Tuesday, October 18, 2011

Mission: Healing October 18, 2011

PGY 39, Day 110

Children and Their Parents

This book was originally composed and written by me in 1985, for CHILDREN AND THEIR PARENTS as part of our Non Profit Child Development Project, run by our Non Profit Health Development Insititute in conjunction with Northern Cumberland Memorial Hospital (at the time, a Non Profit Hospital in the town of Bridgton) and partly funded by the State of Maine.  Although the book was never comnpleted for widespread distribution, it is available @ cost of production.  Again, I will put Bits By Bit up on the blog for commentary and to facilitate development of a NEW Edition.  Forgive the CRUDE Draft and recognize the value of the content, if you will.

Thanks for your help.
Enjoy!
Dr. Mike

Fundamentally, nothing has changed since the book was written.  Think about what you read here and send feedback.  Remember, it was originally written as a Child Development Guide for Children and Parents, under the assumption that Parents are not born with optimal Parenting Skills.  Therefore, we saw it as our goal at the time to work with parents as a team ... to help them develop their parenting skills.  Our target was reduction of child abuse and neglect, which is still, and I suspect will always be a worthy cause ...             

Mission: Healing October 18, 2011

PGY 39, Day 110
Relaxation is one of fundamentals of Stress Management.
This video, if you focus on the sound and the falling water, is very relaxing.  Although brief, it will help most to relax and it can be repeated.  Try it, you might like it.
http://youtu.be/zrIwQlri07A
Enjoy & Happy Tuesday!
Dr. Mike

Monday, October 17, 2011

Mission: Healing October 17, 2011

PGY 39, Day 109

More words from The NEW Stress Management Workbook
from Dr. Mike. The latest (electronic) version is designed for use with The Original Stress Management Workbook and will be put up here BIT BY BIT ... in pieces for your review.  New stuff will be in parentheses, in order to distinguish between NEW additions and the ORIGINAL version.

The NEW*
STRESS
Management
Workbook
A
new & revised 
action plan
for
taking control of your
life and health

*Designed for use in conjunction with your family doctor and The Original Stress Management Workbook

by

Michael F. Mascia, MD, MPH


Preface
(from our  Original Stress Management Workbook, published in 1980. These words were carefully chosen at the time of our original writing. They ring true today, in a New Millennium... more than 30 years after they were written ... and I dare say, these words will likely remain true ... into the foreseeable future.  I will expand on this preface for the New edition, but for now, to avoid confusion, I leave it as it was written and published in 1981.  Keep in mind, that, if you are an individual who wants to TAKE CHARGE OF YOUR LIFE AND HEALTH, think carefully about these words, StepWisely(R) and join me ... walk with me ... as I create, Bit by Bit ... The NEW Stress Managment Workbook. I welcome your participation and feedback. Enjoy! Dr. Mike
 Michael Frank Mascia, MD, MPH October 17, 2011)


The twentieth century has been marked by tremendous advances in
the theory and practice of medicine. Phenomenal scientific and tech-
nological discoveries have found their way into medical practice. Peo-
ple have grown to expect certain seemingly miraculous results from
the institutions and providers of medical care, and often, the expec-
tation is that the "impossible" can be achieved.
There is, however, increasing popular awareness that modern med-
icine cannot perform miracles despite the available science and tech-
nology. Professionals and laymen alike are learning that advances in
medicine, however dazzling, cannot make up for life styles that breed
pathology. Life style is now being recognized as a major factor in the
development of many of our modern medical problems. General atti-
tude and behavior are clearly linked to the individual's health status.
Moreover, most medical problems seem to occur more frequently with
increasing stress, and environmental exposure appears to be a factor
in most illnesses. Expectations appear to have an effect on health and
well-being. Such varied problems as cancer, cirrhosis of the liver, mal-
nutrition, pancreatitis, ulcers, high blood pressure, headache, food poi-
soning, voodoo deaths, and others appear to be influenced by both
internal and environmental factors, both emotional and physical.
Professionals and laymen are beginning to realize and teach that
the individual has a great responsibility in the promotion of his own
health and the prevention of his own disease. The concept of self-care
is steadily gaining acceptance. People are beginning to realize that
they have control over certain factors that affect their health and well-
being. But although these concepts are being accepted more readily,
the methods for their application and general use have not been widely
available.
THE STRESS MANAGEMENT WORKBOOK is designed for the
individual who takes the concept of self-care seriously and wants to
do whatever he* can to promote his own health and well-being, as well
as take advantage of the best that modem medicine has to offer.
Although the book can be read rather quickly, the material is de-
signed to be implemented gradually and thoughtfully in conjunction
with advice from your personal physician. It is expected that your
initial planned changes may take up to two years or more to institute.
""Throughout the book we have used such constructions as "the individual... he" solely
for the economy of language. Our usage of personal pronouns is not, in any way, intended
to imply any connotation of sexual role discrimination.

