Friday, June 28, 2013

Did Fine Without My Help

Somehow ended up on the minutes list of the Education Committee even though I made it very clear I am no longer a committee member or contributor.  The projects include a new one on Judaism in the Cinema to be conducted by a very capable congregant with an interest in that.  AKSE Academy is dormant for now but there is a committee in place as I suggested before.  A visiting scholar will be invited, one who has a previous connection.  What remains missing this year as in past years is an assessment of the quality of what had taken place previously and how to enhance the ongoing activities.  One of AKSE's ongoing Achilles Heels has been the failure of the A-List to solicit feedback from anyone other than themselves or to analyze their disappointing outcomes.  My guess is that the Rabbi classes are not well attended and certainly not destinations that would bring people aboard who are not already aboard for some other reason.  His best sessions on historical summaries of the early Nevi'im books were primarily attended by people who attend shabbat morning services with some regularity and stayed for the presentation.  There is something of a literature on this.  The growth of congregations that carry gender separation as part of their public baggage seems to depend almost entirely on people who use their Rabbi's superlative educational offerings to override their unhappiness with gender policy.  If this does not happen, which it does not seem to at AKSE, the congregation shrinks.  This has been an area where the Education Committee which represents the congregation's best attempt to justify exorbitant financial impositions, really has not done well.  Yet within the minutes I saw something that seemed clearly a notch ahead of the slouch to mediocrity.  And they were able to do this without any particularly Creative or Explorer types like myself aboard.

Monday, June 24, 2013


Each December and June I outline projects for the coming six months.  Usually there are six, some perennial that never get done, a  few finite that get checked off.  My health or weight is always among them but never gets its check mark.  I want to do research and to have my writing more widely acknowledged.  These past two half-years I have had twelve, which makes weekly planning easier than when I had six but the focus was better with fewer in number.  While away, I had some time to work on the coming semi-annual projects, choosing to limit it again to six with end points that are more finite than in the past.  The other six remain in the background.  Eventually I will get around to becoming more proficient with the harmonica and settling Dad's estate but they are secondary to the things I really have a desire to accomplish.  My health is not on it for the first time in decades.  But that is something that needs to be absorbed into ordinary activities and not a point of isolated focus.

So here are the six, subject to another week's or so modification, all with accomplishment deadlines of next New Year's Day.

  1. I will have submitted a poster proposal for next year's Endocrine Society meeting.  This is something very doable, though I am not sure I really want to go to next year's Endocrine Society meeting in Chicago.  My interest has shifted from the technicalities of endocrinology toward the way it is practiced, how one disseminates the principals to a core of residents who will soon be primary practitioners and hospitalists actually doing the work.
  2. I will have submitted a formal estate plan to an estate plan attorney.  This one just needs a couple of Sundays or perhaps a Fourth of July and Labor Day to review forms, fill them out and then find an attorney to guide me.  It has been procrastination at its most overt.
  3. The places in my home where I actually spend my time will be decluttered and clean.  I spend time in the kitchen, bedroom and family room couch.  I eat in the dining room and have created a favorite nook with a fold-down desk in the living room that should be more of my professional area than it currently is.
  4. My blog will be widely read and commented upon.  I have a book on Blogging for Dummies that I mostly read.  I understand the principles and have two topics, the decline of synagogue life and professional dissatisfaction with life as a physician that I know have a potential audience.  One of the phenomena of AKSE and I'm sure a lot of other places is that as people vote with their feet and the baalebatim complain about attrition, nobody solicits the thoughts of the dissatisfied to try to accommodate them without disrupting the core activities of the synagogue.  When I recently decided to become an observer, setting aside any active participation, I got an expected measure of negative feedback in the form of scorn for having acted that way.  What I did not get was any solicitation whatever of why I came to my conclusion.  If nobody wants to solicit my thoughts and my thoughts are important just the same, I will have to volunteer and disseminate them.
  5. I will have submitted four articles for print publication.  Another perennial.  But finite.
  6. The denouement of my professional career will be put in place.  I set my Retirement Countdown Clock as a birthday present to myself a few months ago.  While I like what I do, I like other things as well and really do not want to spend my final years in active practice doing exactly what I've done before.
Seems like a pretty decent list with reasonable justification.  Next step is to carve out dedicated time to do these things, which means a schedule and time in which patients are not continually coming at me.  I think I can do these.  Will assess progress each month.

