My column in the Winter 2017 Gray Matters, Newsletter of the Osher Lifelong Learning Institute at Furman University.

 

THE NEWSLETTER OF THE OSHER LIFELONG LEARNING INSTITUTE @ FURMAN

http://www.furman.edu/sites/OLLI/member-resources/Documents/GMJan2017-PDF_reduced.pdf

PAIN MANAGEMENT AND THE TIE TO ADDICTION – PART 2

Sometimes medicine offers us wonderful, almost unimaginable gifts. Heart attacks that were devastating, life-altering events a few short decades ago are now treated with an expediency and skill that our grandparents couldn’t imagine. A couple days pass, and the victim is home with stents in occluded arteries and directions to modify activity and diet. Pneumonia, once the ‘old person’s
friend’ (so called because it took the aged to eternity), is far less terrifying, thanks to both antibiotics and the pneumonia vaccine.

However, some of the things we do give benefits that are less clear. Although it could be an entire column in itself, the ‘stroke center’ movement, with the promise of miracles from ‘clot-busting drugs’, is a thing full of as many questions as answers. And what about depression and anti-depressants? When I looked up the side-effect profile of an anti-depressant a friend was taking, I was reminded that all of them have the potential side effect of increasing suicidal behavior.

But what about pain management? Thanks to improved understanding of the physiology of pain, the persistence of medical providers, and the investment and research of pharmaceutical companies, we have a wide array of pharmaceuticals available for the treatment of pain. Some are over-the-counter, like acetaminophen and ibuprofen. And others, those we refer to as narcotics or opioids (because in previous times they were derived from opium), are useful, potent, and (as is increasingly evident) fraught with danger unless used very cautiously.

Of course, for a very long time, physicians were taught to be judicious in prescribing narcotics. Our venerable teachers warned young doctors in training to be frightened of the side effects. We were especially aware of the very immediate danger that patients would stop breathing and die due to excess sedation. We were also aware that over time, patients on narcotics might develop problems with addiction.

About 20 to 25 years ago, that whole paradigm shifted and physicians were suddenly accused of callous disregard of suffering for prescribing too few narcotics. I remember this because I was in my emergency medicine residency at that time. We were constantly reminded to give more narcotics and be sensitive to pain. We were taught to use the ‘pain scale,’ in which a patient-reported score of zero meant no pain and a score of ten meant ‘the worst pain of your life.’ Never mind that it was entirely subjective and that there was no objective standard, no ‘painometer’ against which to measure it. We were instructed to see pain as the ‘fifth vital sign’ after blood pressure, pulse, respiratory rate and temperature. Of concern to many, these initiatives coincided with the development and aggressive marketing of ever more powerful, addictive medications like Oxycontin tablets and Fentanyl patches and lozenges.

Patient satisfaction surveys included the question ‘was your pain adequately treated?’ Physicians were castigated when those satisfaction survey scores fell. Physicians were instructed, by non-clinician

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administrators, to give more pain medication to make patients more satisfied. (A satisfied customer/ patient is one that may come back!) Physicians who resisted, in the name of science or safety, were too often met with threats of reduced income or job loss if patient satisfaction scores fell. In some instances, physicians were (and still are) reported to state medical boards for alleged inadequate treatment of pain.

I sincerely believe that most of those encouraging us to write more narcotics prescriptions did so out of genuine concern and compassion. People are in pain, so why not treat the pain? In medicine, where science meets suffering humanity, it’s so easy for us to say, ‘Well, it just makes sense, doesn’t it?’ We assume that our compassion will be supported by our science. It happens with infections; sure it’s probably a head cold, but what’s the harm in an antibiotic to keep the patient happy? The child bumped her head pretty hard, so what’s the problem with a CT scan, even though she looks good? The parents are customers, after all, and want a scan!

With tragic consequences, our compassion sometimes causes harm as the Law of Unintended Consequences rears its ugly head. For instance, those antibiotics for colds? They can cause dangerous allergic reactions and life-changing intestinal infections requiring hospitalization or surgery, and resulting in death. Those CT scans everyone wants? Physicians are trying to reduce the number of scans, as many of us are concerned that they may induce malignant tumors later. And those pain medications? The evidence looks pretty damning.

