Once Upon a Time in Medicine

Gather round kids! Let Grandpa Doctor Leap tell you a few things about the old days of doctoring in the emergency room…

Back in the good old days, medicine was what we liked to call ‘fun.’  Not because it was fun to see people get sick or hurt or die, but because we were supposed to do our best and people didn’t wring their hands all the time about rules and lawyers.  Sometimes, old Grandpa Leap and his friends felt like cowboys, trying new things in the ER whether we had done them before or not.  Yessiree, it was a time.  We didn’t live by a long list of letters and rules; we knew what was important. And we were trusted to use our time well, without being tracked like Caribou through electronic badges.  Those were the salad days…

When I was a young pup of a doctor, we took notes with pen and paper and wrote orders on the same. It wasn’t perfect, and it wasn’t always fast. But it didn’t enslave us to the clip-board.  We didn’t log-into the clip-board or spend twenty minutes trying to figure out how to write discharge instructions and a prescription. We basically learned in grade-school.  EMR has brought great things in information capture and storage, but it isn’t the same, or necessarily as safe, as the way humans conveyed information for hundreds, nay thousands of years.

Back then, kids, the hospital was a family!  Oh yes, and we took care of one another. A nurse would come to a doctor and say, ‘I fell down the other day and my ankle is killing me! Can you check it out?’  And the doctor would call the X-ray tech, and an X-ray would get done and reviewed and the doctor might put a splint on it or something, and no money changed hands.

In those days, a doctor would say to the nurse, ‘I feel terrible, I think I have a stomach bug!’  And she’d say, ‘let me get you something for that,’ and she’d go to a drawer and pull out some medicine (it wasn’t under lock and key) and say ‘why don’t you go lie down?  The patients can take a break for a few minutes.’ And she’d cover you for 30 minutes until you felt better.

We physicians?  There was a great thing called ‘professional courtesy,’ whereby we helped one another out, often for free. Nowadays, of course, everybody would get fired for that sort of thing because the people who run the show didn’t make any money on the transaction.  And when you have a lot of presidents, vice-presidents, chief this and chief thats, it gets expensive!

When medicine was fun, a nurse would go ahead and numb that wound for you at night, policy or not; and put in an order while you were busy without saying, ‘I can’t do anything until you say it’s OK or I’ll lose my license.  Do you mind if I give some Tylenol and put on an ACE?  Can you put the order in first?  And go ahead and order an IV so I won’t be accused of practicing medicine?’ Yep, we were a team.

There was a time, children, when doctors knew their patients and didn’t need $10,000 in lab work to admit them.  ‘Oh, he has chest pain all the time and he’s had a full work-up.  Send him home and I’ll see him tomorrow,’ they might say.  And it was glorious to know that.  Or I might ask, ‘hey friend, I’m really overwhelmed, can you just come and see this guy and take care of him?  He has to be admitted!’  And because they thought medicine was fun too, they came and did it.

In those sweet days of clear air and high hopes, you could look up your own labs on the computer and not be fired for violating your own privacy.  (Yes, it can happen.) You could talk to the ER doc across town about that patient seeking drugs and they would say, ‘yep, he’s here all the time.  I wouldn’t give him anything,’ and it wasn’t a HIPAA violation; it was good sense.

Once upon a time we laughed, and we worked hard. Back then, we put up holiday decorations and they weren’t considered fire hazards.  We kept food and drink at our desks and nobody said it was somehow a violation of some ridiculous joint commission rule.  Because it was often too busy to get a break, we sustained ourselves at the place we worked with snacks and endless caffeine, heedless of the apparent danger that diseases might contaminate our food; we had already been breathing diseases all day long, and wearing them on our clothes.  Thus, well fed and profoundly immune, we pressed on.

In those golden days of medicine, sick people got admitted whether or not they met particular ‘criteria,’ because we had the feeling there was something wrong.  We believed one another.  Treatment decisions didn’t trump our gut instincts.  And ‘social admissions’ were not that unusual. The 95-year-old lady who fell but didn’t have a broken bone and didn’t have family and was hurting too much to go home?  We all knew we had to keep here for a day or two and it was just the lay of the land.

