Cinematic review published in IJUDH

IJUDH
Brian T. Maurer’s review of Emilio Estevez’s epic cinematic journey “The Way” has been published in the International Journal of User-Driven Healthcare.

The International Journal of User-Driven Healthcare (IJUDH) is a refereed, applied research journal designed to provide comprehensive coverage and understanding of clinical problem solving in healthcare.

Interested readers can access the article here.

JAAPA’s 25th anniversary poetry contest winners announced

“Why poetry?” you might ask. Why indeed? Of the many venues available to validate the human condition, poetry is perhaps the most poignant. In a poem, we see the pathos of both practitioner and patient laid bare, crystallized before our eyes, whispered under the ebb and flow of our collective breath. Poetry presents the human heart with its joys and sufferings, trials and travails. But what, you might ask, does that have to do with the practice of medicine? more»

Interested readers may access the winning poems in JAAPA’s 25th anniversary poetry competition here. JAAPA is the official journal of the American Academy of Physician Assistants.

Walt Whitman, 1887

Beware the Ides!

“Beware the Ides of March!”

Thus spake the soothsayer in Shakespeare’s Julius Caesar. Those words foretold the assassination of Caesar in the Roman Senate that very day. You can’t escape fate, it seems. In the Shakespearean folio, the play’s the thing; and here fate trumps human endeavor every time.

Many contemporary patients consider themselves to fall in the same category. Somehow they’ve gotten it into their heads that there is little they can do to alter the course of their health. more»

Remembering Dr. Howard Spiro

I first encountered Dr. Howard Spiro at a medical humanities conference in Williamstown, Massachusetts, some 20 years ago. As a guest speaker, Dr. Spiro shared the podium with Dr. Robert Coles. The two made quite a pair: both distinguished practitioners of the art of medicine; one from Harvard, the other from Yale. Dr. Spiro wore a brown bow tie that day. I recall that detail exactly, because it was the kind of bow tie you had to tie yourself; and I remember suppressing an impulsive urge to discreetly snug it up for him. Curiously, I didn’t actually make his personal acquaintance until nearly a decade later.

One evening in December of 2002 my friend and colleague Dr. David Elpern and I traveled to New Haven to attend an evening lecture at the Yale Humanities in Medicine program. During the drive down, Dr. Elpern told me that Dr. Spiro had founded the lecture series back in 1983. Later that evening over dinner at Mory’s, we learned from Dr. Spiro that he had gotten up a fledgling online journal of similar import, the Yale Journal for Humanities in Medicine.

By that time a few of my early pieces had been published in JAMA and BMJ. Dr. Spiro was eager to hear all about them. I don’t recall whether he asked me to consider submitting something to YJHM at that time or not. At some point I did send him a piece, which he graciously accepted for publication.

Sometime later, after he offered to review my book Patients Are a Virtue, Dr. Spiro asked if I would consider doing a monthly column for the journal. “What would we call it?” I asked him. “Call it what you like,” he said. Shortly after that my “Notes from a Healer” began to appear in the electronic pages of YJHM.

And so began a collegial relationship that lasted up until the time of his death. (Dr. Spiro approved the submission for my March “Notes from a Healer” column days before entering the hospital for a cardiovascular event that would ultimately end his life.)

Every month for the past five years I would send Dr. Spiro a piece for the column, which he would critique, usually in a few brief lines, before okaying it for publication. These critiques were not those of a typical editor. Many times he would comment about something in his own life or how the piece I submitted moved him personally.

“Engineers are among the most difficult patients, for they are convinced there’s a detectable reason/cause for anything/everything.”

“Wise, indeed. One learns with age.”

“You are sounding more like O Henry with time.”

“Your usual beautiful turns. I confess I would have seen the opportunity/really the genius of America in their story, but suum cuique!”

Occasionally, he would point out a grammatical error; and red-faced, I would shoot off a corrected copy with my thanks appended. At some point, he would finally bestow his signature stamp of approval: “Imprimatur.”

Dr. Spiro rubbed shoulders with some of the medical greats of his era. Many times I only learned of these relationships through casual comments he would make on pieces I sent him. For example, in response to one of my submissions he wrote:

“I knew Leon Eisenberg—admired him—look at his CV. I cannot believe that he would want to be considered a mere psychopharmacologist.”

After researching Dr. Eisenberg’s biography, I wrote back, “I took your advice. You were obviously correct in pointing out that the man was much more than just that.” I included an article from Harvard’s FOCUS Online which I thought Dr. Spiro might enjoy . Dr. Eisenberg’s story about the schlemiel was priceless.

Sometimes Dr. Spiro and I exchanged correspondence on matters of medical practice as well. Once, I discovered an article that referenced a paper of his. I sent him the link with a few observations:

“Reading through this review, I couldn’t help but think that you would enjoy it. As it turned out, you were mentioned toward the end of the article.”

‘Stress,’ the American gastroenterologist Howard Spiro writes, ‘increases vulnerability’ to other ulcer-causing agents ‘like H. pylori’. Medical fascination with bacterial causation has, he says, resulted in culpable neglect of the roles of the mind, the emotions and the dietary and behavioural patterns of everyday life. (A Modern History of the Stomach: Gastric Illness, Medicine and British Society, 1800-1950 by Ian Miller)

Dr. Spiro was obviously pleased: “Thanks, glad I am remembered! I worked on stress in the 1940’s, thanks to Selye’s idea of the ‘alarm reaction’ and published my first medical papers back then.”

In turn, I wrote back: “Perhaps my perspective is somewhat skewed, but it seems to me that precious few specialists seem to be able (or willing) to relate to such patients on a humane level these days, a demonstration of the lost art of medicine.”