Addiction to prescription narcotics is growing at a terrifying rate in the U.S. Likewise, death rates from narcotic overdoses have soared. The U.S. has seen 165,000 deaths from opioid overdose between 1999 and 2014. http://www.cdc.gov/drugoverdose/data/overdose.html. In fact, opioid-related deaths have now surpassed deaths from firearms in the United States. http://www.cbsnews.com/news/drug- overdose-deaths-heroin-opioid-prescription-painkillers-more-than-guns/ Admittedly, some of those deaths are not due to prescription opioids but rather to injected heroin. However, many heroin addicts began their addiction issues when taking legitimately prescribed pain medication.

Sadly, seniors are not immune. Physicians don’t want to see seniors suffer, so they often give narcotics even for pain that in decades past would not have been treated with those drugs. We give them for back pain, headache, arthritis, or other less serious conditions. And we use them extensively in treatment of chronic, intractable pain. In fact, in 2015, one-third of Medicare recipients received a prescription for an opioid analgesic; some 40 million prescriptions. https://www.statnews.com/ 2016/06/22/many-opioid-prescriptions-seniors/

Furthermore, seniors not only develop addiction, not only die from accidental overdoses, their narcotic analgesics have a host of side-effects, including (but not limited to) the following: excessive sleep, impaired thinking, increased pain sensitivity, nausea, constipation, and cardiac arrhythmia. In addition, opioid drugs contribute to weakness and loss of balance and thus to falls, resulting in head and spine injury, various fractures, and other trauma. Their already impaired reflexes are dampened by their medication so that for those who still drive, it becomes an even more dangerous activity than before.

No one is immune from this devastating epidemic, not rich nor poor, not young nor old. The medical profession, the mental health community, law-enforcement, social services, churches, families, and friends all have to come together and find ways to roll back the rising tide of death and addiction, which came as an unforeseen outcome of attempting to ease suffering with compassion and science.

This problem will be highlighted this spring at an OLLI bonus event, March 31, 2017: Seniors and Opioids: Unexpected Origins of a Greenville Epidemic. I will be speaking in conjunction with James Campell of the Phoenix Center addiction and rehabilitation facility. We really hope you join us to learn more about this pressing public health crisis.

Sports Impairment and My Southern Man-Card

 

This is my column in today’s Herald-Dispatch.  My hometown newspaper in Huntington, WV!

http://www.herald-dispatch.com/opinion/edwin-leap-don-t-worry-you-won-t-lose-your/article_3706dd19-3472-520d-856d-09e3580d3886.html

It’s a terrible confession to make as a Southern male, but here it goes. I don’t care a lick about sports; not leagues, not high school, not college not pro. It feels liberating to say so. I figured I might as well be honest about it, because I’m forever confronting the reality of my sports-impairment in various and sundry ways.
One way my dilemma arises is I’m standing in the check-out line at a store, wearing my WVU t-shirt when another customer asks what I think of the Mountaineer’s chances this year. I usually make some sort of generally non-committal remark about how ‘I sure HOPE they do better this year!’ Which means that at some point in the distant future, if they manage to win a championship, I’ll have to be more careful and say ‘well, if LAST year was any indication this should be a good one!’ I try not to make eye-contact. It’s too uncomfortable.
What I usually want to explain, but never bother, is that I wear the shirt because I grew up and went to school there. And it was awesome and I have wonderful memories (same reason I wear my Marshall shirt). But it’s hard to stop a die-hard sports fan and say, ‘well, the truth is I really didn’t have time for sports because I was studying a great deal, but I’m proud I graduated!’ That makes people go to the next checkout line and shake their heads.
I’ve noticed the same thing at church. I remember finding myself in deacon’s meetings with little to contribute to the discussion at zero dark thirty Sunday morning. As everyone made the rounds of the previous day’s games, it was ‘Ed, Marshall did well yesterday didn’t they!’ ‘Sure did…(I guess).’ I put my head down, ate my biscuits and gravy and (since I live in South Carolina) I just let the orange or garnet wave pass over.