Thursday, June 20, 2013

Some Time Away

I've been off about a week now, primarily to attend the Endocrine Society Annual Meeting in San Francisco followed by a respite in wine country and an intended viewing of Yosemite which did not happen for having underestimated the distance in my planning.  There were a lot of side projects to be attended from my estate planning to semi-annual project planning to computer upgrades for work to some writing that also did not happen, underestimating my stamina during the conference and my tolerance for wine afterward.  The synagogue annual meeting came and went in my absence, passing by my intent to transform from participant to observer.  But I'm rested and ready to return, though perhaps in a different form from when I left.

Travel probably reveals more about me to me than I learn about the place I visit.  I find myself generally more tolerant of glitches than I am at home.  Perhaps if I were a geek, San Francisco would be a permanent destination, easy to absorb into the technical world.  While there I passed by stores know for their exclusivity.  I am not a person who seeks exclusivity or indulgence, much the opposite.  New things intrigue me.  I never get tired of Chinatown and as I diverted my path toward the Golden Gate Bridge, I got to see if not experience some of the neighborhoods.  And across the bridge I encountered extraordinary scenery and eventually viticulture on a scale not imaginable in the East set amid the usual collection of fast food places and chain motels only a short car stop away.

At the convention I encountered research on how medicine is practiced and how things that I experience randomly can be quantitated.  My pet peeve of inadequate resident supervision has an outcome measurement that somebody did and discussed with me.  My interest in core science was a lot less than that, though a necessary component of understanding what I do professionally.  And it was reassuring to know that the grand professors had the same prescription plan impediments that I do.  Moreover I have the same skepticism of the role of leadership of the Endocrine Society that carries over to my Jewish world and my medical world.

So in a few days I return to usual activities and some catchup.  While will again have a $10 bottle price limit even though I can now tell the difference from the premium stuff I got to taste at the vineyards.  My interest in acquiring stuff has been blunted by the rejection of overabundant premium stuff which infused San Francisco.  I am a little more committed now to carving out some time each week to set the patients aside in order to focus on the more creative observations of medicine.

And there will be the next half years projects outlined.

Thursday, June 6, 2013

Computer Upgrades

Our hospital patient care system was sold to the management with a hint that they would collect their money faster and in greater quantity.  In the minds of clinicians, the core business of the medical center is patient care with revenue as the byproduct but too little attention was given to the clinical capacity of our Electronic Medical Record which has been a struggle to maintain.  My clinical notes are now pages of cut & paste and carry over from last time.  The designers had the saichel not to put spell check or grammar corrections into the doctor's note writing.  I and many others have learned to leave the grammatical errors in the text as the only way a recipient reader can wade through a multipage report and find which few sentences came from the doctor.

Next week rolls out an updated version.  It would be hard to create a downgraded version of NextGen.  In preparation all users had to take an on-line course and a three hour lecture course to figure out how to use it.  I didn't really figure out how to use it as much as I learned what it could do.  If you were to ask me to add a series of fifteen 3-digit numbers I could do it accurately in a couple of minutes, not so much because I attended a few blackboard sessions in fourth grade but because there was a certain amount of drill and experience that accrued as a user.  My many complaints about prescription writing, scheduling tests, creating lists of often used medicines, replacing inane pharmacy defaults with defaults of what I might actually ask somebody to take, all of these were always there but nobody really showed me how to use them the best way or checked with me in two years to see how it was going.  So while I am in California later this month without the patients coming at me, I will try to set a time aside to customize this in a way that makes it more useful.  The notes will not get more professional as a result but with a little luck I will be able to look at the patients more and the screen less while we occupy the exam rooms.

Sunday, June 2, 2013

Golden Gooses

Word has reached me indirectly that some of the baalebatim have misinterpreted my decision to decline AKSE participation for the foreseeable future.  It has not reached me directly.  But Judaism in its many forms has always depended on agents and surrogates and other forms of intermediaries.  In the world of the Rabbinical Assembly until very recently, I could not approach them with a query.  I was at the mercy of my Rabbi to be their member and agree to do this on my behalf.  They have paid very dearly for this approach which a good deal of talent deems unacceptable, even demeaning.

My value to AKSE is really not me but my possessions.  These include sufficient financial resources to meet dues assessments which will continue and my skills accumulated over half a century or more.  What is on my mind does not seem to carry similar value.  There was no intent to leverage my skill to bargain for something else in return, as I never asked for anything else in return.  It is just time to step aside to do other things that I want to pursue more.  Agree, a better experience might have made me more tolerant of what some of the participation has taken out of me and the other opportunities that were set aside while I prepared for what I needed to do.  But had that been important, somebody would have tapped into my mind, or at least read my writing long before now.  So the Golden Goose who can daven and read haftarah on short notice and who can wade through difficult Torah assignments on reasonable advance notice has been taken to schechita, or so they believe.  I just want to do other things for a while.