Archive for the ‘Philosophy’ category

Sam Bush- Part One. ‘Circles Around Me’

December 2, 2009

        Sam Bush is one more rocking right hand mando man. In fact, if you know anyone in the world who lays it down better than Sam please let me know so I can buy all their CDs and study them too. If Doc Watson calls you to cut the mando tracks for your project that shows it all.

        Sam’s new CD, ‘Circles Around Me’ speaks to coming full circle.  It is Bill Monroe, New Grass, side-man and front-man all wrapped into one disc; a must record for anyone with even the slightest interest in what traditional music is all about.  I know it isn’t what Sam meant by the title, ’cause he is not a bragging sort of fellow, but it also hit me that Sam can pick circles around all of us.

        When Sam hits the stage he gives it his all.  Pretty soon he is drenched in sweat and red-faced.  He just ain’t gonna let you show up at his gig and have a bad time.  His band is the same way.  Sometimes I wonder what drives a man like that, but then I don’t have to look too far.  I could never be the kind of mandolin player Sam is (few on the planet are) but as a doc and even in my humble efforts as an artist I always want to give my best.  Sam seems to be motivated to do the same.

        Writer Larry Nager wrote up an article on Sam in the latest issue of  ‘Bluegrass Unlimited.’  If you don’t get BU at least go buy a copy of this one and read this article.  I love Sam’s quote at the end.

        “It’s interesting, ’cause at age 57, I’m just trying to improve as a player and a singer. And I hope on this new record, it sounds that way to the listener. I’m not satisfied. You hear so many people, especially in this town of Nashville- they just want to be famous; that don’t mean it’s a good thing. I just want to play and sing better, and I don’t think I’m there yet. I’m still searching.” -Sam Bush BU Dec 2009

        As good as the cat is, and he is the best, he’s still digging to try and be better.  Isn’t that what should drive us all?  I think as a doc what I did yesterday doesn’t make a bit of difference if I don’t give my all for my people today.  To me that is why the work of an artist like Sam inspires me.  It’s also why I worked so hard on my book.  I wanted to give it my best effort to show what I believed to be true.  Sam does that with his mandolin.  I don’t think fame has got a d@^^ thing to do with any of it and I admire him for it. 

        There’s more I want to tell you, but I gotta go to the doc gig.  I’ll edit and publish this in the morning, and I plan one more post on Sam this week.  Y’all go take in a Sam Bush show.  Take it from this doc; he’s good medicine.

Dr. B

Never Laugh….Dreams Come True

August 22, 2009

        I cleaned up my office study the other day.  I do this every few years whether it needs it or not.  I ran across a small slip of paper that looked like a fortune cookie.  Someone gave it to me me years ago as a  note of encouragement.  It was from back when I first started on my book.

        The message read, “Never laugh at anyone’s dreams.”

        I smiled and recalled that day.  It was from a pal of mine who has a saying I love.  “A true friend is never jealous or envious.”  This buddy of mine is a very successful man.  All through all the ups and downs of life he has always encouraged me, and hoped I’d see the best life has to offer.  I’ve done the same with him.  If my book is well received he’ll be just as happy as it it’d been him, and if his business were to grow in this tough economy nothing would thrill me more.

        My wife and children have always supported my every dream and I have theirs too.  Over the years when I straighten up my study, I’ll find messages from my wife cheering me on, or scribbled notes from my children from the hard days when I started my medical practice.  “You can do it, Dad,’  from my boy.  Or “I love you, Daddy”  from my daughter, complete with a stick drawing of a little girl with glitter sparkles in her hair.  My dream was to live a life of grace and dignity and they made it possible.  They never laughed at my dreams, but did their best to help make them come true.  I hope I did as well by them.

        As I close in on publication of my book, I want to thank all you guys.  You never laughed at my dreams, and I love my readers for it.  I hope someday my wife and I will meet you at one of my book store gigs, and play you a song and share some stories.  You listened to my dreams, and as a writer it kept me going.  

