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MELINDA BURNETT, MD | PHYSICIAN | SEPTEMBER 9, 2016 I write this while sitting in our sailing catamaran, swaying in the wind and current eight feet above sand and sea grass.  I know this because I …

Source: A neurologist who quit medicine and lives on a boat

MELINDA BURNETT, MD | PHYSICIAN | SEPTEMBER 9, 2016

I write this while sitting in our sailing catamaran, swaying in the wind and current eight feet above sand and sea grass.  I know this because I can see right through the water in the Bahamas.  There is clarity here.

When I started this journey thirteen months ago, I was burning with anger.  I was angry at insurance companies for developing complex, mutable formularies, coverage policies, and appeal procedures, maximizing my burden to minimize their cost.  I was angry at pharmaceutical companies and the many layers of profit-seeking middlemen between them and my patients, their unregulated maneuvering resulting in arbitrary swings in drug pricing so that I was unable to tell my patients if they could afford even their generic seizure meds that month.  I was angry at the government, which shortsightedly addressed the morass of medical economics with more bureaucracy, and, with ICD-10, even defined more diseases.  I was angry at my physician leaders, who awkwardly wielded their newly-acquired economic jargon like a weapon, distancing themselves from the fellow doctors they supervised.  And finally, I was angry at multiple EMRs, which clearly placed the doctor’s time and effort last on the priority list.

After all, medicine is complex these days.  The doctors must pay for this.

These concerns of mine could be extracted from any online physician forum, conference dinner conversation, or burnout retreat.  But most of those doctors are still practicing.  So why did I quit?

Consider how I was trained.  In my medical school, I was acknowledged as an intellectual with a higher calling, and the humanity of medicine was emphasized.  I will not just maximize patient outcomes, I will heal; I will not just fill my 3 p.m. slot with a well-reimbursed EMG, I will bear witness to suffering; I will not just maintain my certification, I will embrace the fascinating science of medicine.   When I finished medical school and residency, I didn’t just feel qualified to do a complex job, I felt ennobled, as if my life had a higher purpose.

When I started my outpatient neurology job for a multispecialty practice, I had a lot of fun.  It wasn’t so hard to make a difference.  But over time, my practice started taking on water.  It is a story familiar to many by now.  The administrative duties escalated in spite of a competent but dwindling support staff, and the time allotted for paperwork disappeared out of the workday.  It became all uncompensated time, which was humiliating, as that fact suggested that if I was just more efficient, I should be able to get it all done before dinnertime.  My frustration built as my employers seemed unable to address my difficulties in a manner that respected my time and autonomy.  I needed something more than a “support group,” with the implication that the problem lay within myself, not the system.

And so my dream of becoming a great doctor dissolved.  The message received from multiple institutions was loud and clear: You are no longer special.  You are just an employee.

So I quit.  I live on a sailboat now.

I jumped into my lifestyle change with the old enthusiasm I had for neurology.  I spent several months lying on deck watching sunsets, relishing the fact that it was 6 p.m. and I was home with my family.  These days, my husband and I have control over what we will do each day, where we will go next, and when we will leave.  If a mistake occurs, we change our system rapidly to minimize future errors, and we document only what is necessary.  Finally free to think, I have gazed at the sea on night watch, Southern Cross in my headphones, searching for answers.  What is the fix for uncontrollable health care costs?  What is the fix for Parkinson disease?  What is the fix for burdensome documentation requirements? What is the fix for me?

I am calling this a self-funded sabbatical rather than a career change.  It is hard for a person to give up a profession that requires such a large initial investment.  Slowly, the neurologist in me has resurfaced from its burial ground in the deep sea of disillusionment, and the tsunami of anger is starting to subside.

It is not a panacea, but taking a break from the degrading surge of checkboxes and lethargic dropdown lists has rejuvenated my soul.  While sabbaticals have been traditionally reserved for academics, I propose that more practices consider offering them.  Many benefits are obvious, from improving recruitment, encouraging loyalty, promoting education, and addressing burnout.  Of course, there will be resistance to this expensive idea.  Offering sabbaticals acknowledges the physician as an intellectual with unique motivations, a person worthy of respect.   It may be perceived as elitist, this idea to give physicians special treatment.

