We Can Do Better

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

The pendulum has swung too far.  Fifty years ago there were psychiatric hospitals full of mentally ill patients who were poorly treated and even abused.  “One Flew Over the Cuckoo’s Nest” was required reading.  National outrage peaked and psychiatric hospitals closed leaving thousands of patients unequipped to face the outside world.  Alcoholism, drug addiction, and homelessness began to spiral out of control.

Today major cities like New York, Seattle, Portland, Los Angeles, San Francisco, and others have homeless populations overwhelming local resources.  Los Angeles County now has over 60,000 homeless people, and San Francisco publishes a map to help visitors avoid piles of human feces and used syringes.  Police officers are becoming ill as a result of contact with infected people.  Tuberculosis, Typhus, Typhoid fever, Hepatitis A, and scabies are only a few of the conditions smoldering on the streets.  Rape and violent assault are routine.  California now accounts for one-fifth of the homeless population of the entire country.

The two largest contributors to homelessness are mental illness and addiction.  Most cities have laws against sleeping on the streets, but often those laws are not enforced.  Decriminalizing bad or problematic behavior does not make it go away, and permitting squalor is not compassionate.  Homeless people do not represent a big voting block, but government officials have a responsibility to protect public health and safety.  Experience over the last 40 years has taught me something about caring for homeless patients and starting free clinics, so here are a few thoughts:

  • Commit to addressing the problem. If inaction, complacency, and blame solved problems, we wouldn’t have any problems left.
  • Enforce existing laws and give the police the support and back up they need. That is not being “mean.”
  • Triage people in tent cities. Most need help from social services, many need treatment for addiction and mental illness, some may respond to help from church organizations, and some probably need to be arrested.
  • Organize a volunteer force (the local equivalent of the Peace Corps or the Job Corps). Those not in need of acute treatment for mental illness or addiction might be salvaged with a program that teaches basic living skills.  Such programs already exist in some areas.  College and graduate students could volunteer and earn “credits” toward paying off some school loans.  Colleges and universities would need to cooperate, but at some point you have to put your money where your mouth is.  Tax credits could be given to non-student volunteers.
  • Organize mobile free clinics to vaccinate, screen for infectious diseases, and begin basic treatment. Invite nursing and medical students as well as retired professionals to help.  Sometimes people simply need to be asked.  They would need legal protection from malpractice.  Non-controlled drug samples and old medical equipment could be donated.  I know whereof I speak here.
  • Create transitional housing facilities (like senior life care in reverse). Old warehouses and military style barracks could be refitted. California has the largest percentage of billionaires in the country.  Ask them for help.  No one becomes massively successful because he or she has a dearth of ideas.

Fifty years ago some people were abused in mental hospitals.  Now we allow them to abuse themselves and one another on the streets.  This is a massive, complex, and expensive problem.  But failing to address it will have catastrophic consequences for everyone.  We can do better.

An Idea Whose Time Has Come

Posted on Posted in Brain Science, Continuing Education, Homestudy, Seminars, Webinars

By Mary O’Brien, M.D.

Are you an adult?  Are you sure?  Young people today are taking longer and longer to grow up.  Throughout history people worked hard and started families in their teens.  Only a privileged few could afford the time or money for an education.  Even a mere century ago, finishing high school was a relative luxury.

A few weeks ago, during the 75th anniversary of D-Day, we heard remarkable stories of 18- and 19-year-old boys fighting for freedom and civilization.  These boys grew up very fast.  They had no choice.  Mommy and Daddy could not indulge every whim of their sons.

Growing numbers of people now realize we have a problem.  Young people are graduating from high school and even college with minimal practical skills.  Changing a tire, cooking a real meal, or opening a bank account can overwhelm them.  This is not good.  Many of us were required to take shop class or home economics in high school.  Then, the “geniuses” in education had their way.  The results speak for themselves.

Happily, there is hope.  A young teacher at Fern Creek High School in Kentucky has begun three-day workshops called “Adulting 101.”  Sarah Wilson Abell has been instructing students in real-life skills:  how to handle basic food preparation and cooking; how to change a tire; how acquire the fundamentals of money management; how to read a map (in case Siri is sick); how to behave on a job interview; how to have basic table manners and etiquette; and how to tie a tie.

