel ashamed when I compare my level of personal sacrifice with those that do more, when in reality this is just a different manifestation of the sin of envy.  Instead of wasting energy wishing that I had enough altruism to give up my comfortable life in the northwest suburbs and direct all of my resources to someone else’s great cause, I can stop judging or blaming myself and focus on what I CAN do, and try my best.  I was not programed to live in a hut in Africa, or sacrifice all of my personal resources to some greater cause.  But I was blessed with traits that have enabled me to develop expertise in both medicine and psychology, which gives me opportunities to help others in a variety of different ways.  For this, I am very grateful.

I love identifying other people’s gifts and pointing them out.  I do this because I know we all have a human tendency to agonize over our weaknesses and failures instead of celebrating our strengths and accomplishments.  I also know I feel great when people make me feel special, and so I try to do this for others whenever I can.  

The action I witnessed that inspired this posting was that of Scotty Forester and his friends Abe and Jeep, 16 and 17 year old high school students.  On one of the surprise 55 degree days we had this week, I left work early to take my 3 year old and 7 year old sons to the park.  The boys were immediately drawn to the hockey rink where Scotty, Abe, and Jeep had suited up in their Blackhawks gear to also enjoy the surprisingly warm weather.  My seven year old, Scott, who loves to play and watch every sport he encounters, sat on the side of the rink intensely watching the action in his new Derek Rose jersey from Santa.  Completely unexpectedly, the boy we came to know as Scotty skated over and said, “Hey Rose, do you think I could get some help out here?”  I’ve never seen my son’s eyes get so big as he glanced over his shoulder with obvious thoughts of “who me”??? The smile on his face when he realized he was about to have an opportunity to play with the BIG boys was priceless.  The boys brought out an extra stick and showed Scott how to hold it and shoot.  They then included him in a game of two-on-two where they made sure Scott felt accomplished and proud.  As the sun set and it was time to take Scott home, I thanked the boys for their kind, nurturing act, and made sure I went home with their contact information to use as a future babysitting resource for my 3 boys.  I’ve spent the week wondering if those three boys have ANY idea how much their small act of kindness made a difference in my son’s life.  He’s been glowing over the experience all week, and drew the picture I’ve attached.  I think this is his personal way to “scrapbook” a special memory. 

Random acts of kindness like this remind me how powerful we all are to make a difference in someone else’s life.  I’m encouraged by the fact that we don’t all have to be Martin Luther King Jr or Greg Mortenson to make this world a better place.  I strongly believe that we have the influence to create positive change in the world by doing our best to impact every life we touch with acceptance, love, and kindness.  Even the simple act of holding a door open for a person laden down with strollers or packages could make a difference in someone’s day that we might find hard to believe.  It’s also important to remember that those who act the most “unlovable” are probably the most in need of kindness or affirmation.

So I would love to hear about a “random act of kindness” that you’ve witnessed or experienced.  With all the negative things we see or hear going on in the world, I think we are all empowered by stories of small things that any of us could do to make a difference. J

¹http://scan.oxfordjournals.org/content/early/2010/10/28/scan.nsq083.abstract

Three Cups of Tea: One Man's Mission to Promote Peace...One School at a Time, Greg Mortenson and David Oliver Relin, 2006 Penguin Books

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“The people walking in darkness have seen a great light,” wrote the prophet Isaiah 9:2 about the coming of humankind’s savior in the Old Testament.  It’s Christmas Eve, the celebration of Jesus’ birth.  According to Christian tradition, a brilliant star emerged from the dark sky on this night 2011 years ago to signal that the light of Christ had come into the world.  But it’s also time for the celebration of Hanukkah, the festival of light.  The menorah, with its nine beautiful candles, is the focal point for this special holiday.  The Hindu people also recently celebrated a 4 day festival of light called Diwali.  Each day of Diwali has its own tale, legend, and myth to tell.  My favorite is Amavasya, the second day of Diwali that tells the story of Lord Vishnu, who in his dwarf incarnation vanquished the tyrant Bali, and banished him to hell.  Bali was allowed to return to earth once a year to light millions of lamps in the hope of dispelling darkness and ignorance, leaving in its place the radiance of love and wisdom.  What a beautiful image!  I am comforted that there are so many paths to spirituality.  With so many different people and cultures, it’s not surprising so many different stories exist that we can choose to adopt as our “religion”. 

Why is light so central to all of the major religions?  I believe it’s because these stories of light represent the beautiful glow that illuminates our spiritual essence.  We’ve all heard that the eyes are the window to a person’s soul.  The eyes are where we see another’s inner light and love.  It doesn’t matter whether a person is young or old, sick or vibrant, or beautiful or ugly.  If you take the time to look, listen, understand, and truly connect, you can be blinded by another’s light.

I think it’s no surprise that these celebrations of light come at the darkest part of our year.  This can be a tough time to get through.  As a primary care physician, I’ve seen countless patients come in over the past couple of months with what I like to scientifically call “the blahs”.  All joking aside, human beings clearly do better in the presence of light.  Psychiatry has even formalized the condition with the cute acronym, SAD – Seasonal Affective Disorder.  But there’s really nothing cute about feeling the drop in energy, mood, and well-being that affect millions of people during the months surrounding the winter solstice.  So the creators of our ancient celebrations knew what they were doing when they placed all these celebrations at the darkest part of our year.

At Christmas time I seek out non-traditional Christmas music.  At this point I invite you to listen to my all-time favorite, “Mary Did You Know” by Clay Aiken.  Yes, I’m a little embarrassed to admit that in addition to being a pop queen, I also like Clay Aiken.  Will the teen-age girl in my head ever grow up?!  I kind of hope not. ;-) 

I find the music to be hauntingly beautiful, but the lyrics speak to me even more strongly.  I love the image he weaves of Mary looking down at the mystery of her baby boy, perhaps because I can so vividly remember those first tender moments with my own sons. 

I am touched by the love between a mother and her newborn child because I think this represents human connection in its purest form.  When do people stop loving each other so freely?  When do we learn to hide our tender side with sarcasm and games?  People put up so many barriers to intimacy in such a wide variety ways.  Regardless of your personal religious beliefs, no one can debate that Jesus’ teachings, with all their layers of symbolism and imagery, are powerful.  Jesus said, “Let the children come with me because the ones who are like them can enter the kingdom of heaven.”  I don’t care to speculate about what happens after we die, but I live every day with the goal of creating my own heaven on earth.  I believe loving with open hearts, like children do, is the best way to make this happen.  Don Miguel Ruiz says it best in The Mastery of Love, “When the heart speaks, even with the resistance of the head, something inside you changes; your heart opens another heart, and true love is possible.”

As a physician, I also gravitate to the image of Christ the healer.  But Jesus doesn’t heal with a prescription pad, he heals with love and forgiveness.  I also love the reference in the song to Jesus calming the storm with his hands.  Who doesn’t feel at times like they’re living within a storm?  Stop a moment and think of a person who was there to calm that storm for you.  That person allowed the God inside themselves to connect with the God inside of you.  I’m grateful that I get to do this for patients almost every day.  When a patient comes into my office in the midst of their own personal “storm”, if I know them well enough, I roll up on my chair and hold their hand as we talk and problem solve.  In these moments I can almost see my light pour out of me and into their scared and empty places.  I often can’t fix what’s wrong, but I know my patients frequently leave feeling a little more hopeful, a little more centered, and with a little more faith that they can navigate their next personal hurdle.  This is why I do what I do.  I know my happiness hinges not on the love that other people feel for me, but on the love I feel for other people.  I tell people that I’m a connection junkie.  The feeling of euphoria that comes after a true connection is made can’t be beat.

