Openness to Ideas and How Medicine is Influenced

“I believe in everything until it’s disproved. So I believe in fairies, the myths, dragons…. Who’s to say that dreams and nightmares aren’t as real as the here and now?

—John Lennon

Excerpt From: Kim Lim. “1,001 Pearls of Spiritual Wisdom.” Apple Books. https://books.apple.com/us/book/1-001-pearls-of-spiritual-wisdom/id1448334830

The quote from John Lennon is one I love to hold on to (and not just because I want more from Santa). It expresses an openness to ideas, and a sense of wonder in the world to possibilities. Why does everything have to be proved beyond a doubt to be considered correct? Medicine can get too entrenched with that Black and White Mentality. When the John Lennon approach is utilized in medicine, good things happen all the time. You know that Dr. Anthony Fauci cured a non cancerous disease called vasculitis, which was almost 100% fatal, with a cancer drug in the seventies. People thought he was crazy, but now only 2% of those patients die from vasculitis. This was before the AIDS crisis where he was thrown into the spotlight. Of course, we have to not harm patients. We have to analyze the risks and benefits. We should discuss with our patients if we are trying something somewhat dangerous that we have never done before. But, at times, with should take that leap forward, as Dr. Fauci (my hero) did and continues to do. 

Philosophy: Why Aging in Medicine Strikes at the Heart!

“One must go further, one must go further.”

This impulse to go further is an ancient thing in the world.

—Søren Kierkegaard”

Excerpt From: Kim Lim. “1,001 Pearls of Spiritual Wisdom.” Apple Books. 

Boy, is this true or not!

The world keeps spinning round and round

Yet it is moving slowly in a certain direction. 

Where spinning denotes staying in the same place, 

We know change is occurring, and a newest is on the horizon.

After 40 years a podiatrist, my world really does not exist any more

Is it time for me to move on, like so many of my fellow classmates?

Are there secrets to the human body I can still teach?

Will anyone listen?

Yes, humans must move in a direction that they think is progress.

But does progress denote too much change

Do we have to change what is working?

Progress, or the impulse to progress, demands it.

The old must die, the new born babe is the future

We can not do what our fathers did

We are inbred to not become our fathers!

In the eyes of a dying Steve Jobs, these were the most important aspects of life!! Thank you David Baudrez

In 2011 Steve Jobs dies at the age of 56 of pancreatic cancer, leaving a fortune of $ 7 billion and these are some of his last words...

′′ Right now, lying in bed, sick and remembering my whole life, I realize that all the recognition and wealth I have makes no sense in the face of imminent death.

I have the money to hire the best at homework but it's not possible to hire someone to carry my illness.

Money can get all kinds of material things, but there's one thing you can't buy: ′′ LIFE ".

As I grew up I noticed a $ 300 and a $ 3.000.000 watch show the same time.

That with a $ 150,000 car and a $ 15.000.000 car we can reach the same destination.

That $ 150 or $ 1500 wine generates the same ′′ hangover ".

That in a house of 300 square meters, or in a 3000, loneliness is the same ".

′′ True happiness does not come from material things, it comes from the affection that our loved ones give us."

So I hope you understand that when you have friends or someone to talk to, it's true happiness

Five undeniable facts

1 1 Don't educate your kids to be rich. Educate them to be happy. - Then when they grow up, they'll know the value of things, not the price.

2 2 Eat your food as medicine, otherwise you will have to eat medicine as food.

3 3 Who loves you will never leave you, even if you have 100 reasons to give up. He / She will always find a reason to cling.

4 4 There's a big difference between being human and being human.

5 ️ If you want to go fast, go alone! But if you want to go far, go with it.

And in conclusion...

The top six doctors in the world are:

1 sol The Sunlight

2 Descanso The Rest

3 Ejercicio The Exercise

4 Dieta The Diet

5 mismo Confidence in itself

6 Afectos The Affects

At whatever stage of life you are in now, thank and enjoy the little things to the fullest and treasure the love of your partner, your family and your friends, so that when the day comes when the curtain comes down, you can carry with you the true wealth of this world.

