Doctor Outspoken (A poem about doctors and free speech)

Doctor Outspoken

Dedicated to all the docs who pay for their opinions with harassment and sometimes with firing.

Oh doctor dear, we need you here!
We need you day and night!
We need your skills
At treating ills
So sick folks are alright.

Oh doctor wise, we need your eyes!
We need your healing touch!
We need your knowledge
From med school and college,
Your training all matters so much!

But doctor loud, doctor proud
we need not hear your thoughts.
You tend to complain
And you’re always a pain,
Remember that you have been bought!

Doctor mad and doctor sad,
Please silence your dissident views.
You’re here for the money
And trust me there honey,
We’ll find other doctors like you.

Oh doctor broken, doctor outspoken
We know that you have a full cup.
But don’t speak your mind
Just smile and be kind.
And oh, one more thing…just shut up.

Oh doctor mister, doctor miss,
Do keep in mind who is in charge!
You heal patients’ woes
But you’re really the foes
Of the suits and the clip-boards at large.

Doctor tired, you could be fired,
For sharing the things that you see.
You just have been ravaged
By business-folks savage;
Who think speech should never be free.

Doctor wise who tells no lies,
Thank you for fighting the fight!
If we all surrender
Then none will remember
When speaking for truth was still right.

College kids should know you love them…no matter what.

My column in today’s Greenville News.  Love on your kids when they’re in college!

http://www.greenvilleonline.com/story/opinion/2017/08/30/send-college-students-off-tears-and-joy/607968001/

Two of our sons began university classes last week; one a freshman, one a junior. After spending a wonderful Summer with them, Jan and I always find this a difficult time. It requires that we adjust to walking past empty rooms and accept the fact that they aren’t coming back home at the end of each day to scavenge food and tell us stories. Even their high-school junior sister misses them, although she is under the delusion that the house will be neater with brothers away. (Guess what, papa still lives here!)
Of course, we’re hardly alone. All over the state, nation and world, families send their daughters and sons off to be educated. And what a great thing! Broken parents everywhere have lost children to disease, accident, starvation or war and would love to simply have them alive, much less getting an education. I try to keep that in perspective when I feel sorry for myself.
However, as grand as college is, it’s a time of significant stress for our young people. Many are leaving home for the first time. This means great fun and adventure. But it also means a separation from those who have, for at least 18 years, been their constant supports and care-takers. It means leaving the comfort of the known for new places and new people. It exposes the kids, appropriately, to opinions that challenge their own. It introduces them to other kids from different backgrounds, cultures and lifestyles.
In addition, their sudden unsupervised state opens them up to all sorts of opportunities for bad habits and bad decisions. All of this added together can be very difficult. This is especially true in a time when, for a variety of reasons, some young people seem to be maturing later than in previous generations.
Perhaps this is why colleges are reporting more and more students struggling with depression, anxiety and substance abuse. University mental health clinics are always busy. And many kids end up dropping out or transferring to schools closer to home.
However, there’s one stressor we forget. When we send our kids to college we have high hopes and expectations for them. For years we’ve encouraged them, talked about college and even talked to our friends and family members about our kids’ academics. ‘Oh yeah, Joan here is going to Clemson and then med school; she’s going to be a surgeon! Aren’t you baby?’ (She nods her head nervously…) ‘Rick is planning to be an architect, right dear?’ Or a lawyer or an artist. We think that at 16, 17 (or even in their 20’s) they can plan their entire lives and it will all play out as scripted. That they’ll go to university, get that planned degree, go to professional school or grad school, get that awesome job and then we can tell everyone how great they did.
And yet, what if they don’t? What if they’re frightened? What if they’re tempted? What if they feel outcast? What if they get addicted? What if they get pregnant? Perhaps harder for parents (and kids) to accept, what if they aren’t ready, or just don’t enjoy the academic environment and find that they really just want a job and a family? What if, like all humans, they simply miss home and the places and people they love?
The thing is, we parents (and grands) must never let our children’s identities be completely tied to education or career. Because if is, and if it goes wrong, then the whole structure of their precious lives is shaken. I think this may be one of the biggest stressors of all. That is, their desperate fear of disappointing the ones who worked for them and encouraged them to move forward. It must be absolutely paralyzing.
Our children are valuable because they’re our children. That’s the most important and foundational truth they need to hear. Not because of their grades, scholarships, IQ’s, career goals, awards or anything else. And it needs to be followed by this truth: ‘My precious child, if you are unhappy, if school doesn’t work for you, if you change majors or change life-goals, it’s OK. You are not defined by any of it. I love you no matter what; you can always tell me the truth. And home is always here for you.’
So send them off to school with tears and joy! But always anchor their worth to the love of family, not the success or failure of their educational adventures.

