Back to the Books

Now I remember why I didn’t want to be an endocrinologist!

My internal medicine board certification is set to expire at the end of this year. It lasts for ten years at a time, which seems pretty long until the end gets in sight. Well, the end is now in sight. Bummer.

The internal medicine certifying exam is quite hard. A lot of the questions end with a twist. I’ll be reading the clinical vignette thinking – “I’ve got this! Yes it’s an unusual case but clearly the diagnosis is __________” only to find the question at the end is not “what is the diagnosis? but rather “the best treatment is __________” and five potential treatments (all of which are good for that condition) are listed. Which is best? Why? Back to the story for more clues. It can be pretty frustrating.

I don’t really need to be board certified anymore. My clinical practice days are over, and my most recent administrative jobs have been very high level. But it feels bad to let the certification go. So I’ve decided to hit the books and take the test.

I’m enjoying the studying. It reminds me of when I was a “real doctor” and medicine is indeed very interesting. But it’s also a bit intimidating. There’s so much to learn. A lot of new things in ten years, but even reviewing the basics is a massive and daunting undertaking. Did I really know all this once?

Honestly, I put my chances of passing at 50/50 with the amount of work I’m willing and able to accomplish in the next 4½ months. More will be revealed.

In any event, I’m trying to learn more than just the facts. What higher-level messages am I getting during this process? Here are a few that I already knew (and you probably do too) but are coming to me with renewed force:

Your physiology is very, very, very complicated and finely tuned. Everything interacts with everything else. It’s all connected. Your body really is extraordinary, a marvel, even a “miracle.” If you’ve never studied biology, it would be worth it to learn just enough to be convinced of this through your own study. It could change how you think about your health – or your life.

When something goes wrong, other things are apt to go wrong. This is a natural corollary of “it’s all connected.” I learned this from simple observation in resident clinic. Serious conditions occur together. If you have one, you’re likely to have a bunch. Not all of them are avoidable, but try not to get that first one. Take care of yourself.

Many serious illnesses don’t have an identifiable cause. Some are autoimmune conditions, but then what exactly causes auto immunity? Others are more obscure. Perhaps unidentified genetics or environmental issues are at fault. We just don’t know, and perhaps some cause will be identified sooner or later. For now, sometimes what you get is what you get and there just is no explanation. That’s a hard message.

Doctors have a tough job. There’s so much to know and a great deal of judgment is necessary to balance risks, benefits and competing priorities in managing any reasonable complex individual patient’s situation. Normal physiology is complicated. Pathophysiology is more so. Then you’ve got the various diagnostic tests – sensitivity, specificity, risks, indications, contraindications, etc. – and the treatment options come with a similar set of issues. Back when I was a doctor, this was everyday stuff, not something to moan about, but now that I’m out of practice I have a growing respect for those who are still in the trenches.

As my studies progress, I’ll try to revisit what I’m learning, but this seems like enough for now. My basic message – It’s no fun to be sick, and sickness often snowballs. Take care of your health as best you can. Even then, things might go wrong for no apparent reason. If they do, find a doctor you trust to walk with you on your journey.

And, although it’s not in any of my study materials, trust God.

Pete

_______________________________

You made all the delicate, inner parts of my body
and knit me together in my mother’s womb.
Thank you for making me so wonderfully complex!
Your workmanship is marvelous—how well I know it.
Psalm 139:13-14 NLT

A Lot of Maintenance? “That’s life, man!”

Last summer I bought a new car – new as in “new to me” anyway. Actually it’s 50 years old being as it’s a 1967 Triumph TR4A, now named “Trevor.” (Yes, Trevor the Triumph. I’m prone to alliteration.) Trevor is a cool car, but he’s certainly very different from modern cars. Automobiles were all mechanical back then. Remember hand-cranked windows, manual transmissions, carburetors and distributors? That’s Trevor. There’s more computing power in your digital watch than in this car.

Not having ever been a car guy before, I’ve got a lot to learn. But to me, that’s half the fun of ownership. I like learning new things, tinkering, and do-it-yourself projects around the home. Figuring out how Trevor’s various parts and systems work and fixing or upgrading them myself is part of the appeal. So far it’s been enjoyable.

Hmm…where do I start?

Of course I know my limits. For now, and perhaps even for the long term, I’m tackling the more minor aspects of antique car repair and maintenance, the “1-wrench” or “2-wrench” jobs, and leaving the more difficult stuff to the professionals. (Thank you to the expert team at Maitland Tire Company!)