So when I celebrate any holiday, what I’m really celebrating is a festival of human light.  In these months of darkness around the winter solstice, we need to let our light shine all the more brightly!

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Yes, the holidays are upon us.  What a crazy mix of emotions and thoughts this time of year brings.  It’s a time for shopping, cooking, decorating, preparing, gathering, giving, celebrating, and remembering.  I enjoy this time of year because I get a special glimpse into the traditions, families, and histories of my patients, colleagues, and friends.  I also like paging through the memories in my own mind as I watch my kids grow and reflect upon past holiday experiences with my own relatives.  We are all living a story where we star as the main character. 

I like to reflect upon the tale that I’ve written so far, and imagine what the next chapters will look like.  Stephen Covey teaches us to “begin with the end in mind”.  In his book, The Seven Habits of Highly Effective People, he invites the reader to imagine that they are a guest at their own funeral.  He challenges us to envision four different eulogies.   One remembrance will be given by a family member, one by a friend, one by a business colleague, and one by a church or community acquaintance.  What would each of these speakers say about you and your life?  I’m sure some chapters of our lives are more fun to revisit than others.  It’s human nature to inflate that which brings us pride, and gloss over the chapters that reveal our weaknesses or failings.

Unfortunately we can’t always hide the unbecoming chapters in our stories.  Just ask Britney Spears, who turned 30years old today!  Over the past 10 years Britney has captivated the world with her unfolding drama.  Through a combination of both her and her mother’s efforts, Britney was launched into stardom as a child in the early 1990’s.  Given her “fast” environment and intense personality, it is not surprising that Britney grew up quickly.  At age 18 she shocked the world by appearing scantily clad on the cover of Rolling Stone, definitely NOT looking like a little girl anymore. 

Britney enjoyed 5 years of pop-stardom before starting to unravel.  First it was the 55 hour marriage to a childhood friend, followed six months later by her second marriage to the unreliable Kevin Federline, whom she had met only 3 months before.  Five months later she was pregnant, and when her baby was only three months old she was pregnant again.  Two months after the second child was born, Britney filed for divorce, and two months after that Britney’s closest relative, her aunt, died of ovarian cancer.  What followed was a year of increasingly erratic behavior, a short stay in drug rehab, and then a string of longer stays at a variety of psychiatric treatment facilities.  During this year Britney lost custody of her children and became estranged from her parents.

I honestly don’t think the writers for a soap opera could have scripted a more enthralling story.  The world watched captivated when Britney fell apart because each one of us has either experienced, or lives in fear of being forced to endure even part of what was Britney’s reality.  Have you ever felt intoxicating love followed by devastating heart break?  Have you ever navigated a divorce or custody battle?  Have you ever lost a close relative or friend to serious illness?  Have you ever experienced what substance abuse, addiction, or mental illness can do to ourselves or those we are close to?  Have you ever suffered the pain of having irreconcilable differences with a parent or your own child?  Have you ever had two babies in one year and tried to string together a complete sentence while enduring hormonal swings and complete physical and emotional exhaustion?  Have you ever gone from the height of your career to the depths of public humiliation? 

I think we love to watch the personal failings of those we consider iconic because it makes us feel better about our own shortcomings.  It’s easy to see that Britney made LOTS of poor choices, but she was so young with so many questionable outside influences, I think it’s hard to say that anyone under similar circumstances would have been less impulsive.  I remember watching the paparazzi stalk Britney at her lowest point.  I remember feeling both sorry for her, and shocked at how the public was salivating over her misfortune.

 It was in February of 2008 that Britney was released from the psychiatric ward of the UCLA medical center and started to get her life back on track.  After all the humiliation she endured, it must have taken some incredible inner strength to put herself back together again both mentally and physically.  Isn’t it amazing that three years later she’s back on the stage and rocking the charts?

I think this is a perfect example of what Covey describes as “by design or default”.  Covey eloquently points out that “in our personal lives, if we do not develop our own self-awareness and become responsible for (our choices and outcomes), we empower other people and circumstances to shape much of our lives by default.”  In contrast, living “by design” means that by using our capacity for “self-awareness, imagination, and conscience” we can take back control over our story and create the outcome we want.  As a close friend of mine has said, “I want to look back on my life without regret.”

So I invite you to slow down this holiday season and set aside some time to reflect on your story.  Do you like the main character?  If not, there’s no reason why you can’t rewrite your own script.  As this year comes to a close, it’s the perfect time to imagine what next year might bring, and enact positive changes to make it happen.  With the end in mind, you’ll soon find that you’re thriving, not just surviving.

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I have a confession to make….  I have an addiction to pop music, especially when sung by daring, crazy women.  The problem began when Madonna hit the charts when I was about 10 years old.  I was raised Roman Catholic, and I can still remember the delicious excitement of listening to her naughty music!  As a preteen, I’m pretty sure I barely knew what she was singing about, but something about the positive energy, and occasionally spiritual lyrics got me hooked.

I also love to dance.  The fact that I don’t dance particularly well becomes completely irrelevant to me when the beat of those top 40 dance hits are in the air.  My office staff is used to seeing me hip hop into the office lost in the world of my pop music, but my 12 year old daughter is much less tolerant of my shameless dancing.  Despite my new status as “the most embarrassing mom in the world”, I dance because it lifts my spirits and gets me through those tasks I find to be pure drudgery.  When I’m sad or scared a song like “You Make Me Feel Good” by Cobra Starship takes my thoughts a happier place.  When I’m angry I burn off my negative energy by running 4-5 miles with the more rebellious pop hits raging in my ears.  When I wasn’t subleasing and had an exam room I could “personalize” I had a plaque on my wall that read, “Life isn’t about waiting for the storm to pass, it’s learning to dance in the rain.”  This saying reminds me that although we will perpetually face new challenges, it’s up to us to find ways to make this life our “heaven on earth”.

So this explains why the pop star, Kesha, has provided about forty percent of the inspiration for this posting.  The other forty percent is from the Toltec warrior, Don Miguel Ruiz, author of The Four Agreements, my latest read.  The remaining twenty percent comes from the amazing people in my weight management program, whose bravery I celebrated in my last posting.  My group continues to do great!  We are now up to 19 patients who in sum have lost 266 pounds!  Five of these patients are type 2 diabetics that are now off their medications.  Three are diabetics who were dependent on 4 insulin shots per day, and now only use one small daily injection or none at all.

So what do the pop star Kesha, a Toltec warrior, and my weight management patients have to do with each other?  They have all given me insight into a concept that I find fascinating – social scripting.  A social script is a set of rules that we were taught to believe by society.  Ruiz calls this training “the domestication of humans”.  Ruiz is very big on “dreams”.  He argues that nothing we experience is actually “real” but is actually the “dream of the planet” which “includes all of society’s rules, its beliefs, its laws, its religions, its different cultures and ways to be, its governments, schools, social events, and holidays.”  Ruiz eloquently describes how from birth we are taught “how to behave in society: what to believe and what not to believe; what is acceptable and what is not acceptable; what is good and what is bad; what is beautiful and what is ugly; what is right and what is wrong.”

We spend a lot of our time examining individual social scripts with my weight management patients.  During the first month of the program every patient completes an exercise that identifies their own personal “language of rules” from a set of 72 selections.  I’m intrigued by the fact that my initial patients seem to share several internal rules.  Rules I often see in these patients include “Clean your plate”, “be good”, “please people”, “don’t rock the boat”.  

