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I know a fellow nicknamed Jocko*; he has a habit to exclaim out loud the word ‘good !’ after everything that happens to him. He will do this even in the face of bad news or a bungle. By immediate focusing on ‘good’ he reports he can find something good, some lesson, some asset in the worst of situations. He doesn’t deny the bad – often that’s pretty obvious – this ritual helps him find something positive so that the event is not 100% misery. The plane is delayed? Good. He has time to read. The plan didn’t work? Good. Jocko and his team can learn something from it.

I’ve been trying to practice this to see if it is any good. Yesterday the Elantra was discovered to be dripping oil onto the garage floor; this may be why the oil light has been on for some time. The usual shop tells us there are no appointments available until the end of July. I had Monday off; I had a lot of fun activities planned which all included driving. At first reaction there was nothing at all ‘good’ about this, not by a long shot. I imagined Mr. Jocko would have to work very very hard to extract good from this disaster.

“Good” I exclaimed. I had to open up the hood and remember how to check the oil. I hadn’t been in there ever; it was quite dirty. I gave it a clean-up and I felt good to do so. When the mechanic lifts the bonnet he may be impressed. I checked the oil (low) and filled it with some oil we had on hand (good), and felt good for my industry. “Good” I exclaimed: this happened on my day off. Imagine if I had driven to work, leaking oil, only to have the car break down, unable to drive home. As for the day-off plans? “Good” I had an opportunity to stay home and go through all my ‘watch later’ YouTube cooking lectures, which I did. ‘Good’ we are obliged to go to another service shoppe; perhaps it will be a better experience than our usual one. ‘Good’ I got to call into work to explain I have no wheels and thus can’t get to MESA (a 45-minute drive) so I can stay put and work from home ala 2020.

I see how this approach makes one focus on the advantages and the problem solving benefits. I teach something like this to my patients, the ones who have a habit to immediate go to negative/the worse-case scenario in everything they think and do. “Oh, yeah?” they say, ‘how about …’ bringing up scenarios to defeat the approach.

I too find the ‘good’ approach challenging in the midst of politics, violence, war, and all the other matters afoot these days. I remind myself the practice isn’t to negate the gravity of things, merely not to fixate on them. Certainly we tend to turn into the things we practice. I could use less OMG this is a disaster/gloom complaining in my character.

Someone is organizing a AAA tow truck to haul the drippy thing to the dealership for its appointment on Thursday. Good. I don’t have to worry about this. I can do my day’s work and focus on my job. I will be home today when The Pool Man arrives. Good. I can ask him about the pool light device; can he fix it? I would like not to swim in the dark no more.

Good.

Let us hope so, anyway.

*He is well over four feet.

Having been at my job for thirty years (!) I’ve seen lots come and go in matters of hypothesis, diagnosis, treatments, and such. They have their time and then discarded. This isn’t a bad thing. Science and Medicine are constantly evolving, especially in my speciality.* Thanks to the internet, pop diagnosis and treatments come at fast pace compared to the 90s. I get more and more folks coming in not asking ‘what do I have’ and ‘what can I do about it’, but ‘this is what I have and this is what I need”. It makes me feel like a glorified waiter. ** A lot of my job is education, trying to convey what they do have/don’t have and what’s to be done about it. Here are few ‘diagnosis” coming in on a regular basis I thought I would write about.

“I have PTSD [post-traumatic stress disorder].” This has become a collect-all condition for anyone who has had a traumatic event. The bar seems to have lowered by society what constitutes PTSD and what causes it. I try in a nice way to educate patients having a bad break up or the loss of a loved one or a business going belly up is sad and traumatic but not necessarily ‘PTSD’. Other matters to be mindful of is the notion all trauma leads to PTSD and all cases of PTSD are permanent. Neither are true. Soon after a really bad event, I assure folks their ASD (acute stress disorder) this doesn’t mean they will have PTSD in time. When appropriate, I describe a concept nicknamed PTGO: “Post trauma growth opportunity”: you were given a nasty knock no one would wish on anybody, but choice-less you have the choice to learn something from it and grow. In the end there is some truth to the notion ‘what doesn’t kill us makes us stronger” – modified as ‘can make us stronger”.