But there is a deeper consequence.  On sabbaticals, one can regain control over one’s day and recover a lost sense of agency, an underappreciated but important cause of physician discontent.  This is dangerously empowering.  In fact, my sabbatical has given me new strength to take the helm of my career and do more to be heard, as I am ennobled and willing to fight for my patients and fellow physicians.

Physicians cannot continue to work as uncompensated paper-pushers for a multitude of silent overlords seeking profit above patient care.   The establishment may reject this call to mutiny, but nothing will change until physicians start requesting sabbaticals if they are not offered.  We have given so much already to this system.  It’s time to start taking something back.  We have to restore our status as captains of the ship.

Fortunately for me, those problems seem far away at the moment.  In this light breeze, I search through the clear water below me for the hope that someday this respect I seek will spread like a wave through the health care industry, and physicians will regain their voice before they drown.

Melinda Burnett is a neurologist who blogs at Burnetts Ahoy!

In all world regions, informal care provided by family, friends and the community is the cornerstone of the care system. In LAMIC (low and middle income) these informal care costs predominate, accounting for 58% of all costs in low-income and 65% of all costs in middle-income countries, compared with 40% in high-income countries. Conversely, in high-income countries, the direct costs of social care (professional care in the community, and the costs of residential and nursing home care) account for the largest element of costs – 42%, compared with only 4% in LAMIC where such services are not generally available. In LAMIC, despite larger, extended families, the economic strain on family caregivers is substantial. Typically, around a fifth of caregivers have cut back on paid work, and paid care workers are becoming common in some cities, adding to the economic burden. Moreover, compensatory benefits are practically non-existent.

My answer to Is there a way to tell if I have a ALDH2 enzyme deficiency without drinking alcohol?

Answer by Connie b. Dellobuono:

Do you have difficulty sleeping? Lacking in iron (inner eyelid pale), gasping for breath when climbing stairs or mountain, skin rashes, get’s sick easily/poor immune system,exercise less, eats sugar daily, have migraines, gets irritated easily, and feeling weak? What is your diet look like? Do you have family history of diabetes, heart and liver disease? Where do you live? Is there air pollution? Do you eat protein when drinking alcohol? Do you have addiction problem?

From wiki, on oxidation (related to ALDH2 enzyme deficiency):

Oxidative stress is suspected to be important in neurodegenerative diseases including Lou Gehrig's disease (aka MND or ALS), Parkinson's disease, Alzheimer's disease, Huntington's disease, Depression, and Multiple sclerosis. Indirect evidence via monitoring biomarkers such as reactive oxygen species, and reactive nitrogen species production, antioxidant defense indicates oxidative damage may be involved in the pathogenesis of these diseases, while cumulative oxidative stress with disrupted mitochondrial respiration and mitochondrial damage are related with Alzheimer's disease, Parkinson's disease, and other neurodegenerative diseases.

Oxidative stress is thought to be linked to certain cardiovascular disease, since oxidation of LDL in the vascular endothelium is a precursor to plaque formation. Oxidative stress also plays a role in the ischemic cascade due to oxygen reperfusion injury following hypoxia. This cascade includes both strokes and heart attacks. Oxidative stress has also been implicated in chronic fatigue syndrome.

Oxidative stress also contributes to tissue injury following irradiation and hyperoxia, as well as in diabetes.

Oxidative stress is likely to be involved in age-related development of cancer. The reactive species produced in oxidative stress can cause direct damage to the DNA and are therefore mutagenic, and it may also suppress apoptosis and promote proliferation, invasiveness and metastasis.

Infection by Helicobacter pylori which increases the production of reactive oxygen and nitrogen species in human stomach is also thought to be important in the development of gastric cancer.

Alzheimer’s Disease Data Insigths

Is there a way to tell if I have a ALDH2 enzyme deficiency without drinking alcohol?

My answer to What is the purpose of a juice cleanse? What are the benefits short term and long term? What are the n…

Answer by Connie b. Dellobuono:

Juicing gives your body raw veggies, vitamins and minerals. Use veggies than fruits as sugar is bad. Veggies contain live enzymes especially when consumed after juicing. Juicing helps you:

• Promote weight loss. In one study, adults who drank at least eight ounces of vegetable juice as part of a diet lost four pounds over 12 weeks, while those who followed the same diet but did not drink the juice lost only one pound. The vegetable juice drinkers also significantly increased their intake of vitamin C and potassium, while decreasing their overall carbohydrate intake.
• Boost your immune system by supercharging it with concentrated phytochemicals. Raw juice also contains biophotonic light energy, which can help revitalize your body.
• Increase your energy. When your body has an abundance of the nutrients it needs, and your pH is optimally balanced, you feel energized. Since it can be utilized by your body immediately, those who juice report feeling the "kick" of energy almost instantly.
• Support your brain health. People who drank juices (fruit and vegetable) more than three times per week, compared to less than once a week, were 76 percent less likely to develop Alzheimer's disease, according to the Kame Project.