The “domestication of humans” obviously has a necessary role in society.  With our proclivity to succumb to the seven deadly sins (see my prior posting First Politics, Then Religion, Now Sex?! for details), one could imagine humanity without rules running completely amuck in a Lord of the Flies type fashion.  That being said, I do believe we often ignore what we really want out of life because someone else has imposed their “dream” for what our life should look like upon us.  Having to do things that actually go against the grain of our nature never feels good, but deviating from the social script imposed upon us invariably causes shame.  People “medicate” their unhappiness and shame in a wide variety of fashions, but one common self-soother is food.

It’s important to identify those rules that work for us and continue to do our best to follow them, but it’s equally as important to identify those rules that we don’t necessarily need to follow.  Just because a certain way of life works for one of our “scriptors” does not mean that by default it is right for us.  People need to be empowered to “rewrite” their own script without guilt.  So this is where Kesha comes in because I think it’s critical “You know we’re superstars, We R Who We R”!

References:

The Four Agreements: A Practical Guide to Personal Freedom, A Toltec Wisdom Book, Don Miguel Ruiz, 1997 Amber-Allen Publishing

The Lord of the Flies, William Golding, 1954 Faber and Faber Ltd.

We R Who We R 

You Make Me Feel Good

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Followers of my site may have been wondering what the seven deadly sins have to do with wellbeing, or why I’ve become so interested in the concept of desire.  So here it is….. J  Over the past month I am excited to share that I have launched a weight management program with a select group of 14 patients that I have known very well over the past 3-6 years.  In the last thirty days these patients have in sum lost a total of over 150 pounds!  On average, patients are losing 3.2 pounds per week, which means that my program is taking 45 pounds off this group every week!

After treating the medical complications of obesity for the past 15 years, I know that weight management is one of the most critical healthcare issues facing our country today.  My study of the obesity epidemic has made me aware of many frightening statistics, a few of which I’ll share with you here.  In 1985 8 states had an obesity rate equaling 10-14% of the population and all other states had less than 10% of their population obese.  In 2010, no state had a prevalence of obesity less than 20%. Thirty-six states had a prevalence of 25% or more; 12 of these states (Alabama, Arkansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, and West Virginia) had a prevalence of 30% or more.  Even more discouraging, obesity is no longer a problem for only adults.  In 2010, 17% of American children and adolescents were obese.   

Another scary fact that was reported in January 2011 was that 8.3% of the US population is obese AND already has Type II (what we used to consider adult-onset) diabetes.  This form of diabetes is a direct result of obesity in genetically susceptible individuals.  In 1994 there was not a single state with a diabetes incidence of more than 6% of the population.  In January 2011, 8.3% of the population has diabetes, which equates to 25.8 million Americans.  If the obesity epidemic is not contained, it is projected that 37.7 million Americans will have diabetes in 2031!   People who are obese spend almost $1500 more per year than an individual with normal weight.  Obesity costs our country 147 BILLION dollars per year, and this number is rising.  With the current focus on containing healthcare costs, obesity is a problem we can’t afford to ignore.

So what do we do about it?  I’m very encouraged by the movement in this country to “leave no child inside” and to do away with addictive substances in our foods like high-fructose corn syrup.  That being said, millions of adults have already become victims of their genetics, environment, and ingrained eating habits.  As an internist who cares for only adults, I’ve been searching for the formula to help the hundreds of patients I know and love to find the strength and tools to get back to a healthier weight and maintain it.  I am excited to announce that I am now offering a variety of programs which include medically formulated dietary products to promote rapid weight loss without hunger.  I am also offering nutritional counseling, individualized exercise plans, medical monitoring for patients coming off of their medications, and most importantly, behavioral counseling.

I am fascinated by the process of personal change.  We can all identify people who seem to be living their lives “just right” as well as those that never seem to be making their goals a reality.  Are the people experiencing success “just lucky” or is there some formula that everyone can employ which would enable each one of us to get what we want out of life?  Obviously there is no simple answer, but I do strongly believe that there are certain characteristics that the “winners” in life share, and over the course of time I’d like to explore a few of these.  Today I want to talk about courage.

Every day I get to witness the bravery of my patients.  The way I’ve seen so many people courageously battle a wide variety of scourges from cancer to depression inspires me to never give up and to always keep pushing towards the hope of something better.  Most recently I’ve stood in awe of my weight management group.  I am incredibly impressed by the bravery of these people who for the umpteenth time in their lives are willing to make another weight loss attempt.  I see too many physicians say that “you can’t teach an old dog new tricks” and that my older patients, who have been heavy for decades, will never get down to a healthy weight.  I’m glad nobody told that to my 63 year old insulin dependent diabetic who was on 70 units of insulin each day who is now completely off insulin shots after only 3 weeks on my program.  I also celebrate the bravery of my 330 pound patient who was failing gastric bypass, and with my program is now down to 305 pounds! Every day these patients struggle with the desire to lapse back into their unhealthy eating patterns, but with the right tools, the right team, and bravery sprinkled on top, I have no doubt they will continue to succeed!

I also find myself drawn to brave leaders.  When I see an organization or company tackle a seemingly impossible task, I want to passionately support that effort.  I’ve just returned from Phoenix where I spent three days at the eClinicalWorks (eCW) national users’ conference.  Many of you know that I’m an eCW groupie.    I fell in love with eClinicalWorks because I admired the way the company committed itself to providing an affordable electronic medical record solution to the solo or small group doctors, since this is where the bulk of the healthcare in this country is provided.  My commitment to this company was also fueled by the story behind the innovative leadership.  Four men with unique strengths from one extended family birthed the idea of eClinicalWorks only a little over 10 years ago, and now have a company worth 200 million dollars that is truly revolutionizing the way medicine is practiced.  Every day this company faces incredible challenges in terms of government regulations, provider satisfaction, and being able to affordably provide the latest technology to both solo practitioners and large multi-specialty groups. 

But what really impresses me is eClinicalWorks' continued commitment to innovation.  Over the past month I’ve had the opportunity to utilize one of eCW’s newest features, the care plan module, for my weight management program.  There are still many bugs to work out, but the vision behind the product and the implications for its use are pretty mind blowing.  At the conference I had the honor of discussing my weight management program with the CEO of the company, Girish Navani, as well as the technical genius behind eClinicalWorks, Vice President Sameer Bhat.  I’ve attached the photos I forced them to pose in below! J But once again it paid off for me to be brave (or maybe a little pushy?) ;-), because it sounds like my patients and I will have the exciting opportunity to help the company develop some amazingly interactive weight management apps for an individual’s smartphone or iPad.  These apps will provide inspiring data and much needed support for the brave people in my program.  After attending the national user’s conference for two years in a row, I’m hooked on eClinicalWorks because the leaders perpetuate a culture of positivity and courage at every level of the company, even in the face of a complex and often daunting healthcare arena.

So to the rest of my patients out there that are following this blog for some insight into how bravery can help you in your life, I challenge you to take a close hard look at what you want out of life and start seriously thinking about how you can get it.  Don’t be afraid to try new things.  Don’t give up on a goal you think you can never reach.  Don’t shut yourself off from personal connections that can lead to a treasured support network as you pursue your dreams.  A common thread in all the great success stories was the courage to be brave!

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So did my racy title get the desired effect of having you check this out?  ;-)  I must admit I am feeling a little “daring” with my writing these days.  My father thought my last posting made me sound like an Evangelist.  We’ll see what he thinks about this one.  J

So no, I’m not going to directly write about sex, but rather a closely related topic – DESIRE!!!  I felt the need for all caps because you can’t really talk about desire without emotion, right?  Desire can be a gift when it drives us to accomplish worthy goals.  Unfortunately, desire can also be a curse when it controls us or a loved one to the point that basic principles of human dignity are violated.  When I think about the negative side of desire I think of the movie “Seven” that came out in 1995 starring Kevin Spacey.  I’m still haunted by that psychological thriller over 15 years later!