I remember the time when we could see a patient in the ER and, because my partners and I were owners of our group, we could discount their bill, in part or entirely.  We would fill out a little orange slip and write the amount of the discount.  Then, of course, the insurers insisted on the same discount.  And then nobody got a discount because the hospital was in charge and everyone got a huge bill, without consideration of their situation.  The situation we knew, since we lived in their town.

Back when, drug reps left a magical thing called ‘samples.’  Do you remember them, young Jedi?  Maybe not.  Young doctors have been taught that drug companies, drug reps and all the rest are Satan’s minions, and any association with them should be cause for excommunication from the company of good doctors.  But when we had samples, poor people could get free antibiotics, or antihypertensives, or all kinds of things, to get them through in the short run.  And we got nice lunches now and then, too, and could flirt with the nice reps!  Until academia decided that it was fatal to our decision-making to take a sandwich or a pen.  Of course, big corporations and big government agencies can still do this sort of thing with political donations to representatives. But rules are for little people.

When the world was young, there was the drunk tank.  And although mistakes were made, nobody pretended that the 19-year-old who chose a) go to the ER over b) go to jail, really needed to be treated.  We understood the disruptive nature of dangerous intoxicated people. Now we have to scale their pain and pretend to take them seriously as they pretend to listen to our admonitions.  They are, after all, customers.  Right?

These days, we are perhaps more divided than ever.  Sure, back in Grandpa Doctor Leap’s time, we were divided by specialty and by practice location; a bit.  But now there’s a line between inpatient doctors and outpatient doctors, between academics and those who work in the community, between women and men, minorities and majorities (?), urban and rural, foreign and native-born and every other demographic.  As in politics, these divisions hurt medicine and make us into so many tiny tribes at work against one another.

And finally, before Grandpa has to take his evening rest, he remembers when hospitals valued groups of doctors; especially those who had been in the same community, and same hospital, for decades.  They were invested in the community and trusted by their patients and were valuable.  Now?  A better bid on a contract and any doctor is as good as any other. Make more money for the hospital?  In you go and out goes the ‘old guys,’ who were committed to their jobs for ages.

Of course, little children, everything changes.  And often for the good. We’re more careful about mistakes, and we don’t kick people to the curb who can’t pay. We don’t broadcast their information on the Internet carelessly.  We have good tools to help us make good decisions. But progress isn’t all positive.  And I just wanted to leave a little record for you of how it was, and how it could be again if we could pull together and push back against stupid rules and small-minded people.

Now, Grandpa will go to bed.  And if you other oldies out there have some thoughts on this, please send them my way!  I’d love to hear what you think we’ve lost as the times have changed in medicine.


Grandpa Doctor Leap



Some new, important screening questions for the EMR

Scrolling through FEEMRS (you know, Fancy Expensive Electronic Medical Records System), I was stricken by just how much data is on the chart.  I mean, it’s pretty dang amazing.  But I was, simultaneously, reminded that most of it doesn’t help me.

It helps someone, mind you.  For instance coders and insurance companies.  The complexity of EMR also helps those who track our car to door, door to chair, chair to chair, chair to bed, bed to bathroom, bed to X-ray, request to blanket, request to sandwich, request to TV remote, request to ice chips, complaint to Dilaudid and discharge to angry times.  (The really important stuff!)

But so often, FEEMRS just gets in my way.  I mean, I struggle to find little things like triage information, medications or last menstrual period. And as for visual acuity?  Faggettaboutit!

However, I do think there are some things that might be useful screening questions.  So, here are a few things I think we should have the nursing staff ask on the way into the ED.  I mean, we always ask about drug abuse, interpersonal violence, immunizations, sexual activity, whether or not the withered 98 year old has lately traveled to any Ebola infested exotic locales.  But is it really enough to know if the newborn has stopped smoking? Or are there other more interesting things with which we could further clutter the hallowed screens of our FEEMRS?

I hereby suggest:

What is your preferred pronunciation of the only pain medicine that ever worked for you?  With what letter does it begin?  (Incidentally a patient recently pronounced their favored drug ‘Laudy-dah.’  Awesome.)

What unfortunate thing has lately happened to your medication?  Eaten by dog, stolen by neighbor, smashed by meteorite?   Hey, it could happen…

Is there some species with which you identify and would prefer to be treated as?  Because if so, we may need to call a vet. Or tree surgeon.  (It’s no joke.  Tree-kin is a real thing…I mean, ‘real’ thing.)

