FEEMRS: Fancy Expensive Electronic Medical Records System

I was at a locums assignment yesterday using FEEMRS. (You know, ‘Fancy Expensive Electronic Medical Records System?) It was all kinds of busy, with wait times of many hours. And as I slogged along, relearning FEEMRS after a few weeks away, I realized that it takes about one hour of looking at that screen for me to become exhausted.

It’s just too ‘busy.’ Every bit of the screen seems filled with some data, some field, some time-stamp. Oddly, I struggle to find the triage note, the home medications, the history. I struggle to find whatever orders I have entered and to see if they have been completed. I throw my hands up trying to discontinue orders and I nearly weep when it’s time to discharge a patient, a process which takes far too long with various orders, time stamps, discharge instructions, medicine reconciliations, printer selections and all the rest. Honestly, it’s far easier to admit someone to the ICU than to discharge them. At least in terms of computer time.

That’s the thing about FEEMRS. The ‘flow’ is all off. Oh, it’s data rich. But it’s mentally exhausting. Too many clicks, too little useful data, not nearly enough ‘white space.’

Furthermore, there are the orders to sign and the charts to sign. And after you’ve signed them, there’s another place to sign. And if the nurse so much as helps them to the door, and enters that fact with appropriate time-stamp, ‘0300, touched patient on elbow at door,’ well it’s going to need another physician signature to validate the elbow touching event and document that it was necessary, approved and billable.

Docs using FEEMRS across the country are daily beset by hundreds of orders that require signatures the next day; things we didn’t even know were orders. ‘Placed bandaid.’ ‘Paged nursing supervisor for admission.’

A friend of mine was asked to sign nursing orders for psychiatric meds (Psychiatric Meds!!!), placed by nurses for hold patients three days after he went off shift. He wisely refused but was told ‘its OK, everybody does it’

By contrast, this year and last, I worked at TMH (Tiny Memorial Hospital and its several campuses) where I (gasp!) used paper charts or dictated to a human transcriptionist. My patient’s meds were either in front of me or one flip of paper away. My discharge instructions were a check mark away, or three clicks on a different program. And often, for orders, I check a box and handed it to a secretary to enter into the system. In some instances, my prescriptions were written by hand (not perfect) and could be ‘deleted’ or ‘reconciled’ with a simple tear of the paper.

I notice, now, that when I go back to my hotel room after working with FEEMRS, I sleep poorly. No wonder. I’m clicking and looking, scanning screens and logging on and off until 2 am. I tell my kids to stop looking at screens before bed or they won’t sleep well. I keep it up till the wee hours.

FEEMRS is quietly, slowly, electronically killing all of us and making us less concerned with patients than we are with fields, files, clicks and saves.

Something has got to be done…

I just do n’t know what.

Churches Shy Away From Hard Questions

My column in yesterday’s Greenville News.  While primary responsibility for teaching our children rests with us as parents, the church often drops the ball in its mission to the young.

http://www.greenvilleonline.com/story/opinion/contributors/2016/01/24/churches-shy-away-hard-questions/79054658/

I have a problem with the church. It’s not the music, or the ‘mega-church’ concept. It’s not the donuts or the coffee or any other petty issue. The problem I have with the church is that I fear we are doing a poor job of preparing our kids for life.

What troubles me is the way we dumb things down for Christian young people. Maybe we don’t want to frighten them, maybe we don’t want to confuse them or cast any doubt into the faith we’re trying to mold. But frankly, we are failing them. Because it’s a world of hard times and hard questions, and unless we teach kids how to answer them, they’ll have grave difficulties believing all of the stuff we tried to teach.

One of my kids used to come home from Sunday School and we’d ask, ‘what did your teacher talk about?’ He’d shake his little head and sigh. ‘Moses…again.’ Like all of my kids he wanted more than stock stories designed to get through a study guide every year. In fact, our family has often used the term ‘Sunday School answer,’ when having discussions. For example: ‘why is it wrong to steal?’ Answer: ‘Jesus.’ We all laugh at that, but we all know that Sunday School answers don’t always cut it.

The problem we Christians tend to have is that we have a kind of global ‘Sunday School’ answer for the world, which usually comes down to ‘it’s in the Bible.’ Which is great for established believers to say to one another. But at a certain point in time, thinking Christian kids will start to ask about that book we hold as sacred and about that God we worship. And they’ll wonder whether to believe or consign their faith to myth.