For those of you not familiar with the film, it’s about a serial killer (Kevin Spacey) who sets out to murder 7 people he believes embody the seven deadly sins, which include gluttony, lust, greed, wrath, pride, envy, and sloth.  The seven deadly sins were first described by an ancient Greek monastic theologian in order to provide a conceptual system of the spiritual shortcomings humankind has struggled with throughout the ages.  Each of these sins relates to desire in some way, so I thought it would be intriguing to take a look at them.  For more interesting information regarding the history of the seven deadly sins, I recommend looking at http://www.deadlysins.com/sins/history.html.

Three of the “seven deadly sins”, lust, gluttony, and greed, are obviously the manifestation of normal human desires unchecked.  Let’s take gluttony, for example.  We all need to eat, and a multitude of wonderful human connections take place around the sharing of good food and drink.  Unfortunately, when we consistently consume more than we need, or fill our bodies with unhealthy substances, obesity, illness, and unhappiness are the result. 

 As promised in the title, I’ll now touch on “lust”.  We obviously need this primitive desire to ensure that our species will continue to exist.  On a more cosmic level, the depth of human connection possible when people share themselves physically can lead to the height of spiritual communion, sometimes expressed in the social institution of marriage.  But when people with personal voids repeatedly try to fill that emptiness with meaningless sexual experiences, the satisfaction is transient, especially if there is an absence of other positive relationships in the person’s life.   Further, we can all cite examples of people who have hurt the ones to whom they’re supposed to be committed when lust leads to lies and deceit.

Only those with the purest of callings are able to escape the pull of money in this culture.  The current economic crisis could arguably be attributed to the sin of greed.  How many people overextended themselves when the access to home mortgages was so easy?  How many politicians and business leaders have been led into dishonest dealings because of greed?  That being said, the accrual of money as a result of hard work or a creative idea is extremely satisfying.  The happiest people are not tortured by “keeping up with the Joneses” but rather use what they and their families need, and then become active in charity.

Wrath, the most extreme expression of anger, is also one of the seven deadly sins.  Anger is a completely normal human emotion that serves an important purpose.  We become angry when something important to us is threatened.  We can best understand and keep our anger from turning into wrath if we seek to understand what feels threatened, and then explore whether that threat is indeed real before reacting.  If after careful consideration we determine it is real, we are then often better equipped to peacefully find solutions that protect what’s most important to us.  I’m sure we’ve all felt the strong desire to protect something valuable to us at some point.

I define the sin of pride as the excessive desire to be right.  One of my best teachers over the past year has been Stephen Covey, author of The Seven Habits of Highly Effective People.  One of the habits he encourages is “first seek to understand, then be understood”.  There are so many different attitudes and approaches to life in this world.  Who’s approach is right?  Who’s is wrong?  Although we could all identify actions that are truly evil, more often than not a person’s cultural, social, and economic circumstances influence the choices people make about how to live their lives.  This doesn’t make one way wrong and another right, but rather simply different.  What’s right for one person may be completely wrong for another.  As our very partisan political landscape demonstrates, pride frequently gets in the way of progress.

Envy is the sin of desiring that which we have no right to expect.  Life is not fair.  The natural human inclination to be dissatisfied means there will always be people with more of whatever it is we seek.  The sin of envy prevents people from appreciating the good things they have, because they are excessively focused on whatever they perceive is lacking.  Having a front row to the suffering that disease can cause reminds me even on my darkest days that things can always be worse.

So the first six sins all show how uncontrolled desire will lead to unhappiness, but the seventh sin, sloth, highlights how the absence of desire can be just as bad.  I came to understand this concept after reading Shatter Your Speed Limits by Wendy Lipton-Dibner.  By using a cute narrative, Wendy talks about how people can get what they want out of life by working hard to identify their “burning desire”.  The process is not dissimilar to peeling an onion.  On the surface, we may think we want something, but if we are unable to discover what that achievement truly represents for us, we may not be able to generate the passion and dedication required to make it a reality.  I’ll share that Wendy’s process helped me to discover that starting my own practice was my “burning desire”.  I’m happy to say that after assembling my resources and giving myself the internal permission to go for it, I’m making my dream come true! J

The sin of “sloth” is probably the only vice from this list that I have not felt the pull from at one time in my life or another.  I try to learn from the quieter people in my life how to occasionally “be still”.  I know I’ll always need to keep practicing this!  Each of you has a virtue in some area that makes it difficult for you to relate to one or more of the “seven deadly sins” as well.  Share this strength with those around you who struggle in the areas in which you excel.  In my opinion, this is one of the most special gifts a person can give.

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So I'm finally back with another posting after 6 more weeks of whirlwind start up activities!  Thank you to those of you that attempted to wade through my summary of the health care bill and it's implications on primary care.  I know it was dense, but for those of you that do tune in to the latest healthcare debates, I thought it would be useful to have my perspective as a representative for the American College of Physicians.  I do recognize, though, that although I was excited about what I learned in Washington, it was a little "ho-hum" for most of you.  I often query my patients for their reactions to the things I'm crazy enough to post here for the world to read.  That series often got the "I started to read it, but it was late...." response.  Ok, I get it.  Most of you thought it was boring!!! But it was useful to organize my thoughts and I'm glad it's "out there".

But now I'm ready to talk about more interesting things, like the secrets of a life well lived!  I'm hoping I get some comments to this one.  We all need all the guidance we can get!  I can't even begin to tell you what an amazing trip the past year has been for me.  As I reflect on where I've been, I realize that I'm just starting to see things as I think they really are.  I believe I've gotten to the place I am through some serious self analysis and study from some pretty incredible teachers.  I don't use the word "teachers" in the traditional sense.  Yes, I am a conference junkie, and I read every meaningful piece of psychology and philosophy I can get my hands on, but I learn even more from my family, friends, colleagues, and patients.  For those of you that are interested in following the postings I have planned, I think it's important that I wade into those controversial waters again and share my views on religion so that you know where I'm coming from.  I am an incredibly spiritual person.  Although I formally associate myself with the Episcopal church, I am very equal opportunty when it comes to religion.  From what I've learned so far, all the major world religions in their purest form share similar principles and a belief in some higher power.  I think people call this higher power different things like karma, fate, kismet, God, Allah, Yahweh, etc. but at the end of the day I think it's the same thing.  I love the quote from the French philosopher Teilhard de Chardin, "We are not human beings having a spiritual experience.  We are spiritual beings having a human experience."

Although we are all extraordinarily unique individuals, we are all wrestling with the same human desires, challenges, hopes, and hurts.  The more psychology one reads, the more one realizes how universal our struggles are.  One great psychologist that I think has it "just right" is Erik Erikson.  For those of you that are not pop-psychologists like me, I invite you to read a summary of his theories from this website http://www.learningplaceonline.com/stages/organize/Erikson.htm which I believe gives a very readable summary.  I think it's a great personal exercise to read through each stage and reflect how we think we did there.  As you read, ask yourself "Did I master this stage, or did something happen which left me with a personal deficit that I need to continually work to overcome?"  Tough things to think about, I know.  We should all be reassured, though, that not one of us is perfect.  We all have strengths, and we all have short-comings.  One of the reasons I love my job is that I get a much more intimate view of the human condition than most people in the rest of society have.  Seeing every day that I'm not alone with my inner conflicts and personal disappointments has enabled me to be more forgiving of myself when I fall short of a personal expectation.

