Originally posted at my Substack, Life and Limb.


I have been writing about healthcare for over twenty years, both to the public and to fellow healthcare professionals. I have reported what I have seen, and have attempted to draw attention to assorted issues. I’m no policy maker, no academic. I consider myself a scout and if I do say so, I have done a fair job of predicting trends.

While I consider that reporting to be valuable, people also need suggestions and ideas. Hopelessness is tough to read about. I mean, this isn’t a headline that empowers…





Although, as things fly into pieces, as beds become rare, as physicians and nurses retire or quit, as hospitals close (witness the closure of one of two trauma centers in Atlanta this month), it’s hard to feel be filled with sunshine about American healthcare.


Equally troubling, new reports show hundreds of thousands of physicians and nurse practitioners left their professions in 2021.


(If you don’t want to register for that one, it was about 117,000 physicians, 53,000 NPs and 22,000 PAs.)

I see this every day as primary care and specialty care alike are struggling, and hospitals are shuttering patient care units due to lack of staff.

So what can we do? Sure, we generally can’t do surgery at home. We need the people who are trained in these fields for any number of situations we might face. But since it may get harder and harder to get help from professionals, how can we respond?

There are a few things we can do. But I don’t think that policy, or advocacy, even at higher levels of business and government, will be able to help us much in the foreseeable future. We’re probably a decade behind building facilities and certainly that far behind educating sufficient physicians, a little less but also far behind in nursing staff, EMTs and probably everybody else who darkens the door of a hospital to provide patient care. The stark reality is that we should attempt to save ourselves and those we love. And then scale up from there.

A few empowering suggestions:

Lose weight. I know it’s hard. I’m not shaming or judging, I’m just suggesting. Obesity is tied to a cornucopia of health problems from diabetes to heart disease, from stroke to joint pain and all the rest. My father was overweight and destroyed his knees, so that in the end, he could barely walk. Obesity prevents us from being able to help ourselves or others, as we become more and more dependent on equipment and services, medications and procedures, wheelchairs and scooters just to function. This is not a thing that makes for thriving. While some can’t help it, and I get it, most of us can.

Stop smoking or simply don’t start. Again, I know it’s hard. Smoking cessation is very difficult. It’s crazy addictive and the older I get, and the more I know and love humans, I get it. It’s a small comfort in a hard world. But it’s best to avoid it unless you want to depend on the system to manage your heart attack, stroke care, chronic lung disease, myriad cancers, arterial blockages of limbs with amputation and assorted other miseries. It’s a terrible thing that, if invented today, would never be allowed by the FDA.

Don’t use drugs. Addictions are often very powerful responses to very terrible situations or experiences. Drug addiction is so hard to beat. But if you can avoid even experimenting, do it. And if you can stop, do it. And if you want rehab and help, seek it out. Drugs devastate. Fentanyl and Heroin, Hydrocodone and Oxycontin, Xanax and Valium and Ativan, cocaine and methamphetamine, these things kill and along the way produce terrible infections, heart attacks, strokes, car accidents, violence and assorted tragedies. They also remove parents from children who need them, and burden adult parents with adult children who can’t function. Drugs, bad for you. Bad for the country.

Ditto alcohol. A drink here and there? Sure. A daily coping mechanism? A disease of alcoholism? Alcohol leads to liver disease, ulcers, bleeding in the intestinal tract, heart disease, seizure, violence, DUI with injury and death, personal dysfunction, broken homes. See drugs above.

Work out. Get in shape. I mean it. Walk then run. Lift a little then lift a lot. Bike, swim, hike. If you love America, if you love freedom, then you owe your country an obligation to be useful. You mustn’t expect someone to carry you and care for you at every phase, in every crisis when you’re capable of doing better. It should be your goal to be capable of saving others in times of trial, of rescuing those in danger, first and foremost yourself and your family, then your neighbors and others.

People who talk about patriotism often think only about a fight for freedom. About being armed to resist tyranny and violent crime. That’s all well and good. But if you’re out of shape, if you can’t walk across the yard without being winded, if you can’t bend over to tie your shoes, then don’t tell me about your latest firearms purchase. Again, some can’t help it. Some suffer from very real issues that preclude activity. I’m not talking about that. I’m talking about most of those who can do better.

What else? Learn some basic healthcare stuff. So much that ends up in our hospital emergency departments is simply fear and anxiety. I have often said that part of the problem is that there aren’t enough grandmothers or grandfathers engaged in the lives of family. They had lived long enough to know what was normal and what wasn’t. Short of that, take classes.

Take CPR and first aid classes.

Take Stop the Bleed and learn to handle bleeding emergencies.


Take a First Responder class in your community.

If anyone in the family has the slightest inclination, encourage them to:

Join the military and become a medic or train in an affiliated medical field.

Become a volunteer or professional firefighter, because you’ll not only learn how to manage fires and other accidents, but will get medical training as well.

Become an Emergency Medical Technician, either basic or paramedic level.

Become a Certified Nursing Assistant

Become a Licensed Practical Nurse, Registered Nurse or get a Bachelor’s degree in Nursing.

Become a respiratory therapist, physical therapist, occupational therapist.

Become a Nurse Practitioner

Become a Physician Assistant

Become a physician; MD or DO (it doesn’t matter)

Become a dental hygienist

Become a dentist (get a bad toothache without access to care and you’re immediately reminded why they’re important)

There’s a long list of healthcare careers and one never knows when we’ll run out of people to do the job.

What else?

Make sure your prescriptions are always up to date. Don’t get behind if you can help it. Ask if you can get a couple of months ahead. (Your doctor won’t want to help you stockpile Oxycodone, but maybe will help you with blood pressure medication, insulin, inhalers and other essentials.)

Keep your appointments with your doctors. Go to dialysis, don’t skip it thinking you can just ‘go to the hospital,’ as that hospital may hot have it.

If you’re pregnant? Know where to get OB care. These days many hospitals have no obstetricians and no labor and delivery unit.

If you need something done, an ultrasound for instance, ask your doctor to order it as an outpatient. ‘Just go to the ER’ to get it is bad advice unless it’s really urgent. It will be expensive and time consuming.

Ask for a copy of all of your medical records. Office notes, procedure notes, xray and CT and ultrasound and cardiac catheterization reports, EKGs, discharge summaries from hospitalizations. Keep paper copies and also scan it all into your computer and then to your phone. That $1000 computer in your pocket is great entertainment but it can help you keep all medical records handy. When one hospital tries to request records from other hospitals it can take hours to days to get important information.

I’m about to go to work. Odds are the ER will be full, the hospital will be full, and the ambulances will be running all day long. Every hospital in the area will remain on alert, meaning they just don’t have any beds. This is where we have been and remain.

If you want to save yourself or your loved ones, start with the simple things.

My colleagues and I will still be there doing our best when you need us. But by doing more, by being more empowered, you actually help us.


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