Doctors Are Detectives

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There is tremendous responsibility in being a physician, and I take it very seriously. Any time I walk into a medical facility and see patients, I know that the patients and staff are all counting on me to assess patients fully, make proper diagnoses, and provide appropriate treatments. Basically, I know that I MUST make the right decisions at all times and be at the top of my game. Talk about pressure! Nevertheless, the thrill of solving a problem is so rewarding that it quickly eradicates any feelings of anxiety.

I just read Atul Gawande’s excellent book, Being Mortal, and I love this passage in which he very aptly describes the satisfaction which can come from being a physician:

“You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. It is a deep satisfaction very much like the one that a carpenter experiences in restoring a fragile antique chest or that a science teacher experiences in bringing a fifth grader to that sudden, mind-shifting recognition of what atoms are. It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with problem you cannot solve.”

The truth is that pretty much every physician has come across a case which he or she could not solve, one which necessitated a discussion with a specialist, or a lengthy literature review to aid in diagnosing the zebra who walked into the office that day. Physicians are human, fallible, and though they usually have the answers to the puzzles which are constantly presented to them, they may find themselves stumped every now and then, and that is a dreadful feeling.

It is an honor to serve humankind as a problem-solver, and I will always strive to keep my clinical acumen as sharp as possible in order to provide the best medical care.


Last month, while working an urgent care shift, I caught a bug from one of my patients which progressed very quickly from a viral upper respiratory illness to a bacterial infection. Because I was so congested, the infection also seeded in my upper airways, and I developed bronchitis. Whenever bronchitis sets in, I am in for a world of hurt, because the coughing jags are so violent that I almost pass out from them since I can’t get a breath in.

In an effort to keep social media world happy, I posted my health status just so people would know why I sort of backed off from social interaction during that time. I felt horrible, and my voice was reduced to a strange, congested baritone mumble.

What irritated me was that several people jumped onto social media with health advice. I understand that people were concerned and trying to be helpful. However, there were two facts which kept floating through my head, and which left me scratching my head over how people thought it was appropriate to post advice.

FACT #1: I never asked for any advice from anyone. I was merely posting facts about my condition.

FACT #2: I am a board-certified family practice physician who works regularly in the urgent care setting. Don’t you think I would KNOW how to take care of myself? Why would anyone offer unsolicited health advice to a physician?

I couldn’t help but be bothered by the influx of posts suggesting things like, “drink tea with honey”, or “take zinc”. As an urgent care doctor, I am just as likely to give general, common sense advice about upper respiratory infections as I am to give prescriptions for medications and order in-office nebulizer treatments. I know all about zinc, tea with honey, vitamin C, salt water gargles, etc.

Besides, I ended up needing a course of antibiotics, two prescription inhalers, two prescription cough medications, and three over-the-counter decongestants. No amount of tea with honey, zinc, or salt gargles would have fought off the infection and reactive bronchitis I had developed. One person on Facebook hounded me via Messenger, and when I said I couldn’t chat, sent me a bizarre set of instructions for a concoction which included red wine. I became irritated and berated him for giving me health advice, whereupon he took the opportunity to insult me for no good reason. His disrespect was so blatant that I blocked him. I don’t need that kind of hostility in my life.

Sorry, but I think it is presumptuous and insulting to attempt to give health advice to doctors. In the age of Google, so many people fall under the assumption that they are suddenly experts when it comes to just about everything. Don’t trust everything you read on Google!

When I really think about it, I doubt that people would give automotive advice to an auto mechanic, or financial advice to their CPA’s. So why insult someone with 7 years of medical training and 14 years of experience as a practicing physician?

I believe I have made my point.

The Language Of Medicine


I often forget that my brain was heavily bombarded with tens of thousands of medical terms, because I have no use for about 95% of those words in my daily life. But there is a vast ocean of multisyllabic words swirling around in the depths of my memory which would make any logophile giddy with delight. Back when I was in grade school, I had already cultivated a strange fascination for long coils of letters, a fascination which became an advantage as I was able to spell difficult words with ease, and could edit my friends’ term papers fluidly.