“I have imposter syndrome.” This is an example of a lay-diagnosis I have to figure out what does the patient mean when they say they have it. They usually explain they feel a complete fraud at what they are doing and if people really knew the truth (as the see it) they would be out on their butts for the shams they know they are. There are a few dangers to this one. First, I don’t like people summing up their being by a disorder. I learned this early with AIDS. People went from ‘AIDS patient” to ‘living with AIDS” and this makes a big difference. I hear similar when a patient says ‘I am bipolar” or “I am borderline”. I try to get them to start saying ‘I am someone with bipolar type depression”. With imposter syndrome, I get them to say “At times I feel an imposter in what I am doing.’ I educate everyone feels this way to some degree (discounting narcissists and psychopaths); this is a human emotion. Emotions are not who you are, but something you experience. There is a sort of poor logic to the imposter syndrome. You doubt your abilities but you are certain your view on it is certain? I point out despite what you feel, you are surrounded by others who don’t see you as an imposter – so are they all duped dummies? Better to say I don’t feel certain what to do and that’s OK and not a summary of who I am/capable of and proceed to solve the situation showing the world and yourself what you feel isn’t what you fear you are.

“I have ADHD (attention deficit hyperactivity disorder).” Oh the pain. Many people coming in with this self-diagnosis do have some ‘wiring’ but this is never a black/white yes/no scenario. More important to ask is the question: do your ADD traits actually interfere with love/life/work? If so, then it is a disorder. This can vary in time and context. People erroneously believe if it is a neurological matter, medications are necessary. Not so. Some form of counseling A.K.A. “ADD coaching’ can do a lot as can changing the context. There is nothing wrong about a square peg until you try putting it into a round hole. Maybe the solution is the alter the hole.

“I’m an introvert.” Folks come in all the time announcing this like a horoscope or this somehow makes what the can/cannot do***. Look, no one is ‘introvert’ or ‘extrovert’. We are a mixture of both types of relationship traits, and this changes over time and to the circumstances. What I find important to ask is ‘where do you go to recharge yourself?” if the answer is ‘stay home and read a book” than do so; if you say I go out with others to a social gathering” than do so. Stop putting yourself in a box with presumed expectations how you should be.

*My best friend from medical school is an obstetrician. Birthing babies hasn’t changed with time; it is pretty much the same as thirty years ago, which she likes. We both like to say to each other I cannot imagine how you do your job.

**I have a mug with the inscription “Do not mistake your Google search for my medical expertise”

***Few if any come in announcing they are an extrovert. Thems who have predominantly introvert-like tendencies sometimes feel this is wrong, while them with extrovert seldom if ever they wish they were introspective.

Until you make the unconscious conscious it will direct your life, and you will call it fate. Carl Jung.

A common ‘chief complaint’ from my patients is the emotion of feeling stuck. They describe themselves as ‘lacking motivation’ or suffering from procrastination. The patient always knows what they need to do, but they can’t get themselves to do it. They often hope I have medications for this sort of thing, something to give them motivation. Sometimes this is true when the symptom of being stuck/unmotivated is part of a depression or an anxiety disorder. Get that better and the lack of motivation improves. However most cases of being unmotivated aren’t from depression/anxiety per se, and the solution is not pills – much to the chagrin of thems hoping for such.

I was trained in a classical style of psychology that believes a) the unconscious exists and b) it influences are actions and inactions.

Exploring the ‘whys’ by looking for childhood issues ‘haunting’ the present situation doesn’t especially help solve the problem of being stuck. Insight solves ignorance, but it doesn’t solve inaction. Rather, it is useful to explore the unconscious current reasons why one feels stuck.

Let me pause to say I don’t use the word ‘procrastination’ very much, although my patients use the word. Procrastination is a ubiquitous human trait we all do to some extent, so it isn’t necessarily a ‘symptom’, and the word has some pejorative associations. Certainly my patients feel that way towards procrastination. They often see it as a character flaw, or a sign of ‘laziness”. With the confession of procrastination is self-flagellation for having it. So I try not to waste time with this nondescript non-helpful word.