Parents used to teach these skills, but the days of June and Ward Cleaver and Ben Cartwright are long gone.  This timely idea is spreading.  More and more people in their thirties and forties realize they need these skills.  I recently encountered a 31-year-old woman who didn’t know how to sign her full name because, “We didn’t learn cursive.”  You can’t make up things like this.

Someone reading this is probably not a high school teacher, but many of our readers teach students in the health-care professions.  Starting your own “Adulting 101” class could be tremendously helpful.  In addition to the topics listed above, a few more are worth considering:

  • Good, old-fashioned people skills. Professional etiquette when dealing with patients and colleagues must be taught.  Translation:  Put down your cell phone and look up from your computer.
  • Principles of personal hygiene and dress. Don’t act outraged.  Most of us realize standards couldn’t have sunk much lower.  Our failure to teach and maintain such professional standards has compromised patient care and the career advancement of many students and trainees.
  • Essentials of appropriate speech and behavior in the workplace. As is the case with appearance and manners, there are boundaries that separate work, play, and personal life.  This comes as a shock to many young people.  We do them a great disservice when we fail to correct the situation.

“Adulting 101:” It’s an idea whose time has come.  It should have never gone away in the first place.

Memorial Day, D-Day and Cicero

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Traffic Delays.  Slow Wi-Fi.  Dead phone batteries.  Forgetting a password.  Insufficient “likes.”  These are among the top stressors listed by millennials in a recent survey.  Contrast this with the real stresses endured by similarly aged men storming the beaches of Normandy in World War II and the absurdity of current culture becomes painful.

I’ve always been baffled by the number of people who confuse Memorial Day and Labor Day.  They’re not even embarrassed.  Ask nearly anyone much under the age of 50 what he knows about June 6, 1944, and prepare for a blank stare.  Twenty- and thirty-somethings may well scrunch up their faces in annoyed perplexity as only they can do.  People today lead frenetic, cluttered lives that leave little room for history.  But as Cicero wrote in 46 B.C., “To be ignorant of what occurred before you were born is to remain always a child.”

Memorial Day commemorates those who died in active military service.  Originally, it was called Decoration Day and was observed on May 30th.  Eventually, it was changed to the last Monday in May mostly as an excuse for another three-day holiday weekend.  This year Memorial Day falls on May 27th.  People will have barbecues, picnics, and parades. They will open neighborhood swimming pools and proclaim the unofficial start of summer.  A few thoughtful people will attend memorial services and place flowers on the graves of those who sacrificed all.  But millions will remain clueless as they consume hot dogs and beer.

This year, on June 6th, those of us fortunate enough to live in the free world will observe the 75th anniversary of D-Day (June 6, 1944).  The planning, hope, courage, determination, perseverance, and sacrifice of the Allied Forces on that momentous day cannot be overstated.  The unwavering commitment of thousands of men to stopping the onslaught of the Nazis despite the terror, horror, and agony of it all is beyond our grasp.  What those men endured makes our worries laughable.

The next time you find yourself upset by traffic delays, slow Wi-Fi, or a dead phone battery, remember Memorial Day, D-Day, and Cicero.  Some of us need to stop thinking like children.

Guidance and A Good Example

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Do you teach students? Do you manage employees? Are you setting a good example for those who will come after you? Last week, I heard Jamie Dimon, the chief executive of J.P. Morgan, discuss the importance of cultivating a bench of good people from which the board of directors could select a worthy successor. A truly wise leader in any organization thinks like that. Of course, in order to think and plan on that level, one needs tremendous maturity, discipline, humility, and prudence.

Many people today are too insecure and self-obsessed to train their own replacements. They’re more worried about who might threaten their power and position. But history is a good teacher. Socrates trained Plato, and Plato trained Aristotle. Jesus picked 12 apostles and numerous disciples. Sir William Osler trained an elite cadre of young physicians to follow in his footsteps at Johns Hopkins.