Now, if Christian kids ask that, what will non-Christian folks ask them, or say about it? If they don’t recognize the book, or the faith, or the rules, then all of our ‘but it say so,’ and ‘Jesus loves you,’ may fall on deaf ears. So, when our kids go off to work, college or the armed forces, it won’t take long until someone easily shatters their beliefs; not even intentionally, but simply by asking hard, honest questions.

Kids in many churches today are very kind and good. They go on mission trips and they work in the food-bank. They teach the younger kids in children’s ministries, etc. But all too often they aren’t being asked the hard questions in church, or being taught how to deal with them. And I don’t mean that they aren’t being taught how to ‘make the sale.’ I mean they aren’t sure how to face the issues themselves.

What questions do we need to help them answer? Here are some: ‘Why am I here? Do I have a purpose? What is my purpose? Is there such a thing as truth? Why can’t all of our truths be equally true? Did Jesus exist? Does God exist? What do we need Him for? Is there evil? What is sin? Is the Bible reliable? Aren’t all religions the same? How can we be scientific and true to our beliefs? Is Christianity cruel and mean and oppressive? What if I screw up? Why is there pain, suffering and loss? If there is, what does it say about God? Can I have hope in trouble? What happens when we die?’ (Incidentally, many of the same questions are asked by every kid, whether their families are Christian or atheist.)

That’s only a short list. But if we love our kids then we’ll sit down with them and address those life-shaping uncertainties. We’ll do it using the Bible, and by taking from philosophy and history, art and music, biology and physics and every other area of human endeavor, so that they will go into life equipped with solid answers, not fragile platitudes that blow over at the first wind of disagreement.

They’ll ask other questions; sometimes questions we hadn’t imagined. And may of them will have serious doubts. They may walk away from their faith. But they deserve our patience, love and prayers. Because a faith shaken by honest skepticism will be better in the end.

Church leaders and parents, let’s prepare our young people. They need depth to face the world and transform it. They need truth to help them endure life’s struggles. They need to know they are loved and that their lives have meaning.

But Sunday School snippets aren’t enough anymore.

 

We Should Value Life Until The End. (My latest G-News column)

This is my column in today’s Greenville News.  I understand why people ‘want everything done’ when they’re old.

http://www.greenvilleonline.com/story/opinion/contributors/2015/11/15/we-should-value-life-until-end-ed-leap-thanksgiving-health-care-costs/75585450/

It’s a well known reality of health care economics that Americans spend a lot of money in the last year of life. I suppose that almost goes without saying, since serious illnesses and injuries that result in death are costly, at whatever age they occur. Being hit by a car and dying means you were hit by a car… in your last year of life. And that two weeks in ICU before you die is, obviously, expensive. But this truism is usually applied to Medicare dollars in the care of the elderly. This group often has protracted illnesses that require costly treatments, specialty care, hospitalizations and home-health; despite the fact that the improvements in outcome or length of life are often pretty limited.

When I was a young physician (younger…that’s better) I sometimes jumped on the band-wagon and wondered why everyone wanted so much for so little gain. I was always surprised when elderly patients didn’t want ‘Do Not Resuscitate’ orders, or other ‘advanced directives’ to limit care. I would sit with other young physicians and we would ask each other, ‘what does he hope to gain?’ Or of the family members ‘why don’t they just accept the inevitable?’

That was then. I have taken care of the elderly for my entire career. And over the past year, especially, I have worked in some communities with especially high numbers of senior citizens. That, coupled with the fact that I see things differently since I’m, well, less young, has given me new insight. So let’s re-frame the question. ‘Why don’t the elderly want to simply give up and die without a fight?’ To which the answer is, ‘they’ve lived long enough to know that every second is precious.’ Perhaps more importantly, they know that all of the people in their lives are precious.

I have watched elderly couples, 70s, 80s, 90s, and the way that they hold hands. The way they brush the hair from one another’s faces. I have heard them whisper ‘I’m here’ in the emergency room and ‘I love you,’ in the ICU. I recently listened as an older patient called his wife on the phone from the hospital. ‘How are you? Well you sound fantastic! I’m fine’ He encouraged her and comforted her, and wanted to simply hear her voice. They were anchors to one another in a treacherous, frightening world.

