Caring, competent pawns

“Knights are motivated by virtue. They want to make the world a better place. Knaves are selfish. They desire to extract as much as possible for themselves. Pawns are passive. They follow external rules and regulations…”-Sandeep Jauhar (in his book Doctored) reviewing a concept put forth by Julian Le Grand.

He also reviews a 2010 essay from JAMA by Drs. Jain and Cassel in which these concepts were applied to medicine: “In the halcyon days of the mid 20th century, physicians were viewed as knights. After Medicare was created…doctors’ salaries actually increased…But as doctors profited, they were no longer seen as knights. They were increasingly perceived as knaves bilking the system…”

“A congressional investigation found that in 1974, surgeons performed 2.4 million unnecessary operations costing nearly $4 billion…”

“If doctors were mismanaging their patients’ care, someone else would have to manage that care for them. Beginning in 1970, health maintenance organizations were championed to promote a new kind of health care delivery built around price controls and fixed payments.”

Price controls and fixed payments meant external rules and regulations. 

I finished medical school until 1985. 

Most patients I cared for were members of a healthcare organization with rules and regulations, formularies, the need for pre-approvals, case managers, etc..

I was a pawn?

Unfortunately, surveys conclude that the knighthood to knavery to pawn transition adversely affected physicians satisfaction with their career choice.

Recent surveys also report that 60-70% of physicians would not recommend a medical profession to their children or family members.

This is unfortunate.

Despite the challenges, just always do your best to advocate for and help your patients navigate through our complex, expensive, and often frustrating, healthcare system and do whatever necessary to cognitively reframe at the end of a chaotic day.

I frequently re-read quotes from a 1996 article by George S. Poehlman MD during my career:

“Medicine allows us  to participate in the lives of others and it’s a privilege granted to few…remain humbled by this honor.”

“You will become an amateur anthropologist on whom people’s stories are bestowed-those of the privileged and poor, the old, wise and weak, the young, irreverent, and the strong. This is what makes men and women of medicine wise.”

Hopefully, physicians will stop discouraging younger generations from choosing a medical career!

We will all need caring, competent pawns down the road.

Still adding justification, for some reason

Just back from being the plus-1 for my wife, who was attending a work conference at a hotel in southwest Florida.

I met and interacted with many of her colleagues, or their plus-1’s, some of whom, after conversing for a while, would invariably ask, “what line of work are you in?”

I can honestly say it was the first time I felt completely comfortable in saying, “I’m a Physician, but I also just recently retired.”

However, even though, without fail, all would say,”Congratulations!,” I still felt as if I needed to add additional caveats such as:

“Yep, after a 40-year medical career.”

“I couldn’t believe how many of my classmates had also already retired when I saw them at my 40-year medical school reunion in April.”

“But I’m board-certified until 2029, so we’ll see…”

Et cetera.

But, I’ve made steady progress when answering the question, so I don’t anticipate it will be too much longer until just say “thank you” after being congratulated.

1st Habitat build

Spent part of this past Saturday volunteering for a Habitat build.

I spent the entire time placing furring strips into cinder blocks with a hammer and masonry nails.

I was given feedback from the foreman that I was doing an excellent job.

I wanted to impress, especially since I had respectfully opted out of all suggested ladder and roof assignments.

We quit for the day after 4 hours.

I’ll volunteer again soon.

Just one note to self: don’t forget work gloves the next time to increase the time to the reappearance of finger blisters.

My wimpy hands will appreciate the same.

Paying more attention

“Time seems to speed up as we age…The likeliest explanation for this phenomenon is that our brains encode the passage of years on the basis of how much information we process in any given interval…as we get older, life gets routinized-we stick to the same few places of residence, the same few relationships and jobs.

The standard advice is to cram your life with novel experiences…but if you have a job or children, much of life will necessarily be somewhat routine, and opportunities may be limited. An alternative, Shinzen Young explains, is to pay more attention to every moment, however mundane: to find novelty not by doing radically different things but by plunging more deeply into the life you already have. Experience life with twice the usual intensity, and your experience of life would be twice as full as it currently is-and any period of life would be remembered as having lasted twice as long.”-Oliver Burkeman

Really like this.

I plan on adopting this into my days going forward.

Possibly stop by?

I have a dental appointment, for routine cleaning, later this morning.

The dental office is only about a mile from my previous office.

I’ve been curious about how things are going.

One physician on our medical team had recently, abruptly, transferred.

Another physician was insinuating that he was going to seek another job due to some implemented changes.

A mid-level provider remained a thorn in the side of most all colleagues and supervisors despite attempts to moderate.