Superior leaders surround themselves with first-rate people, and these leaders cultivate several key attributes and skills. Whether you are a senior partner, a professor, or a parent, here are some of the qualities that are essential to your ultimate success as you pass the baton:

  • A deeply ingrained sense of right and wrong. Many people focus on what they can get away with. Moral relativism is not the secret to greatness or even long-lasting success.
  • A willingness to accept personal responsibility for success or failure. Expressions like “It’s not my fault,” “It’s not my job,” do not make for an acceptable mindset.
  • The ability to speak and act with courage. This one is tough in the age of social media nonsense and nastiness. The vast majority of people in board rooms and conference halls are afraid of what someone might say, so they hide behind the commonplace and comfortable. There is no honor in cowardice.
  • The wisdom to encourage and inspire others. Mediocre-management types make excuses. Top notch people bring out the best in others. When you have a great parent, teacher, coach, or boss, you can’t bear the thought of disappointing your hero.
  • The capacity to engage in independent thought and creative problem solving. The world is full of lemmings, parrots, copycats, and complainers. It takes a secure, confident leader to inspire real leadership in others.

Whether you work in a huge medical center, a small office, a corner pharmacy, or at home, someone is looking to you for guidance and a good example. Don’t be afraid to set the bar high.

Pop Quiz!

Posted on Posted in Brain Science, Continuing Education, Seminars, Webinars

By Mary O’Brien, M.D.

Quick!  What illness can cause fatal pneumonia, bacterial superinfection, meningitis, myelitis, encephalitis, acute thrombocytopenic purpura, transient hepatitis, or subacute sclerosing panencephalitis?  The answer is measles.  Each year nearly 20 million people are infected worldwide.  There are 200,000 deaths, most of which occur in children.  The anti-vaxxers are utterly unaware of these facts, but there has never been a shortage of ignorance in the world.

Measles is a highly contagious viral illness that typically strikes children. Unfortunately, more than 90 percent of susceptible people who are exposed will contract it.  Measles spreads mostly by aerosolized droplets from the nose, throat, and mouth during coughing.  The virus can survive airborne for two hours in closed areas like a classroom.  The vast majority of measles cases in the U.S. are transmitted by travelers and immigrants, with subsequent transmission to unvaccinated children and teens.

Measles has a 7 to 14-day incubation period.  The prodrome begins with fever, sneezing, watery eyes, conjunctivitis, and a hacking cough.  Koplik spots develop on the oral mucosa, opposite the first and second upper molars — before the rash develops.  Dental professionals take note.

A sore throat typically develops shortly before the rash, which is maculo-papular.  Macules erupt just in front of and below the ears, then migrate down the sides of the neck.  Papules begin to emerge as the rash spreads down to the trunk and extremities, including the palms and soles.

Peak severity is often marked by a fever above 40⁰C.  Many children have periorbital edema, photophobia, irritability, pruritis, and a hacking cough. These kids look and feel very sick for 3 to 5 days, at which point the fever subsides and the rash fades and desquamates.  Immunocompromised patients may be profoundly ill with severe, progressive pneumonia but no rash.

Mortality in measles is about 2 in 1000 cases in the U.S. and much higher in developing nations.  In the year 2000, measles was officially declared eradicated in the U.S. by virtue of the tremendously effective MMR (measles, mumps, rubella) vaccine.  Unfortunately, multiple outbreaks have recently occurred in California, Washington, Oregon, Utah, and New York.  Many outbreaks have been linked to unvaccinated children in Amish and Orthodox Jewish communities.  Currently, an outbreak of measles in Brooklyn, New York, has been declared.  There were 285 cases, a public health emergency.  Nationally, the figure stands at 465 cases documented in 15 states.

Scientific ignorance and paranoia on the part of some parents and stunning misinformation on the internet has led to clusters of unvaccinated children and rapid spread.  The original “study” claiming that vaccines cause autism was entirely fraudulent.  It involved 12 patients and was thoroughly debunked.  The author lost his medical license.  Legitimate studies of over two million children have demonstrated absolutely no relationship between vaccines and autism.  Autism has been linked to over 100 genetic mutations.  Many people today do not like to hear the word “genetic.”