Pushing the President off a Virtual Cliff Isn’t an Answer

This is my Greenville News column from August 1. I forgot to post it to the blog until today.

http://www.greenvilleonline.com/story/opinion/2017/08/01/pushing-president-off-virtual-cliff-isnt-answer/514120001/

Have you seen the charming computer game that allows you to push President Trump off of a cliff, into a volcano or to some other unpleasant location? It allows tolerant, caring individuals to vent their spleens against the man who they typically say is ‘not my president.’ Of course, it’s only the faintest tip of the iceberg, beneath which is a large mass of angry, violent, eliminationist rhetoric.

Not to be outdone (and certainly not new), I recently saw a similar game that allows players to do terrible things to a virtual former President Obama. In fact (in a search that I hope won’t draw the attention of the fine folks at the Secret Service) I found an entire page of terrible ‘kill Obama’ games.

Of course, there are always fringes; I hope it’s the fringes. But I fear this is becoming an increasingly mainstream behavior. I would like to say I’m surprised, but I’m not. Politics is the new religion, and every religion has its heretics. And what do we do with heretics? We kill them! Everyone used to know that was a bad thing, when it actually involved belief in the supernatural. And we’re still shocked when we see horrific tales from groups like ISIS and the Taliban, where you can still be physically (not virtually) tortured and killed for believing or saying the wrong things.

Now, even in the good old US of A, there’s an underlying rage and disdain that leads some people to harm those who disagree with them. (See the shooting of Rep. Scalise or assorted violent protests on campuses). At the least, that anger allows Americans to publicly fantasize about harm against people whom they consider, thanks to their political position or ideology, sub-human.

Of course, the venom often starts with a Tweet, Facebook or blog post, online comment or speaking engagement. Someone demonstrates that they don’t agree with the latest political or cultural trend. They are called out for their thought-crime, and instantly attacked, threatened, and shunned by a community that points righteous fingers and shouts ‘Shame! Shame!’

Discussion is further shut-down by describing the ‘enemy,’ the ‘other,’ in casually launched terms like racist, sexist, homophobic, transphobic, hateful, intolerant or any number of pejorative adjectives that help put the cross-hairs in more stark relief. (In the old days it was Catholic, Protestant or Pagan!)

The righteous can then proceed to acceptably wish harm on the heretic, as several have recently done (for example) towards Sen. McCain in light of his position on ACA repeal. ‘Should have died in Vietnam,’ one said. Others hoped his tumor would kill him more quickly.

In a post-Christian, rationalist, and scientific world, where we are told we needn’t rely on some deity to hold us to ridiculous and uniform standards of behavior we have come round again to acceptable, post-modern fantasies about killing people who make us uncomfortable.

Admittedly (and as I alluded) people of faith have often led the charge of violence towards the heretic. But for a while, we seemed to be rising above it. At least until the church of politics became the equivalent of the Church of America. (Separation clause aside!)
What strikes me, though, is that the Jesus of the Bible (not the Jesus of modern politics) said in Matthew’s Gospel, ‘’But I say to you, love your enemies and pray for those who persecute you.’

He also said all sorts of other pesky, kind things about greed, caring for the sick, the poor and the prisoners. He even said, as he was being crucified, ‘Father forgive them for they don’t know what they’re doing!’

Christianity teaches us that we’re all ‘works in progress.’ That God will, if we desire, remake us bit by bit, sin by sin, into something far better than what we are, both in this life and in the next. That however bad we are, and He means that, He will forgive if we admit we need it; admit we need Him.

We need to try and see everyone as potential saints, not contemptible demons. Wishing, or doing ill to our opponents is not rational, scientific, libertarian, constitutional, progressive or modern. It’s pre-Christian and un-American. And it harms the hater most.
So stop pushing people off of virtual cliffs. And start praying for all the heretics, however you define them. Turns out, we’re all heretics to someone. That realization alone should open our eyes and thaw our hearts.

Kicking North Koreans Down the Bloody Road of History

I don’t think that anyone really wants a war with North Korea. The potential use of nuclear weapons on either side is the stuff of nightmares; but even without nuclear weapons, the death tolls from conventional munitions such as artillery, small arms, non-nuclear missiles and air-strikes would be extraordinary.