First thing that pops into your mind when I say ‘outstanding warrants.’  Go!

What is your favorite kind of sandwich to eat while waiting on your psychiatric commitment.  Just kidding. We have Turkey.  (It’s empowering to offer a choice even if we really don’t have one.)

This is to be asked immediately on arrival into triage.  Right now, how long do you believe you have waited to be seen? One hour, two hours, three hours.

Do you know the patient advocate’s name and phone number?

For abdominal pain:  Please tell me what kind of cheeseburger, chicken sandwich or friend food you have consumed on the way to the ED, and when you finished….oh, you’re still eating it.

This is very useful and instructive: Why are you on disability? With a few mental health exceptions, if it isn’t evident in triage, it will be a good story.

How many times have you been committed to a state or private psychiatric hospital? If the number of suicidal commitments is greater than ten, patient can probably go to the waiting room.  Especially if eating cheeseburger and suffering from simultaneous abdominal pain.

Is there a particular physician you would like very much to see or not to see? Or want to hurt?

Full disclosure.  What are you here to get, and if you had it, you wouldn’t be here at all?  For instance, work excuse, pain medication, etc.

Who told you you should come to the ER, if anyone:  your physician’s office, your attorney, a police officer, your sister’s best friend who is a CNA at a nursing home, or a 24-hours health line?

Do you find it difficult to stop playing video poker on your phone while talking to a clinician?  

Will you please eat these chips and fill out my satisfaction survey while waiting to come back?

Just scratching the surface.  Send me some of yours!



My Most Important Patient

Medical stethoscope on keyboard as symbol for administration and office

Listening for heartbeat of most important patient


This was my column in the March edition of Emergency Medicine News, as linked below.


My most important patient requires my constant diligence. For this reason, I am seldom far away from him. Only a few minutes inattention and there will be problems. I cannot forget my patient; I am trained to attend to him constantly. I am a professional, and my patient is, ultimately, my customer and the customer’s service is paramount, I am told. I am reminded by policies and procedures as well, and there are those who will contact me, day or night, regarding failure to do what my most important patient requires.
In these 29 years since I started medical school, I have seen many wounded and sick patients of varying degrees of complexity and interest. Legions of fevers and columns of colds, tribes of chest pains and nations of bruises, entire cities of coughs, herds (as it were) of nausea and vomiting and battalions of sprains. Flocks of fractures and entire civilizations of chest pain. But none of them, not one, occupied me like my most important patient.
I was guided by teachers in urgency and priority, I was taught to hurry here, take time there, but always be attentive. I was shepherded by wise physicians before me, but never did any of them put a patient on a pedestal the way my most important patient has been. Neither snakebite nor sepsis, aneurysm nor arterial blockage, pneumonia nor parasite has ever been thrust before me as the most important patient…until now.
What could he have, you ask? What affliction? Who could he be? Of what importance? Celebrity? King? Judge or politician? Child of my own? Parent or priest? Hardly. Not one, not even captains of industry who endow hospitals, have the power of this patient.
This patient, this most important patient of all, stares back at me all day long. I examine and treat him with my hands and sometimes my voice as I stare intently back into his face. I wander off to other ‘patients,’ but all pale in comparison to this one. He violates all privacy and priority and knows absolutely everything. I see a chest pain next-door, or a pelvic pain across the hall; a weeping suicidal woman a few rooms down. I come back and tell my most important patient each secret. The sordid or tragic details of every life I whisper to him, or write upon his screen.
Once my hands loved examining other ‘patients;’ the shape of normal and injured bone, the sound of clear and diseased lungs, the nuance of stroke, the tenderness of the abdomen that took so long to understand. Now I have no time. I must touch my patient, enter the password and let my well- trained fingers run across plastic, not skin or bone. Or speak into his ear with a microphone, far more expedient than time wasted with others. Far more important and billable.
Every time I wander away, my most important patient calls me back; ‘hurry, hurry, tell me about the others! Don’t take too long!’ And others humans, more important than I am, remind me. ‘Don’t neglect your most important patient! Finish everything he needs as soon as you can! He is the key to all of our money! And if you don’t, we will fine you, or punish you in some other way for failing to care for the most important one of all! But make sure the flesh ‘patients’ are happy; give them a little time or they might be upset and not come back, and then what will you tell your most important patient?’
My most important patient is now everyone’s most important patient. He (or perhaps sometime she) is in charge. Sometimes he is shy and recalcitrant and will not wake up, will not look at me with his glowing eye. When that happens, nothing can happen. No orders for labs, xrays or medicine. He is an angry god, and when he is angry no one else can be happy. Sometimes he is confused and plays pranks on me, so that what I thought I said to him is turned on its head or made unintelligible. He is capricious that way; but ultimately far better than ‘people,’ who say and do things that my most important patient isn’t programmed to understand or record. He doesn’t like that, and forces me to do things in a confusing manner because he is angry.
And he is a time miser; he wants all of my time and those who brought him to me (or rather brought me to him, a kind of sacrifice) know that he is greedy and yet expect everything to run as before, when other patients were important.
But I know, and you know, those days are gone like electrons on a wire. Because now, the most important patient of all takes the most time and the most effort and the most diligence because data and billing and tracking and policies are what he does and his handlers love those things the way we used to love humans. And spoiled as my most important patient is, I believe it is unlikely that anything will ever be the same again.
Pity. Humans are interesting. But sick or well, they simply cannot stand in the way of data entry.