My son once reminded me of a saying, which I here paraphrase. ‘We die twice. Once when we breathe our last, and once when someone says our name for the last time.’ The elderly get this. They want to be with the people they love and to be remembered by them. And in particular, those with spouses hold on because that gray, infirm, frail woman or man whose hand they hold is the last repository of an absolute treasure trove of shared memories and stories. No one else knows the same subtle jokes, the same turns of phrase, the same looks that betray fear or joy. Nobody else remembers their trips to the beach or the way their children sounded when they splashed in the pool during vacation. Nobody else knows how to hold their hand just the right way. And no one else understands the importance of touching feet in bed under the sheets, or remembers their favorite restaurant now closed, or grasps the importance of that inexpensive ring worth more than a ten carat diamond.

Friends and children and grandchildren also hold such memories for the aged, or they hope to fill their descendents with those memories before they leave so that, for just a little longer, the stories will survive. They want their love, passion and experiences to remain, and not just in a box in a corner of an attic, that may or may not survive the purge when the house is sold.

The elderly want to fight death the same way we all do. Because life is incredible. And in fact, we should want them around. They have navigated many decades and many challenges. They have wisdom and they have perspective to spare and to share.

This Thanksgiving, if you want to really grasp the holiday, sit down with your older friends, uncles and aunts, grandparents and parents and ask them what they’re thankful for and what they love. (And watch the way they love.) Because odds are, you’ll learn something magnificent and hear some stories that deserve to be treasured.

Then, those ‘end of life’ expenses might suddenly make more sense.

The dangers of a culture of feelings. (My latest Greenville News column.)

Bruce Jenner and the cultural peril of ‘feelings.’

http://www.greenvilleonline.com/story/opinion/readers/2015/07/18/ed-leap-danger-culture-feelings/30303603/

One of the great things about Christianity is that Christians like myself are endlessly challenged. In this modern, ever skeptical world, Christians truly have to ‘sink or swim.’ While some believers are troubled or offended by this, I say it is a gift. And I would point out that Jesus spent much of his life on earth teaching people who wouldn’t simply accept his words without question. I get the feeling he enjoyed the discussions.

The days of defending our faith to non-believers by saying ‘well, it’s true because the Bible says so,’ are long past. If they ever existed at all, that is. Those of us who believe might abide by that rule, but others aren’t so constrained. And they expect, and deserve, more from us than platitudes.

This makes us better, I think. It forces Christians to confront our own beliefs, facts, fallacies, biases, hopes, joys and failings. We don’t get a pass in popular culture, national media or academia. We have to understand history, archeology, language, ethics and all the rest in an endless attempt to try to demonstrate the truth and relevance of what we hold true to those who are unconvinced. And, by the nature of our faith, we are supposed to do it all in love. We are to love God, love man and love even those who press against us, challenging us at every turn. This is how we are to confirm, and spread, our beliefs. Not by theocratic fiat.

This is so true that I would offer a gentle warning to those in colleges, universities and even the media who try to shield their students or audiences from ideas that conflict with their own. These days the ‘trigger warnings’ on content in media, books or classroom dialogue, the banning of contentious speakers (usually from the political right) serve to offer a soft downy nest for minds young and old. But minds (like bodies) have never grown stronger by comfort, only by challenge. If you want people to have incisive minds, it is better for them to be questioned rather than coddled.

But now, perhaps, we Christians have an opportunity to simply take it easy. Because the rules for truth claims seem to have taken a downward turn. The evidence for this is Bruce, aka Caitlyn Jenner. You see, in our evolving culture, ‘facts’ are considered oppressive things. Feelings, however, are inviolable. So when former male Olympian Bruce Jenner feels like a woman, or ‘identifies’ as a woman, that’s all it takes. Suddenly, she/he is a icon of feminine glamor, splashed across magazine covers and welcomed to womanhood by no less than the President of the United States. And anyone who denies him/her is simply on ‘the wrong side of history,’ whatever that ridiculous phrase means.

The greater implications are that everyone must be accepted and embraced based on what they think, or feel, inside. As such, a suicidal person who says ‘I’m not good, I should die,’ must be speaking the truth. A racist of any stripe who sees herself or himself as fundamentally superior must have a unique inner perspective worthy of our respect. And by extension, the young woman with anorexia, who believes she is obese, cannot be denied. All truth emanates from one’s own mind.

By extension, then, who can tell me that God does not dwell in my heart? That my motivations for morality, however I live them out, are false? Who could now scoff when someone says, ‘God speaks to me every day?’ Or even, ‘catering that wedding will violate my inner conscience?’

