As physicians, most of us are wired for perfection. Face it, there are few professions that are expected to be 100% accurate 100% of the time. If you hire a gardener to plant 10 shrubs and one dies, you consider 90% a pretty good yield (and you replace the dead shrub if it is in a “noticeable” location). If you buy 2 dozen filled cupcakes and one has a little less filling or frosting, no big deal. But, as a physician in the course of patient care, if you miss a diagnosis, choose a wrong treatment, or misinterpret a test result, the outcome may be catastrophic. It is stressful. Not only can serious harm come to your patient for overlooking or blatantly missing subtle details, but medical liability can ruin a career (and one’s spirit).

As each year ends and another begins, January brings us many new things. The NFL playoffs, having to remember to write a different year when you date checks (for those of us that still do that), and Election Season! I’m not talking about the nasty and deceiving commercials that are already starting to assault us on TV and other media. I’m talking about the selection of our leaders throughout POMA.

Sunday morning started with a cup of coffee and sharing stories before continuing to work on POMA’s new Strategic Plan. In the conference room, 30 osteopathic physicians were volunteering their weekend to strengthen Osteopathic Medicine in Pennsylvania.

Over three decades ago, I’m not sure who suggested I add a personal statement to my curriculum vitae, but I’m sure it was somebody very smart, whose opinion I really respected and was probably doing what I wanted to do with my career. As time went on, and my career changed, my personal statement changed. In my early years, I was committed to providing the best care I could for the patients who trusted me with their well-being. As time went on and I evolved, and as an owner of a medical practice, my mission expanded, not only in commitment to my patients but to our employees, as they depended upon the success of the practice for their livelihood. When I started teaching in addition to serving as medical director for rural health clinics, my personal statement changed yet again, to focus on community, public health, and preserving our rich osteopathic heritage.

If you’ve read any of my articles over the last year or so I bet you thought I was going to write about the POMA DOes … podcast series.  Well, I am.  Sort of.

I just got off the phone with John in West Virginia. He received an Olds Ambassador Cornet from me to finish what I started. Over the last year, I acquired this instrument and found replacement slides and valves, restored it to the best of my ability and forwarded it to him for solder repair and refinishing. His work is exemplary. He called to inform me that it was received, gave me his assessment and told me when he would start completion of the work I initiated. 

Recently I had a patient encounter go differently than the way I wanted. The patient is fine now, and it was not the fault of myself or the patient or her parents. Rather the problem was with the physicians, and more specifically, the protocols of the health systems they work for. In short, the patient had an abnormal exam, abnormal vitals, and diagnostic studies that I had done in the office that all supported the suspected (and later confirmed) serious diagnosis and just how sick she was. It was clear to me that she needed admission to the hospital quickly. It was even clear to the physicians at the two health systems that I called to try to get her admitted that that was the level of care she needed based on the labs alone. But because they couldn’t see this information in their EMR system, they declined to admit her directly and instead directed that she should go to the local ER even though they would immediately transfer her once she was stabilized, which I had already ensured she was. The reasoning: that’s how we do things. And so, the patient sat in the local ER waiting room for nearly three hours before being seen and then quickly being transferred to a higher level of care facility. A direct admission by either of these facilities would have had her receiving care within an hour.

With the month of November halfway gone, it’s easy to begin to stress about the holiday season. Where am I going to get my Thanksgiving turkey? How long do they need to defrost again? Do I have enough time and money for Christmas gifts? How will I balance seeing my family and my in-laws? All these questions need answering. It’s overwhelming and anxiety-provoking just thinking about it.

In the middle of my yard stands a majestic American chestnut tree. Virtually extinct for decades (1), this mature treasure is now a rare find, considered one of the most perfect of trees, with every part having great utility and beauty. I have learned a lot from that tree. The tree has been there for the nearly three decades I have called this place “home” and most likely a century prior.

I love the commercials that end with “what’s in your wallet?”.  How about “what is your passion?”. In retirement, mine is simple. Music. Not performance, but brass instruments. Specifically, trumpets, cornets, and flugelhorns. Last year, I had a trumpet made that I designed.

