i'm in a hurry

I get this reality reinforced regularly, but I think it bears mentioning. maybe it will be a gas saver or even a life saver, certainly a stress saver. There is an Alabama song called "I'm in a hurry (and don't know why)" and it came out a number of years ago. True then, it remains true today. 

I was on my way to the hospital this morning and an elderly man pulled out in front of me on a stretch of road where the speed limit is 55 and the usual speed at this area is 10 or miles per hour higher than that. He was going maybe 35 and showing no sign of increasing that turtle pace, despite the fact that the light was at least 1/2 mile away. I passed him, on the right, because he also was a left lane loser, and continued on to the light. Guess who pulled up right behind me at the red light? You guessed it. Tortoise and the hare, and despite my jackrabbity move he plodded right up to where I was waiting and we made the turns together and entered the hospital parking almost simultaneously. 

This is not even close to the first time such a thing has happened. It happens on I-35 when I pass somebody doing less than the speed limit, zip merrily on my way only to find them exiting and/or getting to the destination at the same time I do. It is not worth it to stress over who's slow and who's fast. We all get to our destinations at nearly the same time, more safely, less stressed, and maybe the 'slow' guy even gets a little lift when he sees me stuck at the light with him after I had blown his doors off with my Volvo precision racing machine (well, it is a Volvo). 

I find the same thing happening with patients in the office. The more hurried I get the more 'by the way' questions I get, and against all ethical and patient satisfaction advice, my hand is gripping the door handle throughout most of these encounters. That's a big no-no. And it always backfires. If I can go in each room with the idea that I'm there for that patient at that time and take care of their needs and answer their questions readily and ask at the end of the visit "did we cover everything you wanted to have checked?", I'm happier, they're happier, and it took no longer, and arguably less time, than it would have had I been rushed.

So, take a deep breath, go the speed limit, pay attention to the people passing you and seeming to be in a hurry, then look for them at the next stop light and smile, maybe give a thumbs up sign. Especially if you have a fish on the back of your car. God's not a fan of bad advertising. 

an answer to reverend mom

there is a place in heaven for people like reverend mom. her comment on 'my real healthcare plan' brings up an excellent question. children or adults with multiple medical problems pose the biggest problems for and biggest burdens on the current system. obviously not everyone is healthy. disclaimer: i am not a politician or an expert in healthcare policy or funding.

to be candid, i have mixed feelings about this particular case, but it brings to light issues that need to be addressed. i admire all the reverend moms out there, people who are willing to adopt children who have multiple medical problems are truly being 'religious' as defined in the book of james in the bible - caring for widows and orphans. under the plan i laid out, her daughter would cost her quite a bit of money in flexible spending account funds and it is possible her major medical policy would have a higher cost as well. certainly there needs to be some way to make such adoptions more financially feasible for those families willing to take on the responsibility. i don't know who should provide the funds to help. it seems to me that it is not the state or federal government. perhaps the christian community could facilitate such sacrifices of time and love. i may be wrong, but it seems that it's usually christians who do such things. i hope i'm right. maybe some of that money that goes to 'art' or all the money used to advertise tobacco while telling people they need to quit smoking, that would be a start. some of the private funding for the campaigns of politicians could be redirected and more than pay for it, given there is a commercial starting or ending with 'i am ............ and i approve this message' competing with the 'mattress brothers'. 

people with multiple medical problems need health care. if such a person is a child with no family, it takes a special person to even become involved in their life, much less adopt them. it shouldn't bear a penalty, but it will come at a cost. but here are my 'mixed feelings'. the person who is willing to adopt this child needs to know what they have to look forward to in the way of health care costs. yes, it may be a deterrent to said adoption. a family needs to know up front the financial costs involved and make the decision to adopt with eyes wide open. 

so, having a system where the costs of care are known as i have mentioned would allow there to be a forecast of future expectations of the financial aspects of such an adoption.

as for those families whose children or parents or brothers or sisters have these problems, but who are not up for adoption, or even for those people who have these problems themselves, there should be a way that they can live without their health consuming all of their assets. i'm talking about things that people have no control over - to provide aid for those with all the 21st century ills representative of our lifestyle would break any bank.