I’m not trying to be a snob, please understand. In my childhood I just wasn’t formally taught anything about athletics. Admittedly, my dad built a basketball court for me in the back yard. All the neighborhood kids and I had a great time there at all hours of the day and evening. But the rules were not exactly formally enforced. It was as much social time as athleticism. I also learned a little about football in the front yard. Specifically, I learned that ‘touch’ can be widely interpreted. I realized that lying on my back gasping for air one day, looking up at the fading blue sky.
I remember once around sixth or seventh grade that I went to the mother of one of my more athletically inclined friends and asked about joining a basketball league. She was kind, in a ‘bless your heart’ sort of way, and said we might be able to cram on the rules but it wasn’t looking good. Age 12 and I was already too old to start. I got the message and moved on without looking back.
Instead I filled my days with walks in the woods, turning over rocks in the creek for crawdads, seining for minnows, riding horses with my grandfather, shooting arrows into bales of straw, carrying my BB gun everywhere, shooting bigger guns whenever the opportunity afforded itself and generally acting like a joyous junior barbarian. Those became my preferred activities, until I discovered martial arts, then girlfriend, in high school.
My wife Jan grew up with brothers playing football. If I don’t understand a game that’s on, I just ask her and she guides me through. Two of my children attend Clemson University, and the other two are also fans, which is great. But they didn’t get it from me. Just recently they were all talking about the season and daughter Elysa said, with surprise, ‘why look at us, talking about sports like a normal family!’
I have great respect for all those devoted to their teams, who can quote stats like chapter and verse of scripture. May your team get all of the touchdowns, field-goals, runs and everything else it needs. But to all those who never got it, who never fell in love with sports, it’s alright. You aren’t alone.
Do your thing. You aren’t less of a Southerner or less of a man. And when the discussion turns to yesterday’s contest, learn to smile, nod and just say this: ‘that was some game!’

Election Related Illness…

Now that the presidential election is past, national emergency departments are seeing an increase in election-related health problems. While anxiety, depression and homicidal rage are what one might expect, it turns out, according to emergency physician Dr. Chuck McShortridge, the bigger issues seem to stem from people sitting at computers all day long and linking to political posts on Facebook, Twitter, Reddit and assorted other online outlets.
“Just last week we had three patients with massive pulmonary emboli. I asked their spouses about surgery, cancer, fractures, trips overseas, and the common thread was this: ‘No, but he (or she) spent the last six months linking to articles about how Hillary is a crook or Donald is a liar, or something like that.’”
Other physicians have noticed the same. Dr. Maggie McFarris reported another issue: “I keep seeing patients who complain of a constellation of symptoms: blurred vision, sleeplessness, carpal tunnel syndrome and in some cases, acute renal failure. I call it Donald-Clinton Syndrome. They never get off the (expletive deleted) couch. All day long it’s ‘that Hillary is a crook who can’t be trusted’ or ‘he hates women’ and links to dozens of articles a day. They don’t eat, they don’t drink, they don’t exercise, they don’t even have sex.”
One spouse we interviewed in the waiting room of a large ER said, “My wife has lost a lot of weight because she won’t eat! Just the other day I made this great vegetarian dish she loves and all she said was ‘I don’t have time, I just found this incredible piece on Trump at Politico and I have to share it!’ I ate dinner alone. Thank God the election is over say she can finally get the Xanax and IV fluids she needs.”
On a related note, some politically active physicians we met in the course of this article are lobbying to have advocacy counted as CME. Dr. Joseph Mooring, known for his bumper-sticker-laden Subaru, political buttons and frequent presence at online forums, stated: “CME? Who has time for that? I’m trying to save America, and in the process American healthcare! I should totally get credit for the hours I’ve logged trying to save the nation!” American Board of Emergency Medicine representatives said the board might be able to work political advocacy into the new Lifelong education modules.
Practitioners are urged to continue to be diligent in looking for election related illness and injury.

