The CD is done!!

Back in July, on the 18th, we assembled the big band along with all the recording knowledge and experience we could muster and made a CD. I was looking to record a CD

that would capture the essence of this great band that I had been a part of for more than a decade. These guys are some of the greatest people that I know and in addition , they are the greatest musicians I have ever been around.  Their feel for the music, their interest in playing it perfectly and make it SWING is without peer.  In addition, I asked a friend of mine who is a FABULOUS producer to put some of his genius in the recording and mastering of this endeavor. I was rewarded with excellence.

I then looked for a recording venue that could hold a big band and found MADLIFE in Woodstock. These guys are first class and were the most accommodating help you could ask for. Plus they have world class equipment.

We started about noon and set things up. The band showed up around 6-7pm and we were thru with 12 tunes by 10:30pm. True professionals!!

What a lot of fun and music. img_1532

It should  be available soon on CD Baby and on iTunes. Thanks to everyone involved!!

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Remember my name? What’s my name?

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What’s your name??

I was quietly beginning my morning ritual of swimming laps at the local pool, and a man I recognized but didn’t remember where or how began that conversation. I don’t remember the specifics. Don’t ever do that to your doctor. We know some of you very well and will never forget you, and then some of you are, honestly, quite forgettable. You aren’t bad people or folks that we didn’t do our very best to care for you but you probably had something that was, for us, quite mundane and ordinary, yet, for you, a big deal in your life.  It disrupted your usual situation, may have made you take off work or school, it hurt a lot, made you cry and in general was relatively catastrophic.  For us, just another broken arm or leg or elbow or whatever.   The sheer volume is what makes it hard to remember.

And we feel bad when we don’t. We like to think that we care for everyone with the utmost interest and enthusiasm, and it makes us feel like we have let you down when we don’t remember your name and everything about you. We can’t. There is just too much.

Think about it. The week starts on Monday (well it really doesn’t ever “start” or “end” because we work weekends and nights but just let’s use this as a starting point). I don’t like to do elective surgery on Monday. The labs aren’t back, or the last instructions and visit for the patient was on Friday and they have forgotten or misplaced anything they were told.  The paperwork isn’t always where it should be and the OR folks can be a bit sluggish from their weekend. So Monday is a office day. We usually see the folks that were seen over the weekend as “work-ins” and so even with the new scheduled patients, it’s a busy day.  The morning is manageable with around 18 -20 folks but the afternoon can run up to as many as 20-25. So lets say 40 patients on Monday.

Tuesday is an OR day in the morning and rechecks in the office in the afternoon. 3 people in surgery in am and 25 in the afternoon.  So ballpark 28 folks.

Wednesday is a mirror image of Monday but with less “work ins” and so lets use 35 as a good number in the office.

Thursday is just like Tuesday so we can ball park another 28 patients.

Friday is unique. I wanted to incentivize getting all the claims in and all the work done for the week so the office folks could leave after lunch if everything had been taken care of, and the morning was usually office with surgery in the afternoon, again, taking care of “left over” injuries from the week. So, 18-20 patients including the surgery patients.

Monday 40 Tuesday 28 Wednesday 35 Thursday 28 Friday 20.  Grand total= 151. Per Week.

151 per week times 48 weeks per year (holidays vacation etc) = 7,248 patients /year

Over a twenty-year period of practice, 144,960 patients. That is the population of Savannah, Georgia in 2015/16!!!   And don’t forget, each one of these folks knows or is related to a number of people who will remember you took care of their loved one/neighbor/coworker.  And they all may remember you. But there is NO WAY you could remember all of them.

My grandfather was a proctologist (look it up) and a colorectal surgeon in Atlanta. His standard jokes were that he was going to be a dentist but couldn’t stand the smell of people’s breath. The other one was that he never remembered anyone’s FACE.

So, we do remember a lot of you. And if you are remembered, you must be special in some way. Not necessarily a “good way” but usually.  And if you are not right on the tip of our tongue, don’t feel left out!  Savannah Georgia is a big town!!!!

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Its 4 am. The concrete is cool.