The other half of the fun is driving. Trevor’s not fast by modern standards, but he’s fun and we’ve had some great convertible weather here in Florida lately. Almost every time out I’ll get a few honks and waves or thumbs up from other drivers, and pretty often people stop for conversation. They’ll ask about Trevor and talk about the sports car they had, or wished they had. I enjoy that too.

A few weeks ago on Saturday morning, I was stopped at a light when a well-worn, older model Chevy Suburban pulled up alongside. The driver, a 40ish-year-old man who looked like he might know his way around an engine, rolled down the passenger side window and leaned over for a conversation.

“Hey man, nice car,” he said. “What year is it?”
“1967,” I replied.
“That’s great, man. Man, my dad would love to have a car like that.”
“It’s fun, but it is a lot of maintenance.”
He laughed and said, “That’s life, man!” just as the light turned green. We waved goodbye and drove on.

That last thought has stuck with me. He’s right; there certainly is a lot of maintenance to life. Apart from automobiles, we all can probably think of a long list of “to do’s” – mow the lawn, fix the sprinklers, update computer operating system, change the A/C filter, etc. It never stops.

I don’t know about you, but often I resent the need for maintenance, perhaps because it seems to interfere with my autonomy. I don’t want any more “have to do” tasks on my to do list. Fixing things or maintenance often feels forced to me.   I think, Yes, stuff need to get done, but no one tells me what to do! Perhaps I’m a little lazy. I’ll do it when I get around to it. Of course, I need to get around to it now.

That hasn’t happened with Trevor yet. Yes, I’ve had a bit of frustration here and there. I’ve started some smaller projects only to have things be harder than I appreciated, but I’ve reminded myself, This is half the fun. You bought this car to learn new things and have new experiences. You like this stuff. And that’s all true, I do. Attitude makes all the difference.

What’s your attitude toward the “maintenance” required of you? Beyond your possessions, how about your health? Most of our health and wellbeing is simply the result of our regularly scheduled maintenance, or lack thereof. Some tasks are daily – eating, sleeping, exercising, and praying. Others are more infrequent – the annual doctor visit, lab tests, mammograms, colonoscopies. It’s easy to procrastinate or avoid doing even what we know is good for us.

With proper maintenance, and some professional help, I’m sure Trevor has a lot of life in him. The same can be said for most people. Unfortunately too few folks follow the manufacturer’s recommendations. I think I’m doing pretty well, but aging is challenging both physically and emotionally, and I’m still learning about how to best care for myself. How about you?

Take care,

Pete

My Work Here is Done

endI’m not planning on blogging anymore, but I hate to say I’m ending it – sounds to final.  Perhaps we should say I’m “suspending” it like the various candidates who have suspended their presidential campaigns.  Of course suspending usually means they’re done for good.  Have any politicians ever “unsuspended.”  I can’t remember any.

It’s not that I don’t enjoy blogging, but rather that I think that my work here is done. I began this blog two years ago with several objectives in mind including:
– getting my thoughts clear on the relationship between wellness and discipleship
– creating a small body of work on the topic without trying to write a book
– using up some creative energy and having fun writing and managing a web site
Check, check and check!

Have you noticed the authors who write a very popular book but then never say anything different?  Sure more books come, but not more new ideas.  Often the later books repeat the same essential message with new stories or a slightly different twist.  I hate that and am not interested in being one of those guys.  I like to keep moving forward into new territory, which I think has happened between More Health Less Care, The Love Fight and Grace Based Wellness.  Now I think I’ve adequately covered the big picture of that last topic, and the more I’ve done so, the simpler it has seemed to me.

The bottom line – seek and you shall find.  Seek wellness for sure, but subordinate that to seeking after God.  Seek his kingdom first, and wellness, perhaps even health, will come.  The rest is just details.

I hope you have enjoyed or otherwise benefitted from this blog and I intend to leave it up (it’s only suspended after all) and please let me know if I can do anything to help you personally to be well.  Thanks for reading.

Sincerely,

Pete

Doing It Myself. Using Leisure Time Wisely

Are you a do-it-yourselfer? I am. I enjoy doing projects around the home and yard, and I seem to be enjoying it more and more. Lately, I’ve been considering these various activities part of my wellness regimen. Let me explain what I mean.

In modernity we face the problem of too much leisure time. Although we may spend long hours in the workplace, we still have much more personal discretionary time than prior generations. Labor-saving devices, products and services abound. It takes less and less of our free time to perform the basic tasks associated with living. Examples include preparing rapid meals from packaged food rather than cooking from scratch, shopping on Amazon Prime instead of the mall, or hiring a yard service to mow the lawn. Add it all up and we’ve got a lot of time on our hands. What do we do with it?