        I want to hear your dreams too, and I hope you will share them with me.  After all, as my buddy says, “true friends are never jealous or envious,” and I pray you’ll see all your dreams come true too.  

Dr. B

The Grace of the Good Lord, Bluegrass Music, and Door Knob Diagnosis

August 9, 2009

        Don’t worry, I ain’t gonna preach at y’all.  I’m not good enough to tell anybody how to live.  I’m just as imperfect a  sinner as the next guy.

        I do want to tell you though, that what humble success I have had in this world is not my doing.  I was blessed beyond what anyone deserves.  I can’t tell you how many times I had my mind made up on diagnosis, and right as I got to the door, a voice would call and say “Son, I’d advise you rethink that.” 

        Sometimes it’d be when my patient asked one last question.  “Hey Doc, by the way…”  Other times it was because they had a funny look  their face; just a hint of disappointment that Doc had only made a ‘B’ on that encounter in a business where anything less than an ‘A+’ is unacceptable.  And often it was simply the voice.  “Son, you didn’t finish your job here.”

         I call it a door knob diagnosis.  My hand was on the door to open it and move on the next room, and but for the Grace of God I would have.  There were a few times along the way where the implications of difference were so profound I had to go in my office, close the door, and sit there for a minute and dry up the tears and recompose myself.

        God also sent me my music.  He gave me just the right amount of talent; enough to enjoy it to the fullest but not enough to get confused about what I was supposed to do for a living,  If anyone loves it more than me I am happy for ‘em, but as the song says there are 1352 guitar pickers in Nashville.  If Steve Earle knows the competition is stiff, Doc didn’t have to be brilliant to know he’d best keep his day job.

         I’m don’t think I’d a made it without music.  Many a night I drove home dead dog tired and only stayed out of the ditches ’cause the cassette player in my Scout blared away Flatt and Scruggs or some other favorite.  I listened to  a lot of bluegrass going back and forth to the hospital.  If you ever played a note I thank you ’cause somehow it filtered down to old Doc and very well might have saved my life one of those lonely nights.

            Well I said I wouldn’t preach so I’ll get off.  God bless all my music pals.  Life as a Doc can have some hard times, but between the Good Lord, my family and bluegrass music I managed to get me by.  I hope all of you have a blessed Sunday.

Dr. B

An All Time Dumb Question (and the answer)

March 24, 2009

        There is one question no pharmaceutical rep should never ask me, at least if they want to get a second question.  It is this:

        “Doctor, how do you approach the patient with…”  fill in the blank; whatever clinical scenario you choose does not matter.

        Here would be the parallel for a musician.  Lets say you are a mandolin player, and you finish a set with your bluegrass band.  A member of the audience approaches you after the show.  “I enjoyed that.  Could you show me how to play that little guitar in an hour?”

        The answer is, “Well buy a quality instrument, find a good instructor, play at least an hour a day for a year, then come back.  After that you will have a start on it.  But no, I can’t tell you anything in an hour.”

        The same is true in medicine.  Unless the rep is prepared to go to school and invest a hundred hours a week for a few years in basic science before they get to interview the first patient, and then more years of hundred hour weeks to explore every nuance of patient history before they prescribe the first medication and then, well….   the best thing to do is not ask such a question.  Because the answer is, “First you take an history and then you do an examination, and…. oh well, never mind.”  Anything less is like asking a pilot to take off an airplane without going through a pre-flight check list.   (Another approach to life I do not recommend.)

        At best it indicates some marketing guru made them do it.  Reps do some good in this world, and I want to hear about their products.  However, I have no interest to try and explain how to be a doctor in a superficial response.

        I am reminded of the great golf teacher, Harvey Penick.   He was the famous instructor from Austin, Texas.  He taught Ben Crenshaw and Tom Kite, so he knew a little about the game.  So the story goes (paraphrased) his son-in-law wanted to learn to play golf.  The young man was a fine athlete; a three letter kind of guy who was an All-American in basketball.