Thus, many have been shocked that President Trump has seemed openly hostile to N. Korean Supreme Leader, Kim Jong-un. They have blamed him with escalating the conflict, with prodding the rogue nation to the brink of nuclear conflict.

In the end, it sounds as if North Korea were a gentle, quiet land of rural majesty that just wanted to be left alone, when along came Donald Trump, who started being mean to the cuddly Teddy Bear president of exotic, far-off North Korea.

And yet, we forget. We forget that the Korean war of 1950-53 began when North invaded South and that it ended in an armistice, not a peace treaty. That war cost an estimated 1.6 million civilian casualties and some 1.2 million combat casualties. I’ve met veterans of that nightmare. It was a horrible war, and would be again.

(http://www.cnn.com/2013/06/28/world/asia/korean-war-fast-facts/index.html).

However, we also forget that since that truce, North Korea has constantly provoked South Korea with infiltrations by special operations soldiers, with naval and border clashes, assassinations, terrorist events and artillery fire. We forget that North Korean operatives have kidnapped citizens of South Korea, Japan and other nations. (Many of whom never saw their families again.) Go through the list in the link below. It’s not stuff we hear much about, but it’s truly shocking. And the list only goes to 2007.

https://fas.org/sgp/crs/row/RL30004.pdf

Beyond that, we in the West (and particularly college educated Americans) have a stunning ignorance about the singular delights of the land above the 38th parallel. We forget that North Korea, that undying zombie of Communism, is a land of terrible cruelty, torture, imprisonment, starvation and sorrow. As we in the West decry oppression in all its real and imaginary forms, the people of North Korea understand it in full. Over the decades of North Korean tyranny, since 1948, hundreds of thousands have died at the hands of their own government in prison camps and reeducation centers. Attempted defection to China usually results in either more abuses, or return to North Korea with further torment. Starvation, beatings, rape, forced abortions and executions are tools of state, and entire families are punished for the transgressions of one. (I suspect no small number of those crushed souls would say today, ’bomb it, bomb it all; it really can’t get a whole lot worse for us here, eating bugs and rats, and hoping our children aren’t murdered.’)
If you think I’m confabulating, follow the links below.

https://www.hrw.org/world-report/2017/country-chapters/north-korea

http://victimsofcommunism.org/north-korea-under-communism-1948-2014/

So it’s all well and good for us to oppose nuclear war, and to oppose war in in general. But the sudden discovery that North Korea was a super friendly place until Donald Trump? That’s not historically accurate or intellectually honest.

If it all cools off and calmer heads prevail, North Korea will still have hundreds of thousands of citizens living in conditions that rival those of the Soviet Gulags, or the Nazi concentration camps. They will survive day to day, eating starvation rations, being beaten or raped, tortured and murdered; the lucky ones exported abroad as wage slaves.
Those not in the camps, even the true believers, will continue to live in the constant fear that they’ll be arrested. And in the knowledge that their success, their survival, depends on showing unwavering devotion to Kim Jong-un and his family’s dynastic brand of tyrannical thuggery. Political opponents, religious believers, families of those suspected of dissent, all will fear the government or be punished by it. Because that’s how it goes down in the Democratic People’s Republic of Korea.

Assuming, again, that the war clouds pass, free people can wipe the sweat from their furrowed brows and allow the horrors of North Korea to go on, safe in the knowledge that diplomats will continue to talk as nuclear weapons and delivery systems continue to be developed in North Korea. All funded by the slave labor of untold, unknown citizens. And as men, women and children continue to suffer and starve.

What a relief that will be! And those who say ‘not my president’ can meet in safe cafes and discuss how ‘that crazy Trump’ nearly caused a war with a country that has been provoking free nations, and torturing its own citizens, for over 70 years. Safe out of the view of sensitive American citizens who oppose oppression.

I also hope we’re all prepared for what we see when, and if, the DPRK ever falls and the West has access. Because when we go in at last (hopefully through diplomacy or some miracle), when we see the camps and hear the stories, and witness the broken lives and weeping, gaunt faces; when we at last grasp the misery and sorrow that generations of people endured under that regime, we’ll be ashamed. And it will take decades for those people to escape the toxic cloud of imposed fear that enveloped them for so long.

