Breaking Families with an iPhone

Illuminated screens are harming children. One study estimated that children between the ages of 2-5 spend 32 hours a week in front of a TV, an average of over 4 hours a day. Kids between 6-11 spend 28 hours a week watching TV, as well as additional hours on hand held devices and video consoles.

It is felt that the screen epidemic is the causative factor in a multitude of health issues, from ADHD to childhood obesity. Additional concerns have been raised about the content of what children watch. Television programs can reinforce negative stereotypes and contradict the values parents want to teach their children. Even when parents install internet filters, handheld devices with internet access can lead to children being exposed to adult content.

In response to these and other concerns the American Academy of Pediatrics has come out strongly in favor of limiting the amount of time children spend looking at screens. Recommendations are that the total time looking at screens of all types should be less than two hours daily. This is a good start but may not go far enough.

In spite of all of the data and research there is one aspect of children and screens that is frequently overlooked. Their parents are spending too much time looking at screens when they should be looking at their children. I saw this first hand this week while walking in the park near my home.

I was walking near the playground when I came across a father with a young boy. A bicycle on the ground near them revealed how they had arrived at the park for their Sunday afternoon outing. The child, who looked to be about 4 years old, was playing at the edge of the sand near where the playground equipment was located, drawing in the sand in the stick. The father was 6 feet away, lying on his stomach in the grass, thoroughly engrossed in his iPhone, paying no attention to what his child was doing. He was more interested in what was on the screen then he was in what his son was doing.

The father reminded me of how much we have lost to our screen obsessions. I wonder how many conversations have been skipped, how many stories gone untold, how many jokes unshared, because either the parent or the child was looking at a screen. It seems that the American Academy of Pediatrics is on the right track with their recommendations but it is too narrow. The limit should be extended to parents as well!

- Bart

Prayer as Medical Treatment

Her head had been in near constant pain for over 3 weeks. She had endured migraines for years but they had been rare and relatively brief. The pain was not making it difficult to sleep and function, work was out of the question.

This was her 4th visit in the office in a 2 week period. I had prescribed pain medications (which made her vomit), medicines to abort migraines (which had minimal benefit that did not endure) and had even stayed late one day to administer a steroid shot (which was a long shot at best). When I walked in the room the tears in her eyes and the strain on her face told the story. She was emotionally done, the end of the rope had been reached. She wanted help.

Unfortunately I did not have much to offer. All of the options for immediate relief had been exhausted. The next step would be to start daily medications to prevent headache, but these medications can take several weeks to be effective. I ordered a CT scan of her brain, which although medically needless was emotionally necessary to calm her fears and wrote the prescription for the daily medications.

Out of options, as I was bringing the visit to a close I asked, “Are you religious at all? Do you practice any faith?”

“Not really,” she said, “I went to Catholic school though. Why do you ask?”

“Nothing else has worked, so I was going to offer to say a prayer for you,” I replied.

“I’m not religious,” she said, “but I would welcome you saying a prayer right now. I will take whatever help I can get.”

I walked across the room and put one arm around her shoulders and said a simple prayer, “Dear God, Amber is hurting right now. She is frustrated and exhausted. Give her hope, give her peace, and giver her relief from pain. Amen.”

I had been taught In medical school I had been taught to never inject faith into an office visit and to never allow my faith to intrude into my care. Her acceptance of the hug and the prayer proved my former teachers wrong. Faith, expressed as love and concern for a person in need, always has a place.

Bart

House Calls of Death

He was serious alcoholic. His disease was so severe, his addiction so powerful, that 21 stints in rehab had failed. His marriage had fallen apart, his children had been taken in by his parents, he was unemployed, lonely and miserable. He was 41 years old and in his mind his battle against alcohol had been permanently lost. He gave up any hope of recovery and went to his primary care doctor looking for a special kind of help. On July 14 of this year his doctor gave him the “help” he requested. His doctor killed him.

The patient, Mark Langedijk, lived in Holland, the country with the world’s most liberal euthanasia laws. Physician administered death is common there, in 2015 more than 5500 Dutch citizens had their lives ended at the hands of a doctor. That calculates to about one of every 2000 Dutch adults. In Holland, having your life ended by a physician is not a rare event. 

The law, as originally introduced 16 years ago, was purported to be about allowing patients with terminal diseases to choose the timing and means of their own passing, a way for patients doomed with incurable and progressive illnesses to control their destiny and avoid needless suffering.  That is not the current reality. The scope of conditions for which physicians are allowed to give lethal injections has widened considerably. A young woman in her 20’s struggling with post-traumatic stress disorder from child sexual abuse was recently determined to have mental suffering severe enough to justify ending her life. A physician injected her with heart stopping medications.

An increasing number of states in the US have passed laws for physician assisted suicide, which makes the Dutch experience all the more sobering. All of these state laws were advanced with the same arguments and promises given in support of the laws in Holland.  Opponents of these laws who feared widespread and inappropriate use of euthanasia were accused of lacking compassion for the suffering of others. Proponents of these laws consistently argued against “slippery-slope” arguments, saying that controls and limits were included in the laws to make sure they would not be abused.

The reality is that slippery slope arguments are always valid. When society moves in a direction it typically continues in the direction. The debate is not about whether we will move towards greater use of euthanasia, that will happen. The only question is the steepness of the slope and the speed of our descent. When a society crosses the line and says that some lives can be terminated they have embraced a system in which society has the right to determine which lives are worth living and which are not. The stories from Holland remind us that once that line has been crossed,  that over time more and more lives will be determined unlivable and more lives will be ended by physicians.

