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The “Big Picture” Benefit Of Primary Care

Her eyes were bloodshot. She responded to my casual greeting of “How are you?” with a sigh. “How am I? I’m alive, I can tell you that much for sure.” She went on to describe a situation with her adult son who’s in a bad marriage and has struggled with addiction. She sighed again: “I feel weak. I don’t know if I can deal with this one. I’ve had so many hard things in my life already. When will it stop?”

“Many hard things” — yes, I agree with that assessment. She’s been my patient for more than a decade, and I’ve had a front row seat to her life. Her husband died a few years ago (while in his 40′s) of a longstanding chronic disease. Her daughter also has this disease, and has been slowly declining over time. I’ve watched her bear that burden, and have actually shared some in that load, being the doctor for the whole family.

I’ve also taken care of her parents, who had their own psychological problems. They were difficult patients for me to manage, and they had died long enough ago that I had forgotten that difficult chapter of her life. I’ve helped her with her emotional struggle from all of this. It was hard, but she hung on as best as she could. I know. I was there when it was happening.

To me, this is the biggest benefit of primary care. Yes, it’s nice to have a doctor who knows what’s going on with all of your other doctors. It’s good to have a doctor you are comfortable talking with about anything. It’s good to have someone without a financial stake in doing surgery, performing procedures, or ordering tests. But the unique benefit a long-term relationship with a primary care physician (PCP) is the amazing big picture view they have. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

The Practice Of Medicine: When A Funeral Provides Perspective

Here’s my column in this month’s Emergency Medicine News:

I have practiced with the same group, in the same hospital, for 17 years. Because we have been together so long, our group is a family. So it was with enormous grief that we buried our founder, Dr. Jack Warren, 11 years ago after a tragic car crash. That wound is still open, but we still tell stories about his humor, his compassion, and his grace.

As I write this I am tending another wound, or I should say our group is tending another. A second partner passed away last week. Unlike the sudden horror of the first death, the second was progressive, as our friend and partner, Dr. Howard Leslie, left us by degrees, the victim of metastatic melanoma. Jack and Howard founded our group before any of the rest of us arrived. Both of them are buried in the same wooded, hillside nature preserve. Pieces of our group, pieces of ourselves, interred in the red-clay earth. Just as they practiced before the rest of us, so they went to sleep before the rest of us. I think they’ve gone ahead to show the way. So they can one day help us adapt to peace the way they helped us adapt to practice.

But both deaths remind me of partnership. Medicine today is chaotic and difficult for many reasons. Part of the problem is that government and regulatory bodies overwhelm us and litigation threatens us. Part of the problem is that we, and our patients alike, have untenable hopes and impossible standards for the practice of medicine. Read more »

*This blog post was originally published at*

In Front Of The Mirror Of Middle Age

“It was the best of times, it was the worst of times…”

An intermission, the curtain has closed on youth, but the next act awaits.

Caring for hiccups of the heart, like atrial fibrillation for example, often throws me in front of the mirror, of middle age that is, and sadly the reflections show imperfections. Since I am middle aged myself, there are my own experiences. But everyday at work, on my job site, I see the effects of these same middle-age experiences on the atrium of my patients. The results are often profound. So must be the pressures.

I read a passage in the wee hours of the quiet morning, in the dark, with a flickering book light. It grabbed me. It is from Elisabeth Strout’s Pulitzer Prize-winning, Olive Kitteridge. Read more »

*This blog post was originally published at Dr John M*

The Impact Of Attitude On Life

Life sometimes gets in the way of daily posting. Specifically, the treadmill of life sometimes roars too fast.

But as I strolled through the hospital this morning, there was a plain piece of white paper taped to the wall around the nurses station. Although I’m not overly religious (and even highly conflicted about which rituals are the right ones), these words from a pastor/celebrity stopped me for a moment:


The longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, than success, than what other people think or say or do. It is more important than appearance, giftedness or skill.

It will make or break a company, a church, or a home. The remarkable thing is that we have a choice every day regarding the attitude we will embrace for that day.

We cannot change the past, we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing we can do is plan on the one thing that we have, and that is our attitude.

I am convinced that life is 10 percent what happens to me and 90 percent how I react to it.  And so it is with you. We are in charge of our attitudes.

As a cardiologist programmed to “alert” most of the time, words such as these help me. I haven’t seen the studies yet, but I’m guessing that positive attitudes reduce inflammation, which is good for our atria, and our arteries.


*This blog post was originally published at Dr John M*

Life’s Lessons And Playing Dolls

I’m not very good at the sort of play that grownups enjoy. I almost killed a goose once when I sliced and very nearly combined bird hunting with a golf tournament. I can serve a tennis ball — across the fence and into traffic. I once swung at a baseball no less than 20 times as teammates kept encouraging me.

However, I have a great imagination. Imaginary play was my delight as a child, and I rediscovered it when my own children became my born-again playmates.

Unfortunately, I felt inadequate when it came to dolls. Since my poor daughter, Elysa, is blessed with three older brothers, she’s always looking for someone to play dolls with her. Often, that someone is ‘papa.’ Read more »

*This blog post was originally published at*

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