A landmark study published several years ago in the New England Journal of Medicine revealed disrupted stratification of multiple cellular layers in the cerebral cortex early on in fetal development.  The stage for autism seems to be established before birth.

Making decisions based on misguided notions and emotions can be catastrophic.  Those of us in health care and education need to set the record straight.

Look At Me!

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology

By Mary O’Brien, M.D.

Let’s look at congestive heart failure (CHF), chronic traumatic encephalopathy (CTE), and chronic obstructive pulmonary disease (COPD).  We all have our abbreviations and acronyms.  Every discipline does.

Now, courtesy of incredibly foolish behavior sweeping the planet we have SRT – Selfie-Related Trauma.  People around the world are being injured or even dying by doing dangerous things while trying to take “selfies” (photographs, using a cell phone, of themselves and perhaps others who may be nearby).

Most, but not all of these cases involve students.  The top three countries for SRTs are India, the United States, and Russia.  Multiple traumatic injuries most often result from falls into rivers and canyons, from falls off of cliffs or trains, and from motor vehicle accidents.  Drownings and electrocutions complete the list.

The science of photography has changed the world.  For over 150 years, people took pictures of other people, exquisite scenery, major events, and touching moments.  Now, many people can’t get through the day without taking photos of themselves engaged in the most mundane or ridiculous situations.  Look at me in the kitchen.  Look at me at work.  Look at me on vacation.  Look at me by the Statue of Liberty or the Grand Canyon.

We now have two generations, possibly three, who have been conditioned to believe a picture is incomplete without ME.  This is not only pathetic, it is dangerous.

Not long ago, a young woman at a zoo learned an important lesson about the dangers of ignoring barriers to get a selfie.  She went into an area she should not have entered and breached a barrier.  Determined to get not merely a close-up of a jaguar, but a selfie with a wild animal, she turned her back on the animal to photograph herself in front of the jaguar.  The jaguar nearly captured her.  That’s what wild animals do.  Fortunately, the woman survived to recount her foolish behavior.

Barriers and warnings exist for a reason.  They’re there to protect people.  Jaguars are spectacular animals.  They can approach speeds of 80 miles per hour and, like all cats, they are fiercely territorial.  The desire to take a photo is understandable.  The photo should be of the jaguar, not yourself with the jaguar.

There are several lessons to be learned here:

  • Never ignore barriers, roadblocks, or warning signs unless you are the EMT (emergency medical technician) responding to the situation.
  • Appreciate the beauty or wonder around us but realize that we do not enhance the beauty or wonder.
  • Never, ever turn your back on a mountainside, cliff, bridge, canyon, or a wild animal.

If people are really that enchanted with themselves, there are these things called mirrors.

Whoever Shouts The Loudest

Posted on Posted in Brain Science, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Can you tolerate watching “the news” these days?  If you’re much over the age of 40, you probably realize we scarcely have any real news programs left.  Nearly every option revolves around opinion, bias, personal and corporate agendas, and ridiculous panel discussions with people shouting over one another.

I’m willing to listen to almost anyone who can discuss the facts of a given topic in a cogent, logical manner.  Sadly, there isn’t much of that on TV or most other venues.  Somehow people have gotten the idea that whoever shouts the loudest or spews the most obnoxious sarcasm wins.

This is frustrating on TV, but it can be even more problematic at work or in social settings.  More and more people dread family gatherings for this very reason. Most of us are fond of work, family, and friends.  So with that in mind, here are a few tips on preserving such gatherings:

  • Be civil and never talk over another person. Remind yourself to disagree agreeably.
  • Always look for common ground. Most people want a safe, happy, healthy life for themselves and their loved ones.  Start with that assumption.
  • Pick your battles. If it won’t matter five years from now, it probably doesn’t matter much now.
  • Listen carefully and actively. Many people today don’t listen much at all, especially on TV.  They’re too busy planning their next snide, sarcastic retort.  Repeat what the other person has said and try to understand his or her perspective.
  • Remain calm. In a debate, the angry person almost always loses.  Very few people in our culture have ever taken a course in logic, ethics, or debate, and it shows.  Be the adult in the room.
  • Don’t aim to prove you’re right and the other person is wrong. Concentrate on the facts and explain them clearly.  Most arguments have nothing to do with facts.
  • Avoid making accusations. Insecure people become defensive very quickly.  Truly knowledgeable, accomplished, mature people have no need to be defensive or even bother with accusations.
  • Never use vulgar language or derogatory terms. Calling someone an idiot will not persuade him that your point is correct.
  • In a tense situation, let the other person blow off steam. A patient or family member receiving bad news can become emotionally volatile and angry.  Let him vent.
  • Watch your physiology. Aggressive body language and irritated facial expressions are usually the mark of an undisciplined individual.  Practice your best Mr. Spock imitation, especially when others are upset.

If you’re young enough and charming enough, and you master these principles, you just might get your own talk show on TV.  I’ll be rooting for you.

Lest Ye Be Judged

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It occurred to me the other day that I have a peculiar reason to appreciate “retirement.”  It has nothing to do with sleeping in a bit or taking an occasional nap.  It’s completely unrelated to dressing more casually or having a nice cup of tea whenever the mood strikes.  What I was truly enjoying was the notion I had been freed from the onerous task of evaluating other people.  But no!  Last week I had a Salvation Army pick up and the driver handed me an evaluation form.  I was supposed to rate the Salvation Army on promptness, friendliness, and efficiency — among other traits.  The Salvation Army!  I think we’re going overboard here.  I just wanted to donate some clothes.

No doubt anyone in healthcare, law, education, or business knows whereof I speak.  In fact, in recent decades this practice has reached ridiculous proportions.  Faculty evaluate residents who evaluate students who evaluate faculty.  Administrators evaluate managers who evaluate trainees who evaluate the whole system.  Every individual who speaks at a conference, seminar, or lecture is evaluated on everything from the tone of his (or her) voice to the title of his talk.  Filing cabinets and computer databases across America are bursting at their metal and electronic seams with evaluations.

The real question is:  Why do we need to judge one another?  I realize that some form of grading system is necessary through college and various training programs.  But over the past two decades we’ve gone far beyond grades.  We might have developed a national preoccupation with criticizing one another.  I genuinely enjoy giving people good evaluations.  But there are times when a negative evaluation is in order and, frankly, I’d just as soon undergo a root canal.  Every one of us has bad days, bad weeks, and sometimes even bad years.  Wouldn’t it be nice if we could be a bit more understanding?

The process of evaluation can be helpful when it’s geared toward encouragement, guidance, and improvement.  But when it reflects a harsh, critical spirit, nothing helpful happens.  Fighting the tide is not easy.  But I’d like to think that there’s hope.  A very wise man once said, “Judge not, lest ye be judged.”

I gave the Salvation Army people an “A.”

Some Timeless Investment Tips

Posted on Posted in Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It’s tax time again.  Those little pieces of paper that seem so important to the Internal Revenue Service are arriving in our mailboxes.  It’s a good time to review a few basic tips on money management and investing.  You know, the principles no one actually taught us during our many years of training to save lives.

What does money management or investing have to do with health care?  A lot. Financial worries, either personal or institutional, often compromise patient care.  People can act with “impure motives” if dollar signs cloud their thinking.  Everything we recommend to a patient, client, or student should be in his or her best interest.  Those of us in health care should keep our finances in order so that our motives are honorable.  Working with a fiduciary financial planner is similar.  Such a professional is obligated to do what’s best for his client, not himself or his company.