Remaining fully staffed was always a challenge.

Many staff, especially our nurses, would transfer off our team, seeking greener pastures-which was completely understandable.

(Some would return after determining the grass was not always greener on the other side)

All staff were the beneficiaries of a generous annual and sick leave policy.

There were many pregnancies with prolonged maternity and paternity leaves.

There were also unplanned, unexpected personal, or family, emergency medical leaves-some short term, others long term.

Medical center administration’s focus was, appropriately, access for patients, growth of our team’s panel, productivity and optimal encounter coding.

My focus was ensuring quality of care.

I still intermittently saw patients if/when asked or if/when necessary.

I also spent part of every day responding to concerns/inquiries from patient’s, their families, or their legal representatives.

When I retired there was virtually nothing that could surprise me during the course of a day.

The assistant medical director worked with me for approximately two years.

I’m confident she was ready to assume the role as medical director, but I still want to touch base.

Maybe me and my clean teeth will stop by today after my dental appointment 😁!

Protecting my cognition?

Advances in artificial intelligence (AI) are occurring rapidly.

My wife has found many uses at home and at work.

Results of a study were recently previewed prior to publication (Are we really willing to become dumber?-David Brooks-NYT editorial 7/7/25).

Those who used AI to write essays had significantly more references compared to those that wrote the old fashioned way.

However, when the participants were later asked to quote from their own papers, those that used AI had significant difficulty verbalizing content from their papers compared to those that “had used their brains.”

EEG’s also showed higher connectivity across brain regions compared to those who used AI.

“Direct dynamic transfer function” was highest in the brain only group, which is correlated with executive function, attention regulation and other related cognitive processes.

Cognitive deficits may increase with age.

Retirement, by itself, has been associated with cognitive decline in some individuals.

Therefore, I’ll remain in the brain only group, for writing, for now.

A get together with my siblings

It’s great to get together with my siblings but during our time together I always briefly, intermittently, contemplate about how we are all getting older.

Our medical histories are consistent with our increasing age.

My oldest brother is 70. He completed radiation treatments a few years ago for prostate cancer.

My other brother is 68, recently completed treatment for prostate cancer and is scheduled to have a pacemaker inserted later this month due to sick sinus syndrome.

My sister is 67, had a double mastectomy 2 years ago due to breast cancer and has chronic tinnitus.

I’m 65 and have had both hips replaced.

We spent last weekend together.

Despite our growing list of medical diagnoses, our time together is filled with laughter, while often reminiscing, and is so greatly appreciated.

I hope retirement will allow for more of the same.

I know many my age don’t have all their siblings still living.

I’m thankful that I do.

Still pondering social media

I deleted social media apps approximately 2 years ago.

Since being retired, I’ve pondered possibly restarting.

I’m currently reading Four Thousand Weeks-Time Management for Mortals by Oliver Burkemen.

He makes some excellent arguments against restarting:

“Each time you open a social media app, there are a thousand people on the other side of the screen paid to keep you there-and so it’s unrealistic to expect users to resist the assault on their time and attention by means of will power alone.”

“If you’re convinced…that social media hasn’t turned you into an angrier, less empathetic, more anxious, or more numbed-out version of yourself-that might be because it has.”

“Long after I’d closed the app, I’d be panting on the treadmill at the gym, or chopping carrots for dinner, only to find myself mentally prosecuting a devastating argument against some idiotic holder of wrong opinions I’d had the misfortune to encounter online earlier that day.”

You are a soul

One stop on our recent European vacation was the Sedlac Ossuary, in Kutná Hora, Czech Republic.

It’s known as the Church of Bones.

Our tour guide asked for us to give her an adjective to describe our thoughts as we exited the church.

I didn’t have an adjective.

All I could think about was a quote by C.S. Lewis: 

“You don’t have a soul. You have a body. You are a soul”

If/when in the “some” category

Just back from a river cruise, on the Danube, in Europe.

My wife and I had an excellent time.

There were 180 passengers.

I would guess the average age of the passenger's was at least 70.

Most were cognitively and, relatively, functionally intact.

I include my wife and I with the “most.”

Some had significant cognitive deficits and/or were significantly functionally impaired.

They all happened to be elderly men who were accompanying their cognitively and functionally intact wife.

They visibly struggled in multiple ways.

I let my wife know that it’s a reminder to complete challenging travel destinations while we still can and that she can leave me at home if/when I ever fall into the “some” group down the road.

She smiled and agreed.

It’s possible that some of these men had had the same conversations in the past with their wives but, unfortunately, could just no longer remember!