My Turn to Present

To keep retirement from becoming too unstructured, I've enrolled in the Osher Lifelong Learning Institute, acronym OLLI, where I take classes two mornings a week and learn to play Mah Jongg late Wednesday afternoons.  One class, which I also took last semester, has the title Of Minds and Men.  At one time it was for men, but not wanting to jeopardize any access to funding, it has been co-ed for a while.  The enrollment is restricted to as many people as there are weeks in a semester so that each person leads the discussion one time.  I wanted to learn about Echo Chambers, but the sign up sheet got to me last.  Procrastinators being what they are, people captured their date from latest to earliest, leaving me with date at the beginning, which means picking a topic that already has familiarity.  Last time I chose exorbitant drug pricing.  This semester it's Electronic Medical Records.

It's one of those subjects that divides emotion and intellect.  It is hard to overlook the potential of maintaining data in an organized retrievable way.  With little effort I can see lab trends over years, know exactly which xrays are on file and review the reports easily and the images with a little more effort.  Calling up the notes, I know who saw each patient when, though the reputation of the note writer often screams Ignore this One.  Handwriting problems disappear.  Spelling is left incorrect so that future readers can figure out what I typed myself and what falsehoods were generated by the computer which performed better in spelling bee than I did.  Since most people have most of the elements of their exams normal and I pretty much examine everyone the same way, I can create a generic exam, leave what's normal, change what's not, and delete those things I did not examine on that individual.  I should be a great enthusiast, but like most clinicians, I am not.

It's tedious.  And since work is generally task based, the time distribution of the individual tasks that comprises with work day has redistributed in a less satisfying way.  I generally do not like telephone sessions for going over lab work or revising medicines.  The computer requires use of a template to document the call, expanding a one minute telephone encounter to a four minute telephone encounter, most of it filling out the template.  That means call time has to be more scheduled than previously, where a 1-2 minute span on the telephone could be squeezed into an odd moment, to say nothing of expanding the time that I like doing the least.  My records are not adequately maintained, particularly among shared users.  It is common to have a medicine list with three different doses of the same medicine.  The medicine list works on the Roach Motel principal, the pills check in but they don't check out.  Huge amounts of data to tease out successful from unsuccessful processes should capture my professional imagination, but that task and the design to do it goes to somebody else.

I do not know how much credibility I will have among the class, when the other doctor will not be there.  But I will convey the good, bad and ugly in its the most objective way that a person who sees himself as victim can overcome.

Almost Like It Was

It had been my intent to sign back into Sermo the first day of Hanukkah, leaving me with an absence of a few months.  It's the longest I've been away, not even a lurker, and had no interest in being a lurker on return.  At one time Sermo absorbed a lot of my free moments, and even my productive ones.  I would engage in discussions, make fast quips, use the Endocrinology cases that people posted and commented upon to teach my residents on elective with an analysis of the various comments that individual respondents would make, some expert, some less familiar.  Like much social interaction and media, an element of echo chamber became increasingly apparent.  The best scholars both in clinical medicine and in general erudition had moved on.  In retirement I could have depleted all day there, but as my electronic colleagues became less endearing, I gave myself a limited hiatus which concluded yesterday.

My time back was intentionally brief.  Much like you cannot tell the difference in your kids from one month to the next but their aunt who has been in the hospital can, that's what I found.  Scrolling back about 5 days, the subjects and posters had changed, mostly for the better.  Libtard this and libtard  or related sloganeering that so dominated titles of recent years, did not appear in any meaningful volume.  At my exit there were a handful of folks who I thought might be trolls, probably not paid to pitch the political hardball five times a day but self-motivated to see how much of an electronic gathering they might generate.  The physicians I would walk across the electronic street to avoid had disappeared.  A few frequent flyers remained, a fellow who was still between jobs when I left, a fair number of physicians still moping about administrators and insurance companies who'd done 'em wrong, a lot of stuff that might come out verbally at a Medical Staff Christmas party.  I engaged in a few of the conversations, one by a lady who had taught herself to read.  I was taught to read in two different alphabets but would have failed if I had to do it on my own.  One conversation involved the demise of the prestige that once accompanied the MD or DO degree.  True enough, but I decided a long time ago that my self-esteem did not depend on my possessions and my diplomas are my possessions.  My knowledge and skill are shared, and seem to have been appreciated right through retirement.

There were people creating threads who I did not recall from months past.  One had the nom du plume tushi, a fellow from a developing country.  The censors are apparently more tolerant than the state motor vehicle divisions who might have censored that from their vanity plate roster.

Being there had very little emotional impact.  Not offensive.  Not an echo chamber.  Better than when I had left but without the return of the dozen sharp minds of years back whose comments I made a point to read.

An obscure but important book about recapturing a waning Jewish organizational culture in America came out about ten years ago, Getting our Groove Back by Scott Shay, a rather well-to-do NYC banker of Orthodox background.  He devoted a chapter to the attrition of Conservative Jewish affiliation, regarding the loss of the middle as one of the great American Jewish disasters, which it probably is, no matter how self-inflicted.  I think the departure of the best and the brightest who contributed their articulate analyses to clinical and non-clinical aspects of the American medical pageant approaches a disaster for the American medical community.  The forum remains but its previous glory does not with no means of recapture, other than maybe hiring their real scholars and conversation makers as the more beneficial trolls paid to post.  Every bit as self-inflicted as the leadership generated attrition of Conservative Jewish institutions but a public loss just the same.

Have I passed through the exit door for the last time?  Probably not, though even though the offensive posters seem gone, beneficially provocative replacements needed to enhance an attractive physician forum don't seem all that highly desired.