(Maybe in the new version, we will use "she" instead of "he" for "economy of language"?:)

Ciao for now.
Dr. Mike

Mission: Healing October 17, 2011

PGY 39, Day 109
 
A "poem" ... probably just better called a "few words reflecting the dawn" promised and started several days ago ... when Fall was Dawning on Me ... written in Maine.
The photographs below are from New Orleans and Florida.  Have a happy day.
Dr. Mike





Fall Dawning on Me

Out of Darkness,

This Morning Dawns with Cotton Candy Skies ...

Magical

Fluorescent Trees Glow ...

Mesmerize

Shouting in silence ...

First shades of red, then yellow and green

Scream,

"Look at me", "No, me", No, me. I am the brightest!",

they "say", shouting in loudest colors,

 fighting for attention against eternal pink-blue skies.

She called me out for this glowing  feast,

into the cool crisp air, morning dew, soft moss and grass

cold ... feet ...

glide slowly down to earth

Eyes ... and up again

now drifting slowly ... "ahh" ... "apple tree",

red, ripe fruit gently bending branches,

easy reach, yes, "pick the ripest one"

Wet, cold ... "rub to dry ...

 and shine"

"bite" a crunching sweetness ...

 deeply chilling thoughts

Awaken ... chilled ... shaken ...

I

quickly go inside. 



Happy Monday!
Dr. Mike 

Thursday, October 13, 2011

Mission: Healing October 13, 2011

The Stress Management Workbook
Bit By Bit: The NEW Stress Management Workbook
Click the link above to View a free Introduction posted via Twitter.
Eventually, I will figure out how to go live with it.
Give me feedback and I will do my best to make sure that your questions are answered in the NEW edition.
Dr. Mike

Mission: Healing October 12, 2011

The Stress Management Workbook
An action plan for taking control of your life and health
http://www.ihealsolutions.com/thestressmanagementworkbook.php

As promised, I am starting to post bits and pieces of the book, as I see the needs are great and the book is available and ... why not?  Enjoy and contact me via my website, or email at dr.mike@ihealsolutions.com,
 if you want a copy of the book.  Electronic copies are not yet available "officially", but I do have paper copies & can put electronic copies on a disc for those who want it that way.
So, this will be a work in progress on the blog ... with The NEW Stress Management Workbook taking shape as I put pieces of the original Stress Management Workbook out here on my blog, with additions, links and commentary on the Original.
Ciao for now,
Dr. Mike
PS. Always remember that I expect you will use this guidance in conjunction with your personal physician. 
PPS. For emergencies, go through 911 or your local Emergency Room/Emergency Services.
PPPS. Over time, I will help you figure out how to
a. establish a relationship with a good doc &
b. figure out how to get the care you need when and where you need it.

From the original cover published by Appleton Century Crofts.
Drs. Aronson and Mascia retained the copyrights.
New Comments will be put in parentheses

(from the front cover)

An Appleton Book

The
STRESS
Management
Workbook



An
action plan for
taking control of your
life and health

StephenAronson, PhD
&
Michael F. Mascia, MD, MPH

(From the back cover)
 
The STRESS
Management Workbook
numerous and varied as its causes.  The Stress Management Workbook is a unique, complete
guide to recognizing the factors that are evoking stress - at home, at work, in school, and in
your relationships with family and friends. Once you've identified what's causing you to
experience stress, you've taken the first big step toward overcoming it!
The questionnaires, checklists, and self-evalution tools you'll find throughout the book will
helpyou to measure your personal reactions to stress and to develop a stress management plan
that is tailored to your day-to-day needs. The authors teach you how to use such time-proven
stress management techniques as meditation, exercise, deep muscle relaxation, diet, and
self-hypnosis.
Other features include:
STRESS - You're bound to experience it at some point in your life.  Its symptoms are as

• An "Integrated Model of Health and Disease" - which helps you to pinpoint the physical and
emotional effects stress can have on your well-being.