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.

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?


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.


Kudos to the Chemists, Engineers and Factor Workers who make medicine possible

Thanks, Osler, but Kudos to the Chemists, Engineers, and Factory Workers

This is my column in the January edition of Emergency Medicine News.




Think for a second about the most treasured drug or device in your ‘medical bag.’  Or about the procedure you find most appealing, the disease or injury you most enjoy treating.  Personally, I really enjoy doing lumbar punctures, opening abscesses, placing IO lines and applying splints.  And because I’m an emergency physician, I am duty bound to say that I love to intubate…and I do.

I also enjoy doing nerve blocks, whether dental, regional or digital.  In fact, I did my own digital block on my very painful great toe, wherein there was an ingrown nail.  I endured it for about one month, believe it or not, but ultimately I was too cheap to go to my doctor or any other doctor. So I sat down in my bathroom with my wife and kids in attendance. Just before I started, I said, ‘I don’t think I can do this to myself!’  To which my insulin-dependent son, Seth, replied ‘Are you kidding me?’  The shame worked and the needle and bupivicaine left my toe tingling for at least 12 hours.

The point I want to make isn’t that I’m good at blocks or you’re good at chest tubes or any other such window-dressing or self-congratulatory drivel. The point is this.  I may be able to do a darn good nerve block.  But I didn’t invent syringes, I don’t manufacture needles and I haven’t the foggiest idea how to make a local anesthetic.

And as proud and puffed up as we may all be at times, with our advanced techniques and our nifty procedures and tools, the plain truth is that as physicians, we stand on the shoulders of some very brilliant people.  It’s all about perspective, you see.

I am reminded of my relative incapacity whenver I’m asked to check on a sick or injured person outside the device and drug filled walls of the emergency department; at church, perhaps, or at a party.  I’ll gladly check a pulse, feel for a fracture, assess breathing and neurologic status.  I’ll happily do chin lifts and jaw thrusts and even do CPR if needed.  But in the end, I call 911, or say ‘you better go to the ER.’  Because much of what I can do, and you can do, is dependent on a whole host of tests, drugs and devices that we seldom have tucked in our back pockets at any given time.

You see, our compassion for the sick and injured and dying has been around since the first ‘physician’ knelt beside someone he cared for, and decided to stay by their side to help them.  Our diagnostics have evolved since that time.  Our medical ancestors were darn good at looking, listening, touching and smelling, then pronouncing hope or doom.  I imagine, in an age in which we are increasingly separate from the bedside, that those same medical ancestors could give us a run for our modern (increasingly inflated) money when it comes to diagnostic prognostication.  But the things we use every day to increase or diagnostic skills (labs and xrays and cardiograms and ultrasound), and the things we use to save life, prolong life and ease suffering, well those things have changed dramatically in the last century.  And we surely do need them.