In this evolving intellectual climate, no one can do so. My beliefs, our beliefs as Christians, suddenly take on a protected status, not subject to denial, whether they concern abortion, homosexuality or any other hot-button cultural issue. If that’s the ‘lay of the land,’ we would be mad not to use this to our advantage. It is, after all, a supporting premise of modernism. Perhaps we’ll end up in a cultural maelstrom in which feelings superseded all tradition, legislation or litigation, with a federal Dept. of Feelings to arbitrate it all.

However, I sure hope not. Because I’d prefer the give and take of genuine inquiry, the tough question, the freedom to argue and the liberty to boldly disagree, to the mental mush that would result from shielding and ensconcing the whims of every individual’s subjective perceptions.

At least, I feel like I would!

A chart should tell a story. (My EM News column for March.)

 A Chart Should Tell a Story. 

My EM News column for March.

 

http://journals.lww.com/em-news/Fulltext/2015/03000/Life_in_Emergistan__Tell_Me_a_Story.6.aspx

 

 

I suppose it is obvious that I am a fan of stories. I like to hear them, read them, watch them, collect them and tell them. I believe I am participating in stories every day of my life. The story of my family is a beautiful epic. The stories I hear at work can break my heart. One of my favorite stories starts like this, as told to me by an adult man in his forties: ‘The thing is, me and my mama live with her boyfriend. And the other night, her boyfriend had a cardiac arrest! And when he had the cardiac arrest, he rolled out of bed, and crushed the Pomeranian.’ I can tell it better in person.

Obviously, story is truly essential to medicine. The history we obtain from patients is a story, a narrative of the development of whatever affliction they are facing. The medical record we generate is a larger version of the story, which includes past conflicts and resolutions, various antagonists and protagonists, symbolism, sub-text, conclusion and all the rest.

The problem is that in medicine, we have murdered the story. But it isn’t a complicated mystery. The murder occurred because the modern medical record is designed to gather demographics, monitor (and modify) our behaviors and generate bills. Therefore, it must be easily interpreted by people, or computer programs, that look for clicks and checks rather than descriptions. After all, it takes time and training to learn to read and appreciate a well-crafted story. But not so long to do a word-search.

I suspect that it is also a generational issue, as younger physicians have grown up with communication shared in short bursts, whether on television, in music, while texting or using various forms of social media. So I suppose that I understand how we have evolved, or perhaps devolved, in our medical communications.

In all fairness one can ‘reassemble’ the story from click boxes and drop-down menus. It just takes effort. It certainly requires more time than it would take to read a story. It’s rather archeological in nature, in fact. One must look at the nurse’s notes and the time-stamps, the triage vital signs and the things ordered, the timing with which they were ordered and interpreted, the consultations, the disposition, the prescriptions, the out-patient tests. All of it, when properly put together, can give an approximation of the who, what, when, why, how and where of the encounter.

But what we often do not have, particularly in times of crisis when the patient suddenly returns, is the luxury to put the pieces together again. Nor do the consultants and primary care doctors and specialists who see our patients later and who very much want to understand what transpired. And yet, as I travel around, and as I look back on various charts to discern what happened on previous visits, I see check boxes, labs, findings, diagnoses (often vague) but no description. The ‘Medical Decision Making,’ or ‘Emergency Department Course,’ are empty fields. In years past, we were told that these were critical parts of the chart that showed the complexity of our thought processes. I suppose EMR has changed that, on some level. But I’m think we’re worse for it. Looking at those particular blank spaces is like listening to crickets in a field. Or staring into an empty room. The absence of words doesn’t help anyone; least of all the patient.

So let me take this moment to encourage everyone to leave a note, even a wee, little note, describing what transpired in that patient encounter. Fine, if it’s strep throat, if it’s an ankle sprain, I get it. I can figure that out. But for anything with the slightest complexity, anything requiring several labs, or studies or consultants, please tell me a story!

It needn’t involve a ‘dark and stormy night.’ But it should have enough information to help the next person reading it. ‘This 14-year-old girl has had two weeks of intermittent cough, fever and shortness of breath. She has a negative chest x-ray but was noted to have scattered wheezes. She was feeling much better after an Albuterol treatment and her parents agree to arrange follow up with her doctor next week.’ It’s not ‘For Whom the Bell Tolls,’ but it’s a nice, simple summary that helps everyone else to have a sense of what happened. And it did so in three, count ’em three (3) sentences!