Idols All Around

http://www.greenvilleonline.com/story/opinion/contributors/2016/11/14/commentary-humans-easily-deceived-idols-every-sort/93588762/

One of the consistent themes that runs all through the Bible is the theme of idolatry. And if we can learn anything from its writers down the thousands of years and hundreds of generations since they lived, it’s that humans are easily deceived by idols of every sort.
It’s arrogant for us to laugh off the idea of stone and wooden deities, and shake our heads at the fish or dragons, serpents or elephants that they represented to our ancestors. (That’s right, all of our ancestors!) Because we’re no less susceptible despite our assertions that we are modern and rational. Twenty-first century man remains a remarkably idolatrous creature.
This is rarely as evident as it is during a presidential election cycle, when we believe that vast power, and all our destinies, rest with the office and person we are electing. If only we elect him, or her, all our problems will be solved and our enemies smitten! We elevate candidates and politicians to places they were never meant to be, not by God, nor indeed by the founders of our republic, who doubtless had a much more suspicious view of human character than we do; else they would never have built in so many checks and balances.
In fact, during elections we also make idols of government in general, constitutions, courts and legislative bodies. We worship commentators and media outlets and anyone and everything connected with the process. We idolize our own opinions and spend far more time in our own personal echo-chambers than we do either worshipping God or (for the non-religious) simply pursuing secular knowledge or simple joy. Pity, as our self-adulating tirades and tantrums change few minds.
But it isn’t only politics. We all have our idols. Thanks to social media, young people take constant photos of themselves in a kind of self-worship. Social media have also allowed Americans to make an idol of the approval of others, whether in likes for one’s selfie, or agreement with one’s views. The disapproval of others is a bitter pill whose side effects include exclusion from friendly society; a kind of excommunication for heresy. How many opinions would be shared more honestly if not for the fear of being shunned or attacked en masse online?
Conservatives often idolize guns or military prowess, as if they could save us from all danger. And yet the Bible says ‘Some trust in chariots and some trust in horses, but we trust in the Lord our God.’ (Psalm 20:7) (The chariot being the main battle tank of antiquity, by the way.) And liberals make an idol of choice, as if replacing the word ‘killing’ with a euphemism makes it less like the reality of killing an unborn child, less like a modern adoration of the dark god Molech.
We idolize the freedom of sexual expression and sexual orientation, as if all that mattered in this life were who could have sex with whom. And on the other side, we idolize morality, as if our sanctimonious attitudes about sexual sin were anywhere as important as the forgivingness and redemption offered in the Bible to those who sin sexually, gay or straight. Grace matters more than moralism.
America idolizes the idea of compassion and charity without understanding the moral and spiritual underpinnings that make it reasonable and possible. And yet, we also idolize the American concept that everyone can simply succeed if they try, which is simply untrue. The deck is sometimes stacked and there are those who need our assistance, personally and through state programs. Some idolize capitalism, some idolize socialism, but both can become monstrous deities when not applied with Godly wisdom and caution.
The Decalogue begins with ‘I am the Lord your God who brought you out of slavery, out of the land of Egypt.’ And follows it immediately with ‘you shall have no other gods before me.’ And of course, after receiving the Ten Commandments, the people promptly made a Golden Calf and ignored God, the source of all their good things. You can be an atheist and still see the truth in this tale. This is the story of all mankind. The worship of those things we shouldn’t, and the rejection of those things that are truly, ultimately good.
Whether a citizen is religious or not, we can surely agree that we all have idols we should take from their altars. Maybe it’s a good time to start.

On Veteran’s Day ask, ‘what would I die to defend?’

sentinel-377523_1280

 

Veteran’s Day has always meant something to me.  But then, I was born in 1964.  I’m the last of the ‘Baby Boomers.’  I grew up on stories of family members in time of war.  I remember my father, Keith Leap (my name also) leaving for Vietnam when I was four years old, and remember (vaguely) his return.  I recall my uncle’s stories of the Navy, and of a grandfather in the Army in Mississippi and a great-grandfather who served during the Spanish-American War.  There were others, back to the Civil War, the War of 1812 and the Revolution.

I grew up looking for dates of service on tombstones, and for flags, ranks and units of the fallen.  I grew up with toy guns, toy soldiers and war movies, in a time when we threw plastic grenades with caps in them, which sometimes actually went off and frankly surprised us.

A great-uncle I never met was a Col. in the US Army in France during WWI, and I always heard that he said he was determined to bring his men home safely.  Another great uncle gave me a bayonet he took from an ammo-dump in Italy during WWII; there appears to be a ding in the side from a bullet. A neighbor survived the Bataan Death March; not surprisingly, he suffered as an alcoholic as long as we knew him.  I once met a gracious gentleman who was a former Wehrmacht soldier, who (after a CT scan when his arms were held above his head) said ‘the last time I held my arms like that one of Patton’s soldiers had a rifle in my back!’