So we may go on and on about Osler and Halstead and all of the other greats of medicine. But we must also nod to Roentgen and Fleming, to Pasteur and to Salk and to untold others whose research, whose attention to science, allowed the evolution of what we call modern medicine.  And it’s not just those ‘oldies but goodies.’  Science and technology have exploded so rapidly and with such complexity that we would be hard-pressed to even begin to name the countless men and women who have lifted us up in order that we may practice medicine as we do today.

Think about the Sonar researchers who gave us ultrasound.  Think about the chemists and biochemists who gave us newer, better antibiotics; and those who are now exploring antibody directed therapies.  Consider the engineers who design systems to make plastic into the life saving tubes we place in airways or collapsed pleural spaces!  Consider the dietary researchers who gave us TPN, and the brilliant folks who designed radiation therapy machines, CT and MRI!  Stand in awe of those who laboriously invented machines to count cells, and lab media to detect Troponin levels, the products of blood clots or the hormone HCG.  Nod in gratitude to those who designed, then crafted steel and titanium for fractures; and those who created tiny coils and stents to be placed in small blood vessels.  Be thankful for those who took their knowledge of the human brain and their compassion for human suffering and created the amazing pain medications we have today; so amazing people will do almost anything to have them!  As a man whose wife survived a massive saddle embolus, I’m eternally grateful to the folks who devoted years to developing thrombolytics and anticoagulants; and to those who discovered how to make the chemotherapy agents she received for her cancer as well.

But let us not be rude.  Consider all those who work in labs and factories, doing often dull and repetitive work in assembly and packaging, to satisfy our need, our desire, for drugs old and new, for needles and test-tubes, for Foley catheters and Word Catheters, for central lines and the drills to place IO lines.  And what about ultrasound?  Those machines don’t assemble themselves; and we certainly don’t put them together, do we?

Wait, there’s more!  There are those who are in design and marketing.  Those who sell and ship.  Those who track supply and try to make production more efficient.  There are untold numbers of men and women who give us the ability to ease pain and save lives.

Good heavens I could go on and on. But you get the picture.  What we do, in modern emergency medicine, is amazing and sometimes borders on the miraculous.  We have every reason to be proud.  But just as the college grad should honor the sacrifice her parents made for her, so we as clinicians must honor the gift, the effort, the brilliance and dedication of those who imagine, create and produce the very stuff that makes our work more than a series of apologies and misery.

Hats off to all of you!  And thanks for sharing your brilliance and dedication with those of us who can look our patients in their eyes and say, ‘I think we can fix this.’

Staying on the ground is a blessing (My Greenville News column for today)


Here’s my column in today’s Greenville News, on the blessings of not flying this Thanksgiving.


As I contemplate the Thanksgiving just past, I am thankful that friends and family traveled to my home. In part because I’m blessed with family, blessed with house and job, food and health.  But I’m thankful for another reason.  The location of my various family members does not require me to set foot on an airplane.

I recently took a whirlwind trip to San Diego, California for a speaking engagement.  How amazing flight is!  We can cross mountains and oceans, continents and hemispheres. We can make meetings hundreds of miles away and be home for dinner with the family.  And all of it while watching the news as if we were in our living room (except eating what we want), in a climate controlled,  ever-so-slightly reclining chair.

And yet.  Among the many activities of modern life, I doubt if any are as demeaning to the human spirit as commercial air travel.  For instance, on my recent flight from GSP, I checked in a few minutes past my 60 minute window.  I know, there has to be a cut-off.  But it required me to go home (to Oconee County) and wait 12 hours for my next opportunity to fly.  (It was a blessing, as I had church and lunch with family.  And mind you, it’s rather serene passing through Seneca, Clemson, Easley and Powdersville at 4:30 and 5:30 am.)

I returned and wound my way through security.  Ah, security.  When I travel with my wife, she says to me (as I begin to take my shoes off and grumble), ‘be polite…you don’t want to go to jail.’  I find our current system of airline security…’less than optimal,’ as it were.  ‘Take off your belt. Put your laptop on the conveyor belt.  Take off your shoes.  Move it along people.  Come on. Step through.’  Since Jan wasn’t there, I was reminded by the sign that said, in essence, inappropriate joking might result in arrest.  So I kept my raging thoughts to myself and smiled.

