Doctors With A God Complex II

(Oct 2014)

I wrote the blog post about the doctor with a god complex in May of 2012.  Since that time I've met many physicians who more than favorably balance the equation.  That is, they are humble, conscientious and place a premium on listening.  I'll lead with a recent New York Times interview with one of them:   Dr. Laurie Glimcher

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(May 2012)

New to this area I sought out a doc just to have one on hand in the event I needed one. This guy came well recommended by some acquaintances. I met with his Nurse Practitioner a few weeks ago Monday. She takes my history (did a decent good job) and set me up to see the doc himself that Friday.

You know the drill. They get you undressed and cloaked in a butt exposed `gown.' This of course, has nothing to do with setting the scene so that the doc is top dog and the patient is a vulnerable sot. -;

The guy comes in, doesn't even look at me. Sits at a little table and opens his laptop. Starts barking numbers and concludes: "We're gonna put you on a diet. Your BMI is too high." I tell him I lost 20 lbs in the last six months, ride 200 miles and climb 18,000 feet on a bike every week, that muscle is heavier than fat (Beyond BMI), that the BMI is a 19th century metric, that I no longer eat meat, and refer him to the BodPod results I submitted when I met with the NP.

He ignores that and keeps looking at his laptop. Then he says that the prostate exam and full urological workup I had just last May (biopsy that showed NO evidence of enlargement or cancer) was worthless and that nothing is as good as ... and then he just sticks his index finger in the air and waves it.

I didn't respond because this was so stump stupid on his part that I was (believe it) speechless.

I tilted my head, smiled, got my Irish up and said "... and then what? A biopsy and blood work that I just had 6 months ago?!"

He then slammed down his laptop and said: "I'm not accepting you as a patient. I'm not going to argue with you."

I was, again, taken aback and surprised at the crude arrogance. Then he tells me to get dressed and a nurse will tell me what to do next.

I left a few minutes later and pondered deeply as to what this meant. Finally, I found another doc. A few days later I sent this idiot the following letter:

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Dr. X:

I understand your prerogative to decline accepting patients.

I am in agreement with you that it is better that you recognized what would certainly have been apparent at a later time. Being most generous in my description there is an incompatibility between us.

Candidly, I was surprised and am mildly distressed at your behavior.

Having been the Clinical Director of a psychiatric hospital for abused and neglected children and adolescents I have many, many times been reminded of the importance of listening to my patients and staff.

It is my conclusion that you emphatically failed your profession in this regard.

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So, my advice to all of us: don't be intimidated by physicians who are so arrogant that they suffer from a God complex.

From a psychological perspective such people lack confidence in their ability to maintain a interactive and candid relationship with the client / patient.

More, several recent `gold standard' research reports conclude that arrogant and self-absorbed physicians have a much higher `fail' rate and more malpractice allegations than others.

Word to the wise.

Characteristics of Emotional Maturity

An admired acquaintance recently experienced a complicated and painful cycling accident.  He is an avid and accomplished cyclist in his 50s.  The effect of such injuries requires that he (we) call upon our experiences and capacity for managing (sloppily, we all admit) stress, `dead' time, handling boredom, too much self-reflection, overthinking every damned thing. 

So here is something I have read and re-read to remind me (and hopefully others) of what it means to be a grown-up.

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Maturity: noun. 1. a being full-grown or ripe, 2. a being fully developed, complete, or ready, 3. a becoming due (Webster's New World Dictionary).

1. The ability to experience and understand our own deepest feelings and needs, and to be able to act on and express these feelings and needs in appropriate and constructive ways. This is opposite from "acting-out" our needs in unconscious, destructive patterns of behavior. This aspect of maturity includes the ability to experience and tolerate especially intense feelings - which inevitably occur in life - and to be able to appropriately express these feelings, or contain them until an appropriate and responsible means for expressing them is available.

2. The ability to act on and react to life circumstances with intelligence, sound judgment and wisdom. This aspect of maturity is opposite the tendency to act impulsively, without taking the opportunity to think through our actions or consider their consequences. (Wisdom: having the quality of good judgment, learning and erudition, soundness.)

3. The ability to recognize, empathize with, and respect the feelings and needs of others. This is opposite from a selfish and chronic preoccupation with our own needs, with no awareness of, or sensitivity to, the needs of others.

4. The ability to delay the immediate satisfaction of our own needs, so that we may attend to other more pressing needs or actions. This is opposite from a condition in which our immediate needs always take precedence over all other needs.

5. The ability to love - to allow another's needs, feelings, security, and survival to be absolutely paramount - just as if these were our own.

6. The ability to adapt flexibly and creatively to life's changing circumstances and conditions. This is distinct from the tendency to respond to life's challenges in rigid, outmoded behavior patterns that are no longer particularly effective or appropriate.

7. The ability to channel our energy, both positive and negative, into constructive contributions to ourselves, to others, and to our communities.

8. The willingness and ability to be responsible and accountable for our own circumstances and actions in life, and the ability to differentiate our responsibilities from those of others. This is distinct from blaming others and seeing ourselves primarily as the victim of other's behavior, or from maintaining a sense that we are somehow responsible for the happiness and well-being of all those around us. Responsibility arises from a stance of strength and competence; it does not include pronouncements of blame, shame, guilt, or moral inferiority/superiority, as all these are judgments added to the basic condition of responsibility.

9. The ability to relate comfortably and freely with others, to like and be liked by others, and to maintain healthy and mutually satisfying relationships.

10. The ability to choose and develop relationships that are healthy and nurturing, and to end or limit relationships that are destructive or unhealthy.