But then, the world let it happen in exchange for the comfort of empty discussions and endless sanctions as we (the West and China) kicked North Korea and her people down the bloody road of history.

God forgive us when we see what that ‘peace’ cost.

Electronic Devices Shouldn’t be Used as Comforters (for Frightened Children)

Welcome new physicians! Watch where you step…

Today is the day that new resident physicians begin their training all across the United States.  Today, our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (OK, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.  Anxiety-filled and debt-ridden, they will embark on four to seven (or even more) years of training to make them knowledgeable, technically proficient physicians.

I will occasionally wax poetic and philosophical for their benefit.  But not today.  Today there are practical matters.  Today I want to give them a few pointers, to ease their transition into the maelstrom of post-graduate medical training.

1)  Any flat surface that holds still, is free of gross body fluids and not used as a walk-way or cook-top will serve for a quick nap.  Practice sleeping in odd positions:  sitting upright, reclining at various angles, lying sideways or with your head cradled in your hands.

2)  In my day (always wanted to say that!) we filled our fresh, white lab-coat pockets with review books, algorithms, reference manuals, scissors and calculators.  And candy bars.  You, doubtless, have a smart-phone of some incarnation, which contains all that we had, as well as the Web.  Which means, where we had to play video games in the lounge and find answers in giant, antiquated things called attending physicians and books, you can look up fun facts on hyponatremia and instantly play Angry Birds, whether you’re on rounds, in the cafeteria or hiding in the call-room, pretending you didn’t hear ‘code blue.’

3)  Eventually, you may decide the lab-coat isn’t worth it.  Don’t be surprised.  Your kids will eventually wear it for Halloween.

4)  If you keep the lab coat, what with the extra space in your pockets, carry extra candy bars.  Or protein bars, or whatever it is you crazy kids snack on these days.

5)  Watch where you step.  Trauma patients and cardiac arrests are exciting!    But there’s almost always some body fluid on the floor when the shouting is over.  Try not to get too covered in blood early in your call night.  It’s sticky and gross.

6)  You know so much.  You don’t know anything.  Keep those two ideas in constant tension.  Odds are, your command of modern evidence-based medical research is extremely impressive.  Eighteen years after residency, I can still leave you in the dust when it comes to making decisions and knowing who is sick and who isn’t.

7)  See above.  Learn, as quickly as you can, who is sick and who isn’t.  Hopefully medical school helped; but don’t count on it.  If you know this simple thing, you will know when to go for help, when to panic (or not) and what to tell your upper level residents and attending physicians on rounds.  And you will become that greatest of commodities:  useful.

8)  Look professional, develop your own style.  Be comfortable.  My friend Sherri used to wear pearls on call, with her green scrubs.  They always made her appear elegant, no matter how much pediatric vomit had been hurled her direction.

9)  Patients can be frightening.  But remember what they told you at camp, about bears, raccoons and snakes.   ‘Don’t worry, they’re just as afraid of you.’  This is kind of true.  Except patients really aren’t afraid to ask for pain medicine or call attorneys, whereas you are afraid to do anything since you can’t believe you know anything yet.

10)  You may be more frightened of physicians than patients.  But remember, the people assigned to train you are smart, capable and experienced.  And they put their tentacles in their pants just like everyone else.  Ask them questions, listen and watch.  And remember what I said above:  be useful.  My surgery resident was fond of saying, ‘Help me, don’t hurt me!’

11)  You will soon have a thing called a paycheck.  It will have a stub that shows how much the government is taking from you.  Do not be surprised.  This happens to everyone.  It’s just that you owe a lot more money than most people.   Cheer up!  Everyone expects you to be rich someday, so they can complain about the fact that your rich.  (Whether you will be or not remains to be seen.)  Remember that no matter how little or much you make, never tell a contractor or car-dealer you’re a physician.  Tell them you work in customer satisfaction, or something nebulous like that.

12)  Crazy people, even really crazy people, are sometimes terribly ill.  Pay attention.

13)  Ill people, really ill people, are sometimes very crazy.  Pay attention.

14)  Medicine is inexact.  I promise you will make mistakes. Don’t live in fear, and don’t let error define you.  No one in medicine, or law, is capable of perfection.  Except for being perfectly insufferable, of course.

15)  If you poke things that look like they are filled with blood or pus, they will explode into your face; if you tend to hold your mouth open when you focus, well you know what will happen.