Chest pain? Summarize it and describe the plan. Trauma? Tell me why they were safe to go home. Headache? Explain, however briefly, why it wasn’t necessary to do more work-up. Heck, make it a game! A kind of ‘micro non-fiction.’ (Micro fiction can be a story as short as six words.) Diligence at this craft makes us more effective, more succinct communicators. And in the press of modern medicine, that can only be a good thing.

When my children were little, bedtime was always accompanied by this question: can you read a story? I’m just asking a similar thing of my colleagues. Before you put the chart to bed, write me a story.

And if it involves a Pomeranian, so much the better.

Enough sarcasm! Healthy kids need more than vaccines.

Thanks to the current Measles outbreak, the news is full of stories on vaccines and anti-vaxxers. The ‘blogosphere’ and ‘Twitterverse’ and all the other social media dimensions are buzzing with invective against ignorant unvaccinated savages and their backward science denial. For the record, I’m a pro-vaccine physician. My children have been and are vaccinated, despite being unsocialized homeschoolers.

I’ve had my own share of needles; physicians are mandated to have Hepatits B, Influenza and all the other standards. As a former Air Force Officer, I also enjoyed the singular delights of Typhoid and Yellow Fever immunization (although I managed to miss out on Smallpox).

Granted, I have been unimpressed by this year’s Influenza vaccine. Science and scientists are imperfect; sometimes vaccines are as well. If you don’t believe this, chat with someone who was paralyzed by Guillain-Barre’ syndrome after a vaccination.

While watching the many recent news stories and Internet posts on vaccines, the thing that has most intrigued me is the sense of superiority by those who are pro-vaccine. It’s the old ‘anything for the children argument,’ coupled with ‘everyone who disagrees with me is a knuckle dragging idiot.’ I think it merits discussion because there are quite a number of things that are good for children, but which are not so generally accepted by modern Americans.

For instance, it’s well known that modern kids don’t exercise enough. We are growing generations of overweight children because they simply don’t go out and play. Despite our knowledge of this, their parents lavish them with televisions, video games, tablets and smart phones and plant them squarely in front of convenient electronic nannies at the earliest possible convenience. From what I’ve seen in some of my pediatric patients, it’s much easier for mom or dad to text their friends or play poker if the toddler is busily watching Frozen on the i-Pad. What could go wrong?

Next, how about antibiotics? By which I mean this: well educated, pro-vaccine parents still go to the pediatrician expecting (and too often receiving) antibiotics for the viral head-colds their kids are spewing. ‘Whenever he gets this, his doctor gives him some Amoxicillin and he gets better every time, so I’d really like a prescription.’

Of course, he was going to get better anyway. What are they, anti-science? It’s well known that antibiotics are overused, for everything from head colds to cough, ear infections to sore throats. Sadly, my colleagues often cave to the pressure and steadily, more strains of bacteria are resistant to the drugs we count on to kill them.

Guess what else research tells us? Hold on, because this is going to be difficult. Kids are more upwardly mobile when they live with a married mom and dad. And even poor kids (in single parent homes) do better when they live in neighborhoods where there are lots of stable two parent families. I mean, you can deny it, but you know, science. Not only so, when dads are at home (you know dads, those old, out-of-date accoutrements from ages past), the kids are less likely to get into trouble with the law, with drugs or with promiscuous behavior; a few among a host of positive side-effects caused by involved, physically present fathers.

And of course, there’s the fact that promiscuity and depression in teens may be related. (Whether causally or not is debatable, but there is an association.) In addition, according to HHS, ‘four in 10 teen sexually active girls have had an STD which can cause fertility or even death.’ http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/stds.html That is to say, our Hollywood inspired, cool parent take on teen sexuality, ‘everyone is doing it and that’s OK’ may be a little, well, unhealthy. Sorry, it’s science.

Finally, the cost of college is soaring and increasing numbers of kids are unable to pay back student loans. This is largely because, despite their amazing, expensive degrees in sociology, gender studies, multicultural studies, film and assorted other less than marketable fields, they simply can’t find good jobs. If we love our kids, and those kids aren’t on their way to really good, lucrative degrees, we should nudge them towards the trades that allowed their ancestors to prosper. In the current economy, they’d be better off as carpenters, builders, plumbers, welders, mechanics and all the rest. Think of those programs as ‘economic vaccinations’ in an era of epidemic financial struggle.