i still don't think the government is responsible for these problems. the government shouldn't penalize people for doing the right thing, but subsidizing them? i don't think so. there should be ways to not tax the money used for healthcare that's legit. much like where insurance pays for your gallbladder surgery but not your boob job, pre-tax dollars could be used for the former but not the latter.

so...rambling, i don't have an answer for people who, by doing the right thing, have added burdens to themselves that are not 'fair'. i really think many would do the same thing regardless of who pays for it. they would find a way. it may be the government involvement in health care that has caused the problems we have currently. without their 'help', the 'church' as a whole would have been responsible and it would have had to step up and show that the 'true religion' is their true goal. regardless of how these things turn out, He knows what He's doing, we don't have to worry. we have to work, we have to be active and we have to pray, but we don't have to worry. i suspect that many of our health problems would be gone, and others more easily managed, if we stopped worrying. but that's another blog.

mirrors 2

ok. this may be a little deep and maybe i'm going down a rabbit trail or rabbit hole or whatever, but i thought of another angle on mirrors. here goes.

as parents, our children are mirrors. they do reflect what we do more than what we say, that is true. and it has been said that most of our beliefs are in place by the time we are 8 years old. 8 years old.  our 'programs', if you will, are up and running, including our world view, the way we treat other people, and many things of which i'm not certain, but i'm pretty sure there's more. that should make us pretty nervous if our kids are under 8 and very observant if they're older. we should take care of what our children see and hear. we should teach them the values we want them to have. they are like clay that hasn't hardened, cement we can put our handprints in, a blank slate we get to write on. we too often delegate this to others. i'm not talking about schools, because most of the time before 8 is gone before kindergarten starts, so even though some can make homeschooling work, not everyone can, and public school won't ruin your children any more than homeschooling or christian school will fix them. you are the most important teacher your child has, even if he spends a good portion of his day at school. your influence will reach through that of the teacher and the principal and the friends. your attitude toward others, how you treat them, what you say about them when they are there and when they are not, how your actions look when people are watching line up with those when you're alone, all these things will show up in 'the mirror'. your mirror. 

do you know those microphones that seem to have a delay between what is said and when you hear it? or those keyboards that have you typing for several characters before you can view what you've written? multiply that delay by a lot. what you do today with your kids may not show up for a long time. a very long time. the bible says 'train up a child in the way he should go and when he grows old he will not depart from it.' i had trouble with that verse in proverbs for a long time. i know plenty of people who are good people whose kids have turned out not so good. and i know the opposite occurs as well. but someone clarified it for me - it doesn't necessarily mean that they won't depart from it but it also means it won't depart from them. hence the discussion about programs that are running.  and mirrors. mirrors with delay. so thinking about our kids as mirrors should sober us and make us consider our actions. but there is a danger in this mirror philosophy. some people, many i would say, see these mirrors as something different. 

when we treat our kids like mirrors that are reflecting back on us, we make a mistake. we can't let this occur. by doing this we don't let our kids fail because we don't want to be seen as failures as parents. mistakes, poor choices, are good teachers if we allow them to occur and go to their logical end. when they are toddlers, we should let them be hungry when they don't want to eat what we've prepared for them. but she's so thin! if i take away her bottle she won't eat anything! the lady at walmart says she thinks my child has malnutrition! maybe even a vitamin deficiency! 