16)  Scalpels really are sharp.  Pneumonia and HIV and TB and Hepatitis really are communicable.  Psychotic patients really will try to choke you.  Medicine is dangerous.  Be careful out there!

17)  Human beings are really frail, vulnerable and hurting.  Be gentle and kind whenever possible.

18)  Have fun!  Don’t think of it as residency, think of it as a chance to spend most of your waking and many of your sleeping hours in a huge, cold-building where people are dying!

19)  Everyone is proud of you.

20)  Pay attention to what the nurses say.  They aren’t always right.  But for quite a while, they’ll be right more than you are.

21)  Only three to seven years to go!  Hang in there.  Remember, it’s no different from Boot Camp.  It just lasts much, much longer.

Rural Suicide and Mental Health; my column today at Politico.com.

Here’s a column of mine, published today at Politico.com.  Everyone wants to make these issues into right/left battles.  I was asked to write this, and it concerns mental health, which is a topic very important to anyone in emergency medicine.  I have written for publications of various political orientation and I’ve tried not to let the liberal/conservative division limit me too much.

http://www.politico.com/agenda/story/2017/04/suicide-er-rural-hospitals-000398

Thanks!

Edwin

 

Can we Change our Minds?

It’s easy to be excited about facts when they support our own opinions. It’s nice to believe that uncomfortable facts are fake. Likewise, it’s comforting to believe that everyone who disagrees with us is ignorant. When the truth is so obvious, we say, how could anyone but an uneducated bumpkin deny it? And yet, it seems that much of our knowledge is incomplete and that our deeply held beliefs may be more fragile than we imagine.
I was thinking about this recently when I listened to a podcast about evolution. It was a discussion about some events that happened last November at the venerable Royal Society in London. It turns out that some well-respected scientists think that perhaps evolution isn’t just due to ‘random mutation and natural selection over time.’
According to some researchers at the meeting, our DNA is even more amazing than previously believed. It appears that external stressors change the way plant and animal DNA works so that creatures adapt much more rapidly than we thought. This doesn’t necessarily mean evolution is wrong; but certainly our understanding of it is probably incomplete.
This poses a challenge to some beliefs that have been held in exactly the same way by scientists, and the lay public, for a very, very long time. Can we handle the change in paradigm? Could we ‘adapt’ if we suddenly found out that evolution is a bit off? After saying for years that it was a not a theory but a hard fact?
The science of medicine changes all the time. For the past 20 years, physicians in training were taught that they should never hesitate to boldly give narcotic pain medication to patients who asked for them. Because after all, ‘why would anyone mislead their doctor?’ And who were physicians to judge? We were told, ‘you can’t create an addict in the ER.’
Except, according to some pesky researchers, it appears you can. Some people can become addicted after a very short course of pain medication. They’re just wired that way. And now pain pills and heroin are killing people in staggering numbers. Our venerable, white-coat clad instructors were wrong. (What? Physicians and professors wrong? Perish the thought…) And now we have to face the facts and change our behaviors as doctors.
New, intriguing information presents itself all the time in many areas of study. The bacteria in our guts may have to do with obesity and mental health. Litter boxes may contribute to human mental illness due to a parasite cats sometimes carry. Socialism in Venezuela is a disaster. Foreign aid sometimes worsens international crises. Who knows what’s next?
But what if we discovered a slam-dunk gene for religious faith that was so powerful that those who had it couldn’t help but believe? Could their detractors still regard them as simpletons or haters? What if we learned that the absence of that gene made for equally solid atheists? How would we believers treat them? What if some transgender people really have a body dysmorphic problem like anorexia? Or that there is a genetic marker that indeed makes them identify with another gender? What if discussing it isn’t hatred, bigotry or compromise, but compassion? What if we find, someday, that the science of climate change isn’t settled?
Obviously science advances. We love that idea until it bumps into us. What do would do when science, or new historical information, or some other new finding puts our personal beliefs in question? Can we let go of our political correctness? Or religious rigidity? Can we stop calling our opponents rude names? Are we OK with new facts when they contradict ideas dear to us?
It’s hard to let go. But just as we look back on our ancestors and smile about their quaint beliefs, someone will eventually do the same to ours. It will likely be the case that we were wrong about many things in ways we could never have imagined.
As times change and knowledge grows, we should all be a lot kinder in the way we view the opinions of others and cautious in the way we view ours own. Today’s unassailable fact could become tomorrow’s flat earth. A little humility, a little willingness to open our eyes and the courage change our minds, are probably in order all around.