Some people just work harder. They live in maintenance-free housing, hire many personal services and concentrate on making money. That’s fine if they really need the money, but if money or career success have become idols, as they often do, the opportunity to spend more time at work is a temptation that leads many down a path they later regret.

Others seek to be passively entertained. Give them the TV (or the internet), a couch and a beer and they’re in heaven on earth! What more does one need? Work to put food on the table and cover other essentials, then relax. Unfortunately a life consisting only of a nine-to-five job and five-to-nine relaxation (plus weekends) is also unlikely to produce robust physical, emotional and spiritual health.

To be well we’ve got to spend our personal discretionary or leisure time more wisely. Beyond explicit “self-improvement” activities, ordinary hobbies or other intentional voluntary activities can also very good for us. One of my choices is to be a “do-it-myselfer.”  Not for everything of course, but I like yard work of all sorts. (It’s time to start more amaryllis from seed again. That was a fun project last year.)   And I enjoy tackling minor home repair, construction and electrical projects.

Installing a timer switch for the front door lights is my most recent small project. It turned out to be harder than I thought. It seems the electrical boxes they were using in 1971 aren’t quite as big as they make them now, but I got it done and it feels good.

Another quality Job by Peter J. Weiss

Another quality job by Peter J. Weiss

Why does it feel good? Many reasons I think. Here are a few:
–  It provided a sense of accomplishment. I did something useful.
–  New learning was required. I enjoy learning.
–  I saved a bit of money. No need to hire an electrician
–  It added to a general sense of competence, of control over my life. I don’t have to hire someone; I can do these things myself.

It’s got me thinking maybe I should opt out of more modern labor-saving methods. Maybe doing more things the old fashioned way would be a good way to spend my leisure time. What else could I try to do myself? Baking my own bread perhaps? I used to do that when I was single. I’m sure I’d enjoy it again, and Sharon would help; she likes to cook and bake from scratch. It could be a couple’s activity.

We’ll see. For now, I’ve got enough to keep me busy. What do you do with your leisure time? Is it helping you to be well?

Two Reminders From Antonin Scalia

Antonin_Scalia_2010Antonin Scalia’s recent demise has everyone thinking; mostly it seems about the divided nature of our country and President Obama’s choice to fill the Supreme Court vacancy. But it’s got me thinking about two different matters. The first is reasoning and decision-making. Justice Scalia was known for sound reasoning proceeding from firm legal principles resting on a view of the Constitution as having a single and unchanging meaning. Many disagree with his views on that last part, but his method and legal record should remind us that our principles must rest on something. We can’t draw our principles from nothing.

Reasoning is important to us as we make decisions and take actions to improve our health and wellbeing. What is the best way to live? How should we decide? What is our model? What principles have we found to guide us in decision-making, and on what foundation do they rest? Here’s a diagram of how I’m viewing the best case for us as we proceed.

IMG_0890 (1)

We should be making our choices after reasoning through the facts of our personal situations using the principles that apply, and those principles should be based firmly on reality as we understand it. In short, reality matters. Are body and mind separate “parts” of people? Do humans have souls and an eternal existence? Is there an unseen spiritual reality underlying and supporting our perceived material reality? If so, how does that work?

Just as the Supreme Court Justices have different views the nature and meaning of the Constitution, as individual people, we may have differing understandings of reality. Their disagreements, based on variation in views of the Constitution, illustrate for us how our views on reality matter in our personal choices. The President and the Senate together will select the next Justice, based in part on his or her view of the Constitution, and we have little control over that. However, we each have complete control over how we understand reality, and there is nothing more important.

Yet how much time does the average person devote to thinking about the big picture, to investigating the big topics? How much time have you spent investigating and settling upon a personal worldview, one supported by evidence? Many people choose to “go with the flow” and accept the prevailing cultural norms. That’s what I did for a long time, until a more careful inquiry caused me to rethink it and draw new conclusions; conclusions that have changed my principles, choices, actions and results – for the better!

I encourage you to thoroughly investigate reality for yourself. Ask the hard questions, spend the time to search the evidence and draw firm conclusions before more of your life passes behind you. Which brings up the second Scalia reminder. His death reminds me that I am going to die. So are you, and no one knows when for either of us. The second matter makes the first all the more important.