So as I reviewed the eight stages of development that Erikson writes about, I was happy to see that I'm right on track! :-)  I'm finding that I'm straddling stage 6 (Intimacy and Solidarity vs. Isolation) and stage 7 (Generativity vs. Self absorption or Stagnation).  Stage 6 is supposed to take place from age 18-35, but has been pushed back a bit in my generation as we start our families later.  Stage 7 typically includes ages 35-65, so at age 37, I guess I'm right where I should be.  Stage 6 is where we learn how to love.  It is during this time that we hopefully find mutually satisfying relationships and often start our families.  Stage 7 is when we tend to be occupied with creative and meaningful work and with issues surrounding our family.  Strength comes through care of others and production of something that contributes to the the betterment of society.

So that's what I'm trying to do with the creation of my practice.  I want to be MORE than just a doctor who refills your medications and treats your latest infection.  I believe the goal of a true primary care provider is to help each patient achieve a new level of excellence relative to wherever they are when they walk through that door.  I hope that my studies and life experiences will enable me not only to keep my patients physically safe and healthy under my care, but also can provide some level of insight or inspiration to tackle the much more difficult pieces of overall wellbeing.  So I plan to make this blog about lessons I've learned, and a venue for sharing snippets of great writing or ideas I've come across that have spoken to me in some profound way.  My patients or those of you who are close to me will probably realize that I will annonymously write about snipets I've learned from you.  I truly believe the tools for achieving happiness reside in the ability to find mutual love, respect, and understanding.  Tonight I'll end with one more quote from Teilhard de Chardin.  "Someday, after mastering the winds, the waves, the tides and gravity, we shall harness for God the energies of love, and then, for a second time in the history of the world, man will have discovered fire."

Mark Chagall (1966) The Burning Bush

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Hope everyone had a nice 4th of July!  I think I may have to be just a holiday blogger.  I get all of these ideas, but it seems I need these three day weekends to find the time to put my thoughts together into an entry for you all.  So my last posting started to tackle some of the components of the Patient Protection and Affordable Care Act (ACA) that the American College of Physicians (ACP) feels will help attract more medical students into choosing careers in primary care.  I wanted to address the other cause of the primary care shortage in this posting, which is retention.

There are a lot of frustrated primary care doctors out there these days.  My last posting provided an overview of the challenges a primary care doctor faces.  In addition to being a multi-tasker extraordinaire, primary care physicians have been facing increasing amounts of paperwork and regulations to be in compliance with everything from insurance companies, malpractice providers, professional organizations, and the government.  The rules change quickly, and the challenge of keeping up can be daunting.  Too many primary care doctors are deciding it’s not worth it, and are leaving the field.  

The ACA will enable millions of uninsured Americans to have health insurance, but this insurance will most likely be an extension of medicaid, or HMO plans, which many privately owned primary care practices do not accept.  Hospital owned clinics can afford to see patients with these insurance types, because even if they lose money in their primary care divisions, they can make that up with the services that those patients utilize throughout the rest of the organization.  Community health centers also play a very important role because they are mostly government funded, which enables them to provide a high level of care for medicaid patients.  Many primary care doctors have been hesitant to be "employed" by hospitals or community health centers, though, because of the loss of autonomy that path requires.  Since many primary care doctors will choose to continue to run their own practices, it is important that these doctors be able to afford to take care of the millions of uninsured Americans who will now be enrolled in Medicaid under the ACA.  With only 2% of graduating medical students choosing to practice in primary care, it's important that we keep our current primary care providers motivated to stay on the front lines where they can care for the American public.

So in this photo you see me and my ACP colleagues with Representative Walsh whom we talked with in May.  In addition to Representative Walsh, I spoke with the senior aids for Representative Quigley, Representative Roskam, and Senator Durbin.  We asked these legislators to support and fund the following programs within the ACA so that Americans could feel more confident that after the millions of uninsured gain coverage, that there will still be primary care physicians for them to see.

Fixing the Flawed Payment System

Eliminate the Medicare Sustainable Growth Rate (SGR) and

Transition to Better Payment Systems for Physicians

• The SGR is a major component of the formula the Centers for Medicare and Medicaid Services (CMS) uses to calculate physician payments for providing services to Medicare patients.  It is based to the Gross Domestic Product (GDP) and not on actual health care practice costs.
• The SGR has produced steep cuts in physician compensation for services to Medicare patients.  The SGR is a target for expenditure on physician services.  If actual expenditures exceed the SGR, which they have every year since the formula was created, physicians' payments are cut.  Because healthcare costs are going up much more rapidly than the GDP, physicians are facing deeper and deeper cuts to their re-imbursements every year.
• If the SGR payment system is not replaced, Medicare physician payment rates will be cut about 40% by 2016.  Practice costs will rise nearly 20% during this time.  The baby boomers have just started enrolling in Medicare.  In the next 5 years there will be an additional 6 million seniors enrolling in Medicare.
• The problem is that there is a huge national deficit with no money to fix the SGR.  We at the ACP spoke with our representatives about enacting legislation that in the absence of permanently replacing the current flawed Medicare SGR payment system, would at least enact legislation to provide the following three things
  • Stable payments for all physician specialties for at least 5 years while providing higher updates for undervalued primary care services
  • Requirements that different payment models be pilot-tested on a voluntary basis during the 5 year period of stable payments the above legislation would provide
  • Designation of a specific transition period for broad adoption of the new models that have been shown to be the most effective based on the pilots

Mandatory Funding for the Medicaid Comparability Program

• Medicaid primary care payments are always significantly less than Medicare payments.  In some states, they can be less than half the Medicare rates.  This means that for the same service, a primary care doctor receives significantly less for the same work if they see Medicaid patients.
• The Medicaid Comparability Program ensures Medicaid payment for visits and vaccinations by primary care physicians will be no less than 100% of the applicable Medicare rates.  
• Mandatory funds have been provided in the ACA to fully implement this program at no cost to the states.

Leveling the Playing Field

Congress should ensure continued mandatory funding for the Medicare Primary Care Incentive Program (PCIP) through at least 2015 while enacting further reforms to support the value of primary care.  

• A new report by the Council on Graduate Medical Education (COGME) recommends compensation to primary care physicians be increased to 70% of the average payment for other physician specialties in order to retain a sufficient supply of primary care physicians.  
• PCIP begins to address inequities in payments for primary care physicians by providing a 10% bonus payment for designated primary care services provided by internists, family physicians, geriatricians, and pediatricians.  
• While the PCIP falls considerably short of COGME's recommendation, it will result in the largest sustained increase in payments to primary care physicians in decades.

Planning for the Future

Congress should ensure continued mandatory funding at the current levels authorized by the ACA to allow the Center for Medicare Services to fully implement the Center for Medicare and Medicaid Innovation.  Dedicated funding is needed to ensure that the new Center has the resources needed to accelerate broad pilot-testing and adoption of new payment and delivery models to achieve the following goals 

• Improved access to primary care services
• Improved patient outcomes
• Achievement of better value for beneficiaries and taxpayers
• Ensure that physicians and other clinicians and providers can count on the funding being maintained for their participation in and for the duration of any models funded by the Center

Continued mandatory funding Patient-Centered Outcomes Research Institute

• The ACA establishes a non-profit, tax exempt corporation, known as the Patient-Centered Outcomes Research Institute (PCORI) to provide comparative effectiveness information to assist patients, clinicians, purchasers, and policy makers in making informed health decisions.
• The function of the institute is solely informational.  It is specifically precluded from making mandates regarding coverage, reimbursement, or other policies for any public or private payer.
• As much as $700 billion of health care spending per year is wasted on tests and procedures that do not improve health outcomes.  Hopefully PCORI could provide information that would improve patient care, while reducing unnecessary health care spending.