A Simple, Cheap, Health Fix.

This is my latet column in the Greenville News.  Healthcare is expensive, so it’s much cheaper not to need it in the first place.

http://www.greenvilleonline.com/story/opinion/contributors/2017/03/02/commentary-simple-health-fix/98636916/

I have never wanted to be the medical advice columnist. ‘Dear Dr. Leap, my feet sweat all the time. I’ve tried everything! What should I do?’ Nope, I’m not your guy. Neither do I want to opine on study after study about statin drugs for cholesterol or discuss whether women should take estrogen. There are physicians who love those questions! And I think they’re fantastic. But I’m an emergency medicine physician. Which means I have an attention span only somewhat longer than a Jack Russell Terrier. So as long as no squirrel runs across the room, I’ll finish my thought.
I think a lot about what brings people to the hospital. And I have come to some conclusions. If people want to live healthier, longer and better, then the solutions are not especially complex. But they involve pretty hard decisions. They don’t, however, involve pills.
Obviously some people have terrible diseases and medical events and simply can’t help the medications they need to take. I’m not talking about them. I’m talking about the vast number of Americans who, with a few lifestyle changes, could take no medications and be just peachy.
So here goes. Stop smoking. No, don’t even start smoking. It does nothing but bad things. It makes your teeth decay, gives you mouth, throat and lung cancer, causes emphysema, worsens asthma and costs way too much money. Money you could spend on important medicine, or no medicine, on your kids, or could save for a trip to someplace cool. Seek out help from a physician or support group and put down the coffin nails.
Next, eat less. Being overweight is bad. I’m not ‘fat shaming,’ I’m trying to save lives. Being overweight is unsafe, since you can’t rescue yourself from danger as easily. Being overweight makes you sluggish, strains your heart and causes your hips and knees to wear out, resulting in joint replacements. It makes it harder to exercise. It contributes to diabetes. Obese patients are harder to care for when they’re ill; they don’t always fit in CT scanners and their surgeries are more difficult and take longer to heal. How do you lose weight, you ask? There are lots of plans and lots of people to help. But it starts with the decision to sometimes look at yummy food and say ‘nope, I’d rather be a little hungry but healthy.’
Now this is radical: stop sitting around. Do things. Be busy. Walk, hike, have an active hobby. Stop binge watching shows for hours (in fact, a study not long ago suggested that binge watching increases your risk of dangerous blood clots in the lung). Step away from the tablet, the television, the gaming system and go outside. You needn’t run marathons or Iron Man races to just keep moving. Humans stayed fit for millions of years before there were gyms or exercise equipment. Of course, they were busy trying not to starve or get eaten, so they had an edge on us. But they died by 30 or 40, so we have it a little better.
Also, don’t take drugs of abuse. And if a doctor offers you a narcotic, unless you have cancer or a badly broken bone, say ‘no thanks.’ You’ll be better off in the end. Drugs are killing people in staggering numbers; so is alcohol. Therefore, while you aren’t doing drugs, don’t abuse alcohol. Don’t drink and drive, drink and boat, drink and hike, drink and shoot, drink and fight; you get it. Alcohol is dangerous. Also, wear your seat belt. Or helmet if you ride a bike or motorcycle. Additionally, don’t text and drive!
For simple illnesses like colds, don’t take antibiotics. Don’t ask for them and decline them unless absolutely necessary. In fact, for simple illnesses and injuries avoid doctors, X-rays, CT scans and all of it.
I could go on. But these things alone, if taken seriously, would change the face of medicine and the financial makeup of the entire healthcare system. And the best part? They don’t involve a prescription, an X-ray or even a visit to a doctor. They’re low-tech, low-cost interventions.
Some of my favorite patients are the 90-year-olds who show up for something simple; a bruise or a cut, fresh from yard work.

‘Sir,’ I ask, ‘what medicines do you take?’
‘None.’
‘Who’s you’re doctor?’ ‘Son, I don’t have one. Can I go home now? I have beans to pick!’
‘Well there you go. That’s why you’re 90.’

Life and Limb: the Rural ER

Welcome, readers, to my new column in the Daily Yonder!  It will concern rural emergency medicine and things I see through that particular lens.  Have a great day and feel free to share liberally!  I’m honored by the Daily Yonder to be included on their team, dedicated to all things rural.

Life & Limb: In Rural E.R., Exams Include the Obvious Questions, Like ‘Did You Get a Turkey?’