Workplace Wellness Programs and Respect for Our Humanity

file0001229562991Workplace wellness is a big issue these days. Employers large and small are designing wellness programs to (hopefully) produce healthier employees. I wish I could say that it’s because the top leaders love and care for their employees as people, and in some cases that is certainly true, but what’s motivating most is a desire to maintain or increase profitability by decreasing absenteeism and presenteeism, increasing productivity, and lowering the cost of the employee healthcare benefit.

Increasing profit is a worthy goal as long as it doesn’t come at the expense of treating people humanely; that’s worth a little thought as we business leaders design our wellness programs. In my mind there are three main categories of wellness programs which I’ll term: a) the Public Health approach, b) Carrots & Sticks, and c) Inspire & Invite. In practice, employers typically blend these styles into their own unique program. I believe it’s important to understand each of these methods in order to design an integrated and human-honoring plan.

Public Health

The Public Health approach involves making changes to the physical environment or culture (emotional and behavioral environment) that affect all employees. These broad programs or policies can be either positive (or additions) or negative (or removals). An example might be eliminating candy machines and fried or high-calorie food from the cafeteria. Many firms also have instituted non-smoking campuses. Creating a positive and vibrant “culture of health” is a goal for some employers. In my view these examples are reasonable approaches that can positively shape employee behavior at least while they’re at work.

The counter argument is that such policies suppress or reduce “choices” and that choice is a good thing. This is a valid argument, but we know that people are not always able to make good choices. The Christian worldview suggests that human beings find it nearly impossible to make good choices most of the time; our national problem with lifestyle illness supports that view. Yes, people do need to be protected from themselves (at least a little bit), and it’s not wrong to be somewhat paternalistic in our designing our wellness programs if it comes from our love of and respect for people.

Naturally one can go too far in this direction and restrict liberty in the name of wellness. Banning all possession of candy or fast food on the campus might be an example.   “Food police” are not humane. Similarly a policy of not hiring smokers or creation of a workplace culture where athletics or fitness is glorified and unfit or overweight individuals are shamed does not reflect love and concern for people.

Carrots & Sticks

In a Carrots & Sticks model the employer provides incentives or penalties for certain health behaviors or outcomes. You’ve probably seen many of these. An insurance surcharge for employees who smoke; payments or deductible reductions for employees hitting body mass index targets or completing a health risk assessment are examples. In my view these are also reasonable steps as long as they are accompanied practical tools and help (say health coaching) to enable employees to change, that is, to get the carrot and avoid the stick.

As with the Public Health approach, Carrots & Sticks can be taken too far. Employers may design many-step or many-outcome plans integrated with their insurance benefit and triggering various copayment reductions and other benefit enhancements or penalties. These may continue to increase in complexity or materially change from year to year. Beyond a certain point, I think programs of this type can become attempts to micromanage employees’ lives. Micromanagement does not honor our nature as individual agents. People hate it at work, how much more do they hate it when it involves their personal lives?

Used sparingly, Carrots & Sticks can be good as a stimulus for people to try something new. Sometimes people could use a little help getting ”unstuck” from bad habits. Perhaps that one-time incentive to run a 5K turns a couple of participants into dedicated runners afterwards, or that mandatory health and wellness class gives an individual a nudge towards healthy eating that grows over time. In my case, it was only after joining the Navy (which uses a very big stick approach) that I began to run and found that I actually enjoyed running.

Inspire & Invite

This is pretty simple; people need inspiration, and are inspired by the stories of others and visions for themselves. Business leaders get this as it relates to their business; they create a compelling company vision, and they tell inspirational stories of customer service, overcoming operational challenges, or other business success. They’re trying to inspire and invite employees to contribute to achieving the corporate vision.

How about doing the same for them as individuals? Help them see that they can be well. Find employees to share stories of personal health problems and success in overcoming them. Invite employees to tackle their own health challenges and provide the resources to do so. That’s Inspire & Invite. Personally, and even though at any given time most employees may not be ready to change, this is my favorite approach because it’s about connecting with others on a deep emotional, and even spiritual, level.

Can you take Inspire & Invite too far? Maybe. If it becomes overbearing and creates a culture where people feel hassled, that’s too far. But I haven’t seen that yet. My perception is that employers tend to overdo the Public Health approach and Carrots & Sticks while limiting Inspire & Invite which seems by comparison too “soft” and perhaps less measurable.  Yet it’s exactly this “softness” that people require to truly change on the inside.

Let’s remember what it means to be human while we develop workplace wellness programs for the other humans that we call our employees.