We avoid doing something if doing it causes discomfort or pain. We are wired for safety to avoid anxiety-provoking situations. This is true for psychological pain (like doing the overdue taxes) or physical pain (like exercise or cleaning the attic).

Here are some tips for becoming ‘unstuck’.

First, we start with the assumption being stuck makes sense. It is not because the person is lazy or incapable of doing otherwise. This is fixable.

Second, what is the benefit of this behavior? What are you getting out of this? Patience sometimes balk at this notion. They bristle at the suggestion they are ‘doing this on purpose’. They say they don’t like being stuck. Indeed so, but if that was all of it, they would quickly do something about it. This gets back to the Jung quote at the top of the entry. We explore these unconscious benefits, prior to actually making a move – but not for too long. One shouldn’t endlessly turn over stones looking for unconscious contributions as this becomes a sort of stuck in itself.

Third, start moving. There needs to be action. What are you willing to do today? I ask them. Stop looking at the big picture, those lofty goals of ‘clean out the room’ or ‘do the taxes”. Start with what’s easy. I like the everyday at the same time approach, to do something/anything for five minutes. Example: every day at 10AM – regardless of motivation – you pull out something for the closet. Do something about the taxes, such as organizing the piles of papers. Get someone to account to/give your praise for your industry.

Through repetition, things get easier to d, and pain dissipates and lo! the project is done – and motivation becomes the reward – not the instigator of the action.

  • Recently at work I got an email with a form asking me to provide information for the website. I wasn’t aware we had a website – no, that’s not true, I knew we had one but no one uses it. I haven’t seen it in years and I don’t think anyone has bothered to manage. Apparently this is being addressed – good for them! – so fill out the form I shall. However the malapert inside me wants to write the following:

  • Name – Heavens to Betsy don’t you know this by now? I’ve been working here since 2005. Also, this is going into my bio, so the reader can just look at the title. But, if you insist: I go by several titles some of them quite lofty and others less tactful. My favorite is ‘Spo’. Call me what you will, just so long as you don’t call me late for dinner.
  • How long in this profession? I have been a Spo since the get-go, nearly sixty years now. It is a noble profession, something I was born to do.
  • How long [where you work]? Since 2005. Patience above this is over 15 years! Time to move on?

  • Where did you go to school? Starting with nursery school, I’ve been through ten schools: eight official one and two unofficial: school of scandal and school of hard knocks. I did best in elementary school and have gone downhill since.
  • What are your areas of specialized interest, experiences, and/or training? I enjoy shouting and I enjoy rolling down grass hills. I’ve had lots of experiences in both although no official training in either. I’ve learned through trial and error- lots of error. I suppose what you are asking here is what sort of head-shrinking I do. I was trained as a Jungian which means I delight in Dungeons and Dragons types played in the psyches of man. This gives me a rich fantasy life and is far more fun than dreary old Freudian and Object-relations schools where everything gets down to suppressed sex and violence.

  • What led you to those interest areas? In Jungian psychology I get to wear funny costumes and don ersatz Viking helmets. You don’t get that sort of stuff doing cognitive behavior therapy no siree.

  • What do you love about [where you work]/what keeps you here? A paycheck/health coverage. And the food is good. My office has a nice view.

  • What are you most proud of in your career? Despite everything I am still at the same job thirty years later. How many can say that? However with the buyout from The Overlords I wonder what happens next. There is a part of me that wants to get the boot just so I can experience it.

  • What are you doing when you’re not working? I lead a dull life. Most of all laundry. I’ve learned the ‘quick’ option on the Maytag seems to work just as well as the ‘full load’ option, so I always use the former.

  • Tell us something about you we probably don’t know. Here you go –
  • I have kissed a skunk
  • I have never watched ‘The Kardashians’ (and I don’t intend to)
  • The sound of Styrofoam rubbing together makes me itch
  • I like very much concrete positive feedback I am liked/I am OK/I am doing a good job – yet I seldom every receive any. I’ve learned to live without.