Look, vaccinate away. I’m for it. But if we really care that much about the kids, there are a lot of things we can and should do to secure their long-lasting health and prosperity.

Let’s have a lot more dialog and a lot less superiority in these discussions. And let’s remember that vaccinations are only part of a bigger picture that includes physical health, education, economics and the very fabric of our family structures.

Who do we trust for medical advice?

My February column in the SC Baptist Courier.  Who do we trust, and who should we distrust, when we look for medical advice?

http://baptistcourier.com/2015/02/wholly-healthy-who-to-trust-for-medical-advice/

How do we know what to believe about anything? In times past we read books, we took classes, we spoke to experts. These days? These days we do the same, but we also search the Internet. And we seem to do it with special fervor when it comes to questions about our health.

I can’t throw any stones here. Even a physician has knowledge that is limited to his or her specialty, or personal experience. (And even if I had kept all of my textbooks, they would be woefully out of date by now.) So, from time to time, I’ve searched the Internet for answers to questions. Not only for myself and my family, but sometimes even when working. It’s not unusual for a patient to tell me about their chronic condition, only for me to discover that I have no idea what the syndrome actually is. Some of these diseases require specialized care and leave me scratching my head, so it’s off to the World Wide Web I go. Then, once I know enough not to sound entirely ignorant, I try to call their doctor to ask what to do next. Furthermore, new drugs and devices are constantly hitting the market, and I am not ashamed to say that I have to look many of them up! Emergency medicine physicians like myself are generalists, and we know when to cry ‘uncle.’

There are, for physicians, specialized smart-phone applications or Web-based services. And for patients, there are plenty of Websites available. Sadly, not all of them are very good. And not infrequently, the advice and direction given causes more anxiety then relief. I’ve noticed, even on physician websites, that there is a strong, and often inappropriate, tendency to ‘assume the worst.’

Therefore, patients who want to search for medical information should look for well-developed sites which are closely monitored by professionals, and which rely on scientific evidence. The popular site WebMD comes to mind. Likewise, some universities, or medical centers like Mayo Clinic, have extensive data-bases online that can be reliable and useful places to answer common medical questions. Finally, there are many new tele-medicine services, which (for a fee) connect patients to real-time doctors who can answer questions and even diagnose or treat common illnesses.

However, some sources of information are less than stellar. Recently, physicians with the British Medical Journal assessed the therapies recommended on the Dr. Oz show and the popular series, The Doctors (http://www.bmj.com/content/349/bmj.g7346). The results were not encouraging for those who look to those programs for guidance. According to the research, only about 1/3 to ½ of the recommendations made were based on good science. I don’t believe that the hosts intentionally deceive; but when shows depend on advertising dollars, truth can sometimes be obscured for purposes of money or ratings.

Quite understandably, we all want answers; particularly when we’re worried. But in an age of exploding access to information, it’s wise to remember that not all that passes for medical advice is actually true and safe. And that in the end, for any serious concerns, it’s probably best to go to an expert and actually ask your doctor.

 

The Flunami Hits Like a Wave, Then it’s Gone (My column in today’s Greenville News.)

The Flunami Hits Like a Wave, Then it’s Gone

http://www.greenvilleonline.com/story/opinion/contributors/2015/01/03/ed-leap-flunami-hits-like-wave-gone/21210471/

 

Like sports, the practice of medicine has seasons. For instance, summer is the season of injuries, bites and stings. People plunge from waterfalls, roll about in fire-ant hills, wreck motorcycles while wearing bathing suits (it’s as bad as it sounds), try to catch rattlesnakes and find themselves impaled on fishhooks.

Then, after the madness of Memorial Day, July 4th and Labor day, a magical,mystical thing happens. The emergency rooms become quiet. There is often a week, or two or even more when the insanity settles down and the waiting rooms are relatively empty. I love that time. I long for it during the sultry, alcohol-scented, sun-burnt, inappropriate swim-suit laden shifts of mid-summer.

This year it happened as well. There was a kind of pause, a low tide, even noticeable in the midst of the rising ER volumes across the country. Except this year, it was like when you’re at the beach and it isn’t actually time for low tide, and it suddenly goes out and you think it looks strange and fascinating. And you point out to sea. And someone yells, ‘Tidal Wave!’