         “Mr. Penick,”  he said.  (no one called him Harvey)  “I want to learn to play golf.  Can you give me some lessons?”

        “Sure.  I’ll send some clubs.  Next time I’m there I’ll show you a few things.”

        “Great.” 

        Mr. Penick shipped him out a set  of clubs.

        After a few months Mr. Penick went to visit.  The son-in-law greeted him with great enthusiasm.  “I sure am glad to see you.”  Months had gone by and it had been a terrible go of it.  “This game is giving me a fit.”  Like all beginners the hooks, slices, and tops far outnumbered the sporadic solid strikes of the ball. ” Why did you wait so long for the first lesson?”

        Mr. Penick smiled.  “This is the second lesson.  You have already had the first.  In golf, a great athlete must be humbled before they are ready for the teacher.  Now we are ready to start.”

         I feel the same way about some of these reps.  They are young, smart, educated, good-looking, and pop society hip, but hopelessly unsophisticated about medicine.  I can no more give them a sound bite approach to lipid management than I can teach them to play the mandolin in an hour, or golf either one.  It also holds true in writing, a fact I have begun to learn over the last nine years.  Each discipline takes years to even get started.

        Mr. Penick died a very old and wise man.  He charged five dollars for lessons, but to everyone who knew him he was a very rich man.  He understood things about life most people never know while here on Earth.  He even came close to understanding golf, which is near  impossible.  I wish I had the privilege to know him, but at least I got to learn from his ‘Little Red Book.’  I am glad he left it behind.

        Maybe I need to teach some of the drug reps how to play golf.  I’d start by making them memorize Mr. Penick first. 

Dr. B

Something To Do With Money

March 12, 2009

        We used to have an old Doc in town who had the same answer for every problem.  Regardless of the issue at hand, when something was wrong he’d say, “I don’t know what the problem is here, but it has something to do with money.”

        Most people in health care want to do right by people, and they are easy to work with.  But, whenever I run into folks who will not act in the patient’s best interest old Doc’s adage can be used as a powerful  motivational tool.

       Take a case last month.  I had a patient with a couple risk factors and a good story for a pulmonary embolus.  (Blood clot).  I wanted  a CT chest to rule out a clot.  The little chart review person at the insurance company told my people we would have to do a plain chest x-ray instead.  With the diagnosis in question, that is a little better than a coin flip, but not much.  They would not budge.

       Often I have to call, but this time our referral tech was able to make them understand.

       “What should I tell them Dr. B?”

       “Hmn.  Why don’t you go with the BBQ speech?”

       “O.K.”

       In a minute she was back with an accession number.  The CT was approved. 

        The BBQ speech goes like this:

        “Y’all like BBQ?” 

        They usually say yes. 

        “Well, I’m glad, ’cause Dr. B says you might need to visit us for an extended stay.”

        “Why is that?”

        “He wants you to know if anything happens to his patient while you obstruct their care he keeps a lawyer on retainer.  And boy does this lawyer love BBQ.  We have the best down here.  He thinks it won’t take more than two or three years to sort out.  With her being a mother of three, he believes a jury would have enormous sympathy in the event of death from a delayed diagnosis of pulmonary embolism.”

        “Really?” 

        “Yeah.  He said not to worry too much.  This is a rural area, he doubts it would go for more than three mill or so.   Old Dr. B is  a very patient man.  Why he’s like a little terrorist; he ain’t going away.  You’ll love it here.  Like I said, the barbeque  is great.

         There are all sorts of variations on the theme, but the fundamental principle is always the same.  You have to speak to what motivates them.  I gave a up a long time ago trying to make them understand I hoped to help a human being; that matters to them not in the least.  But when you start to talk money they will often listen.  Like the Old Doc said, there’s something wrong here and it’s got  something to do with money.

        By the way, my patient’s blood clot treatment went well, and she should do fine.