 

 

Its 4 am on a Saturday morning. Its dark. I’m on my back underneath a 1967 Chevy Nova. Really! Putting new leaf springs on this car. I bought it from a guy near Carrolton. My wife was kind enough to drive me over there after I had looked at the car earlier. It was rough but all there. The guy had put a 400 cid V8 in it but not done such a great job. The floor pans needed work, and there were a few rust spots, but in general, it was all there. The hood was fiberglass and not painted and the steering was a bit “wonky” and the radiator needed replacing, but it was all there. And the price was right. So we went to his house and picked it up and drove it home.
Over the next few months, I replaced the floorpans and exhaust and engine and radiator and painted the whole engine compartment and rewired stuff etc. Your standard HOT ROD project.
But it needed new rear springs in the worst way. It came from the factory with the single “monoleaf” spring and I was going to stiffen up the rear suspension with the “multi leaf” springs. But I needed some time to do this.
I was on call at the ER for my orthopedic patients as well as the general ER call because at that time I didn’t have a partner. My previous partner had split off with the other guy I had hired and left me alone in solo practice. So, time was at a premium.
Time is the only thing that we really have on this earth that is precious. We don’t know how much we are going to have, so it is up to us to spend it wisely. Eventually, we all end up “wasting” time, yet if we carry the burden of making every moment count, we all fail miserably. I have had some friends who disparage sleep (“ I’ll sleep when I’m dead”) and naps (more valuable every day I age LOL!), but I personally feel sometimes we need to re boot.
In my situation, I had a family as well as a practice to run as well as being on the hook for “Call” which can snatch you out of any situation that you are involved in to send you to the care of someone who needs your expertise. I suppose the two ways to manage this is 1. Do whatever you want when you want to and expect that you will not be able to complete all activities, or 2. Sit at home and wait for the phone to ring. I couldn’t do the sitting at home part, so I just tried to live my life as best as I could with the expectation that I may suddenly have to leave whatever activity I was doing and head to the hospital.
Not so bad on me, but does put a burden on your family because you cannot be depended upon to be where and when they need you all the time. Missed birthday parties and ball games…….the list goes on. Yet, it was the path I chose. I digress.
So, when you are doing a spring replacement project and you are the ONLY one doing it, you need to jack up the car, take out the springs, replace them and let the car back down. It take some time, and in my case, I wanted to do it all at once so I could get it back in the garage and back rolling again without much down time.
I knew that after 2-3 am, if I haven’t been called out to the ER, I probably wasn’t going to be called. Seems the 3 am hour is the best time for quiet in our world. It is also seems to be a universal finding because the SEAL team thinks it’s the best time for a clandestine assault (so I have read…?).
So, I carefully planned my early morning mechanical adventure for the time between 3 am and 8 am on a Saturday am, a time when I could have some “radio silence”. And it all panned out ok. Which is why I was on my back in my driveway at 4 am wrenching away. (Yes, my wife and kids were asleep and if I had something go awry I was in trouble, but I was very careful and dodged that bullet!)
So, use your time wisely. And YES I finished the car (for you gear heads) with a killer small block and roll bar and sub frame connectors and exhaust and all the speed stuff…..

It was fast. AND a show winner. Red of course.

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Like this but not tubbed.

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10 simple ways to lose patients

 