If God is Not Done with You, then He is not Done with YOU!!

LOOK CLOSELY AT PHOTO 1
(Don't go  to photo# 2 until you look at #1 closely..)This is an interesting, even  breathtaking couple of photos. 
Be sure to  read the 1st caption below picture before going to the 2nd photo. 
Look  closely at the first photo take your time, then  scroll down very slowly



Look at the picture above and you can  see where this driver 
broke through the  guardrail, on the right side of the culvert,  
where the people are standing on the road,  pointing.... 

The pick-up was traveling  about 75 mph from right to left 
when it  crashed through the guardrail. 

It  flipped end-over-end bounced off and across the  culvert outlet, 
and landed right side up on  the left side of the culvert, 
facing the  opposite direction from which the driver was traveling.

The 22-year-old driver and  his 18-year-old passenger 
were unhurt except  for minor cuts and bruises.

Just outside   Flagstaff , AZ , on U.S. Hwy 100.   


Now look at the second picture  below...
 



 



 




If God isn't done with you, Then God isn't done with you !! 

Words to Live By

This was an email sent from a friend. I agree with everything said. It is always good to reflect alittle on how we are living on this earth. Love, Rich

As we grow older, and hence wiser,

we slowly realize that wearing a $300. or

$30.00 watch   - - - - - - -

they both tell the same time...

 

Whether we carry a $300 or
$30.00 wallet/handbag - - - - - - -

the amount of money inside is the same;

Whether we drink a bottle of $300 or $10 wine - - - - - - - - - -  - -

the hangover  is the same;

Whether the house we live in is 300

or 3000 sq. ft. - - - - - - - -

loneliness is the same.

 

You will realize,

your true inner happiness

does not come from

the material things of this world.

 

Whether you fly first or economy class,

if the plane goes down - - - - - - --

you go down with it...

 

Therefore.  I hope you realize,

when you have mates,

buddies and old friends,

brothers and sisters,

who you chat with, laugh with,

talk with, have sing alongs with,

talk about north-south-east-west or heaven & earth, ....

That is true happiness!!

 

 

FIVE UNDENIABLE FACTS OF LIFE:

1. Don't educate your children to be rich.
Educate them to be Happy.
So when they grow up they will know
the value of things not the price.

2. Best awarded words in London ...
"Eat your food as your medicines.
Otherwise you have to eat medicines as your food."

3. The One who loves you will never leave you
because even if there are 100 reasons to give up

he or she will find one reason to hold on.

 

4. There is a big difference between

a human being

and being human.

Only a few really understand it.

5. You are loved when you are born.
You will be loved when you die.
In between, You have to manage!

If you just want to Walk Fast,

Walk Alone!

But if you want to Walk Far,

Walk Together!

 

SIX BEST DOCTORS IN THE WORLD:
    1. Sunlight
    2. Rest
    3. Exercise
    4. Diet
    5. Self Confidence and
    6. Friends


Maintain them in all stages of Life and enjoy healthy life.

 

Sent with Smiles,
Affection and Love !!