Dr. B

Dr. B’s Secrets to Longevity

March 9, 2009

        I have been a Doc a long time.  Along the way, I have learned some secrets about longevity from my patients.

        Years ago, one of my patients made it well into his hundreds.  I got to where I didn’t charge him.  He was way too valuable in terms of advertisement.  When people asked him how he lived so long, he said it was because he chased young women, chewed Wrigley’s Spearmint gum, and that Tommy Bibey was his doctor. 

        In a small town word of mouth is everything.  A number of people signed up for me as Doc because of that man, but today I have to tell you what is true;  all the credit was due to the Good Lord.

        Last week I saw a lady who was 96.  She was in a hurry to get to the Walmarks.  I asked her if she was going to drive, and she said, “Heavens no, Sis is gonna take me.”  Sis is my patient too and she is 99.  I attribute her long life to that baby aspirin I prescribe for her on MWF, but that is not it.  She knows the real secret is to choose your ancestors carefully!

        Another fellow I had was a volunteer at the Nursing Home in his 90s.  Someone asked him why he did all that, and he said, “Someone has to look after these old folks.”  I love his spirit.  It never occurred to him to ask anyone to look after him; he was all about helping someone else.

        I am not certain why some people live so long, but it seems most of them are sweet little old ladies or farmers.  For the most part aggressive and hostile chain smokers don’t seem fit the profile, although I guess there are a few.

        The Lord knows all the real secrets.  As the song says, when we get to heaven ‘farther along we’ll know all about it.’  There we will have an eternity to figure out what we don’t understand here.

Dr. B

Red Cross In Australia

February 9, 2009

        Folks, our friends in Australia have a major disaster on their hands.  A wildfire has leveled towns and killed a lot of people there.  I saw their Prime Minister on T.V. and he was very upset.  I can be cynical about politics sometimes, but this man was in genuine pain.  His television address was no political play whatsoever.  It reminded me of the despair we all felt about Katrina.  

        I write because I love to write and tell y’all about bluegrass, and I keep my blog pretty much commercial free, but when I see a good cause….  well, I guess it is just the Doc in me, and I’m gonna send ‘em a little something.  If y’all feel so moved, I hope you’ll consider that too.  One of my readers is Ms. Karen who is from Queensland, and I pasted her response to my query below.

Dr. B

 

Here are her thoughts:

Thanks Dr B. It has been an horrendous few days in our beautiful sunburnt country. It’s the worst natural disaster in our nation’s history. It really is incomprehensible how ferocious and devastating the fires were. The fires are mainly in the state of Victoria which is on the southern tip of mainland Australia (only Tasmania is further south). We lived there for 6 years – in fact, two of the places we lived in were affected by the fires. All my family live in Victoria but are thankfully out of danger. They are about an hour away from the worst hit areas. The fire was so intense that people simply didn’t stand a chance – no matter how well prepared they were. The death toll is now up to 130 and climbing. Entire towns have simply been wiped out. Arson is suspected in a large number of cases so these towns are now crime scenes. Over 750 homes have been destroyed. It really is catastrophic. We have a nation in mourning at the moment. My three-year-old understands what’s going on – he asked me some very insightful questions today about where people are going to get clothes and food from. Then he told me he wanted to give the people whose houses burned down a present. We’re going down to the bank tomorrow to give some money from his piggy bank (and mine!) to the cause. Life is so precious…thanks for your thoughts and prayers.

In a painfully ironic situation, north Queensland is in flood. Some towns are totally underwater. A 5 year old was taken by a crocodile in flood waters yesterday. We certainly have both extremes going on in this vast country…

  •   Karen Says:
  • February 9, 2009 at 6:59 pm e  Thank you so much Dr. B!  The Red Cross are co-ordinating the main fundraising for disaster relief. Their address is http://www.redcross.org.au – the website is rather slow as there are so many people donating, so please be patient.

    Thanks again for supporting our people. It’s going to be a long road to healing…


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