Because now, after the calm of early Autumn, hospitals, clinics, emergency departments and all the rest have felt the unrelenting devastation of the Flunami. That’s right, folks, Influenza A, H3N2, is here and it has crashed on the shores of humanity. I’ve seen it, and it looks like a vast, ten foot wall of secretions and tissues, carrying in its wake entire pharmacies of cough and cold drugs, Rock and Rye, Hot Toddies, Neti-pots, unnecessary antibiotic prescriptions and work excuses.

Life in medicine these days is an endless litany of ‘fever, cough, cold, headache, stuffy nose, body aches.’ Or, in some cases, ‘cough, sore throat, stuffy nose, fever, cold, body aches and headaches.’ And sometimes: ‘I’m hot and cold and hurt all over and I think I’m dying. Oh, and I have a stuffy nose, cough, fever and headache.’ You get the picture. In the end, the days and nights of patients, doctors, paramedics, clerks and nurses are all filled with wheezing, cough and misery as people who haven’t been sick for a very long time suddenly re-discover the inestimable wonders of the flu.

I’m not trying to minimize it. I know how badly it can make a person feel. While I don’t ever actually recall having Influenza, I remember that sort of aching misery with other illnesses. I know that it disrupts holidays, travel, school, businesses and entire economies. I also know that in some cases, it’s very dangerous. The very young, very old and those already ill and weak are in danger from the flu.

However, for the overwhelming majority of humans, the current Flunami is a shaking, aching, sniffling, hacking inconvenience that will go away on its own, no matter what we do. In time it will wash across the land and back out to the vast green sea of human illnesses. As such, a visit to the doctor is generally a waste of time and dollars.

I know, maybe I’m betraying my profession. But in truth, while we’re glad to take your money, flu leaves us feeling a little inadequate, and your cough only shares the joy with the staff and everyone in the waiting room. And most of the time we’ll say this: ‘I’m sorry, you have the flu. I can’t do much for you.’ At this point I’m not even doing many flu swabs. (If it walks like a duck, you know.)

Sure, sometimes you need an inhaler, sometimes a little something for nausea. Occasionally, what seems like flu is pneumonia and requires an antibiotic. Some people, every year, do die from Influenza. But mostly, it’s just the human condition. To add to the general, achy woes, this year the vaccine is less useful than predicted at fighting the current strain; it happens, despite the best efforts of scientists.

Even the much advertised, much prescribed drugs Relenza and Tamiflu aren’t much help; while they may reduce transmission in some instances, they only make people feel better a day or two sooner at best; by only 14 hours in one study. Negative study results of the drugs haven’t been exactly forthcoming from the manufacturers, it appears. See for yourself: http://www.medscape.com/viewarticle/823431

Bottom line? Hang in there. Even the Flunami can’t last forever. Before long we’ll be attacked by insects and burnt by the sun all over again. And honestly, it will be a pleasant change of pace.

‘They didn’t do nothing in that ER!’

How often do we have this interaction:

‘My wife was here yesterday for belly pain.  That doctor didn’t do nothing! Told me she just needed to get over it. I am not happy and something needs to be done about this!’

(Frequently spoken by spouse.)

Records are reviewed.  Treatment:  Included numerous doses of morphine and phenergan, as well as fluids and Zofran.  Frequent warm blankets were applied.  Labs included:  CBC, Comprehensive Metabolic Panel, Lipase, Urinalysis, Pregnancy Test.  All negative.  Imaging:  CT scan of abdomen and pelvis with contrast, followed by ultrasound of pelvis.  All negative.  Discharge medications:  Hydrocodone, Naprosyn and Phenergan.  Discharge follow-up:  Despite lack of insurance, an appointment has been arranged with general surgery (or gynecology) who will see the patient in one week, whereas it would normally take eight.

When confronted with this fact, patient and family say:  ‘Well yeah, they did all that.  But nobody did anything!’

It’s a peculiarity, I suppose, of our society that even the most aggressive, compassionate and thorough care is considered ‘nothing.’  Perhaps it’s frustration, or perhaps it’s a need for more prescription medication.  Maybe it’s all somatization.  But on some level, I have to believe that we have transcended ‘science.’  People simply don’t believe in the wonders and effectiveness of the very system they count on every single day.  And in a subset of the population, there are two other phenomena.