If there is no course correction, Americans will one day wake up in a world where death doctors are performing house calls, a thought which should be sobering to us all.

Bart

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reference- The Daily Mail November 30, 2016

How to, and Not to, Apply for a Job

We needed a new receptionist. Receptionists are the first voice patients hear on the phone and the first face they see when they come into the office. They can be the difference between a positive or negative impression of not only the practice but of the doctor on a personal level. A bad hire can lead to damage that takes months to overcome. With these reasons in mind I began the search process with a sense of dread. I did not want to make a mistake. Again.

I decided to attack the problem on two fronts. I called a local temp agency with whom I had worked in the past and also put an ad on Craig’s List. The resultant flood of resumes and applications revealed a lot of how, and how not to, apply for a job. Here are some of the lessons learned.

1-Career Objective statements on resumes are often stupid and can kill an applicant’s prospects.

I do not know who teaches medical assistants how to compile a resume but someone has been telling people to say really stupid things at the top of their resumes. Here are some of the opening goal statements-

“Obtain a Administrative position where utilizing extensive skills and knowledge will help people.”

“My objective is to one day rise up in a company and expand my knowledge, strengths and interests in the different things I do in life, also to learn and grow from my mistakes which I consider stepping stones in life for a better future.”

2-Many applicants seem to be seeking a job other than the one for which they are applying.

I received resumes from applicants stating they wanted to “improve sales” or “work in a hospital” setting as well as  others that did not make any mention of the position for which they were applying. In a competitive market applicants should take the time to edit their resume so it appears they are applying specifically for the job in question.

3-Grammar and spelling matter

One applicant was very interested in a "postion" with my company. She didn’t get it. She didn't get the position either.

4-Many applicants don’t understand they need to do what the boss wants.

In order to make the process more efficient I decided to conduct all of my initial interviews via Skype or FaceTime. There are times when I can tell someone is not a good fit within just a few minutes. It seems unfair to both of us to make someone drive to my office for what may be a brief interview. FaceTime seems to be a great way to conduct a brief initial screen and respect other's time. I called one applicant and asked if we could schedule a brief initial interview on FaceTime. She replied, “I would rather not do that.” The result was that she did not get interviewed at all.

5-A little homework goes a long way.

In our area our office is the top rated practice on Yelp. I have an office website and Facebook page as well as this personal website/blog. Less than half of the applicants I interviewed had taken the time to read about me or my practice and as a result were unable to give specific reasons why they wanted to work for me. They came across as interested in any job, not for this specific job. As I was looking for someone who believed in our vision and philosophy of care these people placed themselves at a significant disadvantage.

6-Your past is not a secret.

One applicant sent over by the agency gave a good interview and we were ready to hire her. Then her background check revealed she had multiple felony counts pending for stealing prescription pads and writing fraudulent prescriptions. Another applicant had judgments against her for breach of contract. In an internet era a person's background is only a few clicks away.

7- Do it right and you may get more than you expect.

The person we hired had none of the above problems. Her career objective on her resume was “To obtain a position in a company where my experience and skills can be utilized to better improve patient satisfaction.” As our primary focus is quality care and service, this statement showed she shared our values. Her resume emphasized her experience in medical offices in a clear and concise manner.

When I called and asked if she was available for a FaceTime interview her reply was perfect. She told me she thought that was a great idea and that she would be available that afternoon. When I “called” her, she was dressed nicely, had appropriate hair and makeup, and was ready with a smile and pleasant demeanor. She had done her homework and knew who we were and what our values were. She had read our reviews on Yelp and told me she liked our emphasis on customer service.

Finally, her social media presence showed someone who was mature and committed to family. Everything about her was positive and appealing. When all of this was combined with the talents she revealed when she came in for a working interview it is not surprising that I hired her right away at a salary above what she requested.

She comported herself like a winner and won the job. She made me feel like a winner as well.

Bart

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Fighting to be Thankful

I woke up Thanksgiving morning feeling more stressed than thankful. While not unaware of the blessings that fill my life, these blessings have recently taken a back seat to stress. Turnover in the office, conflict in some relationships, a recurrence of chronic pain issues and even a sick dog have weighed heavily on my mind. My morning began with a tinge of sadness and I found myself reflecting on more negatives than positives.

A tweet helped change my mind.

The tweet was from Don Willett, Texas Supreme Court Justice. It featured the picture in this post with the comment, “This Thanksgiving, remember with gratitude America’s peerless military, far from home & close to danger.” I did what as Justice Willet suggested, and took time to remember the blessings secured and preserved by the millions of men and women who have served.

I remembered that I live in a free nation, with a free economy in which I am blessed not only to have a job, but to own my own business. I go to work when I choose, leave when I choose, pay my employees what I choose to pay them and am free to do what I believe is in my patients’ best interests.

I am free to worship. Each Sunday morning, I wake up with the ability to not only go to church, but to choose which church to go to. The pastors are free to preach whatever they want without fear of recrimination or arrest. I am free to give to the church of my choice and the money I give is not taxed by the government.

I am free to vote. I may not always like the choices I find in the ballot booth but I am free to vote, or not vote, for whomever I want. The candidates are chosen by the people, not by the government.

I am free to speak out. I can criticize the government, I can march against perceived oppression, and can stand on a street corner with a sign supporting or denouncing any cause or position I choose.

I have all of these rights and hundreds more because someone else fought for them. My ability to sit with my family to eat Thanksgiving dinner today exists because of others who have sacrificed time with their families in order to preserve my freedoms, which is a lot to be thankful for.

Bart