it gets worse when they go to school. teachers and school counselors are either witting or unwitting (is witting a word?) participants in this phenomenon. 'he's gifted, you need to get him into a special program after school' ' she's not performing up to her potential' ' he's our best player' 'she's not turning in her homework' ' he doesn't seem to care about his grades'. you name it, you may have heard one or more of these. the undertone of such comments is 'you're not a good parent' or 'you can succeed  through your child'. both are bad. moms seem to be more susceptible to the former, dads the latter. so you do their homework, put them in the special program, let them join the traveling soccer team, whatever. but so you look good in the mirror, you will do it. it often shows up as mom saying things like 'we have a lot of trouble in school' or 'we're not eating very well' or 'we're so busy going from practice to practice'. when moms say 'we', i cringe. in this setting, this means she is taking over for the child, and the child will be damaged by it. what is that mirror (the delayed one) going to look like when she grows up? when he goes to college? gets a job? never having been allowed to fail or quit the gifted/ap class or take time off or not perform at full steam all the time, he will have unreasonable expectations of himself, not knowing that he never did it alone when he was younger. she may be distressed, depressed, stressed. he may keep it up and pass it on to his kids, like the mirror that he is. his programs are telling him that to rescue his children is the right thing to do and that he would be a bad father if he lets them fail so he goes against what his education/religion/faith/psychology class/pediatrician tells him to do, and goes ahead and does what his mother/father did, almost without thinking. so the cycle continues ad infinitum. i see it daily on both sides, the 'bad mom' side at least as often as the 'dad living through his child's success' side. of course the 'bad mom' victims come to me for help for their 'poor eaters' and 'underachievers', while the stress fractures and misuse/overuse injuries of the latter group are their ticket into my office. it's amazing what one can see when one looks for it.  you just have to look in the mirror. 

mirrors

the only thing worse than having televisions (and loud music bothers me, too, but that may be my age) in restaurants is having mirrors. big mirrors, along the walls, where one can't help but look. it may be tempting to some to watch a sporting event while eating if the tv is within easy view. it truly is a temptation, no doubt, and for me, at least, it doesn't matter what's on, just that something is on. and i don't even watch that much in the way of tv sports at home on my own tv!

ok, though, mirrors are worse. it's nearly impossible not to look at oneself in a mirror that's within view. am i looking good? bad? do i have something in my teeth? is my fly unzipped? is somebody watching me watch myself in the mirror? it's a big problem. humans are drawn to mirrors like flies to ...

my favorite preacher on the radio, alistair begg, recently said "the value of the mirror is not narcissism so that we can congratulate ourselves, the value of the mirror is in order for us to see our predicament and do what we can to fix it." well, in a restaurant, beyond fixing a hair that's out of place or an unzipped zipper, we're faced with either narcissism or seeing our predicament. it always looks to others like narcissism, trust me. but to me, unless i happen to be in some place where i can compare myself favorably to the others in the mirror, i'm faced with a predicament, and that predicament isn't going to be helped by eating in that restaurant. i'm overweight, slouching toward obese. i'd like to be thinner. maybe they should put skinny mirrors in restaurants as they allegedly do in clothing store dressing rooms. then narcissism could at least have a turn. as it is, the mirror that i can't help but look at is showing me this guy looking back who's not the guy i picture in my mind's eye. and i hate the mirror for that. for showing the truth. 

my wife recently gave a great statement - "our bodies are older than our minds are willing to admit". ouch. what happened to "you're as young as you feel?" 

in the bible in 2 corinthians 10:12, paul says "we do not dare to classify or compare ourselves with some who commend themselves. When they measure themselves by themselves and compare themselves with themselves, they are not wise." so really a mirror is just a way to compare ourselves with ourselves of the past or some other "themselves" who are svelte and fit and look great. we are not to do that. sure, we are to see our predicament and look for a way out of it, whether it be physical or spiritual.