Slomo: A Soul check for us all

     I have been asked why I write my blog for hours and hours on sunny days or late into the night. Part of the answer lies in this very well done video on a doctor that simplified his life to save his soul. This blog is more from my heart and soul than anything else I do in medicine, because it is pure. A pure gift without expectations of rewards. It allows me to get off my treadmill of chaos and deadlines, and just be with the act of giving.
     The video explains that this doctor had to save his soul or materialism and bitterness and depression would have got him. He had to do something big, but individual, and right for him. He had to do something "soulful" which always brings you peace, joy, and happiness. In the video, you can see the true joy he receives. Contrary to majority opinion, it is not escaping life, but living life robustly.
     I work hard, and have some materialistic tendencies I fight, but I try to find what brings me peace, joy, and happiness to stay centered. When I am not centered, I am unhappy. I have been centered enough in life, that I feel terrible when I am not.
     Some of you know I love basketball. It is a game I have played in 7 decades, so it is the only remaining activity of my long ago youth. Playing basketball, as I did this morning, makes my heart sing for joy, even when I am not wearing my iPod. I do not have to visualize my childhood, one or two dribbles and I am transported back 50 plus years ago.
     My best friend is my wife. Being in medicine, and working long long hours has not afforded me many long term friends. Alot is my fault, but in reality, it is really my choice. I have willingly chosen to dedicate my life to my best friend for the last 42 years. She is my soul mate, my companion, my heart and soul. I would rather be with her, or my children, than anywhere else.
     So, I will not start the San Francisco version of Slomo. But, I will take his incredible insights, and continue to find my soul, and keep my soul healthy. I will continue to ask when confronted by opportunities, is this something that will help my soul and bring more love and health and peace into this world? If the answer is yes, I may be adding a new skill.

Walk In My Shoes: A Powerful Short Video!!

We daily envy the good fortunes of others which brings our spirits down. We are all incredible gifts, and I realize that life is unfair! This short but powerful video will be analyzed by everyone differently, but it's point is to get us thinking. We need to have a heightened appreciation of our gifts, not failures, our successes, not shortcomings. We do need to walk in another's shoes to really understand them. We will never understand them if we are only thinking about ourselves all the time. I think I could watch this video 10 times, in 10 different emotional places, and get 10 different responses because it is that powerful. 

End of the Year Reflections from Dr Rich Blake

The sun is setting on another year. Quite unbelievable to me as I do not know where it went. But I love this time of year. I love to reflect on the past year's events, and on where I am going next year. I see my successes and failures, my smiles of happiness and tears of sadness, and search for the meaning of what just happened. 

I do feel too scattered this last year. Most of my goals for the blog went unfulfilled as I just muddled through. But, I did stay involved. The blog connects me to some subliminal side of medicine that is just wonderful. I feel it is part of me and apart from me. I am teaching through it, and yet being taught by it and my interactions with my readers. I am a better podiatrist, better person, because of it. But how?

My wife Pat and I celebrated our 35th Wedding Anniversary in Provence this year and found a beautiful poppy field like the one above. The poppies symbolize natural beauty for me, and I fell in love with them years ago in Monet's paintings. Monet had passion, and simplicity. He surrounded himself with beauty at Giverny which daily inspired him. Caring for others is my passion. Podiatry gives me a tool in which paint with simple strokes. 

So much of what I want to say in my blog is so simple. Keep It Simple Stupid my mantra. Listen To Your Body my daily saying. Stretch more. Ice more. Power Lace. Our bodies will tell us if we need to be more complex. 

I thank my readers for a good year. I thank my wife for smiling when she walks past me while I am blogging. I wish I had great plans for the blog in 2013, but life will direct it more than I. I apologize to those I promised things, but failed to produce. I have so little time. Part of me needs to lay in that poppy field more, to relax more, to be with my family and friends more. Part of me is upset at poor health care I see and sometimes deliver. So I will continue being with this blog that continues to call me to be a better person, a better human being, a better doctor, and I will continue to continue. 

Happy New Year!!

Musings from A Footstool: Let's Celebrate Our Feet!!

Blogging on Sunday is Musings from a Footstool

Anyone who sees the following Celebration of the Golden Gate Bridge's 75th Anniversary will know that San Francisco knows how to Celebrate. My wife and I watched this from my office yesterday. Unbelieveable!!

Celebrations are a great part of life, my family tries to celebrate everything, it connects you to life, to others, to joy, to this world around us.

When was the last time we celebrated our Feet. May is actually National Foot Health Awareness Month, and I am waiting to the end of the month to ask you to celebrate your feet. Do something nice to your feet this week. Buy some new shoes (another excuse!!), paint your nails, scrub off some calluses, massage your arches, be more committed to your YogaToes, make an appointment with your podiatrist if something hurts, or just say thank you.