Dr. Spiro’s assessment: “Boy, are you right! When I was young, we talked to patients. Lab data and images were scanty. Since 80% of patients get better with time and the right hand of fellowship, the clinician counted. But that will return after disenchantment spreads.” He had entitled this reply I-Thou.

On a professional level, Dr. Spiro was supportive of my clinical practice as a physician assistant. He strongly advocated for the advancement of “mid-level practitioners” as he called us, feeling that we were the answer to the primary care clinician shortage problem. “The expertise you demonstrate in the way you care for your patients is evident in your writing,” he wrote. “I argue with my colleagues, many of whom feel that medical practice should be regarded as the exclusive domain of the physician.”

“As you may know—or more likely may not—for the last 20 years I have been pushing the idea that physician assistants or nurse-practitioners should be doing pediatrics and general internal medicine. Very few in the internal medicine business agree.”

“Your enthusiasm, amity, empathy for your patients—and your prolific writing skills—continues to reassure me that physician extenders—if I can call you that—should constitute our general docs and pediatricians. It’s a canard that they will not recognize serious problems! I keep wondering why you do not talk about that—or maybe you do, indirectly, or in other places.”

This past fall Dr. Spiro wrote that he would be traveling to Arizona to give a medical humanities presentation at one of the medical schools there. “I would like to use you as an example of a clinician who not only practices humane medicine, but writes about it well. Send me a copy of your CV. I imagine you to be somewhere around 45, give or take.”

I sent him my résumé with the caveat that he was off on my age by more than a decade. “Hah! You write with the vigor of someone in his early thirties,” he quipped.

Toward the end it was evident that Dr. Spiro was becoming a bit forgetful. When the name of George Bascom resurfaced in one of our e-mail exchanges, he wrote: “Tell me again how you knew him.”

“It was you who knew him personally,” I wrote back. “I only knew him through his poetry. In any event, he was a fine mensch who continues to influence clinicians from beyond the grave.”

“If you didn’t know him personally, a word like mensch—which I take to be a personal assessment—might be out of place,” he replied. The response stung.

I took a deep breath and typed out a reply. “According to the dictionary, a mensch is someone to admire and emulate, someone of noble character. It’s meant as a compliment to highlight the rarity and value of that individual’s qualities.”

I suppose those words might just as well have been written to describe Dr. Spiro himself.

Howard M. Spiro, M.D. (Photo credit: Peter Casolino Photography, New Haven, CT)

We’ve come a long way, baby!

PA: a post-modern acronym devised to denote a select group of highly trained top-notch healthcare professionals groomed to provide state-of-the-art compassionate care in collaboration with practicing physicians, upholding the vision to restore the practice of medicine to its prior place of unselfish service to humankind.

The January 2012 issue of AAP News (Volume 33, No. 1) carries a front-page article about PAs as key members of the team model of care in pediatric offices.  Chris Barry, PA-C, is highlighted as the medical liaison from the AAPA to the AAP.  Jack Percelay, M.D., AAP liaison to the Accreditation Review Commission of Education for the Physician Assistant, describes PAs as having “a collaborative working relationship with physicians.”

Like their pediatric patients, PAs have demonstrated tremendous growth and development over the past three decades.  As bona fide clinicians now recognized and welcomed by the American Academy of Pediatrics, we’ve come a long way, baby.  more»

Author to speak at 6th annual Cell2Soul retreat

Author Brian T. Maurer is slated to speak at the 6th annual Cell2Soul retreat to be held at Sheep Hill conference center, Williamstown, Massachusetts, the weekend of October 1 – 2, 2011.

Maurer will deliver a short talk entitled “Donning the Yoke” on Sunday morning, October 2nd.

Additional topics at this year’s gathering include the medical humanities, surviving survivorship, absolute self-care, dignifying dementia, navigating madness, the odyssey of coyote medicine, and sacred undertakings.

Readers interested in additional information can access it here.

Author’s books now available at iTunes bookstore

Brian T. Maurer’s books Patients Are a Virtue and Village Voices are now available as iBooks for purchase and download at the iTunes bookstore.  Interested readers may click on the links below to access these titles.

Readers may also search for these titles directly at the iBookstore using the following ISBNs.

The ISBN for Patients Are a Virtue is 9781257166220.
The ISBN for Village Voices is 9781257351039.

Author to deliver 2011 Memorial Day keynote

Author Brian T. Maurer will deliver the keynote address at this year’s Memorial Day exercises on Monday, May 30th, in the cemetery of Saint Bernard’s parish, Simsbury, Connecticut, at 9:00 AM.

Several years ago a woman at work placed a notebook in my hands — the diary of her brother in which he had recorded his daily thoughts while on duty in the early days of the conflict in Iraq.  It was a sobering read.  Like many Americans of that era, he served his country well.  When it comes to war, we are all writers, recorders of deep sentiments in our everyday lives.

Addendum:  A 12-minute video presentation of the 2011 Memorial Day keynote address may be accessed here.

A litany of symptoms solved

If you are an avid reader of medical narratives, you may have come across Dr. Lisa Sanders’ invitation to participate in solving the diagnostic dilemma of a 76-year-old woman suffering from chronic weakness, fatigue and mood swings posted in yesterday’s New York Times.

Over 500 readers, both lay and medically trained, weighed in on the differential diagnosis over the course of the day.  I submitted my two cents as comment #358.

The resolution of the case appears in today’s Times at this link.

You can read my final thoughts about the clinical case presentation here.

Hats off to Dr. Lisa Sanders and Times columnist Tara Parker-Pope for putting together this thought-provoking diagnostic exercise!