  1. Don’t live in the community that you practice. Whatever you do, you don’t want to run into your patients at Walmart or church or the baseball field. The more involved in the local community you are, the more likely it is that people will know you and your family. And people like to know their doctor. I don’t care what the marketing people say; health care is a trust issue. People want to know who you are and a little about you if they are going to entrust their health care to you. Stay away from social clubs and don’t let your wife ever get into one of those women’s clubs, because that just breeds referrals!!!
  2. Don’t be available or flexible. I mean, you went to medical school and have all that training and expertise, they should wait ‘til you can see them. This running around and working people in the schedule does nothing to make your day easier and certainly is a bother. I don’t care that they REALLY appreciate you taking their day and situation into account. They really like it but no reason for you to do it!! And when the ER calls, always make them feel like they are imposing on YOU to help them with THEIR little problem that they should be able to handle. And try to NEVER go to the ER to do anything because you will be there all day.
  3. Don’t ever do free or volunteer work or for that matter take Medicaid or Medicare. These are money losers and you won’t get paid for your time or expertise or your liability risks. And when someone gets hurt that knows a family member or neighbor that you have taken good care of despite their ability to pay, all you get is someone else wanting free care, never someone with insurance. And it never pays off.
  4. Don’t be glad to see them. I mean, you got up really early today and made rounds on some really sick folks at the hospital and had to do some really hard surgery and you should be entitled to be a little bit perturbed when people come to see you at the office after all that!!! So, make sure that you don’t really make them comfortable. What they really want is some time with you and to feel like you are really listening. So, if you don’t sit on a stool and talk to them and listen carefully to what they are saying you can get thru clinic a lot faster. Just tell them everything they need to know in your fastest medical jargon without explanation. And if you put your hands on them, even on their shoulder or hold their hand, OMG, they will think you are wonderful! You don’t want that.  Don’t ever legitimize their complaints. Spend as little time with each one as possible. And if they don’t have anything you can do and make money on, then tell them you can’t do anything for them and suggest they go elsewhere. Don’t tell them where, just abandon them to find their own way. Don’t suggest other avenues.
  5. If you can’t find anything wrong with them, tell them that. It makes them feel really bad about coming in to see you and taking up your valuable time. Make sure you make them feel small. Maybe they will think you think they are nuts and never come back. Don’t give them alternative diagnostic pathways or referrals or possible explanations. Even though we can’t always find out what is wrong with patients, that clearly means they are nuts, not that you might not be able to detect something that is difficult to discern diagnostically.
  6. If something goes wrong with their treatment, regardless of the reason, make it their fault. Even though they may not have understood directions that to you were perfectly clear, and that you breezed thru in 5 seconds when it should have taken longer, don’t make it your responsibility, it’s theirs for sure.
  7. Do just an adequate job. I mean, you don’t get paid for doing the extra stuff (glitter on colored casts, suckers for the kids, etc.) Just do what the insurance will pay for and that’s it. It’s their insurance anyway. If the drugstore is closed and it’s after hours, don’t give samples ‘til they can go by the drugstore, or loaner crutches or a loaner Wheelchair! You might not get those back!!!
  8. And whatever you do, don’t try to put yourself in these people’s shoes. They have the problem, not you. They don’t need any extra sympathy/empathy. That is the job of the social worker!! Don’t ever get down on their level and try and get to the root of the problem. Just do what is easiest for you.
  9. Though there are a lot more things to do to lose patients out there, never let your referral doctors (or physical therapists or chiropractors or anyone who refers you patients) feel like you appreciate them and their office staff. Treat them for what they are, underlings and minions who can’t deal with the problem and are dumping it off on you to deal with. Never thank them for the interesting patients and the trust they have in your ability and intellect.
  10. Keep them waiting in the waiting room. That’s why it’s called that. Don’t try to hurry to get everyone seen on time, You are the important one. And if you do have an emergency, whatever it is, don’t tell the patients in the waiting room. They can just sit, Don’t let them have the option to reschedule or come back another time or see if what they are there for is something that can be done by a nurse or technician and doesn’t really need to see the doctor. Just keep them in the dark.

 

(It made me feel really bad to write the stuff above, but I have seen it and know that it exists today, still. Fortunately these situations are in the minority. I love my patients, and although some were more challenging than others, that’s what makes it fun and interesting. I wouldn’t trade my clinical years for anything. And fortunately, I believe that most physicians are compassionate caregivers. Love them too!)

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Rings and Things……..

 

 

I was called to the ER during the morning hours, say around 11 am to see a young girl from the local High School who had an injury to her little finger of her right dominant hand. She was helping roll up the volleyball nets after PE class and got her little finger caught inside one of the small holes in the volleyball net poles and had removed all the skin and contents of the finger from where the finger met the hand to the end of the digit. This is called a “de-gloving” injury.  The problem is that there remains attached to the hand, only the bones and ligaments and tendons and the nerves, vessels and all of the skin has been basically removed.

This type of injury is also seen when mechanics or people working around machinery wear their wedding or other rings and get the ring caught in the machinery which pulls off the ring along with the rest of the finger. Even one of our astronauts who went to the moon lost a finger this way jumping off a wagon and his wedding ring caught on the side of the wagon and pulled off all the “meat” from his finger. Insurance companies for a lot of manufacturing facilities forbid the wearing of rings for just this reason. So it’s a pretty well-known problem and results in an amputation at the level the ring was when it left.

The problem wasn’t the injury to this little high school girl, it was the “rest of the story”.  She was a GREAT high school varsity basketball player, one of the stars. This was her dominant hand.  She is a beautiful young lady and she needed a revision of her amputation to a previously beautiful hand (think rings and pictures and things). Finally, her Dad didn’t have any sons, so he had poured all his sports knowledge into his star player /daughter and thought this would be the end of her career if it couldn’t be repaired.

There is no good operation for this injury except to revise the amputation at the level of the “ring” injury and give the patient a functional hand, minus portions of one digit.

You can imagine the emotional maelstrom that was occurring in the room in the ER. After much discussion, to include cosmetic finger prostheses and a promise that she could still play basketball, I took her to the OR and surgically revised the amputation. There was nothing left past the little finger metacarpal so she lost the finger as it joined the hand.

I had a wonderful compassionate hand therapist at the time and she had many, many interactions with this young lady. We made her appointments with a finger prosthesis manufacturer etc. but after she began using the hand and found out that it didn’t really affect her Basketball game, her entire demeanor and personality snapped back to normal, as did her dad’s and she even declined to have a finger prosthesis made for her. (the prostheses are quite good BTW and look very real, but they are very expensive and are only good for looks, not sports).