In saying thank you to your feet, you stop for a moment to appreciate them. All they have done for you. The walks they allowed you to take, the marathons they endured, the start and stop in tennis or basketball they provided, the spring in your step when you heard good news.

My feet allow me to stand tall, jump for joy, take a charge in basketball, run to catch a bus, run to catch my children (and someday hopefully my grandchildren).

Thank you feet. Even as a podiatrist, I do not say thank you enough. Thanks for a job well done!! I will try to treat you better. Not abuse you as much. Thanks for letting me celebrate all the joys in life like the Golden Gate Bridge's 75th Anniversary. Thank you.

Musings from a Footstool: How to Appropriately Bill for Lending a Shoulder to Cry On

Blogging on Sunday is Musings from A Footstool (Philosophy)  


 Medicine is too much now a days about doing things. You do things so you can dictate you did something. You dictate that you did something so you or your biller can bill for that something. Was that something helpful? No one in charge really seems to care. Was that something hurtful to the patient? So what since you can bill for it. If you did it, you can bill for it. The more you bill, the more you probably will get paid. So do a lot, whether it helps anyone or anything really does not seem to matter (but it should help your pocketbook). 

     How sad? 

     When you talk to billing coordinators that deal with insurance companies, they do emphasize that the sky is not the limit on these matters. Normally health care providers can get paid for one something for any visit encounter. That provider may feel you need 5 or 6 things done to get the ball of progress rolling towards healing, but they feel the pressure of only doing 1 something. So, they might as well do the most expensive something, even if it is probably the least predictable to help you. They can rationalize that there will be another visit. More can be done to help next time. But, that next time, the pressures of making a living are still there. 

     So, where am I going with all this?

     And this soapbox is just as much directed to me as to any other health care provider.

     We need more hand holding, more shoulders for a patient to cry on, more smiles, more pats on the back, more gentle nudges, and more open caring. Providers care, but medicine tells them to be careful about showing that care. It makes you vulnerable, and you do not want to be that. You have to be in control of every situation. You have to say you know what is going on, even if you do not. And you sure can not bill for that extra meaningless time with the patient. There is no billing code for "Lending Your Shoulder For Patient To Cry On" even if that was the most important part of the healing process to have occurred in months. 

     

Teamwork

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I hope you will grant me a short bit of reflection for today is my 30 Year Anniversary of being a podiatrist at Saint Francis Memorial Hospital, San Francisco, California, at the renowned Center For Sports Medicine. This photo represents who I am--A Team Player. I team up with my wife for a great marriage, I team up with my kids and one spouse and friends, and I team up at work to be the Best I Can. When I play sports, winning is secondary to how I held up my end of the bargain and played hard for my team. When I am at work, I am always thinking about others (my staff, my fellow docs, my patients). I strive to be a great Team Player and never ever let them down. Do I? of course. Do I want to let them down? never. 

I must admit I am tiring after 30 years. My energy level is waining. I continue to fight my battles, but I feel a deep call to simplify and keep centered. I know I have to re-invent myself every few years, so last year I started this blog, started teaching more, and I am currently trying to learn Electronic Medical Records and ICD 10 codes. Everything I do is for a team of one form or another. My office, my hospital, my patients, my family. So, I was sad no one knew that this was my big day. And I am  very very proud of this day.The significance of today was all I could think of. 

I am 57, and after spending a lot of money getting 2 kids through private colleges, need to continue to work for retirement. But, the next 15 years can be at a more relaxed pace. So, with the help of good health, I look forward to the last 1/3 (15 years) of my practice life as a sports medicine podiatrist increasing my blog as a form of teaching, increasing my formal teaching and lecturing, maybe a little research, maybe a few trips for R and R. 