I have regrets. Lots of them. With all due respects to Edith Piaf, people who have no regrets are brain dead, under the age of six , or are sociopaths. Ms. P’s iconic song may be less about no regrets and more about not feeling bad about having made mistakes, but more on this anon. People make all sorts of mistakes and bungles; I hear about them (and make them) all day long. I recently listened to a lecturer who did some research on regret. He discovered all regrets fall into basic categories; they confirm what I see at work and in my own life. I thought to share them with you, in case you have regret.

1: The ‘should have’ types of regret. Realized later in life, these are the things we wish we had done: I wished I had taken that job, moved to Washington, said ‘yes’ to this and that proposal. I wish I had spent more time with family and less working. I wish I hadn’t worried about this, that, and the other, These regret types are legion and many get colored with age/wisdom. I am wary of these sorts as they often keep one’s mind (and energies) in the past and not in the present.

2: The regrets of morality. These are the things we should have done or wish we hadn’t done. Folks well into their dotage can still ruminate on some nasty they did in their youth, like bullying or lying. One of my more poignant regrets is I did not say or do anything when my grade school class ganged up on a small quiet girl who took the abuse in silent tears. I hope she grew and did not let this terrible trauma taint her life. Forgiveness is important here, although one of the hardest things to do.

3: The loss of contact. “Joe” and you used to be close, and then in time you lost track of Joe. Joe is on/off in your mind all the while with some vague sense of someday reaching out. But then you don’t; you sense it would be awkward, and Joe may be uncomfortable or even reject the reunion. So your anxious what-ifs prevent you reaching out. This usually ends when you hear Joe recently died or some time ago – just as you were thinking to finally reach out. I thought for years to find my high school friend and prom-date Donna only to find out on FB she died in January. The obituary seemed to imply she had divorced the scumbag she married in our 20s, and apparently died not in a relationship.

When I work with patients (or myself) haunted by regret, I try to get them to find some way to forgive themselves and move on, and take with them what lessons can be learned. Also, and this is important: is there anything thing that can be done to heal the wounds?

By translating the lessons of regret into their opposites, ‘anti-regrets” shall we all them, they give guidance to a good life:

When in doubt, give something a try. My usual rule “When in doubt, don’t” is a terrible safe one that often leads to regrets. Be bold in life, speak up, try that course, take that trip.

Do the right thing, even when it hurts. There will be real damages for doing such but there will be no lifelong regrets for not being bold.

My favorite anti-regret lesson is reach out. Overcome that fear of awkwardness and rejection and contact the Joes in your life, past and present ones, and be with them. Studies show the Joes in your life hardly ever feel awkward or uncomfortable for you reaching out. Quite the contrary, they are delighted you did so. Do this before they die.

This way Ms. Sparrow’s song becomes a positive and fulfilling truism.

Note: The Board of Directors Here at Spo-reflections were puzzled by this one, and almost didn’t let it through. I don’t blame them, I am not sure what I am saying here either. I thought writing my thoughts out would solidify things but it didn’t work. Spo

Earlier this week at work I met the newly hired RN (nurse practitioner). I am told via office-gossip there is another one making his debut next month. Last autumn there were vague ‘someday’ speeches from The Bosses one or more would arrive some day, and here they are. I don’t know yet what capacity they will be working. These things are not told to me. Over the 17 years at this job I have seen several nurse practitioners come and go and they never stay long; let’s see how long these two last.

I have mixed feelings about nurse practitioners. On the positive, having anyone with a working pager and access to a prescription pad allows me to go away to conferences or on holiday, covered person. Imagine a vacation without having daily to call into work! With a MD and a RN on-board, the patients have a choice of two types of providers. The nurses, usually female, are often preferred by female patients, especially ones with trauma or PTSD issues.* In my experience, nurses are better than doctors, and females are better than males, at providing support and nurturance in counsel, which are so important when dealing with folks with mental illness.