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So hopefully a few of you out there have managed to get through this very dense synopsis of what we at the American College of Physicians believe the ACA will provide to the American people if certain programs are funded.  Clearly there also are many key areas of health reform that the ACA does not address.  There are also policies within the ACA that should be improved or revised, but we at the ACP strongly feel that we should not throw the baby out with the bathwater.  The aspects listed in both my last posting and this one are important advances to ensure access to primary care for all Americans.  Hopefully I've inspired at least a few of you to inform your friends and families of these important issues that the ACA adresses, or maybe even to write a note to your congressmen in support of funding these provisions within the ACA.

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Hello again!  So here is my next posting on my series in healthcare politics.  I wanted to get this up sooner, but my time for thoughtful reflection has been limited these past two weeks. J It’s an exciting time in my practice.  I had two new employees start last week who I think are great, and with whom I know my patients will enjoy working.  Kristina is my new medical assistant who in addition to her friendly personality and strong medical knowledge, also carries with her experience from two different electronic medical record systems.  She is learning eClinicalWorks like a champ, and we are excited to re-establish an osteoporosis center over the coming year because she has experience with bone densitometry from a prior practice.  Kristina will continue to work towards a degree in nursing while she works for me.  Maggie is going to be taking over a large part of the administrative role in my practice.  Maggie has an associate’s degree in accounting and finance, and is going to help manage my practice while she continues to finish her four year degree.

So back to healthcare politics….

The Patient Protection and Accountable Care Act (ACA) is a very complex piece of legislation that President Obama managed to get passed last year.  It has been disparagingly referred to as “Obamacare” by many, and has been attacked for certain provisions such as mandating health insurance coverage and encouraging discussions on end-of-life issues (death panels).  Now although there is still significant room for improvement within the law, there are some pretty groundbreaking advances that have the potential to dramatically improve the way healthcare is delivered in this country.  Unfortunately, our country is very politically divided at this point in time.  Certain issues which really should be non-partisan, have been assigned to one political party or another.  This often causes legislators from the opposing party to avoid these issues like the plague out of fear of committing political suicide.  So we are left with a situation where the Republicans want to repeal ACA, which the Democrats won’t let happen.  As a result, the House of Representatives is exerting their power by not funding the programs that were put in place by the ACA.  Basically, this leaves our country in political gridlock with a whole lot of nothing happening. 

I travelled to Washington DC in May with the American College of Physicians (ACP).  This is the primary internal medicine organization in the country, and after 9 years of membership and participation, I was appointed a fellow earlier this year.  The ACP is made up of internists from all over the country, and is a group of doctors that practice medicine for very altruistic reasons.  One of their primary stances is that healthcare should be a basic right in this country.  They are very committed to seeing that the current system changes into one that is not only sustainable, but also provides a rewarding healthcare experience for both the patient and the provider.  The platform for any healthcare reform always has to start with primary care.

Some of you may not be aware that there is a primary care shortage in this country that is starting to hit a crisis level.  Internal medicine, family practice, and pediatrics are considered the primary care specialties.  One could argue that primary care is the hardest field within medicine to do well.  This is because of the enormous volume of information your primary care doctor has to manage.  At the end of the day, it’s your primary care doctor’s job to know about everything related to your health.  We are the “moms” or “air traffic controllers” in the world of the patient.  We do all the referrals, field the vast majority of questions, and do most of the patient’s refills.  Add on top of these already challenging tasks all the documentation that’s now required by the government and the insurance companies, and it’s easy to see that this job is not meant for the weak of heart. 

A bigger reason for the critical shortage of primary care doctors, though, is the fact that they are the lowest paid doctors in the medical world.  All doctors pay the same amount for school, but how much they make out in practice is very different.  The average medical student is graduating with $160,000 of medical school debt at the age of 30.  Given the big income discrepancy amongst primary care doctors and specialists, it’s not surprising that students are choosing to specialize instead of stay in primary care.  Today only 2% of medical school graduates are choosing to work in primary care.  This is a scary statistic given that 100% of the population needs a primary care doctor.  Those of us in Chicago with private insurance may not notice the shortage since we live in an area that attracts primary care doctors instead of a rural area or undesirable part of the city.  So we need more primary care doctors, and the Accountable Care Act addresses this issue both on the supply side and the retention side.  I’m going to address the supply side in this posting, and we’ll get back to the retention issues in my next posting. 

1.       The ACA includes a provision for increased funding for the National Health Service Corps.  This is a program that repays part of the medical school debt in exchange for working in an underserved area.  For every 2 year commitment, doctors can get about $40,000 of loan forgiveness.  Note this still means that a young doctor has to live and work in an undesirable area for 8 years on average to pay off their debt.  This translates to now having to wait until their late-30’s to live where they may want to, but at least it’s an option for loan repayment which also helps to meet the primary care need in areas of the country with the least amount of access.  Currently there are about 7 applicants for every National Health Service Corps grant available.  Increasing the number of grants will increase access in the areas of the country that most need it by encouraging medical residents to pursue primary care in underserved areas to pay off their debt.

2.       Section 747 of the ACA would increase funding for training in primary care medicine across the country.  Obviously we need to make this investment if we want to be turning out enough well trained primary care doctors.

3.       The ACA also provides funding for a team of 15 experts who would determine whether the demand for health care workers is being met, and then identify and fix barriers which keep physicians from entering and staying in careers in primary care.

So those are the provisions that will help us to encourage more medical students and residents to pursue careers in primary care.  It may not be the most glamorous of the medical specialties, but it is probably the most needed role.  As a member of the American College of Physicians and as an advocate for those who do not have access to care, I support funding these provisions of the ACA to ensure that everyone has the opportunity to improve their health and wellbeing through primary care.

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I’ve always had a tough time deciding what political party to affiliate myself with.  I’m either a conservative democrat, or a liberal republican, and I’ll admit that my stance changes based on which candidates are taking on the issues I feel most passionate about at the time.  I will also admit that up until 2010 I was somewhat politically apathetic because I saw so many problems within our healthcare system, but very little hope for real change.  President Obama’s support of the HITECH act which passed both houses in 2009, started to change my outlook on the future of healthcare in our country.  This piece of legislation provided funding to physicians for the transition from paper records to electronic records.  If certain quality and reporting measures can be met with the electronic medical record (EMR) that is implemented, there is up to $44,000 per physician to help pay for the implementation.  In addition, grant money is being provided by the government to state based regional extension centers to further aid implementation processes for physician offices. 

Those of you who have engaged me in a conversation regarding EMR have probably heard way too much about how I believe universal EMR implementation will revolutionize health care and the way physicians can interface with their patients.  Allow me to summarize what I see as the biggest benefits of this technological revolution.

1.       Physicians can now communicate with their patients through a variety of media including secure email over patient portals, text messaging, and automated phone calls.

2.       Patients now have access to their personal health records 24 hours a day, 7 days a week.

3.       Physicians will be able to access labs, diagnostic images, and ultimately even records that were completed at other facilities anywhere in the country.  Having more information in the doctor’s hands leads not only to better patient care, but also lower healthcare costs because tests do not need to be repeated.  Unfortunately at this point in time individual physicians can restrict the flow of information by not granting electronic access to other physicians.  This results in a cost for the patient because they have to pay for a paper copy, and instead of focusing on the patient, the doctor must reenter all of the information manually.  It will be a glorious day in only a few short years when all of your health information is securely housed within an electronic health exchange, because I've personally seen how difficult it can be for patients when their doctors don't grant electronic access of patient's records to other physicians.