Thank you for allowing me to have this special time with you. Please let me know topics you want to hear about. Consider us a Blog Team. I don't want to let you down. You are part of my team as we try to help people with various foot and ankle problems.

Optimism: Pass It On

The video above is about optimism and alot more. It is about finding out who we are as athletes and as individuals. It is about cross-training when you are injured and can not do our sport. It is about accepting who we are at any given moment and looking for answers in a positive light. It is about the glass half full. It is about realizing the journey is more important than the end result. It is about joy.

     As a kid, I would listen to the San Francisco Giants games on the radio. When the Giants came up, I would bat for them. When the Giants pitcher was on the mound, I would pitch for them. There was such joy in this journey. My childhood is filled with great victories of this sort. They are very happy memories. I would dream one day of playing for the Giants.

     The practice of medicine should be like this, celebrating all the victories, staying optimistic in the defeats. Finding hope in everything should be the goal. If strike 3 is called, the fun should only be beginning. I don't believe in strike 3 in medicine, the patient should get to hit like in T-Ball until they put the ball in play. I doubt major league baseball will go for that, but doctors/therapists/patients should. Give up after 3 failures at something. Nonsense.   

Philosophy: Is your health care provider really seeing the whole picture?

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I love this image of a health care provider looking into a patient's problems. I can work with patients for a long time and realize I am only seeing such a small part of who they are and what ails them. Health care providers learn to look through the stuff that separates, but only as a patient opens up. I am afraid modern day medicine is retreating behind a thick wall to some degree. The beautiful art of medicine lies in the decoding process of all the pieces we are given. I have been recently treating a patient named Stephanie. Because of how serious her injury, I am really getting to know her. She has a nerve injury we are trying to sort out. She is getting many opinions on my recommendations. We talk, we email, we explore. I am so impressed at her strength, but understand her fear. Most health care providers want to see their patients face to face for every exchange, but it is not practical. The fragmented images are more fragmented on paper, or phone, or internet, but it is just a new learning curve. I have learned to love the ease of the email. But, since I am from San Francisco, I miss the hugs (probably why I got into medicine in the first place).

Today I had a great visit with a patient named Robin. Very complex spirit, but very centered, and easy to be with. I am sure I am seeing her through a peep hole, or a crack in the fence. If her health requires alot of investigation, I feel she will be fun to work with.

The world is crying out for health care providers to be primary care doctors (where the buck stops!!) Not triage doctors which hear a complaint, and always just swish you around to various specialists. Every specialty should have super specialists and general care specialists. I feel I do a decent job as the primary care podiatrist for my patient's foot and ankle problems. By being the foot primary care specialist, the buck stops with me!! Even though I am sending Stephanie to various specialists, I gladly take full responsibility to help her decide her options, to wade through the complexities. If you have a foot injury, you should have a primary care foot specialist who takes care of you--and that can be a physical therapist, podiatrist, orthopedist, chiropractor, etc. Someone who is committed to know what every one is saying, and to see you through the injury to the end. Someone who will be priveleged to see you at a deeper level.

Putting the Pieces Together

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I had a great discussion today with a patient Valerie. She appeared from the onset to have Hallux Limitus (limited range of motion of the big toe joint) as her primary source of pain, but as we discussed her situation and the onset of pain it seemed like her symptoms correlated more with nerve irritation. The nerve that runs on the top of the instep can get irritated from shoe laces and eyelets real easily. So again her and I as a team will try to Put The Pieces of the puzzle Together. Today was her initial visit, so we had the first rock today. Not sure how high it will go. We started by icing the big toe joint 3 times daily with a 10 minute ice pack and avoiding activities that bend the toe too much (lunges with her trainer, and high heels). But we also started with lace skipping to remove pressure on the eyelets that are the most painful, tongue padding with felt to spread out the pressure over a larger area, and gentle nerve stretching with ankle range of motion movement. I told Valerie to email me in 2 weeks to see how she is doing, and we can add another rock if needed.

