Sunday, February 17, 2013


I've given myself a respite from my own shul this winter.  I've not been absent entirely but absent enough to see if anyone takes attendance.  In all likelihood nobody misses me.  This winter brought my monthly day trip, Rosh Chodesh across town, a chance to sample an attempt at transdenominationalism across town, my periodic platelet donation, one weekend as Ba-al Shacharit at my own place and next shabbos I return as Torah reader.  While I cannot say whether anyone missed me, I can say that I found the absence welcome.  Nobody there seems obligated to respond to me, whether I comment on our service or on the experience someplace else.  Judaism in my mind is ultimately about the exchange of ideas, some welcome, some not.  Our sages were constantly engaged in dialog and current students thousands of years later learn by chevruta. I tap into my own sources, primarily, where no interaction is expected.  The lack of interaction where I do expect it creates a negative.  I run my medical teaching in an interactive way, whether with patients or residents or students.  I ask them questions, pose something perhaps provocative in the way of science or they query me.  At Mercy Philadelphia Hospital ideas create energy.  On Sermo somebody posts a comment and dozens of comments from people I am never likely to meet ensue.  On Facebook an article from The Forward will generate a dozen responses.  Some of my FB Friends post items of interest to them that will have been read by thousands with remarks from dozens.  This doesn't seem to happen at AKSE, or if it does I am isolated from it.  Trying to generate an AKSE Academy generates less enthusiasm each year, including from me.  The Rabbi for all intents and purposes never makes comments that generate discussion or even incite people to send cards and letters.  The President might but he controls discussion.

In a setting where mode of worship can never be regarded as inviting to large segments of the community, some form of compensation needs to be implemented to attract attendance.  Embracing/Engaging/Enriching, the logo, can providing there is really a commitment to innovation and advancement.  It just hasn't been there.  I'm not sure too many people recognize its absence.

Suggestions to make a shul more interactive would be welcome.

Monday, February 11, 2013

Exit Ramps

Steering onto the exit ramps of public Judaism and of medicine.  Both have a fair amount of traffic.  Both have created an attachment for me over a very long time in some form.  Yet each has become more of a private calling than a public expression.  There is a superb lecture on character as a prerequisite for leadership positions in Judaism.

Rabbi Reiss cites sources that require effective Rabbis and other communal leaders to have both personal character and the willingness to irritate their constituency for the right cause.  I have found no shortage of people willing to make decisions that generate leadership induced attrition.  And at times people who do this conduct themselves in a way that is beyond reproach, but too often not.  And too often what is promoted as the right but unpopular cause is both faulty and unpopular.  There are limits to what people will accept, giving many a wannbe Jewish leader the Pyrrhic victory of a noble purpose but no talent to implement his vision.

Medicine takes a parallel approach.  No shortage of distinguished accomplished charismatic medical school alumni who engage in dastardly conduct.  Attrition may be a little harder in this forum where people depend on this type of activity for their livelihood but underparticipation seems rampant.  Clinicians have very little incentive to fully engage themselves in the pageant of medicine, opting instead their own niche, whether that be their individual practice or their lab.  Medical societies lose their purpose.  The American College of Physicians moves toward noctor parity as a surrogate for their own physician participation.  People still see patients and run their practices, but they are on the exit ramp just the same.

Thursday, February 7, 2013


Hard to pinpoint why I have felt sad for the last two days in the absence of any precipitating event.  I do not feel angry, irritable or particularly irrational.  While my professional schedule seems full, it does not come across as overwhelming.  There are just a lot of things I think I would like to do or ought to do but lack any activation energy or inclination to do them.  Sure, the patients will get seen, the email will get looked at, my medical license will get renewed on time and I will have my upcoming Torah reading reasonably polished in the two weeks remaining.  It's the stuff that doesn't have deadlines which languishes.  There is a new NEJM article that I should read but nothing will happen if I don't.  I'd like to have my kitchen and bedroom more functional than they are, but no woe will befall me if they stay cluttered.  And my harmonica, which I purchased with great enthusiasm a year or so ago, rarely comes out of its case.

Two days of notable symptoms is hardly justification for getting myself of SSRI's.  Maybe if I accomplished a couple of the wanna do's but don't hafta projects, the accomplishment would reverse my mood a little.  More likely watchful waiting will do the same.

Sunday, February 3, 2013

Clean Up

Before leaving for vacation in December, I devoted a few minutes each day to moving papers off my desk.  Copies of consults went to a canvas bag.  Stuff that needed to be signed got signed.  Some papers got tacked onto my bulletin board.  And there were things that I knew I should not discard but had no intention of reading again.  These went into a corner.  The effort to tidy revealed some useful stuff like writing pads, post-it notes, file folders and blank billing cards.  These went in another corner.  Pens went in a drawer or a cup and prescriptions went into a drawer.  Having been back at my desk a month past my return, the laminate surface had again become invisible.  With a half hour of early morning quiet this week, I again sorted papers, finding and separating a few of special importance which went into a folder on the window sill.  Things to sign will get signed within a few days.  The canvas bag still has room for more copies of consults.  And billing cards got filled out to try to keep the disapproving comments from the management from having its usual validity.

As much as I enjoy having a desk and an office with a door tucked into a generally untraveled corner, I do not particularly like working at my desk.  Never did.  Not since first grade when the left over Halloween candy got stuck in the cubby created for books and papers beneath the desktop, only to be purged in all its stickiness in April.  Junior High went well.  There was no desk or any kind of personal space other than a hall locker.  The most successful people would have no turf but journey from classroom to gym to library to another classroom to the bus home.  We did not have backpacks.  Some of us had briefcases but more of us had two rubber straps with clasps to minimize the risk of our portable books and loose leaf notebooks scattering.  Unorganized was not a handicap in that setting but became one in college where the dorm had a desk that I did not like to sit at to study, as did my apartment in medical school.  Residency returned me to lack of formally designated workspace for the last time, which may be why many people, myself among them, thrive as residents.  I had one main book, not that many papers, and journals that came in the mail unsolicited.  Somebody else filled out forms or wrote prescriptions.  I traveled light.

But now I accumulate paper once again and it has to be sorted and purged from time to time.  It's a low priority in my mind, though not necessarily in management's mind.  I like being with the patients and with the residents in the exam rooms and on the wards and sometimes in the conference room.  I can work effectively wherever the computer terminal and charts are, roaming from one patient unit to another as the need arises, without a good sense of professional headquarters.  Like the rolling stone, no moss or paper gathers.