Keeping all of this in mind, there are some timeless investment tips that apply to almost all of us:

  • Saving and investing are different. Step 1 is to get out of debt. Step 2 is building up an emergency fund of at least three to six months of living expenses.  Then investing can begin.
  • Educate yourself and don’t invest in things that you don’t understand. In our culture you can earn an advanced degree and have no idea how to handle money. The first thing you have to invest is time.
  • Sign up for a 401(k) or 503B plan at work and fund it to the max. Investing each month (with money taken out of your paycheck before you see it) is the best path to security.
  • Watch out for management fees and fund expenses. There is a cost to investing, and awareness is key.
  • Take advantage of time and youth. Shocking numbers of people in their 20s, 30s, and 40s have no investments at all.  Modest, steady, monthly investments in your 20s and 30s can lead you to millionaire status in your 60s.
  • Whether you’ve been investing for six months or six decades, do not make decisions based on fear or greed. What separates most people from their money is emotional overreaction when markets tank.  Anyone who has worked in an ER (emergency room), OR (operating room), or ICU (intensive care unit) knows you cannot save a patient if you panic.  “Steady as she goes” sounds simple, but it’s tough when markets correct as they always do.  Stick it out.  The rebound always occurs.
  • Diversify investments and institutions. Depending on your stage in life, some mix of stocks, mutual funds, bonds, REITS (real estate investment trusts), and CDs (certificates of deposit) is prudent. Never put all of your eggs in one basket — or in one hen house.
  • Don’t fall for hot stock tips, free-dinner seminars, or charming financial sales people.
  • Don’t fuss or meddle too much. Some people cannot leave their investments alone. Occasional adjustments are warranted based on your personal situation and market conditions.  A giant oak will never reach its full potential if it’s transplanted every few months.
  • Be cautious and discipline yourself. People with significant financial assets often develop significant egos. Don’t let brokers take advantage of you by flattering your ego.  Remember the Bernie Madoff scandal.  Unscrupulous people can be master manipulators.

Some combination of hard work, discipline, prudence, and common sense helped you develop your career.  Those same principles can help you secure your financial future.

Don’t Do Anything Rash

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary  O’Brien, M.D.

Are you feeling upbeat and happy?  Have you looked at your end-of-the-year financial statements and credit card bills?  Most of us are feeling a bit tense and dismayed these days.  But take heart.  The markets have improved since Dec. 31, 2018 and your statements aren’t as bad as they look.

This is actually an excellent time to re-group financially and protect yourself from further chaos.  High frequency trading and complex algorithms contribute to frightening volatility on Wall Street.  A single comment from a government official can trigger 800-point swings on the Don Jones Industrial Average.

However, there are a few prudent principles that still work and may well save your sanity.

  • Get out of debt! This requires a daily commitment, but it’s worked in countless cultures for thousands of years.  Since financial security has a massive impact on health and emotional well-being, learning how to save money and reduce debt are crucial.
  • Don’t spend more than 25% of your monthly income on housing. No one “needs” or “deserves” top-of-the-line everything.  For 40 years, I’ve watched my fellow physicians fall into this trap.  And it is a trap.
  • Don’t even think of buying a house or condo if you can’t put at last 20 percent down. Aim for a 15-year mortgage.  It will not double your payments.  It makes no sense to end up house-poor because you’ve made a bank rich.
  • Stop buying or leasing new cars. Buy a used car or dealer-program car, take care of it, and drive it for 10 to 12 years.  I kept my last car for 22 years.  It was just fine.
  • Don’t be an impulse buyer. We can all live without much of what we have.  Consider the people who lived in Paradise, California, or the panhandle of Florida.
  • Don’t waste money on eating out or ordering restaurant food in until you’re completely debt free.
  • Stop wasting money on fancy coffee drinks and alcohol. Both your wallet and your waistline will benefit from these two steps alone.
  • Never buy anything to impress other people. If your friends are impressed by your Smartphone or your handbag, you need better friends.
  • Stop indulging yourself with excessive spending on hair, nails, facials, massages, etc. Many young women fall into this trap, especially if they pay attention to “beauty influencers” on social media.  You are capable of taking care of your own grooming.
  • Resist the temptation to go on vacations or indulge in entertainment until you have eliminated all debt. Millennials like spending money on “experiences.”  I recommend the experience of being debt-free.

Finally, use the money you save to build up an emergency fund of three to six months of living expenses.  Twelve months are better.  For most people, this should be at least $10,000.  Shocking numbers of people can’t afford to miss a single paycheck — just ask the folks affected by the partial government shutdown.

Next time, we’ll tackle some tips on investing wisely.  Until then, don’t do anything rash.