What is the purpose of a juice cleanse? What are the benefits short term and long term? What are the negatives?

My answer to How can one double-check whether the medication a person is prescribed is correct?

Answer by Connie b. Dellobuono:

Ask your mother’s reaction to the medication. What time of the day it is taken and what kind of side effects are observed. The caregiver can start writing down these observations including list of meds, food eaten, elimination/constipation, sleep time, anxiety and other observations. Then present your week of observation to the doctor. And get a second opinion from another doctor.

How can one double-check whether the medication a person is prescribed is correct?

Alzheimer’s Risk Factor, formula by Connie Dello Buono , ©12Sept2016 Assumption: Female, over 60yrs of age, on western diet, lives in Northern hemisphere, have families with cancer, diabetes and de…

Source: Alzheimer’s Disease Data Insigths

The United States National Institute for Occupational Safety and Health has suggested diacetyl, when used in artificial butter flavoring (as used in many consumer foods), may be hazardous when heat…

Source: Popcorn workers lung disease

The United States National Institute for Occupational Safety and Health has suggested diacetyl, when used in artificial butter flavoring (as used in many consumer foods), may be hazardous when heated and inhaled over a long period.

Workers in several factories that manufacture artificial butter flavoring have been diagnosed with bronchiolitis obliterans, a rare and serious disease of the lungs. The cases found have been mainly in young, healthy, nonsmoking males. As with other end-stage lung diseases, transplantation is currently the most viable treatment option. However, lung transplant rejection is very common and happens to be another setting in which bronchiolitis obliterans is known to occur.

The disease has been called “popcorn worker’s lung” because it was first seen in former workers of a microwave popcorn factory in Missouri, but NIOSH refers to it by the more general term “flavorings-related lung disease”. It has also been called “flavorings-related bronchiolitis obliterans” or diacetyl-induced bronchiolitis obliterans.People who work with flavorings that include diacetyl are at risk for flavorings-related lung disease, including those who work in popcorn factories, restaurants, other snack food factories, bakeries, candy factories, margarine and cooking spread factories, and coffee processing facilities.

In 2006, the International Brotherhood of Teamsters and the United Food and Commercial Workers petitioned the U.S. OSHA to promulgate an emergency temporary standard to protect workers from the deleterious health effects of inhaling diacetyl vapors. The petition was followed by a letter of support signed by more than 30 prominent scientists.The matter is under consideration. On 21 January 2009, OSHA issued an advance notice of proposed rulemaking for regulating exposure to diacetyl. The notice requests respondents to provide input regarding adverse health effects, methods to evaluate and monitor exposure, the training of workers. That notice also solicited input regarding exposure and health effects of acetoin, acetaldehyde, acetic acid and furfural.

Two bills in the California Legislature seek to ban the use of diacetyl.

A 2010 U.S. OSHA Safety and Health Information Bulletin and companion Worker Alert recommend employers use safety measures to avoid exposing employees to the potentially deadly effects of butter flavorings and other flavoring substances containing diacetyl or its substitutes.

A preliminary in vitro study, published in 2012, suggests that diacetyl may exacerbate the effects of beta-amyloid aggregation, a process linked to Alzheimer’s disease. Research in rats and mice has shown that diacetyl can damage the airway and damage cells that line the airway.

In 2015 there were allegations that the health of workers who roast coffee is threatened by diacetyl.

Other postemployment benefits (or OPEB) is an accounting concept created by the Governmental Accounting Standards Board (GASB) by pronouncements designed to address expenses that entities may or may not be legally bound to pay, but pay as a moral obligation.

Digital Health ecosystem with a focus on the end-to-end delivery of services. Leading players across the value chain, including IBM, AirStrip, CirrusMD and iHealth. Motherhealth is looking for inve…

Source: Digital health, millennials, smart audio devices