• Diet guidelines - You'll learn which common foods can ease or increase the symptoms of
stress.

• Practical stress management exercises that you can fit into your busy schedule.

The stress Management Workbook combines the best of modern medical information with
realistic self-help techniques. As the authors emphasize, a certain amount of stress in your life
is normal and healthy. This book simply shows you how to find and keep the perfect balance for
you - so you can enjoy life to its fullest!
About the Authors*(see updates below each author)
Stephen Aronson, Ph.D. is a licensed psychologist with more than 10 years' experience as an
organizational development and training consultant - to schools, summer camps, corporations,
and government groups. He has taught psychology at the university level throughout the
country. His professional interests include the development of communication skills, and
team management.
(*Dr. Aronson has continued his work in Portland, Maine for the many years since this book was originally published, and he will be invited to help me with certain sections of The NEW Stress Management Workbook.)
Michael F. Mascia, M.D., M.P.H. is a Board Certified Family Practitioner with a private medical
practice in Bridgton, Maine. He has taught Family Medicine in major medical schools, and is
actively involved in the research and development of stress management techniques. Dr.
Mascia is a diplomate of the American Board ofFamily Practice, and a member of the American
College of Preventive Medicine and the American Academy of Family Practice. He received his
M.D. and M.P.H. degrees in 1972 from Tulane University.
(*After 14 years of rural Family Medicine, Dr. Mascia returned to the University of Maryland and The Maryland Institute for Emergency Medical Services Systems for further training in Anesthesiology, Critical Care and Hyperbaric Medicine.  Since then, he has taken teaching and leadership positions in several academic institutions including SUNY in Syracuse, New York; Tulane University, in New Orleans, Louisiana; and West Virginia University, in Morgantown, West Virginia. While caring for, teaching about and researching the sickest of patients, Dr. Mascia has continued his interest in and use of Team Development & Stress Management principles and strategies to optimize teaching and patient care.)
  
Drs. Aronson and Mascia have worked together, conducting stress management workshops for
corporations, government groups, and individuals.
Appleton-Century-Crofts / $8.95 0-8385-8696-1 (the original price from 1981)

(*Drs Aronson and Mascia worked together in Bridgton, Maine for 14  years and continue to collaborate on this work.) 

Tuesday, October 11, 2011

Mission: Healing October 11, 2011

PGY 39, Day 103

Should we call it the HIT Parade?
Easy now, don't jump on the bandwagon. Think first; jump later? Think and walk? Better yet, StepWisely(R)

This is my latest comment with regard to Health Information Technology flaws and fixes.

Happy Monday! I will try to post on your blog (DONE http://biomedres.blogspot.com/2011/10/more-on-hits-impact-on-dr-patient.html?showComment=1318263890772#c2930562617135789482) and will go to my blog as well.

Thanks again for including me in your conversion(s). It is good to know that some are thinking (actually thinking) about doing the right thing in regard to HIT.

BUSINESS OF MEDICINE vs PROFESSION OF MEDICINE vs HEALTHCARE

Regrettably, as with all things medical over the last couple of decades, there are many (THIRD PARTIES) out there who would be happy to take some $$$ out of this pot ... without regard to impact on patients and patient care. In other words, most (if not all) of these systems are a great source of income for the vendor and I venture that ALL would FAIL the scrutiny of cost benefit analysis, if they were in the mix of new products and services being examined. DON'T give them the money! Make them prove that it is worth it!

But, everyone has (without good reason) jumped on the HIT train ... and it is being pushed full speed ahead ... before the tracks are laid. Sure, I like the data to play with, but is it worth compromising patient care to get it? And, the prices you are paying are a RIP OFF! 

My advice? If you don't want to waste money on HIT, 1. Don't buy anything before you test it! 2. Better yet, make it yourself and run pilots before you spread it around like fertilizer ... cough ... cough ... sputter. 3. Don't waste your time negotiating with 3rd party HIT vendors. Make them prove their systems by loaning trial hardware and software for testing on site!