but the real fault is not with the mirror or the restaurant, they are just players. the fault is that i, like many of us, spend too much time, whether in front of a mirror or not, looking at myself. not in aristotle's "an unexamined life is not worth living" way, but in a "what about me?" "why me?" "what am i going to do?" "what do they think of me?" "what can i do to make them like me/love me/keep coming to me/keep working for me/keep paying me/keep being my friend?" way. those things are not for me to consider regularly. sure, a brief check in the mirror is fine, but to get lost in it considering the person in it is wrong. we are called to consider others more than ourselves. humility is not thinking less of oneself, it is not thinking of oneself. what a goal! in 2kings there's a king named hezekiah and he shows off his "stuff" - all the treasures of judah and the temple - to some people, in a "look at me and what i've got" way. God wasn't happy with that and so isaiah (i think it was him) told him that he would be punished and that the punishment was that his children and his children's children, yada yada, would never be kings and would suffer all kinds of stuff and the country was going down after he was gone. his response? "but nothing's going to happen to ME?" we are hezekiah, or at least i am. more concerned about us and now and what i've got or don't have than about my ancestors and neighbors and those around me every day at work or school or wherever and what my actions and words do to them or for them beyond what they get me and to heck with the budget deficit and the environment and social security and medicare and world hunger and the war in wherever and my church and my pastor and the lady who's ministering to inner city kids and my friends who are in pain from divorce or their kids and the effects on them and ... i can't go on. i feel like the teenage girl in boulder, colorado, from early in my practice when "mall bangs" were all the rage and cans of hair spray were used daily and 'green' boulder began to broadcast the depleted ozone message and the effects of aerosol cans and global warming and all that when it was new and news and her response was "to heck with the ozone, i've got to have my bangs!" ouch. 

my real healthcare plan

Everyone should take out a high deductible major medical policy to cover catastrophic stuff, big stuff, then have enough money available either liquid or line of credit, to cover that deductible should it be needed. Then we should pay out of pocket for our "incidental" stuff like sinus infections, bronchitis, sprained ankles, prescriptions, shots, checkups, etc. We could use a health savings account, use pretax dollars, and be able to "roll over" unused balances from each year if available. Then we would become better consumers of healthcare and not the entitled brats we've become. We would think more carefully about the MRI that's ordered, the prescription that's given, whether we should get generic, etc., and be responsible for our own healthcare costs. For families having kids, they might save up a few years' worth of savings from their good health to cover the costs of a new baby, and then the catastrophic plan would cover a premie with big needs or a high risk pregnancy. We would be more likely to have mom come move in with us, maybe we would even build on an addition for her and hire a nurse/aide to care for her at her home or ours, if we compared the costs of a nursing home and the heartaches of such an arrangement with this "radical" though time-tested method of caring for the aged.

Sure, you could go with the car insurance idea to decide how much insurance you could get for the money, but the idea of using the difference between the premium on your major medical policy and your "cover it all including prescriptions" plan to put into a health savings account with the ability to roll it over and even get interest on the money would help the elderly pay for their long term care since they've been paying into this for years and haven't been counting on the government to manage it, they've been managing it, and if they want to go to the Bahamas to retire to a seaside village "nursing home" and they can afford it, so be it.

I'm not political enough to know who's for this, if either of the candidates is, but I'm pretty sure it's not Barack Obama. 

As a physician, I should become more like our colleagues, the veterinarians, and know how much things cost and be able to give people a reasonable idea of how much things will cost and let them help in the choice. If there's a cost difference for the same procedure at one place vs. another, they should know. We would have a big element of change on our hands, both physicians and patients. For this generation, which has grown up saying "sure, go ahead, I've got insurance" to find out how much something is going to cost and decide if they should get it or do it, is going to be uncomfortable at first. It's going to affect malpractice because if I recommend something and the patient doesn't want to do it (like vaccines now!) then has a bad outcome as a result of choosing not to do it, I'm liable under the current system, even if I was adamant about them needing to do it or get it or whatever, and documented my advice. Maybe videotaping of consent will help this. You get taped turning down my advice. Now of course if my advice results in a bad outcome...I'm still liable and should be. And many things aren't black and white, and the definition of a bad outcome will have to be ironed out. Oh, so many things, but our consumer economy can get through it, we just have to quit being ostriches as far as how much things cost (physicians and patients) and be willing to present and accept options.

Unlike our friends the veterinarians, though, one of our options (at least currently) isn't going to be "or for this amount, we can put X to sleep". I'm a little afraid that time may not be far in the future, especially if humanist atheists are running the system. But I digress...

But I need to know!