I ultimately made my flight, checking my bag to the tune of a soul-sucking $25, then wedging myself into a small seat on a small aircraft on the way to Houston as non-checked bags, possibly containing bodies, were forced into various compartments by people still in possession of their $25.  In Houston, I snacked quickly, boarded, then wedged myself between two individuals whose dimensions made it more comfortable to merely hold my hands above my head all the way from Texas to San Diego, as if being robbed.  Not to mention that my ‘row-mate’ to the left made odd grunting noises over and over, while awake, and while both playing on his iPad and watching the pay television mounted in front of him.  ( I wondered if he were contemplating eating me…grunts can sound rather like ‘yum’ in a dark cabin.)  I remained vigilant and survived, arriving in San Diego late at night but safe and sound.

When I  returned from San Diego back to Houston and Greenville,  I did something I had never done before. I road the  golf-cart/shuttle in the airport.  When I told the driver where I was headed, a little proud of my ability to walk quickly, he said, ‘you better get on.’  It turns out I had arrived at Concourse C but had to find my way to Concourse Z, subsection 15, sub-subsection alpha, orange, gate square root of 6.

You see, when one goes to Greenville, SC from larger cities, one often has to leave from remotely located, obscure parts of large airports.  After riding on the transport, riding on the train, running some more and finding my way to what I thought was the tiniest concourse in Houston, I was directed down another hallway, and another, and yet another until I came to a small door with a sliding panel and had to knock three times then whistle. A man slid it back and asked if we were there for the flight or the poker game.  Outside our biplane was ready and waiting.

I’m not blaming anyone.  Lots of people, lots of planes, lots of destinations.  It’s difficult to keep flight affordable, safe and (relatively) on time.  I understand.  And I felt for the dejected, overworked clerks, flight attendants and pilots I saw, for whom the glory of flight had long since passed, as evidenced by their mussed hair and desperate sprints for the exit doors.  God bless them all.

I’m just saying, ‘thank you Lord for keeping me on the ground for Thanksgiving.’

Faith and science often seen working together

This is my column in today’s Greenville News.

I hope you enjoy it.




This has been a terrible summer in many ways.  A time of loss from
fires in Colorado.  Continued sporadic deaths of US combat troops have
broken hearts at home.  The shooter in Aurora, Colorado left us
stunned, wondering about both mental health and evil.  And even in my
quiet Oconee County, the death angel has hovered, leaving us with
drownings, shootings, car accidents and every assorted misery.
Loss and suffering are ubiquitous.  I spend a lot of time talking to
my kids about how to make sense of things; and it isn’t easy.  I don’t
always have good answers.   Unfortunately, life will illustrate to
them that trouble is a fraternity (or sorority if you like) whose
membership qualifications are wide-open; everyone ‘rushes’ it
Of course, the good thing about trouble is that it often makes us
mere humans rise to greater heights.   In the face of suffering, we
rail against it.  From every political and cultural stripe, we are
wounded by the wounds of others.  Our techniques and ideas may differ,
but we want to stop tragic calls in the night, painful diagnoses,
crimes, funerals, wars and all the rest.
Enter science.  With science, we have a weapon to level against our
difficulties.  With science we can at least delay our inevitable
deaths.  We can ease the pain of disease. We can give function to the
paralyzed; hope to the dying and their families.  With science we can
sometimes predict natural disasters and man-made acts of terror, and
either stop or mitigate them.  With science we can have more food,
better food, cleaner water and safer homes.
With our capacity for reason and science, we can stare into the face
of so much pain and say ‘I reject inevitability!’
However, one thing that science hasn’t yet done is find a way to ease
the heartbreak of, or give meaning to, the loss that plagues us.
Science is behind the curve, as it were.  One day it may break
through.  Science might reanimate the dead after much longer periods
of time.  Already there are discussions of ‘uploading consciousness,’
that is, taking our ‘selves’ and saving them to computers so that we
live on after physical death.  Perhaps science will allow us to travel
through dimensions, or time, to places where we are happiest.  Or will
simply learn to erase the pain from our memories; an idea that is not
entirely agreeable to me, since our painful memories are still
sometimes treasures.
All of this is guess-work.  Suffering is not.  It persists and
descends all too frequently. This is one very important role of our
religious faith.  Although religion sometimes meets with anger and
opposition over social issues, in drama real or contrived, it is (like
science) a way of seeking truth and giving meaning to phenomena.
Faith gives us a framework in which to view loss, and a canvas on
which to place our hope.  Faith eases our thumping hearts and soothes
our frantic minds.  It helps us to be kind in trial, to be hopeful and
patient in loss, to be forgiven and forgiving and to be  loving in the
midst of anger.  It gives many of us a reason an answer to life’s
While science moves us forward, faith has a critical role, if only
for believers.  It gives those of us with faith even more impetus to
strive.  It encourages us to make this life brighter, and more
wondrous, for ourselves and others; even as we hope for the next.
In a very real way, science and faith are exactly hand-in-hand.
Faith gives us a vision of better things.  Faith talks about endless
life; science prolongs life.  Faith teaches us to comfort the sick and
dying; faith gives us tools to do so.  Faith tells us to feed the
hungry; science allows it to be done more effectively.  Faith tells us
that things are not always what they appear; science sometimes lifts
the curtain to see things as they are, even as it always postulates
(just like faith) about what may yet be possible.
There is no need for any combat between either side.  South Carolina
illustrates this perfectly, as our citizens populate high tech
industries, cutting edge universities, and practice faiths of every
sort.  Theist, agnostic or atheist, we all have similar dreams and
visions.  And we ought all to work together to make a better future
for our children.  And to give them the means to both understand, and
transform, the world and their own lives.