©Maryland Institute, 1998

Training and Weight Loss

I'll start with the weight loss first.

I think it is a mistake to think that more exercise alone will result in enduring weight loss.  Fat burns best at an aerobic level of effort.  The number of calories burned during aerobic effort is usually put at 300 per hour.  If I train for 6 hours I've burned 1,800 calories.  If I ingest nutrient in the way of food and fluid in order to sustain myself in training ... it is a wash.  I ate what I spent.  Which is smart training. 

Weight loss means that we have weight to lose.  If we are skin and bones to begin with we run the risk of losing muscle mass if we try to lose weight.  Most of us are not skin and bones.  I certainly am not. 

Typically, if we are overweight (everybody decides for themselves what that means), the first several pounds can come off quite easily and quickly by eliminating the obvious culprits in our diet: alcohol, bread, pasta, etc.  Thereafter, i.e., after the initial success, it gets `harder.' 

In my case (190-195) the first 20 pounds came off with little problem.  Two pounds per week was my goal. 

When I hit the 175 pound mark I found myself feeling without energy (physical, intellectual, emotional) for a few days at a time.  That is what I called a `plateau.'  Meaning, my regular habit had been to `graze' during the day; but I ended that when I started the weight loss program. 

I found that I had been too restrictive and unbalanced in my eating behavior for the first 20 pounds.   I didn't have a) the available fat stores that had earlier sustained me during the day; b) I was not eating enough carbohydrates to support my energy needs.  So I had to reflect and reconsider what and how often I ate.

My current healthy body weight goal is quite challenging: 160 pounds, i.e., an actual weight loss of 15 pounds (+/- 3 lbs). 

So I have three concrete tasks ahead. 

The first task is to not regain the weight I lost.  In the excitement and sense of accomplishment I feel at reaching my 175 pound weight goal I experience the impulse to `let up' and have that forbidden food (the glass of wine, the bread, the pasta with cheese). 

The second task is to not be too `severe' with myself.  That is, if I am so preoccupied with eating less that I can't STOP thinking about it I'll get resentful and angry.  We all reach that point where we say something like "Screw this.  I've had a hard day / going through a tough time / I'm a grown adult, not a lab rat." 

So, in order to not be severe with ourselves:

• We need to accept that we are establishing a new `norm' for our eating;
• We should not weigh ourselves every day;
• We should select foods and set of eating habits that we can live with;
• We should not feel pressured to eat or drink differently when in social situations;
• When we predictably slip up we shouldn't disparage or be self-demeaning;
• When I eat the last piece of pizza (or whatever) on the table I don't rush to put on the hairshirt. 

The third task is to allow ourselves to experiment to find what works for us.  I am not a zealot of a particular `diet.'  I'm not a vegan, a vegetarian, a paleo, etc.  I don't have a set of hard and fast rules.  The `third' task is to be me ... just less so :)

Currently my food and eating regimen is as follows:

I typically don't eat breakfast.  Never have.  I like a cup of black coffee in the morning.  But if I expect to be up and active (not training) in the morning I'll have a can of Ensure with a scoop of whey protein even if I'm not hungry.  Because I know that a) I'll need energy later, b) I may feel hungry later. 

I like sardines.  Me and that other guy on the planet are the only ones who like sardines.  So when early afternoon arrives I'll have one or two tins of sardines.  Maybe some ketchup to moisten it up. 

For dinner I eat a salad.  The term `salad' is elastic in our culture.  I used to pile all sorts of stuff in the salad making it into a 1200 calorie absurdity: raisins, Feta cheese, lots of different kinds of nuts, etc.  I've slowly fessed-up to this game.  Now I eat more leafy stuff, carrots, vegetables.  No raisins.  A few nuts.  No-cal salad dressing. 

I may, even, have a glass of wine.  The jury is still out on that.  If what I'm doing is not working I'll experiment. 

If and when I wake up at night I don't graze.  I'll get a `taste' of lemonade or something. 

Finally, many people know more about weight and training than I do.  I am solicitous of their thoughts and experience without being `defensive.' 

Training:

I don't do `ultra' training anymore.  I have learned that putting in all of that time (many hours almost every day of the week) on the bike only left me flat and without motivation to do other important things in my life: be a husband, a neighbor, have the energy to read without falling asleep, etc.  I also found that doing ultra training had me alone for long hours: I was getting lonely, if not actually squirrely.  I didn't cultivate my friendships.  I became distant from intellectual interests and activities.  I had two speeds: Full On and Full Off. 

These days I train for shorter distances, faster.  I live in the mountains and there is a `penalty' for being heavy, chubby, etc.  You climb more slowly and it impacts your overall speed. 

So, spending less time on the bike but putting out more intense effort works for me.  I can participate and even enjoy those other things.  I have more time for people.  I am getting more (and more satisfyingly) active in my work, my profession. 

When I train I make sure that I have had something in the way of `fuel' before I take off.  For me that means liquid nutrition.  One scoop of maltodextrin mixed with one scoop of whey protein.  Drink it down.  And I carry one 12 oz bottle of water and/or a bottle of the liquid nutrition I had as a pre-ride drink.  Depending on the weather (hot) I may bring more water.  I take electrolyte pills. 

After my workout I have another `hit' of maltodextrin and whey protein. 

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The goal is to comfortably get to a lower weight in a reasonable time.  The parallel goal is to do so in a manner that is congruent with a healthy and non-severe lifestyle.

The other important goals are:

• to be fast on the bike (competitive, set records, exceed my expectations);
• to do my work and my job really well;
• to cultivate a better relationship with my family members;
• to have a social life.