I could describe it to you in excruciating detail and tell you all that went into its creation. Hours of work spanning 4 to 5 years. Hundreds of hours determining its specifications. Countless hours spent emailing and phoning strangers who guided me educated me and provided their insight, all without compensation. I was able to form bonds with complete strangers over a shared love of brass instruments. In many ways, the community of brass instrument repairers and developers is more close-knit than the community of musical performers. Performers need design and repair people, the reverse is not true.

Recently, I reconnected with a woodwind man I hadn’t seen in decades. He has been a guest conductor in the UK, Europe, the Netherlands, and behind the old Iron Curtain. Oh, I forgot, Carnegie Hall and the Kennedy Center also. I guess you could say he’s been successful.

After we caught up and relived the past we spoke of the present. After a life on the road, he taught Jazz Musicology at two different universities. We’re both retired. He still performs in Pennsylvania and North Carolina just because he wants to.

Two different individuals, two different career paths, each with a shared passion in retirement that we shared in our youth. Music. When I told him about my trumpet design, he almost fell over. He demanded details, photos, etc. I gladly complied.

Why share this with you? Simple. Find or rediscover your passion. Don’t wait for the future. Do it now. Had I continued my passion for music while I still practiced psychiatry, I would have more fully benefited from the combined experience. Fortunately, I didn’t miss out entirely. I nurture my soul now. As is often said, “better late than never”.

A few days ago, my wife and I attended a concert by the Baroque Orchestra. Between selections, I whispered to her about the orchestra’s use of Eb and piccolo trumpets during various selections and why they were used. It wasn’t difficult. I had a teaching assistantship in the music department at my undergraduate school. I was a math major who taught “Intro to Music” to freshmen. Music has always been a part of me.

Walking home from the concert I said that I wished I had studied musicology in depth. She asked if I meant instead of practicing psychiatry. Heavens no. I should have done both.

“What is your passion?”

I have always been fascinated with growing things, mostly vegetables, occasionally flowers and houseplants. I have had varied success with the flowers and the houseplants, but, for the most part, I have had some spectacular yields from my home garden.

It’s been a year, and what have I learned? This being 2021, and since Covid-19 has pretty much put a kibosh on the last 365+ days, one would think “all things Covid” is what has been rumbling around in my brain, causing all of these mental gymnastics. Well, no, actually, my “what have I learned?” is more on the lines of:  It’s been a year since I retired, and what have I learned?

“Aunt Lisa?” one of my siblings’ children asked, “Have you always used cloth napkins?” during dinner at my home. It made me not only consider when I started using cloth napkins, but why.

Head, Shoulders, Knees and Toes, Knees and Toes...

I have to admit, when I was young, I did not like to color. We all had to do it in elementary school. Coloring was a skill that taught us how to follow instructions, express creativity and stay in the lines. As a child, I followed instructions well, was more creative with words rather than drawing, and honestly, I had trouble staying in the lines, (though, my difficulty staying in the lines helped discover a vision problem).

Have you ever found yourself faced with a task so daunting and seemingly insurmountable that you procrastinate to the point where the task keeps mounting? Maybe it's a garage that needs cleaned out, a checkbook that needs reconciled, a mountain of incomplete medical records waiting for your finishing touch, a stack of CME articles that need to be read, a case review that needs written for submission for publication, a shelf exam requiring dedicated study? Me too.

Usually to restore wellness, one seeks activities that are peaceful and tranquil. Such activities might include yoga, meditation, exercise, or reading.

Have you ever wondered how you accumulate so much stuff and why you keep certain things? Recently, I have had the distinct privilege and responsibility to sort through the belongings of people who are close to me that have died. In the past five years, I have peered into the intimate life details of my mother, father and most impacting, my husband of 26 years.

How are you doing?  This is usually the first question I ask my patients when I see them in the office.  I suspect like many of you, the typical answers I get now (terrified, I don’t know, bad) are different than what I would have gotten six months ago (good, ok, not bad).  What hasn’t changed is the thing that patients most need from us – information.

As physicians, we tend to offer solutions and process thinking to our patients to solve their problems and stumbling blocks. Yet, as a group, physicians are facing burnout at unprecedented rates and are having trouble solving our collective problem. Single physician centered solutions, like practicing mindfulness, can be helpful but doesn’t not impact the overall systems of practice.