Once I reached my college years, I immersed myself in the world of complex vocabulary by concentrating on the sciences. I thought the terminology used in chemistry, comparative anatomy, physiology, and microbiology was absolutely beautiful, and enjoyed learning it all. Even now, when I alight upon a scientific passage or book (a recent favorite was The Disappearing Spoon by Sam Kean), I almost get giddy with anticipation of what I am about to read. Though I appreciate the world of medical nomenclature and can pronounce the tongue-twisting jumbles of letters, I no longer have the same passion for them I once had.

I know that one of the reasons why I no longer adore words like cholelithiasis (gallstones) is because of my deep immersion in medical language for so long. I became tired of having to memorize massive amounts of information, and I realize there are esoteric medical terms taking up valuable real estate in my brain, terms which I will likely never use because they delve into subspecialties like hematologic oncology or cardiothoracic surgery, neither of which I discuss at length. I still remember most of the mnemonics which are a necessary part of the memorization process and am thankful for their existence. But there are only a few which stuck, the ones which have utility in my current practice of medicine, such as OOOTTAFAGVAH, SEXLAB, and “Some Lovers Try Positions That They Can’t Handle” (I will leave these undefined for those of you who like puzzles).

In some ways I guess I could say that I am bilingual, since medical speak is a completely different entity from regular, everyday speech. When my medical hat is on, I shift in to medical language effortlessly, and occasionally find it challenging to replace descriptive medical vocabulary with layperson terms. Usually the blank stare from a patient or friend is enough to jar me from my speech patterns and find more general words to describe a physiological process, a disease, or a treatment course. I suppose the science nerd in me will remain very much intact as a result of the vocabulary floating around in my noggin!

Let The Doctor Rest


One of the biggest grievances I have as a physician is the fact that people assume that I am on call all the time for every random medical question. People will ask me questions at the gym, the grocery store, and via email. Many people have even contacted me on Facebook with detailed medical questions which they expect me to answer, and some will even cop an attitude when I very nicely tell them that I cannot address their question via Facebook message. No other profession deals with the same amount of queries. Would you ask your tax person a detailed question via Facebook?

I have even gotten texts in the middle of the night (thank goodness I turn my ringer off while I sleep) with medical questions. Sometimes the questions don’t even pertain to the person asking, but to a friend or relative. That is when I get annoyed, because it isn’t my responsibility to dole out free medical advice to everyone.

I realize that by putting my foot down and setting boundaries, I will cause some individuals to seek diagnoses on their own, which is also quite frustrating. They will go online and attempt to find a diagnosis, despite the fact that they have no medical expertise whatsoever. These are the people who infuriate doctors, because they will march into doctors’ offices and behave as if they have all the answers. This type of attitude is not only frustrating to medical professionals, it can be downright dangerous when the wrong diagnosis is made.

Please understand that I will not diagnose your niece’s boyfriend’s strange skin condition, even if you send me five images of the condition, taken at different angles and at different stages of the flareup. Such requests take unfair advantage of all of my schooling and post-doctoral training, which I have every right to charge for. As a matter of fact, it would be irresponsible of me to respond to such requests.

If the medical malady is of an urgent or emergent nature, then I suggest that you avail yourself of the appropriate service. Urgent care centers and emergency rooms exist for a reason. I am not a stand-alone urgent care center, nor am I a doctor on call 24/7. Please respect my time off.

For those of you who are physicians or surgeons, I welcome responses to this post.

Minimalist Footwear

minimalist footwear

Please check out my latest article for American Fitness Educators which discusses minimalist footwear! Original post can be found at:

Less Is More

Are there benefits to training in minimalist footwear? Studies have demonstrated that training while wearing minimalist shoes results in enhanced performance due to greater foot pliability and a closer approximation to a barefoot stance. Since our feet adjust to wearing raised heels over time, it can be incredibly challenging to keep our heels on the ground while performing exercises like deep squats. Proponents of minimalist footwear may even argue that barefoot is best for heavy weightlifting, but the risks of exposure to microbes or hazardous fragments of glass, metal, or rocks, make minimalist shoes a much more feasible choice while at the gym.