On the negative, the nurses (so far) have come with the attitude ‘I am just as good at this job, buddy”. In my experience this is not so. They boasted their abilities, but quickly bailed when encountering difficult cases. “Oh, I’m just the nurse” they tell these patients, and send them to me. If you are going to claim you are just as good as a doctor, don’t pull this ‘I’m only a nurse” on your patients. On the whole I do a good job, thank you very much, so I often look brilliant in comparison.


Another issue: they don’t stick around, they retire or find other jobs. When they go, which is often sudden, they leave patients in a lurch and I get them – many are not happy about the sudden departure of their provider, and several very unhappy and uncomfortable about seeing the big bad male doctor, member of the patriarchy, and all he represents.**

The pay for two nurses is probably less than the salary of one psychiatrist and the clinic gets more work out of them. If I were a paranoid, I would worry my post is now jeopardy and I will be sacked by The Overlords, as less lucrative.

I wish I was working with another physician. This is said out of professional loneliness. For awhile there was ‘The Other Doctor’ but he went away to do a small pay-out-of-pocket set up***. We didn’t have much in common and we didn’t interact much but it was nice to have a colleague next door to bounce ideas off of him and consult on psychiatry stuff. Finding a proper psychiatrist to work here is near impossible. I sense the clinic is hiring nurses as doctors are not to be found for love or money. The few shrinks looking for work are heavily sought after and they can choose from far more lucrative offers than our humble abode.

I learned the nurse I met will work with children and adolescents , which is more rare than unemployed psychiatrists, so she fills a much-needed demand. I hope she stays. The fellow showing up in February is a wait and see sort whether he will be full time or a part time person is he an RN, a MD, or some other alphabet combination, and is he well over four feet.

Do you see a RN or a MD for your health care? Are you satisfied?

In your experience, are RN practitioners as good/better/worse than the doctor?

*There is a paradox to this. In general, female patients do better with female practitioners, but you don’t say to a female patient “because you are female, you are being assigned to the female nurse, and not the doctor.” Not nice.

**On the other hand, some patients are glad to have a ‘proper doctor’ now, having seen the nurse when I wasn’t available.

***It turns out a lot of shrinks in PHX work only for cash. How they manage to pull this off I don’t know.

Mondays are actually my slower days at work, compared to the other ones. There is the usual Monday morning Rx renewals that come in all at once from pharmacies, sent over the weekend, and there are a few frantic calls, but these are predictable and soon addressed. This Monday will be more ‘exciting’ that I will be calling to renew my own prescriptions to test if my medical coverage is indeed up and running. Over the weekend a basic prescription was filled at Uncle Albertsons without fuss, so there is hope. Still, I’m not counting my chickens.

On the this week’s agenda items not typical is meeting with a nurse that got hired, which is news to me. There’s been rumors of such for some time, but no official word was given until I saw her on my schedule I am supposed to train her on using the EHR and I have an hour to do so. Fat chance of that. By the way, the last time I heard of it, The Overlords were hiring a nurse of the male-type, but the one on the schedule sounds definitely female. I wonder what happened to him.

Another Monday matter: possibly paying for a medical convention that is scheduled for June; the early bird deadline is this Wednesday. If I go, it will be the first in-person medical conference since 2019. I miss these shindings, not only for the chance to get out of Dodge but to pow-wow with my fellow wizards and earn credits in a lecture hall rather than via recorded lectures heard sitting at home. Do I dare take the chance by June it will be safe enough to travel? My license expires this July and (in theory) the State of Arizona could ask for proof of Continuing Medical Eduction credits, not just asking for every three year pound of flesh costing me 800 dollars.* Stirges.

I’ve decided this week to throw out all my journals that sit on the shelves in my office. Not once in my decades of shrinking heads have I ever pulled one down to consult them. All the latest news and updates are on line and on apps, so the paper journals mostly for something to put on the shelves so I look smart. Admittedly without the the shelves will look a little bleak, and I don’t know what else to put there. I suppose some tasteful objects d’art or clever knickknacks might be jolly, although come to think of it, the zoom appointments (still the majority of my cases) see only Urs Truly sitting in his chair. I suppose if I stare at the empty spaces long enough something will come to mind.