I was immersed in veterans and their stories.  And the ones I knew were ever humble and kind.

Was I taught to idolize war?  Was I taught that bloodshed was the answer?  Was I taught that violence was some sort of higher good, as if we were Lacedaemonian children of Sparta?

I don’t think so.  I think I was taught to idolize sacrifice, courage, and simply fortitude.  I grew up in Appalachia; fortitude was necessary, if only for my ancestors to survive against nature.

I suspect that much that these men did had less to do with bravery than determination; in practical application they can look the same, I suppose.

Many brave men and women follow that tradition of service.  They fight, are wounded and die on many fields.  They live or die by their conviction, by their camaraderie, by their patriotism and belief in something higher.

This is hardly limited to the armed forces.  Many live their convictions, in all sorts of fields of endeavor.  But what I wonder now is this:  who will die for their convictions?

We live in a time when many people, especially those in universities, are emotionally wrecked by the slightest challenge to their beliefs, the faintest intrusion into the coddled safety of their own fragile minds.  College administrators give them coloring books, Play-dough, therapy dogs.  Safe rooms are established where they can cry when things don’t go the way they perceive that they should, when there is no trophy or certificate for all.   I suppose this is included in the price of tuition?

But on Veteran’s Day, I must ask of all Americans, what beliefs will they, will we, go through life willing to die to defend?  We should all ask this. What matters most?  Faith, country, family, these are things men and women historically died for.  Ideology?  To some extent, but I wonder.

Will generations of young people learn the lesson of Veteran’s Day?  Not that they need to serve in the military to be real Americans; not that the only heroes are those in uniform, those in battle.  That is a heresy that would produce a warrior class, and we don’t need that.

The lesson, as I see it, is different.  What will you have the courage to stand up and live for, instead of lying down and weeping?  And what will you have the fortitude to die for, if it comes to that?

On this beautiful Veteran’s Day, contemplate that, whether you are or were or never were in the armed forces.  And find an answer.

The future may call on you to decide.

I Love America! My latest Greenville News column.

It’s an ugly political season.  But I still love America!  This is my most recent column in the Greenville News.  Please share liberally.

http://www.greenvilleonline.com/story/opinion/contributors/2016/10/23/ed-leap-love-america/92453876/

Over the Summer I was working in the ER at North Greenville Hospital, doing some temporary work for GHS. I arrived in Traveler’s Rest early one morning to get some breakfast and a drink for work.
As I pulled into a drive-thru, I looked at the nearby gas-station. I was amazed at how busy the place was. And I was suddenly overwhelmed with love for America and her people. It was about 6:45 in the morning, but there were cars and trucks of every variety. I saw utility company trucks and pest-control vans. Those pulling trailers full of lawn-equipment, with mowers and weed-eaters. Electricians, plumbers, contractors, police and EMS workers were getting out of all manner of vehicles. Many essential, difficult jobs were represented, as men and women were headed to work. Motivated by dreams of success, and by love for those they support, they were up with the sun. There were people of every race and ethnicity, many of them working on the same crews, for the same companies, laughing together.
It was going to be a long, hot day, so they were loading up on breakfast, coffee, snacks, water and other drinks. Trucks were being fueled, the staff of the gas station hurrying to keep up. There was an energy there that was quintessentially American. I felt honored to see it.
The wonderful thing is that America and Americans, for all our contentious behavior, remain wonderful. We work and innovate. We strive and create. We educate and parent and look after our loved ones young and old. And despite the reality of bias and discrimination, we are one of the most welcoming nations on earth. We adjust to social changes, we generate and rapidly adapt to technology, and even when it looks bizarre, the average citizen and average politician try to make democracy work.
We are conflicted at times, but usually over means, not ends. We want to help refugees even if we reasonably fear terror. We may worry about immigration but typically enjoy immigrants as our friends and neighbors. We desire to see the poor and their children lifted up. We still, as a nation, want to see justice done. Thus we are equally offended by false imprisonment of the poor and by the way the wealthy and connected sometimes stand apart from the law.
I meet all kinds of Americans in my work. I meet poor, rural Southerners struggling to find jobs, and facing chronic diseases with limited resources. I meet immigrant families trying their best to care for sick children. And even though we live in the South (where popular media loves to paint us as just so hateful), I regularly encounter doting white grandmothers and grandfathers cuddling and adoring their beautiful, mixed-race grandchildren, looking after their sons and daughters-in-law who have different skin colors, and sometimes different languages. I am often amazed at the men and women whose English grammar may not be perfect, but who learn Spanish out of love for a partner; not for a grade in a class or semester abroad.
I see my colleagues care for everyone, with never a thought to treating them poorly because they are gay, lesbian or transgender. I watch as physicians and nurses struggle mightily against the death and suffering of people different from them.
There are churches and pastors, congregations and church groups as well as government and secular organizations (and individuals) who help provide housing for the poor and drive people to work who are battling the nightmare of drug addiction. Those same people adopt children and spend time and money to give food to hungry families.
In America the laborer and the academic are both passionately devoted to fairness and those who never graduated high school are as important to the republic as those with advanced degrees.
Are there exceptions? Obviously. And it doesn’t take many hateful, cruel, manipulative people to cause great damage. ‘A little yeast works through the whole batch of dough,’ said St. Paul.
And yet, the lovely reality is that we remain a great nation, going through a hard time. I don’t know where it will lead. Maybe to darker places, maybe not. But for now in America, the America I see every day that I work, the America that starts the day early and ends it late, working together for common cause, the love outweighs the hatred, the strength outweighs the weakness, every time.
That’s something to celebrate.