Shock Absorption Tools: Simple to Complex Approaches

     The above video demonstrates further the basic approach to many sports medicine injuries and pain syndromes: advancing the treatment gradually from simple to more complex treatments based on the needs of the patient. As the patient's symptoms are followed, more complex or more simple approaches may be warranted. It is up to the health care provider to understand and become familiar with treatments for the problems they work with from simple treatments to more complex treatments. You definitely must follow the basic principle of "Do No Harm", but in this high tech world, simple approaches to many problems can be the best. I find this area to be the least interesting to the new podiatry students and residents I teach. They want to learn the best treatments, equating simple with ineffective. I admit, there is no glamour in most of what I do, but the patients seem to overall get better. Perhaps I am just getting old, stuck in my old ways, but perhaps I am also wise. I know I am wise for creating an environment that lets my patients help decide their treatments in my team approach. Some of the simplest methods of treating injuries or conditions are just being invented and I love them, so I know I am adaptable at least. Medicine will be forever a humbling experience as health care providers stumble to find out what works for each individual patient. And as many of my patients already know, I can stumble my way through alot.

     The above video briefly discusses the simple to complex approach to treating shock absorption issues from stress fractures, heel bruises, knee and hip arthralgias, and low back pain. From the patient's standpoint, it is important to know if you are being treated simply or complex and what are the myriad of options available if one treatment plan does not work well enough. The title of this implies that we always go from simple to complex, but every way is possible in the art of medicine. It is okay to go from complex to simple. It is okay to go to simple to complex to slightly less complex to simple again as the experimentation continues to help patients. Test what works.

Injury Rehabilitation Priniciple: Going Alone is Never Good

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The Alone Hiker

I have spoken to 2 patients today that I sense are feeling alone and scared with their injuries. They both have significant disabilities with their injuries, and I am struggling to help them without much luck so far. They are always on my mind and I can not help but feel alone too in helping them. I am lucky to be surrounded by gifted health care providers to help me, but sometimes they say nothing can be done. But, I have been around too long to believe it. I recognize my limitations, and I see so many gifted souls out there. My soul tells me "one step at a time." One step of progress, one change in direction, one lesson learned, and we are able to take another step.

I wrote a poem once about this progress which I will retell now. It is entitled "On Death Experienced". The death is the darkness we feel in our hopelessness at the loss of who we are, the loss of our identity as athletes, or as healthy individuals. Some of you will relate.

ON DEATH EXPERIENCED

The fist is hard

As it explodes so deep

The emotions so high

Talk seems so cheap

Death of self plays a sour note

A loss so deep that everything

Is affected and actions in remote

Continue the self while the soul begins

In that very death, flowers bloom

Priorities shifted

As inward

we drift

The self being sifted

When death is experienced

The grief cycle will play

Inner strength must end it

With friends we can say

I'm ready to go on now

At least for another day

To work with you in the garden

And accept my stumbling along the way.

Rich Blake

Great Foot Story: The Practice Of Excessive Happiness

I have a great partner Dr Jane Denton whose patient this story belongs. Did you all see the movie entitled "Patch Adams", starring Robin Williams. For all those in the medical profession, it was very inspiring, and we all practiced medicine alitttle gentler and kinder after seeing it.

Here is my partner Dr Denton, watching her patients walk down the hall, analyzing how each shoe functions, although perhaps not too many clown shoes.

    One day, a patient presents with severe pain in both of her feet. When asked how the pain developed, had she done anything different in her activities, the patient responded by saying she had just come back from vacation where she had worn very large clown shoes for about a month. The clown shoes were very big, and she was able to wear her normal shoes inside them, yet her feet moved around within the clown shoes, as she toured China.