Dysfunctional movement patterns become established throughout the body over time. Conventional athletic shoes can often contribute to ankle and foot dysfunction because they inhibit natural foot action. If you don’t believe it, then try to perform some of your physical activities barefoot and see how well, or poorly, you perform. Chances are that the impaired mechanics in the feet and ankles will make it difficult at best to perform those activities. By gradually switching over to minimalist footwear, an athlete can essentially correct improper foot mechanics and optimize kinetic feedback throughout the body during movement.

Benefits Of Minimalist Shoes

Conventional athletic footwear features a cushioned heel which also can compromise power. In contrast, minimalist footwear features little to no heel, and the soles are very thin and malleable, so they allow the joints in the foot to move and adjust to weight loading movements. In addition, the heels and midfoot make solid contact with the floor, causing more activation in the glutes and hamstrings. Studies have demonstrated that people who wear minimalist footwear develop greater strength in their legs and feet, since more power is transferred from the working muscles, through the feet, and into the movement. Plyometric movements and sprint power will also be enhanced while wearing minimalist shoes.

A 2011 study by Squadrone and Gallozzi assessed the ability of experienced runners to estimate the degree of inversion, eversion, dorsiflexion, and plantarflexion, of a slope surface board placed under their right foot while standing. They found that the degree of proprioceptive feedback which subjects received while wearing Vibram Five Fingers® was much more accurate than in subjects who wore a standard running shoe. In conclusion, cushioned shoes conferred a distinct disadvantage when compared to minimalist shoes during assessment of foot position awareness.

How To Transition Into Minimalist Shoes

Anyone who is transitioning from conventional athletic shoes to minimalist footwear needs to do so gradually, since the body has to adjust to radically different proprioceptive input. There have been cases of metatarsal stress which developed after converting too quickly to minimalist shoes. However, once the transition is made, noticeable strength gains should occur. Try spending about 15 to 30 minutes, twice a day, wearing minimalist shoes around the house. After about a week or two, you can try them out at the gym one to two days a week until you become accustomed to the feel of the shoes. Be aware that your gait and foot stance will probably change as you acclimate to this type of shoe.


Squadrone R, Gallozzi C (2011) Effect of a five-toed minimal protection shoe on static and dynamic ankle position sense. J Sports Med Phys Fitness Sep;51(3): 401-8.

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“Are You Sure You Broke It?”

It’s amazing how much an injury to a small area can hurt like the dickens! I recently fractured my right great toe by dropping a 25 pound weight plate on it (oh, the hazards of being a gym rat…) and have been dealing with a tremendous amount of pain from the injury. I had done the exact same thing (albeit with a 10 pound weight plate) on the left great toe back in 2002 and experienced pain in my toe for a full year, so I am dreading having to endure the healing process again. Driving has become a major hassle, because pressing on the gas and brake pedals loads a pressure on the extremity which radiates to my poor broken digit. I am now limited to wearing flip flops and a couple of pairs of athletic shoes with larger toe boxes which accommodate the swelling somewhat. I say somewhat because the athletic shoes I have worn have created nasty blisters on the top of my toe, creating a completely different type of pain which is stacked upon the deep bone pain. Oh what fun.

When I shared the news that I had broken my toe, a couple of people had asked me if I knew it was broken, and one person kept yammering on about what to do to treat the fracture. I am a medical doctor who has seen more than my share of fractures, and I KNOW what a fracture looks like. What I don’t understand is how people can ask me if I know for sure, or how they can tell me I need to see a doctor for it. Rest assured, I am in excellent hands with my doctor: ME.

Here is a collage of images taken of my toe from 30 minutes post-injury to 36 hours post-injury. No X-ray will aid in the diagnosis, nor will it change the treatment course. Yes, it IS broken. This injury will definitely set me back with training and competing because I will not be able to perform plyometric exercises, treadmill work, calf work or lunges for a while. However, I will not be deterred from continuing to train around my injury, and will take this opportunity to develop a heightened awareness of pushing through the heel while performing exercises which target the glutes. Who knows, maybe this injury will be a blessing in disguise, a tool to help me round out a problem area?