Let’s Stop Bullying (Attention Adults!)

This is my latest column in the Greenville News.  Bullying is at its worse, but most acceptable, when adults use it to intimidate people who disagree with them.

bully-655659_1280

http://www.greenvilleonline.com/story/opinion/contributors/2016/10/09/lets-stop-bullying/91666120/

Let’s Stop Bullying

I well remember being bullied on the school bus. Many cold, wet mornings (a large portion of the year in WV, by the way) I found my junior-high self sitting in front of high school juniors and seniors who turned their class rings upside down, then used them to hit lesser life forms on the top of the head in a whipping motion. Turning around in pain and anger, trying to find my assailant, was pointless. ‘What are you looking at?’ they asked. It was a very long ride to school.
To this day, kids are still assaulted and treated badly by other kids. Children and adolescents are called cruel names and belittled by those who have more things or more opportunities. They’re told that if only they’ll wear these clothes, or listen to that music, engage in some sexual act or take that drug, they’ll be accepted. Bullying comes in many forms, it seems. And now we have the added joy of the Internet. No small number of young people have been mortified, emotionally traumatized, considered suicide or actually committed it in response to online slurs and cruelty, or embarrassing photos or video posted online.
These days, adults are supposed to understand, and teach their kids, that no one should be mistreated, harassed, harangued, belittled or besmirched in our hallowed school hallways for any reason at all. But something happens after we leave school. Suddenly, adults believe that bullying is OK as long as it’s about something that’s really, really important, and as long as the people they bully are different from themselves. It seems that in actuality, adults are the worst bullies around.
These days, in order to find bullying one need look no further than any discussion about politics (or frankly, culture, religion, science or almost anything else). I’m simply stunned at the way purported grown-ups with differing opinions can treat one another. Online forums and media comment sections drip with disdain. Those who believe ‘the wrong way’ are instantly labeled ignorant, or irrelevant, and often called names. Sometimes, people even wish death upon others.
In fact, that’s one of the clearest forms of adult bullying I see. ‘Well, if you weren’t so ignorant, you’d understand the truth.’ Even those with no particular knowledge of a topic consider those who disagree to be stupid, plain and simple; it’s a strange kind of ‘pseudo-intellectualism,’ in which the enlightened get to wear the mantle of truth. A truth largely determined by the crowd; not surprising in an era when truth is considered a personal choice like food on a buffet.
This sort of argument is everywhere. And not just in the Wild West of the Internet. Even noted political figures accuse their detractors, saying that they’re uneducated and backward or they’d see the truth.
Adults love to bully, no matter how much they pretend to hate the idea. We see it in its soft form in the recent video of celebrities reminding everyone else not only to vote, but who to vote for. They’re the cool kids. They may not be the smartest but they’re the richest and best; they’re sexy and sarcastic. Don’t you want to be like them? Remember, beautiful, rich, famous people are much better (and insightful) than regular poor people!
Comedians once entertained us with the universal, self-deprecating, slap-stick humor of everyday life. Now they, too, are the cool kids yelling their invective at everyone who dares to have an opinion off the mainstream. Biting and cruel towards those they don’t understand, they represent little more than a shinier, richer form of the old-school bully.
Bullies use words to great effect. Disagree with a candidate? You must be a racist, or a sexist. Disagree with a law? You must be a bigot or a fascist. Believe your God is real? You must be a fundamentalist nut! You don’t want to be a bigot or fascist or a nut, do you? Then just do like everyone else does and you’ll be so cool! There, now doesn’t it feel better to be like the crowd? (Now remember kids, you should always be yourself and follow your own heart. Until it takes you outside the bleating herd, that is.)
Robust dialogue is good for a nation. As in evolution, ideas diverge and produce more good ideas. The future of our freedom demands that we disagree. But bullying is the stuff of brutish children.
So let’s stop it, shall we?