    You see, this patient had also seen Patch Adams with Robin Williams, and discovered it was based on a real life person. The real Patch Adams continued to live life differently then some of us. So she looked him up, and found out he was leading a tour of 40 clowns through China visiting hospitals and orphanages. The trip was life changing, and the 2 months of foot pain was worth it without hesitation. See the link below, perhaps your life may be changed forever. Thank you Patch Adams!!

http://www.patchadams.org/get_involved

Injury Recovery Principles: Crossing from Sickness into Health

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This scene reminds me of the journey we all take during an illness or injury to regain our health. The Crossing from Sickness to Health needs a boat load of people at times to help us. For the normal sports medicine injury that I see, there may only be a few on that boat--patient, doctor, physical therapist, family and friends, shoe store personnel, internet resources, and referring source (like Yelp, Tribe, primary care physician, etc). For more complicated cases, that boat can be pretty full. Yet, sometimes with a full boat in these severe conditions, the patient can still feel very alone since they lose sight of the primary care provider steering the ship. In the crowd of people on that boat, no one is actually calling their name when the time comes to disembark, or change course. Perhaps that person in charge of steering has never been established in the first place, and the boat may not be able to be docked on the other side at the best end point.

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I imagine sometimes that my patients feel alone in turbulent waters when they do not have good direction, or attempt to do it alone. In a world of super specialities, whom is looking out for that patient as the primary care giver. Every specialist, whether podiatrist, orthopedist, neurologist, etc, tends to look at the patient through some tunnel vision. The medical world needs to see the dilemma facing these patients when no one is truly guiding them. Patients are routinely told when they see a specialist to come back if they want surgery, come back if they want orthotics, come back if they want more physical therapy, etc, but how does the patient make these decisions. And when symptoms get worse, no wonder some patients choose some course of action, only because they do not know what else to do.

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As health care providers, we need to prevent our patients from going it alone, and feeling that way. As patients, if your injury seems difficult or challenging, and the symptoms are lingering or worsening, we need to identify one person who will oversee the problem. One person who may steer that boat to the right landing dock. Podiatrists as a group tend to be generalists, as I am, or super specialists in surgery. When you see a health care provider, find out if they are the one to manage your injury, or only deal with one part. I love to manage my patient's foot problems from start to finish, get second opinions when I am stuck, get one of our MDs to treat their other problems, get the primary care doctor involved when necessary, and work with the physical therapists helping them. I believe email is working well for complicated patients keeping the communication flowing. I am looking into a computer program that patients can keep track of their symptoms, and then email when appropriate. Through this blog I am trying to engage my patients more to understand the complexities of medicine and where it may apply to them. There are no rigid answers, but patients need to find the right person for their injury, be it MD, Podiatrist, PT, Chiropractor, or other allied health professional, to help steer the course from illness to health. Good luck! 

Injury Rehabilitation Principles: The Looking Good Syndrome

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The “Looking Good” Syndrome: Confusion created right at the start of treatment

Many patients present to my office with a difficult problem and a pattern of treatment I would consider sub par. This sub par treatment may be performed by top physicians and physical therapists, and others in the health care system, all with good intentions. I am amazed at times at the treatment given, and I must think that the health care providers must have been burnt out when treating the patient. Why were these good clinicians giving patients such inadequate treatment? It took me awhile to see a pattern in these patients. I call this syndrome of inadequate care The Looking Good Syndrome, although I still grasp for a better title.


Yesterday I saw Helen for the first time. Helen matches the profile of this syndrome well, and I even told her so. She has had a significant ankle problem for several years, and very inadequate treatment. The injury to her ankle is very disabling and she is only 21 years old!! Helen is cheerful, very positive in nature, bubbling in personality, walked into the office without limping, and good looking by any definition (when you read this Helen please don’t blush). After examining her ankle, even though it was obvious she needed x rays and a MRI, I had to force the words that she needed these tests out of my mouth. There is a psychological block (and I sure hope some psychologist reading this can explain in the comment section) to spend the money, time, effort, etc. to order these tests since the patient is “Looking Good”.