She went on to play basketball thru the rest of High School and college, got married and ended up with twins.

She still lives in town here and I see her dad and mom all the time and she runs a pretty profitable little business here.

She does everything she wants with no problems.   A great ending to a potentially devastating injury.

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State Wrestling

 

My son wrestled during high school. It’s the only martial art that is really left in our physical education curriculum. Man to man, the field of battle is engaged and your job is to subdue your opponent. Wow. Tough to watch. There were some really good wrestlers on his high school team. He did well also going to state 2 years in a row. One young man was a very quick and strong wrestler. Because my son wrestled and I was usually there to watch him, I was the “de facto” physician for the wrestlers.

This really quick and strong fellow, we will call him Albert, injured his knee during one match. He dislocated his medial meniscus and then “popped it back into place”. The meniscus is a circular piece of cartilage that occupies the space between the rounded condyle of the femur and the relatively flat tibial plateau and is torn during a twisting injury to the knee. You can read more here:  http://www.howardluksmd.com/types-meniscus-tears/

He could do quite well when his meniscus subluxed back into its normal position but upon occasion it would slip out and “lock up” his knee and he couldn’t wrestle. He put up with it, learning how to put his meniscus back into place until one day it dislocated and stayed out. It was one week before the State Tournament his senior year and he was expected to place quite high. I obtained an MRI that confirmed the diagnosis and had a sit down talk with him. He wanted it fixed and wanted to wrestle in the state tourney one week away. I told him that was HIGHLY unlikely but we would see. I scoped his knee on Monday before the tournament on Saturday. The operative findings were the best they could be and with a couple of quick snips, took out the damaged, torn portion of his meniscus.  After arthroscopy, patients usually have a swollen sore knee. He started immediately on Physical Therapy with Ice and compression and ROM exercises and more exercises.  His treatment was intense but his desire was quite tenacious.  Saturday, he was ready to wrestle. He made weight and had several matches before him. He won them, one by one.  And he won the State Title in his weight class.

He has gone on to start his own business and be a successful business man. He isn’t bothered by the knee which healed nicely.

Drive, Intensity, and Desire cannot be minimized in his accomplishing his short term and long term goals. Also, young people heal faster than older folks!!! LOL!!

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Its the Little things……

We here in the South have a number of sayings that are not conventional or easily translated from the words that are used. I grew up in a large city and didn’t come across very many of these “sayings” that Jeff Foxworthy has made a living from until I came to this county.

When I was in Atlanta, during my residency, working in a metropolitan downtown office, there were stories that were told of some of these “sayings” and when I came to the more rural setting where I started my practice, I was confronted with some more.

I never knew that being “ILL” was something that had to do with attitude rather than diseases. Apparently when someone is “ILL” in this area, they are out of sorts or disgruntled about something. Usually it goes like this……….”Sarah sure is ILL about the church supper the other night”…..and they go on to enumerate the cause of the ILLNESS.

My nurse came from the West coast (California) and was quite well spoken and had a great command of the English language. When she went to a supermarket here in town, she checked out with her groceries at the counter as usual. As she was walking out the store with her groceries, someone said, “You come back now”, and she promptly turned around and went back to see what the concern was, thinking that she had left her change or something of that nature.

Another nurse from Indiana was working in “our area” and was doing the interviews of the patients before the doctor was to see the patient. She was going in and asking the usual questions such as, “well, what are you here for today?” and the sort. She entered one room and asked the question, “well what can we do for you today?” and the patient said….”I’ve got a risin’ and its come to a biling and its got corruption in it”.  She smiled and said, “OK, the doctor will be right in” and turned and left the room.  She closed the door behind her and the MD said, “what are they here for today?”

She said,” I have NO IDEA”.

Finally, I was discussing the treatment of a “fracture” in a forearm in a small child, and was trying to explain to the parent, who had been to see another physician before coming to my office that I wasn’t sure that I saw the need for more than “skillful, watchful, neglect” for this injury because I didn’t see a fracture line on the x-ray and I thought that the line that the radiologist called a “fracture” was probably a nutrient foramen, and it was going to heal fine without treatment and that I wasn’t sure that I could “appreciate” a fracture line.

The parent looked stunned for a moment and said, “I didn’t mean to make you mad, I was just telling you what they told me and I didn’t mean to offend you!!!” He didn’t understand that I didn’t “See” the fracture, i.e. didn’t “Appreciate” the x-ray findings that he had been told were present.

It’s the little things………

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