EPIC Go-Live Day! And a prayer for wisdom…

Some dear friends of mine, at Busy Community Hospital, are having a momentous day.  Today is the ‘Go-Live’ for their brand new, shiny EPIC EMR.

For those of you outside the hallowed, creaky halls of medicine, EPIC is one of the most widely used electronic medical records systems in America.  It’s big, it’s expensive, it captures lots of data, integrates ER’s, hospitals, clinics, labs and everything else.  (Probably your cat’s shot records too.)

EPIC is also a company highly connected to the current administration; big donors to the President.  FYI.

The problem isn’t what you get out of it, it’s the cumbersome way you have to put it in.  In my opinion, for what that’s worth, EPIC is not intuitive. It takes a long time to learn to use it well.  I have never used it in a situation where it could be fully customized, but I’m told that makes it easier.  And admittedly, some docs and nurses truly love EPIC and are at peace with it.  I suspect they have implanted brain chips or have undergone some brain-washing.

https://giphy.com/gifs/zoolander-ac38RqTgQXYAM

Typically EPIC instruction occurs over weeks, as it has for my friends.  The first time I used it was in a busy urgent care, which was part of a large medical system.  And I learned it over one hour. On the Go-Live day.  So I’m sympathetic.

Thus, I have a prayer for those in the belly of the beast right now:

A Go-Live Prayer for those with new EMR systems.

Lord, maker of electrons and human brains, help us as we use this computer system, which You, Sovereign over the Universe, clearly saw coming and didn’t stop.

Thank you that suffering draws us to you.

Thank you for jobs, even on bad days.

Forgive us for the unnecessarily profane things we have said, or will say, about this process.

As we go forward, we implore you:

Let our tech support fly to us on wings of eagles and know what to do.

May our passwords and logons be up to date.

Protect us from the dreaded ‘Ticket’ submitted to help us.

May our data be saved, not lost.

Let the things we order be the things we have.

Shield us from power loss, power surge, virus and idiots tinkering with the system.

Give our patients patience to understand why everything takes three hours longer.

And may our prescriptions actually go to the pharmacy.

Keep us from rage and tirades.

Protect the screens from our angry fists.

May everyone go home no more than two or three hours late.

And keep our patients, and sanity, intact.

Great physician, great programmer, heal our computers.

Amen

 

 

 

 

 

 

The Presidency Won’t Change the Division

The first presidential debate is over, and all I can say is that these are interesting times.

The fact remains that whichever candidate wins the presidency, the nation’s polarity will not be suddenly reversed. We are spinning further and further from one another all the time, divided by many issues, by race, gender, religion, accusation and insult. Are we one nation anymore? Hardly. We’re many nations trying to control all the others.

The election itself cannot change that. Whether Donald Trump or Hillary Clinton wins, they are unlikely to do so by a wide margin. And they will make policies that nearly half of the country will find objectionable. Maybe both parties need to strive to bring unity more passionately than they strive for electoral, legal and legislative victory.