The patient is too healthy looking to have a serious injury. Does that make sense? No!! Anyone can get a serious injury. But, no health care provider actually wants anyone to have a bad injury, and the reasons at any one moment can be numerous. A bad injury denotes possible diagnostic dilemmas, possible difficulties in treatment reflecting poorly on the provider, possible requirements of effort that a burnt out doctor, therapist, etc. may not want to expend, and the list goes on. But, for the average clinician, a serious injury to an otherwise healthy looking patient is just too sad on a human level, and so easily dismissed as something that the patient will recover from with ease. Should health care providers be allowed to be human in the 21st century? I hope so.

What are the components of Looking Good which affect this syndrome? First of all, it is the physical nature of the patient. Secondly, and probably the most important, it is the positive personality of the patient. This positive personality, when the health care provider is collecting initial impressions, may steer the course of treatment away from a potentially negative diagnosis. How is a negative diagnosis avoided? The proper tests to make that diagnosis are never done. If done, the results of the tests may be minimized. If you match the positive personality of the patient (glass is half full), with an otherwise negative (glass is half empty) doctor, trouble brews in setting the course correctly in developing a great treatment plan.

What does all this really mean? Patients who feel that they may have a serious injury need to push these health care providers along gently (they are not machines). Assume that they are human and actually don’t want to learn any bad news about you. You, on the other hand, want your body to work correctly for many years to come and need their help to make things right again. How are things made right again? First step is always in ordering the right tests, and then moving the treatment through the roadblocks, over the plateaus, and up to Grandma’s House (always a great place)!

Compromises Made in Medicine

Inspiration from the Campo dei Feuri in Roma, Italy

Campo dei Fueri is a great people-watching square. When my wife and I arrived on a sunny, hot Italian Sunday, a flood of people in Italy passed us by. Sipping our drinks (see photo of my wife Patty in the middle in blue) thousands passed the tiny outdoors café. Their individual stories would have been so fun to hear. The square has many historical points, but the large central statue of Giardano Bruno (see photo), burned at the stake for his beliefs in 1600, dominated the scene. What got him into trouble you may ask? Bruno believed the world was round. He felt strongly enough that he could not keep it secret. He died for what he believed in!!

This would never happen in medicine in the 21st Century. But, you do see a subtle selling out by medicine to the dictates of insurance companies. It is usually a subtle undertone in the treatment plan when the healthcare providers chose for their patients only tests, products, etc. that are covered by the insurance. The patients are getting sometimes a small view of all their treatment options.Providers must sit back and look at their practice. Are they compromising too much?? With all of the changes in health care technologies, and the added experience of those practicing medicine, every clinician should be practicing at a higher level with better outcomes than 5 to 10 years ago. Is this so? If not, what can be done to change things about the practice? Is too little time being spent with patients?  Are all the treatment options been carefully explained to the patient, especially when there are many choices?

And what about the patient’s role? Patients are getting more and more squeezed with higher premiums. If they can choose between two treatment plans, one cheaper than the other, cheaper sounds gooood! But is it appropriate to help?

As I mentioned in my post on the K.I.S.S. principle, keeping things simple is normally a great starting point. Simple is normally less expensive since it is more patient-time involved, and less doctor/therapist-time involved. However, with office visits getting shorter, patients may not be getting a good picture of their choices. Only one treatment plan may be presented. In my business, treatment plans can often be numerous, based on many factors. Patients must speak up and ask for their options. Be more vocal. Express when money is of great, or of no concern (usually when the initial treatments are not effective, and the patient begins to feel very vulnerable). Definitely, the way medical reimbursement is going, all patients will be asked to pay for more. Doctors and patients must become well versed in the K.I.S.S principle with cost-effective treatments that have good positive outcomes. We are a wee-bit overly tech happy, which definitely costs more.


So what have I learned from Bruno. He gave me more resolve to not sacrifice any treatment for any reason. He reminded me to fight for my patients by standing up for what I believe. I won’t be burned at the stake, but I must daily feel joy in my ability to help patients the best I can. This way I will enjoy practicing medicine, and all its sacredness.