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About Me
The factors involved in my choice of medicine as a career were numerous. However, the central factor was the service ethic instilled in me by my family, my teachers, my Sunday School teachers, and the minister at my church during my adolescence. I received a very clear and consistent message from all of them: whatever ability an individual may possess should be used for the benefit of others as well as for oneself. There has also been a strong tradition of craftsmanship in my family, both men and women. Medicine offered me a means of both satisfying the service ethic and maintaining the tradition of craftsmanship. In retrospect, I don’t believe I was as aware, at the time, of the desire to have a craft as I was of the desire to live up to the expectations of those who raised me, but it has led to some of my most enjoyable and memorable experiences as a physician.
When I was a child, assembling plastic models of ships, airplanes, and rockets, I had no idea that I was developing fine motor skills that would eventually serve me well while suturing, with split-millimeter precision, a laceration on the face of a screaming child. Some of my most contented and satisfying moments in medicine have been spent, often in the wee hours of the morning, reversing the damage caused by a moment of carelessness. Although I repair far fewer lacerations now than in my years in the Emergency Department, I still derive a great deal of satisfaction from putting together something which has been broken, and feel the most peaceful, focused moments of my day occur at such moments.
Sir Arthur Conan Doyle, the creator of Sherlock Holmes, was himself a physician, and much of medicine involves assembling and analyzing evidence (symptoms, physical findings, lab and imaging results) in order to solve a mystery (arrive at a diagnosis). That is probably the most intellectually satisfying aspect of medicine. However, what is most gratifying to me as a physician are those occasions when I am able to meet my patients’ emotional needs. I remember, with fondness, a patient who came to see me about five years ago in tears because of her fears about carpal tunnel surgery (she had just had positive nerve conduction studies). I began by showing her my own carpal tunnel release scars, told her about my own clinical course (which, of course, reflected many of her own symptoms), and then proceeded to regale her with a series of amusing anecdotes relating to carpal tunnel syndrome (there’s humor in most human situations, if you have the inclination to look for it). She left literally holding her sides, aching from laughing so hard, apprehensive, but no longer terrified. That was one of my greatest therapeutic triumphs.
I came to Kaiser Permanente rather late in my career, in my early fifties. I spent the first decade of my career, after completing an internal medicine residency and working for a year for the U.S. Coast Guard, working as an Emergency Room physician. I then operated my own industrial clinic for eight years, sold it, and worked four years for the organization that purchased it before joining Kaiser Permanente. I came to Antioch as the Lead Physician in Occupational Medicine and was later made Associate Chief for Antioch and Martinez. It is a challenging and stimulating job.
What I like best about being a Kaiser Permanente physician is the opportunity to integrate treatment of work-related injuries with the remainder of an individual’s health care. In my prior work situations as an occupational physician, it was nearly impossible to achieve the type of coordination of care that I can now accomplish by simply picking up the telephone or sending an e-mail. Many work-related injuries, especially those that are more complex and prolonged, occur in the context of other health problems, and Kaiser Permanente is uniquely suited to addressing such contributing and complicating factors. While some of our patients may feel annoyed that we are making such a concerted effort at smoking cessation, even when treating them for work-related injuries, most of them realize that this is a reflection of our commitment to them. As an organization, we want them to be our members for life and for those lives to be long and healthy.
While I regard my practice style as fundamentally conservative, in certain respects I have become therapeutically more aggressive over the past decade or so, as a consequence of my commitment to evidence-based medicine. Clinical studies, as well as my own experience and that of my colleagues, have suggested that with certain problems (such as shoulder impingement, tennis elbow, and carpal tunnel syndrome, to name several) corticosteroid injections are more likely to be beneficial earlier on in the clinical course, rather than saving them as a last resort. I am certain that this change has resulted in fewer patients requiring surgery. Another area where my style of practice has changed is that I am using certain types of medicines frequently used for chronic pain control earlier on in the clinical course, before the pain has become chronic. I am convinced that this helps to prevent the development of chronic pain in a number of clinical situations.
Besides membership in the Alameda-Contra Costa County Medical Association and the California Medical Association, I am a member of the American College of Occupational and Environmental Medicine. One of the clinical areas where I spent considerable time when I had my own clinic was that of medical surveillance of individuals exposed to toxic substances. (The Cal-OSHA inspectors in the North Bay came to my clinic for their annual physicals.) My practice now is predominately treatment of musculo-skeletal injuries, but I hope to eventually engage in more medical surveillance and clinical toxicology. The Occupational Medicine Board is a division of the American Board of Preventive Medicine, and I would really like to expand my role as a preventive medicine physician. With the patient population I currently serve, musculo-skeletal injuries predominate, and prevention is largely a function of ergonomics. I try to incorporate preventive ergonomics into my practice whenever possible, but this remains one of my challenges.
While I have always enjoyed classical music, over time I have developed more of an interest in opera. I have been fortunate enough to have heard some of the world’s greatest opera singers perform in San Francisco and at Zellerbach Hall in Berkeley, and look forward to more concerts and operas in the future. Opera is primarily about emotion, and only secondarily about music; I believe this is why it appeals more to me now that I have grown older and developed more mature tastes. On the other hand, jazz, R&B, rock, bluegrass, and country have lost none of their appeal.
Besides music, I enjoy swimming for endurance, hiking, photography, and traveling. However, with three children planning on completing PhDs over the few years, travel has been (and is likely to remain) rather less extensive than I would like. Still, if there are sights more memorable than watching one’s child cross a commencement stage, I cannot imagine where or what they might be.
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