4.       Data that is reviewed during a visit can now be anonymously reported to research organizations so that better treatments and therapies can be developed more quickly.  In the future, physicians will be able to predict if you have the biologic predisposition to have a side effect from a medication instead of the “just try it and see” approach we need to use now.  Ultimately we will also likely be able to practice prospective genetically based health maintenance.  This means that not everyone will need the same screening tests with the same frequency.  In the future, after a genetic analysis, doctors should be able to inform their patients what negative health outcomes they are most at risk for, and then order preventative testing based on the probability of an illness happening, instead of the “one size fits all” model we use now.

5.       There will be a major environmental impact as physician offices and hospitals become “paperless” and use significantly less toner.  I've been amazed by the reduction in paper and toner usage in the places I've practiced that have converted to electronic medical records.  Imagine the impact on a national scale!

So for those of you who have been frustrated by the growing pains in your doctors’ offices while this transition is implemented, maybe this will encourage you to hang in there.  After 12-18 months of using an electronic medical record, everyone gets the hang of it and the benefits begin.  I am very excited to play a more active role in this revolution as I continue to offer EMR selection and implementation services to those health care organizations and physician offices that stand to benefit from my “lessons learned”.  One of my missions is to have a HITECH “platinum practice” where the most exciting technological innovations will continue to be implemented so that I can continue to provide FIVE STAR service to you, my patients. J

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So today's post is in honor of all the incredible mothers out there!  

Last week I was honored to attend the book signing of one of my best friends from high school, Hollee Schwartz.  My amazing friend is the author of Good Enough is the New Perfect, which she wrote in concert with her friend from college, Becky Beaupre Gillespie.  I feel their book offers one of the most amazing cocktails to successful motherhood that I have ever seen.  Despite being in the throws of getting my new practice up and running, I have gobbled this book up in the last ten days like candy.  The book looks at the generations of women that have come before us, the legacy they have left, and the challenges we modern mothers now face. 

The premise of the book is that in our quest for perfection many of us have not found happiness.  Let's face it - in our fast paced, high pressured communities, who among us hasn't found herself trying "to win the motherhood Olympics"?  Addicted to signing up for the endless offerings available to mothers and children throughout Chicago, many of us have found ourselves overscheduled and just trying to keep up.  In addition, I feel we live in an age of information overload.  Previous generations never "seriously contemplated whether we had the right mix of organic vegetables on our plates when they were shooing us into the neighborhood" with bologna sandwiches and processed cheese.  Today we have to worry that if we step ten feet away from our car with our children fastened securely inside that we can be arrested for neglect.  These pressures are intense even for those moms not working outside of the home.  When you throw a career into the mix, some women can be pushed to their breaking point.  

As a physician, I have so many people coming into my office who just "don't feel good".  After listening to the history, examining the patient, and checking the necessary labs and tests, I often am faced with a paradoxically frustrated patient because everything that we can objectively measure is normal.  The next question I'm often asked is, "Could this be related to stress?" and my answer is always YES!!!  If you are unhappy, or if your work, family, or personal relationships are not working, "your unhappiness is palpable to the people around you" and inevitably will have negative effects on your health.  This is what drives me to be more than a vehicle for pushing pills and ordering tests.  I think doctors need to identify what factors are negatively affecting a patient's health, and then work as a team to develop a strategy the patient can employ to make it better!

One of the first steps is identifying that "good enough is the new perfect".  I've had to learn this lesson time and again as I've navigated the world of the working mother.  I throw myself into being the best physician I can be, but I often don't feel as accomplished on the motherhood front.  I do my best to stay on top of the kids schoolwork, attend to their personal safety and emotional needs, and keep the house stocked with nutritious options, but just last week, after a particularly grueling day of getting this practice off the ground, I fell asleep without remembering my six year old had lost his second tooth and was expecting the Tooth Fairy to pay him a visit!  At 6am when I heard the boys stir, I immediately remembered my foible and prepared myself to face that special place in hell for mommies like me.  Luckily my quick thinking allowed me to construe a story about the Tooth Fairy mistakenly going to California to look for my son, since that's where he lost his first tooth.  As only a six year old could, he bought it, and was overjoyed the next morning when he found under his pillow not one dollar but two!  Late fees, of course!

We all need to reach "a point in parenthood where we make peace, more or less, with the inevitable mistakes and concessions" that go along with raising a family.  We need to celebrate our successes and forgive ourselves when we don't quite meet the mark.  Focus on leveraging your strengths, and control the voice within your head that berates you for your weaknesses.  Personally, I'm going to stick to my talents as a physician, because I've proven I'm a crummy Tooth Fairy! ;)

Thank you to Hollee Schwartz Temple and Becky Beaupre Gillespie, authors of Good Enough is the New Perfect, 2011 Harlequin publishing.

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"We can work through any transition!"

Because of HIPPA I can't openly thank the patient who inspired this posting today, but you know who you are....

Transitions are tough.  Most people don't like them.  Usually I think of transitions when it comes to relating to my children, but once again I'm seeing how the lessons I've learned during my last 12 years of motherhood serve me well in other areas of my life.  I have been blessed with four very "spirited" children.  Now to those of you who are familiar with Raising Your Spirited Child by Mary Sheedy Kurcinka 1998 you will know that "spirited" is a much more positive word for "difficult".  The cover of the book describes it as "a guide for parents whose child is MORE intense, sensitive, perceptive, persistent, or energetic."  I always marveled at those parents that could take their babies and toddlers to restaurants.  Parents that could put their baby in a carrier and watch a movie REALLY blew my mind.  My kids have always demanded center stage.  As babies they've needed to be held, walked, sung to, and danced with.  As toddlers they've been able to blow any other kids' tantrums out of the water.  Happily, by grade school age they've all managed to "pull it together" and become what I like to call "civilized human beings". :-)

Now I don't think anything happens by accident.  I think my children are growing up into well adapted human beings because I improved my ability to navigate transitions.  One of the main things Kurcinka's book taught me was how to anticipate and then manage transitions.  My favorite example was getting my daughter ready to go to day care when she was 4 years old.  This used to be a NIGHTMARE.  Almost every stage of the process was accompanied by a tantrum.  After reading Raising Your Spirited Child I recognized these morning battles for what they were - a transition from home, mom, and dad, to daycare, where she would stay for 11 hours.  I subsequently implemented a strategy I learned from the book of printing from the internet pictures of the various tasks we had to complete before getting out of the house in the morning (getting dressed, brushing hair, brushing teeth, etc.).  Each night I started having my daughter lay the pictures out in whatever order SHE chose to complete them in.  The next day we woke up and immediately looked at the pictures to remind us of what we had to do.  Miraculously, the tantrums decreased almost 100%!  

I've also learned about managing transitions because I have 3 boys who stutter.  We work with Kristin Chmela www.chmelafluencycenter.com who is an extraordinarily gifted fluency specialist, and Megan Carick, OT www.kids-in-sync.com who I've nicknamed "the child whisperer" because of her remarkable instincts when working with children.  Both Kristin and Megan have helped me to see that my boys' fluency is dramatically affected by the way we manage transitions.  Under their tutelage I have learned an incredible amount about navigating change. 