FYI:  Here’s a link to a website detailing famous scientists who were theists.


Self-evident truth in medicine

Some things in medicine are obvious.  Despite the endless worship of ‘evidence-based’ medicine, and the constant barrage of studies on every conceivable topic, we do certain things because we know they just seem right.  I take as evidence the fact that we daily try to save lives, devoting research time, untold gazillions of  dollars and heroic clinical effort to our continued goal of staving off death.  Why is this?  Do we know that death is inherently worse than life?  Well, since we can’t see beyond the grave, and can’t exactly engage in double-blind, placebo controlled studies about the after-life, the answer is ‘no.’  But we assume that life is preferable to death, based on our feelings, our sense of the thing.

The same is true in our personal lives.  No one can show me a scientific study that details why he or she married a particular person.  No one can offer up a mole of affection for empiric analysis.  And yet, we don’t doubt the existence of romance, or the reality of love.

And yet, medicine is filled with situations in which ‘self-evident truth’ is systematically ignored, and those who believe in it intentionally and often viciously marginalized.

For example, after years of being told that physicians weren’t giving enough treatment for pain, and after years of clinicians saying, ‘yes we are, and too many people are addicted and abusing the system,’ the data from CDC says that far too many are dying from prescription narcotics, far too many infants being born addicted, and far too many people, young and old, are using analgesics and other drugs not prescribed for them.  To which many of us say, ‘duh!’

And then there’s the customer service model, the thing which causes clinicians to lose their jobs as satisfaction scores fall due to disgruntled patients (often upset over not receiving the drug they desired…see above paragraph).  This is a darling of administrators.  And it clearly has flaws.  As a recent article in Archives of Internal Medicine points out, physicians with very good ‘customer satisfaction’ scores tend to have patients with poorer outcomes.  Do you think?

Of course, Electronic Medical Records is another.  Those of us engaged in the practice of medicine on real people can tell you, EMR has promise, but in practice it consistently does three things.  Reduces productivity, takes us away from patients and results in far too much data being recorded and stored.  It needs to mature, rather than being forced on everyone from above.

There are others, of course. Board certification is beginning to look very much like a profit-generating machine, despite the paucity of evidence that it matters.  (I am board certified, so this isn’t sour grapes.)  Federal privacy laws (known as HIPPA) has left us awash in unnecessary passwords and regulations.  EMTALA, the law which protects the uninsured has probably resulted in more costs, and more loss of qualified physicians and necessary facilities than any other piece of legislation in history.  We know it…but few people are interested in studying it honestly.

All I”m saying is that physicians, and ultimately everyone, will have to mix science with good sense, and learn to embrace their own insights and powers of observation.

Studies have their place.  But their goal is the discovery of truth.  And sometimes, more often than we realize, the truth is right in front of us.

As we say in the South, ‘If it had been a rattlesnake, it would have bit you!’