Otherwise it looks like another typical work week. I hope it is peaceful enough to allow some quiet time for The Muses or someone like them to enter in with more clever notions for writing than this one.

*In theory they ask for CME every time I renew my license but they never do. I need forty done by July; as of this week I have thirty. If I go to that conference I could earn 15 credits but what if the conference falls through?

There are a lot of forms flitting about the office this month. The clinic where I work requires everyone to fill out updates on their information and insurance. Many remonstrate their information is ‘the same’ but the place is firm they need to do this. As a consequence, between now and approximately the end of March, when I go to fetch somebody from the waiting room, they are hunched over a clipboard, usually in a cross mood. They often assume it is I who is making them do this.

There is a new version of the checkout slip. When I finish with a patient I give them this slip to bring to the check-out gal. It’s amazing how often between leaving my office and going to the check-out window instructions are forgotten.* The slip, which is white, states what we did and the charges for such and when I want them back and whether this person needs an appointment with a counselor or the house manager or the billing lady. There is also the ‘blue’ slip for telephone calls as these too are billable (sometimes). The white and the blue have merged into one (no new color, alas) with add-ons of all sorts of possible charges. The goal: bill for services being done already but haven’t been charged for, as the clinic has been unawares it was possible to do so. **
This new form sure doesn’t lack variety; it has lots of things I thought were just part of being a good doctor, like reviewing records or doing leave of absence papers. Some other examples: providing education on smoking, diet, and weight – who knew one could bill for each of these separately? The form reminds me of the Innkeeper’s song ‘Master of the house’, from Les Misérables:

Residents are more than welcome
Bridal suite is occupied
Reasonable charges
Plus some little extras on the side!
Charge’em for the lice, extra for the mice
Two percent for looking in the mirror twice
Here a little slice, there a little cut
Three percent for sleeping with the window shut
When it comes to fixing prices
There are a lot of tricks he knows
How it all increases, all them bits and pieces
Jesus! It’s amazing how it grows!

The other new form is a rating scale. For years, the academic-types at the psych-conventions have encouraged us lesser shrinks to use rating scales. These are simple checklists the patients do while waiting in the waiting room prior to their appointment. This is the psychiatric equivalent of having your vitals done before seeing your primary care physician. In theory this is a more objective way of measuring progress (or lack of progress) in treatment. There are heaps of these things. As a first step we are using the PHQ-9 which is used to evaluate depression. Rating scales are not only ‘standard of care’ but another billable endeavor. Hot puppies.

It’s been a challenge for Urs Truly trying to remember to circle all services on the checkout slip, and making sure the patients are given a PHQ-9 prior to coming in. Ideally, the latter leads to better patient care, and the former leads to more money. Keep in mind, I am on salary, regardless. In a sort of weird “trickle-down theory” the more bucks raked in should lead to a pay raise for me. ***

I suppose it’ll take some time for the receptionists, the patients, and I to get into the hang of distributing and utilizing rating scales; I am curious to see if all the nickel and dime charging shenanigans ‘add up’ to anything. No harm trying anyway. As a salaried employee I do what the The Boss asks.

*The more pessimistic types at work wonder if patients purposely change the instructions given to them to suit their purposes. “Oh, the doctor wants me back in 4 months” when I asked them to return in one.

**I suspect this is the result of a consultation with The Overlords who are more savvy at billing codes.

***Fat chance of that.

The first fortnight of the new year at the office is always the same. Patients have their deductibles recommence. This leads to a lot of phone calls, requests to change meds to something cheaper, or hopes of finding ways to make prescriptions less expensive, like a higher-dose pill to cut in half. Many resolve this matter by skimping on doses – or stopping meds all together.* Patients will also find weasel-ways to get prescription renewals without having to have a check-up. “Oh, I’m fine, the same really” they say, “can’t I come in in six months – after my deductible is met?” I take it these sort of shenanigans are a USA matter only; Spo-fans outside of The States can tell me if insurance deductibles (and their consequences) apply to their countries.