In my opinion, these are the five most important rules to follow in order to have a successful transition:

1. People need to be prepared and given time to assimilate to the transitions they are faced with.

2. People can only accommodate to change if they feel like they are part of the process.

3. Nobody reacts well when they feel like their power is taken away from them.

4. Communication is the key to successfully moving through any transition.

5. Nobody wants to be unreasonable, and everyone simply wants to be understood, respected, and listened to. 

I call on these principles to help me to successfully navigate times of change and conflict regardless of whether it is with my family, my patients, my staff, or a doctor I'm trying to shepherd through the transition from paper to electronic medical records.  Thank you to all of my patients that are being patient enough to work through this transition with me.  In the words of my unnamed patient, together "we can work through any transition!"

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As we celebrate our holidays this week, be it Easter or Passover, I would like to personally take a break from the insanity that has been my life the past couple of weeks and say thank you.

Thank you to my mother, who has enabled me to be the woman I am today.  My mom left her career as an elementary school teacher to stay home with my sister and I.  She has always been and continues to be a mom superstar.  Growing up my mom modeled a type of excellence for my sister and I that we now do our best to emulate.  Although she did not work outside of the home, she threw herself into her roles as the girl scout troop leader, the president of the PTO, and the president of the Pittsburgh Junior League.  While doing all of this she kept an impeccable household, and ran a business as a seamstress out of our home.  When my father launched his engineering company, she contributed her aptitude for finances, organization, and personal relationships to step in as his office manager.  Today in between caring for my ailing grandparents in Milwaukee and trips to Minneapolis to help my sister, she is the second mother for my kids, and often steps in as my household manager.  The most important gift my mother has given me, though, is compassion for others and a desire to serve those in need.  I can be there for your needs because she is always there to help me with mine.  Thank you, Mom, for being "the wind beneath my wings".

Thank you to my father, the one who modeled the courage that it takes to make this first step as an entrepreneur.  My dad started his own engineering company when my sister and I were 12 and 15 years old.  My mom did not bring in a salary, and they had no significant savings to rely on, but my dad had a vision he was passionate about.  He was 41 years old and felt he had the knowledge, experience, and inspiration to make something out of nothing.  It was hard work, but his enthusiasm, charisma, and incredible work ethic saw him through.  He ultimately sold the company for a nice profit.  Through either nature or nurture, I have that same bonfire inside of me to create the perfect medical home for my patients.  I have a vision of a place where I can provide for as many of their healthcare wants and needs as I can.  My father also taught me about persistence and determination.  He himself never shied away from a daunting task, and he never allowed my sister or I to either.  When we were faced with a challenge, he didn't rush to our aid, but had this saying, "Do you know how you eat an elephant? One bite at a time...."  I believe this attitude enabled me to discover that I was capable.  I knew my father would never give up, and to that end, neither will I.  I am proud to say that this attitude has allowed me to accomplish much of what I have to this point, and I think it will enable me to establish my medical practice for all of you as well.  Thank you, Dad, for giving me the courage and confidence to take this step.

Thank you to my sister for always being my friend, my confidant, and more recently my inspiration.  My little sister works as a high powered corporate executive.  She also manages to care for three year old twins while excelling at a full time job that often requires travel, even overseas.  She is a black belt in six sigma, and works on large IT projects in the realm of organizational readiness.  As I have been developing my ideas regarding electronic medical records, and how I can help make the transition easier for my doctor colleagues, she has been a remarkable sounding board for all of my ideas.  I am so impressed with her expertise in this area, and it's great to be challenged by her active mind.  People have thought my sister and I were twins.  I, however, happen to be the quieter and softer spoken one of the pair, so those of you who know me will have a sense of her energy! :-)

Thank you to my in-laws who bought a second home close by so that they could travel more often from their home in southern California to be with us.  They also are true team players, and pitch in to help with my kids whenever asked.  They also were with me during the week I came to the decision to leave my former practice.  This was an incredibly emotional time for me, and their support was incredible.  After knowing them for 18 years I truly feel like their daughter, and I know I can always count on their love.  They are another critical unit for my children.  Their love and enthusiasm for being with my children also brings me the inner peace that provides me the internal permission to be home less so that I can work towards my professional goals.

Thank you to my brother-in-law who got this website and blog up and running for me in record time!

Thank you to my nanny, Margaret, who is often mistaken out in public as my kids' grandmother.  Her loving nature is infectious, and she brings happiness wherever she goes.  She also keeps our laundry and household mess under control when I am gone, a true blessing!  She is incredibly reliable, and even when there is terrible weather, or she is sick, she is always there.  This means I can always be there for my patients.  

Thank you to my girlfriends - you know who you are.  I appreciate your listening ears as I've worked my way towards this big transition.

Thank you to my 11 year old daughter for being so supportive of my work.  Her creativity amazes me and I am so grateful that I have been blessed with a daughter that I can watch grow up into the amazing woman she is meant to be.

Thank you to my boys for always bringing a smile to my face no matter how challenging my day was.  They remind me to stop and cherish the little things - a cuddle on the couch, a walk to the park, bubbles, coloring, songs, and stories.

Thank you to my patients that are choosing to come with me on this journey.  The outpouring of support that I have gotten from so many of you through email, snail mail, and phone calls this week has been overwhelming.  At times I've even been moved to tears because it's more than I ever expected.  Your faith in me has only renewed my commitment to each and every one of you.  Thank you for putting your lives in my hands.  I promise to do my best to live up to your expectations.

But most of all thank you to my husband.  We've been together for 18 years, and I feel so blessed to have chosen the perfect life partner for me.  He is the rock upon which I lean.  He supports me through everything and I know that he will always be there "for better and for worse".  He loves me even when I don't act very lovable.  He listens with an ear that never tires.  His brilliant mind helps me to work through tough challenges.  His arms comfort me when I'm feeling down.  He celebrates my successes and encourages me when I have disappointments.  He is an amazing father to our children.  He allows me to take risks, and has more faith in my abilities than even I do.  My gratitude for his presence in my life is hard to put into words.

People often ask me, "How do you do it?  Four kids, a medical practice, EMR consulting, Sunday school teaching, girl scout leading, running...."  So here's the answer - I've been blessed with an incredible team that lets me "shatter my speed limits**".  So take this holiday time to tell your supporting cast how much you appreciate them.  Remember everything, whether positive or negative, rolls down hill. :-)

*From M.A.D. Leadership For Healthcare, Wendy Lipton-Dibner, 2009 Greenbranch

**Shatter Your Speed Limits, Wendy Lipton-Dibner, 2010

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Flexibility

My goal is to provide multiple options for my patients in terms of appointment times, locations, and communication.

Integrity

I hope to build a practice where trust abounds, so that patients feel safe in our care.

Value-Commitment

I am grateful that you have chosen to put your healthcare in my hands, and I plan to go the extra mile to see the pain and hope in each of you, so that I can help you to improve your health using whatever tools may be necessary for each of you as an individual.

Excellence

I plan to hire and train a staff that can continually change and grow to meet the needs of our patients. I personally hope to continue to stay current and implement the latest technology and medical knowledge so that I can remain an expert in my field. 

Safety

My goal is to create an environment that adheres to strong practice guidelines so that all of our patients can be both physically and emotionally safe.

Team-Orientation

I want every doctor, employee, patient, colleague, and family member to know that they are part of the Northwest Specialty Medicine Team.

Accountability

Every member of my Team will need to be answerable to each other, our patients, our colleagues, and ourselves.

Relationship-Savvy

I want everyone at my practice to remember that the stronger the relationship, the more we can accomplish with each other, our patients, and our colleagues. I want to constantly work to build trust and rapport and to create long-standing relationships with everyone we meet.

From M.A.D. Leadership For Healthcare - Proven Strategies to Get People To Do What You Want Them To Do, Wendy Lipton-Dibner, 2009 Greenbranch Publishing

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