Seems as if Governments are in a good position to help develop a SECURE INTERNET that runs parallel to, but separate from the existing hardware and software. Over this INTERNATIONAL HEALTH NET, Personal Health Information could be shared (Standardized Data on OPEN SOURCE SOFTWARE that each patient and provider has) between providers and patients anywhere in the world. Open source, Non Profit COOPERATIVE makes the most sense, because NOBODY should profit (over and above a reasonable wage) from Healthcare. Like ($$$) banks, the information would be held by each patient and provider, but not in central data banks.

Just my opinion:)
To be continued ...
Dr. Mike
Michael F. Mascia, MD, MPH
dr.mike@ihealsolutions.com"

T

Sunday, October 9, 2011

Mission: Healing October 9, 2011

PGY 39, Day 101

Thinking about Steve Jobs, and my brother Peter. Good men, lost to the world, but lives lived well.

V2

Sunny Day

Silent ...

Sunbeams Spotlight Shimmering

Leaves

Flutter ... dance in gentle breeze ...

soon to be naked trees.

Some, radiant dressed, scream for attention ...

about to drop their cover.

Reflecting ...

rhythm, autumn's amber glow ...

crystal blue skies ...

eternity.

Seasons ... men ... women ... come and go,

cricket, squawking bird, rustling squirrel,

each endless solo

squall and swan song sung ...

to no avail,

sensing ... warm, sweet, calm ...

days savoring seasons' fruit ...

moments pale.

Watching, wondering how can it be?

The inchworm ... tiny thing,

efortlessly dangling ... floating ...

up ... down ... side to side ...

on a sparkling string ...

nearly invisible.

But, that is just a distraction.


Have a Happy Sunday and Do The Right Thing!

Dr. Mike

Saturday, October 8, 2011

Healing: Saturday, October 8, 2011

PGY 39, Day 100
This morning, I wrote these words and sent them out on twitter, as I was enjoying my morning coffee. Just a few moments on a Saturday morning ... awake moments of meditation. Try it. You might like it.

10/8/11 10:47 AM
BEING ... Warm sun, hot coffee, birdsong, blue skies, sweet air ... leaves sparkle ... glow ... dancing in the gentle breeze ... is.
Dr.Mike

Friday, October 7, 2011

Mission: Healing October 7, 2011

PGY 39, Day 99

Fall Rhythm ...

Hushhhhh ... the only sound in this sweet air ...
and a few notes ... birdsong ... chipmunk rustling ...
gently drifting through trees ...
green leaves flutter and dance ...
Submission.
Sunbeams,
burning through flesh, take the chill out of bones,
and spotlight the brilliant ones screaming for attention ...
standing out among the forest's green, gray and brown.
Ahhhhhh ... being ... this is ... an intermission.
Summer's swan song over,
sweet day's calm,
silent blue skies give a hint of what was
and
what is to come.

Happy Friday!
Dr. Mike

Mission: Healing October 7, 2011

PGY 39, Day #99
Business of Medicine: More on Problems With Health Information Technology ...

These are comments on a HIT bloggers reflections regarding my Top Ten HIT Problems Post from a few weeks ago ...
Some day I will figure out how to link all this together, so that it can be followed.

Thanks for including me in your conversation.  I take it that in the UK your HIT is non proprietary and Government property?
As a front line provider & proponent who has dabbled in EMR creation and relational data bases for ... how long have they been available? ... I am continually struck by the inadequacy of proprietary EMR products available in the US.  And, I can only conclude that the proprietary model is the major barrier to eliminating the flaws ... or is it Ego? Money/Ego? Money vs Ego? Money & Ego ...
Anyway, no matter what the causes, I strive to set up a Non-Profit Doctor-Patient Health Care Cooperative, and think that the HIT problems can be resolved as a part of the Mission. The objective would be to find a group of IT people who will work together with me to create the ultimate open source HIT platform.  I can do it on paper ... I just can't do it electronically.
It is interesting to note that the HIT people look at me as if I have two heads when I tell them that their product is not good enough, because it gets between us ... between the Doctor and the Patient ... and takes time away from my patient care time.  They just don't get it.  I should not be surprised, right? HIT people think that interacting with a computer is natural, right? Prove me wrong.
Well, like it or not, I have watched technology chip away at the Doctor Patient Relationship and nursing time ... bit by bit over the years.  Now, it is simply madness ... And, while it may not make a difference ... in certain scenarios where care is irrelevant and people will get better anyway (most clinic patients), it is a serious problem in the ICU, or in the OR to have 25 - 50% of physician time spent on computers.  This is foolishness! Especially today ... in an era with availability of such sophisticated technology. Doctors and nurses spending precious patient care time on computers?  This is CRAZY, not NORMAL! NOT RIGHT and NOT ACCEPTABLE. If I only had a chance to talk with Steve Jobs ... I am sure he would have seen the value of fixing this problem. Ah, well ... it is what it is.
Right now, as it stands, we could instantly solve the HIT interphase problem and help reduce unemployment by hiring scribes to serve as the interphase between Doctor and Patient ... one for each patient in the ICU and one for each patient in the OR.  (Do what you like in the clinic.)  This would work as an instant stop gap measure while we push to bring this monster around to a technology that is friendly to the Doctor - Patient relationship and  Nursing care of the patient.
To be continued ...
Dr. Mike
dr.mike@ihealsolutions.com