January was the month I was told a prescribing nurse was to start, but I see no evidence of his arrival. The clerical staff, who usually know these things before I do, inform me a few folks (MDs and RNs) are provisionally hired but there’s no word when they start. If rumors are right, there are three or four new folks are coming onboard, which makes me wonder if this is the year I get sacked. Perhaps a few RNs would cost less than Urs Truly. Before the place was sold, I wouldn’t think such morbid thoughts, but now The Overlords are in charge, it’s possible. However, let’s not count our chickens. I’ve lost count of how many potential coworkers I have heard were coming only to have them never arrive.

This year is the year I buckle down and do rating scales. These are quick fill-in-the-blanks questionaries patients get and do after checking in and while waiting for their appointment. They are psychiatry’s equivalent to having your vitals taken whenever you visit the GP. Arguably, they are more objective means to monitor progress of depression, anxiety, well-being etc. It is also arguable if these rating scales really better treatment. Regardless, they are becoming standard of care; I might as well get the ball rolling before some outside agency steps in to tell me to do so or else.

Another matter seen every January is an upswing in pharmaceutical representatives. After a relative hiatus in November/December, they return en masse. I admire their perseverance, given there is only little-old-me to woo, and I badger them with questions they can’t answer. Perhaps there is a correlation to the deductibles and the return of pharm reps, who are flogging brand names. One of my medical new year’s resolutions is to not bear-bait them by poking holes in their presentations, but smile, nod, and listen. At least I always say thank you for their time, the food, and the samples they bring.

Otherwise my job is really no different day in and day out and each year is like the previous one. New patients show and old patients move away, drop out, or go elsewhere due to change of insurance. While it isn’t various, I take pride my work has meaning to it. ‘Burn out’ isn’t about working too much, it is about what you do feels to be of no meaning or value. By that definition I am certainly not burned out.

*Patients are picky about what they will buy/not buy. What makes something ‘too expensive” is subjective, and sometimes curiously at odds with other items. Outraged patients forgo their medication for cholesterol or depression, but not for anxiety. These are relatively not too expensive and insurance companies rightfully deduce if they are not covered the patients will pay for them themselves.

Brand names usually have

Lots of folks make New Year’s resolutions, noble vows to better themselves. Some folks pish-posh this ritual on the grounds they are already continuously improving themselves, and others decline on the conviction they are fine and require no improvements (oh the horror!). Alas, many who make resolutions fail. This is too bad, as it discourages one to try to mend something they know they should or really want to. Here is what I tell my patients to do – and do myself. Spo

Rather than make cosmic resolutions like “learn Spanish” a better approach is to do the following: every day – hopefully at the same time, to get it into your muscle memory – do five minutes of Spanish lessons. That’s it. Set an alarm and if you can, tell someone you are doing this, so they can remind and prompt you. Urs Truly’s iPhone goes off every day at 830PM as if to say “Hey, whatever you are doing, and regardless of motivation, stop it , and go do five minutes of Duolingo”. Getting started is the hardest step, so once you start doing your five minutes you are likely to keep going. Feel good you did something; mark it down on a calendar for you or others to see, or use an app like “Way of Life”. I have done ‘every day for five minutes do some Spanish”and this is nearly 1,000 days in a row now. I don’t need the iPhone to remind me anymore, for I start thinking about it around 8PM, so I go ahead and do it. The reward (besides learning Spanish) is I now have motivation to do this. Mind! Motivation is the end emotion, not the start. “I don’t feel motivated” is pushed aside and is not relevant.*

I accomplished my 2021 resolutions that were simple, repetitive, and realistic. The once a month jobs, like ‘soup of the month’, I had circled on a face calendar to see every day to remind me to do this.

“Do two CME courses per month” failed miserably as I did not have it on my calendar; it was a vague to do sometime, which seldom happened. In 2022 I plan to do better by applying the mentioned rules.

I am thinking now about what I want to accomplish in the new year, like ‘every morning drinking a glass of lemon water’, and “clean out the rubbish’. Journeys begin with a single step and succeed with regular walking; developing good routines and habits are similar.

*Sometimes there is unconscious drives not to succeed, or mixed feeling/consequence to do a task. This need exploring at the beginning.

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