Very often, in the course of a day, a mom will bring a baby who is fussy. Or who has a fever, or isn't sleeping. It's amazing how happy they are when I find something wrong! Or rather, how disappointed they are when I don't. It's better for the child to have an ear infection to explain the problems than it is to have some viral thing without a specific name causing all the trouble. Regardless of the fact that the virus will pass without treatment and the ear infection will likely require antibiotics (for more on this, see future blogs about antibiotic use). Oswald Chambers, in My Utmost for His Highest, my favorite daily devotional, said on July 18 "We command what we are able to explain, consequently it is natural to seek to explain". In this instance, I think his words ring true. An ear infection is a known entity. Viruses are not. Some people will say "it's just a virus" and be happy or disgusted that their child was lucky enough not to get some infection that had a name or a treatment. The truly paranoid, of which there are a growing number, think of all the viruses that strike fear into the hearts of parents, like West Nile virus, or measles or mumps, or HIV, to name a few. A balance between disgust and fear is a reasonable position. It just is interesting that parents, especially closer to the weekend, are happy that their child has a "known" problem, rather than a nebulous one that is not as predictable or treatable, even though their child will live through it and be fine after.

a behavior management metaphor

OK. I talk to parents daily and discuss behavior management. I try to teach to ignore certain things that aren't good if they aren't trends in that child's behavior but are more just episodes. But I couldn't/hadn't come up with an analogy until just the other day. And it really applies in several areas.

Our new employee lives in an apartment complex. They have assigned parking spots. They have the right to call a number and have a car towed that is in their spot. They pay for that right in their rent. So, someone parked in her spot. Once. It was a big truck. She debated calling the number for the tow, but decided against it for a couple of reasons. One, it may have been a mistake or ignorance on the part of the big truck owner. Maybe he wasn't informed of the policy, maybe he had an emergency and the seriousness of that superceded the importance of the policy at that point. Maybe, if she talked to that person, she would find out. Her choice was to call or just deal with it and park somewhere else. But, even though she considered the possibilities above and chose not to call, another reason for not calling was that she was afraid of the response of the person driving the truck. He would know who called because the spots are assigned, and he might cause her some trouble if she exercised her rights. So, she didn't report it and let it go. And it's only happened once. Did she make the right choice? Yes. Were her motives good? Yes and no. Or maybe just yes. However, if the truck continued parking in her spot because of her lack of response, if it became a trend rather than an episode, she needs to report it and take it to the next level. Regardless of the possible ramifications? Maybe. She should definitely consider these and make plans to control them to the best of her ability, and she should find out who this big truck's owner is and why he's parking in her spot. Then, if he is just doing it because he can, and he refuses to cease and desist, she must exercise her right to the spot and take the necessary actions.

Can you see the analogy between this and a child's behavior? Maybe he forgot to take out the trash like you told him to. Maybe she didn't remember to make her bed, or to call when she got to her friend's house. But if these things continue, and the rules are spelled out and communication has occurred and the behavior begins to be a trend rather than an episode, the parent must take action. Action taken when it truly is an oversight or accident is counterproductive and often results in the attitude of "heck, I get in trouble no matter what I do, so I'll just do what I want because my parents are controlling jerks and yell at me when I make a little mistake". Whereas, if the episode is overlooked and the child later realizes it, and is remorseful ( I know I'm asking a lot of the imagination), then great strides in trust and relationship have been made. 

So...it's ok to find another place to park every once in a while, even though it is your spot and you have every right to claim it for yourself. You may end up with a new friend or a relationship that you didn't expect, because the owner of the truck really didn't mean to park in your place and he's really surprised and grateful that you treated him with respect despite his behavior, or his perceived behavior. Motive is the key. Many are looking for reasons to get mad, to exercise their rights, because they see the affront as being toward them vs. an honest mistake or an episode of behavior. Parents have to be grown up enough to distinguish between episodes and trends, to be willing to park elsewhere if needed, or to call for a tow truck if needed, and to not be afraid of the child's response to this and the damage that child could do if called to account for the behavior. But boy it's easier to call for that tow truck if you'd made every effort to communicate with the child and only have them towed if they are unwilling to fix their problem. Maybe on another blog we'll discuss what to do when the tow truck is called.