Mission: Healing October 7, 2011

PGY 39, Day #99
As usual, I am thinking ... always thinking more as I recover from my week of patient care and sleep deprivation. Delayed processing of the events of the week and examination of my emotions ... a trick I have learned over the years to keep emotions out of my interactions with patients. This works for patient care, but I am sure it drives everyone else in my life crazy.

Anyway, lately I have been thinking that I need to start posting some of my Stress Management strategies & some pages from the "Stress Management Workbook: An Action Plan for Taking Control of Your Life and Health". I wrote it with a Psychologist friend & co-worker (Stephen Aronson, PhD) to help worried well patients get healthy and stay healthy. More than half of my Family Practice patients (I did Family Medicine for 14 years before Anesthesiology & Critical Care) were suffering from stress related disorders, and, even though less than 10% of the folks were motivated to "take control" of their own health, I thought it was a worthy endeavor. The book was written in 1979, and published by Appleton Century Crofts in 1981, and ... low and behold, it is still sound and relevant. I have threatened to publish an electronic version and to write a new edition for years, and, maybe I will just have to start posting the updates in the blog.

The fact is, that little has changed with regard to the fundamentals of Stress & Stress Management, but I can update the book with new and emerging problems since the original publication. Not much needs to be added, but there are some issues that deserve special attention for the New Millennium. Specifically, I will update the immunization section, add a sections on AIDS, and bits for some of the newer global issues and worries such as terrorism, financial instability and disaster preparedness. Also, an electronic version should enable strategically placed live links for references and easy user updates.

Hopefully, I can get some feedback and interaction from my Twitter Followers, Facebook Friends and Blog Readers, so that I can fine tune the New Edition to make it particularly relevant and helpful. What do you think?

Dr. Mike

Monday, October 3, 2011

Mission: Healing October 3, 2011

PGY 39, Day 95
Recovering from another week in the ICU. This was a moderate week, in the sense that we had a strong care team and a patient population that did not exceed our capacity. In other words, we did not have to stretch beyond capacity at any time during the week and all patient care, teaching, research and administrative objectives were met. it is not uncommon that some unimportant things have to be put off, so that patients can get the care that they need.
For obvious reasons, patient care details can't go in here, but I can and do talk about my goals, objectives and methods ... patient care, teaching, research and administration. Patients and Patient Safety always come first in my book. Toward that end, I have developed some tools that are designed to keep inexperienced Doctors and Nurses on target with our Mission: optimal patient care. These are all part of the StepWisely(R) System that I have been using over the last few years.
Previously, I have given you bits and pieces in this blog and through twitter. Here is a bit more ... will expand on it over time.
STOMPP(TM)IT = Strategic Targeted Operations Management for Patient Protection & Preservation Integration Tool: A tool to keep the team on Target with the Optimal Patient Care Mission. This team development tool is a series of check lists that helps the members of the team to stay FOCUSED on the CRITICAL GOALS AND OBJECTIVES that are most likely to result in a good outcome. They include General Patient Goals and TOPS(TM) (Targeted Organ Protection Strategies) that are patient & organ specific. In other words, they are designed for the management of each patient on the basis of each patient's specific needs. While I can't be specific about any real patients, over time, I will give theoretical examples of how these are used in the care of each critically ill patient.
That's all for now ...
If you have specific questions, you can contact me by email @ dr.mike.ihealsolutions
Ciao for now,
Dr. Mike