One, the striking disappointment that seems to emerge with negative CT scans or tests.  As the husband of a cancer survivor, a negative CT scan is enough to bring me to my knees in songs of praise.  To many, it’s simply a failure.  Two?  This is tricky.  But when you don’t feel the cost of any procedure or test, whether because of outstanding private insurance through an employer (typically a public employer), or through Medicaid, the value of the testing, the treatment, the thought processes involved, can all seem as cheap as dirt.

Odd times indeed.  The more we do, the less we are perceived to do.

Inverted homeopathy.

Edwin

 

The Best Way to Learn Tolerance? Raise a Teenager.

Here’s my latest at the Huffington Post!

http://www.huffingtonpost.com/edwin-leap-md/the-best-way-to-learn-tolerance-raise-a-teenager_b_6149546.html

 

If you want to understand tolerance, it’s helpful to have teenagers. I have four of them. Four wonderful, brilliant, engaging creatures brought to this earth by their mother and me. They are entertaining, they are well-read, they are courteous and insightful. And they are each, at times, surly, self-centered, lazy and stubborn. (You know; like every human ever born on this earth.)

I would give my life for any one of my children if they needed. I would stop a bullet, stand in front of a train or give them a kidney. I believe I’ve already demonstrated my love by watching ‘ironic’ sit-comes with them for hours on end.

But sometimes, well sometimes, they drive me absolutely crazy. And never more than when they think they know everything. Which is pretty much every, single day. It’s a huge conflict because their mother and I, in fact, know everything.

Not a week goes by that they do not remind their parents about another social injustice in the treatment of women or minorities, another philosophical quandary (are chickens sentient and if so, what about factory farming?) or the latest research suggesting video games are good for mind, body and soul (and give you a shiny coat as well). They quote statistics on global climate change, they argue with one another about licensing parenthood. And they seem to go out of their way to pick ‘hot-button’ topics to challenge the apparently irrelevant education and moral authority of their parents. In our house, ‘because I said so’ is a long lost trump-card.

This is particularly interesting because my wife and I are what you might call ‘conservative.’ Or what others would no doubt call ‘right-wing, Bible-thumping, Southern nut-jobs.’ In the colloquial, that is. And it’s even more interesting because our children were home-schooled. (I know! Can you believe it?)

Our children were raised in the Baptist church, in the sultry, Confederate Flag waving ‘Buckle of the Bible Belt’ (where damned progressives would go for eternal torment if they believed in such things). Our four kids, stewed for years in all things Southern, are each deeply concerned about their pet causes, among which are included social justice, renewable energy, global climate change, animal rights, fairness, equality, racism and feminism.

So as you might guess, we disagree on certain issues from time to time. But here’s the remarkable thing. Their mother and I may not always share their opinions, but we don’t love them one iota less. Nor do they love us less! Dinner conversations are always fascinating. We all learn from one another. They lift their Baby Boomer parents to new ways of viewing old problems. And hopefully (can you hear me Lord?) we anchor them in traditions and truths that have remained relevant for thousands of years and hundreds of generations of their ancestors.

I am so proud of them. I see in their eyes, and hear in their passionate words, the fire I first saw in their mother when we met in college. Their mother, who still has a t-shirt from the first Earth Day, and who was aggrieved to be born too late for Woodstock. Their mother who learned to tolerate a staid, gun-loving, tradition following Republican, who became their father. I became more like her and she became more like me. We ‘tolerated’ each other so well we ended up with four children in about seven years. And they’re like both of us. We all tolerate one another in abject, breathless, unquestioning love.

This is how it works. We can banter about the word ‘tolerance’ if we want. But it’s too easily a weapon of suppression. Tolerance is the word we now use to say ‘you have to agree with my views.’ However, as one sees with teenagers, tolerance in truth means to disagree, but to respect. And in it’s highest, most beautiful incarnation, to disagree and yet love.

We all change over time. I don’t know exactly how my kids will end up; where they will lie in the political, moral and spiritual spectrum of the future. But I know that even when we disagree, I’m proud of the people they have become through this wonderful mixture of reading, listening, arguing and discussing. (And no small amount of parental prayer.)

The thing is, if a bunch of rural home-schooled kids can grow into the kind of people who can endure the views of their parents without screaming, and if those parents can face the emotional and intellectual wanderings and pilgrimages of their children without shipping them off to boarding school, then there’s hope for a world of tolerance. As long as we understand that tolerance doesn’t have to mean agreement. But it does have to mean love.