A President's Week In One Sentence

I couldn't make this up if I tried.

President Trump defended son-in-law Jared Kushner after it was revealed that he tried to set up a secret line of communication with the Kremlin; went to Italy for the G-7 summit meeting of seven major world leaders, where he wouldn't join a consensus about the Paris climate deal; congratulated Greg Gianforte, who was charged with misdemeanor assault after body-slamming a reporter, on his "great win" in Montana's special election; attacked the media and its use of anonymous sources (again); retweeted a Fox News story that relied on just one anonymous source; tweeted that the U.S.' trade deficit with Germany is "very bad" and "will change"; shamed Kathy Griffin for scaring his son, Barron, when she posted a video that depicted her holding Trump's severed head; made "covfefe" a thing; announced that the White House would no longer take questions about Russia via his press secretary; defended Carter Page, whom his aides have repeatedly said he doesn't know; is still considering banning laptops on international flights; broke a campaign promise by allowing the U.S. embassy in Israel to remain in Tel Aviv; asked the Supreme Court to reinstate his travel ban; and abandoned the groundbreaking Paris climate accord.

OMG! What a week.
Breath, but not too deeply as the skies fill with coal dust and carbon emissions.

Innovation Over Quality

It has been called many things but it boils down to thinking and planning without limits.

Now this sounds creative, innovative and forward thinking and at times it is, but when the foundation of any structure or organization is not solid, any thinking or planning without limits only creates stress and frustration.

Any organization, (be it healthcare, education focused or business) must focus on it's core functions and operations before it can be innovative. And simplification of thought and planning can help immensely.

But for many in leadership, the urge to innovate instead of working toward a solid foundation first, is tempting at best, paralyzing for the organization at worst. Leadership's role must be to focus the workforce on the present instead of dreaming of what if's of the future or failures of the past, particularly as operations are hampered in the present by mismanagement, missed deadlines, unfocused operations, unsatisfied stakeholders, excuse filled customer service and lack of focus.

Efficient operations and quality service providers are focused on immediate quality improvement and planning with the intent to make solid the day to day operations that is the core function of the organization. It's tremendous to pontificate the what-if's of innovation unless this core functional foundation of operations is in disarray.


Focus first on the core elements of operations and make those perfect. Then innovation builds on a strong foundation and is likely to propel operations into the excellence everyone imagines. Build innovation upon chaos, and there is no hope for excellence, let alone survival.

System Failure

"When the system fails, you create a new system." 
- Michael K. "Omar" Williams

 

Leadershit

Marcel Schwantes writes and literature confirms dysfunctional leadership...

These common thought patterns hold leaders back, destroy their self-esteem, and damage relationships in the workplace.

1. VERY EXTREME—seeing things in black and white, and blowing things out of proportion.

2. VERY BROAD—generalizing from a specific; labeling people rather than their behaviors.

3. VERY NEGATIVE—seeing the glass as half empty and dwelling heavily on the worst possible outcome.

4. VERY DEMANDING—wanting things their way and having expectations that cloud a sense of reality.

5. VERY JUDGMENTAL—condemning others for their shortcomings and being unable to forgive.

6. VERY OBSESSED—getting on a track of being unable to budge or view things differently; persevering about something that is out of their control.

7. VERY CONFUSED—having pictures in their heads that do not match the "real world"; feeling that they don't get what they think they're "supposed to" get; having a hard time seeing things without denial, blame and negativity.

8. VERY INTOLERANT—having a need to have things the way they "should be"; finding it difficult to have patience and tolerance for differences that don't fit their needs and expectations.

9. VERY PERFECTIONISTIC—having a need to be "right" and not make mistakes, as that would mean one is inferior or is a failure; having permeating low self-esteem.

10. "SHOULDING" ON SELF AND OTHERS—placing expectations of how one "should" be, thereby limiting their ability to accept self and others without judgment, leading to negativity and tendency to criticize.

Fat

Fat Triggers are responsible for weight gain. Obesity is the proximate cause of many diseases.

Fat Triggers

1. Allergenic Foods - inflammatory responses that make losing weight impossible

2. Sedentary Lifestyle

3. Toxins in foods, in the water we drink, in the air we breathe, and within our homes; Disruption of hormone signaling system that regulates metabolism

4. Deadly Belly Bugs: A healthy gut is critical for ensuring health; stimulate  formation of new fat cells;  cause leptin resistance,

5. Sugar Overload

6. Too Much calorie consumption; satiety mainly affected by food quality not caloric content

We have to eliminate the triggers to eliminate obesity to create better health.

Death in Paris

This is one of those days I'll remember.

Paris was attacked today. Nearly 150 people were killed in several venues with the largest loss of life being at a small concert hall where a rock band from the U.S. was playing.

Like many who take advantage of global opportunities in college, Nohemi Gonzalez, a student at California State University, Long Beach, was in Paris studying during a semester abroad program. She died in the attacks. I can't imagine how her parents feel at this moment.

Live like everyday is your last.
It could be.

I Teach, Therefore I am

Marveled at "10 Things This Instructor Loves" by Jane Dmochowski in the Chronicle of Higher Education. She astutely notes that "affection and respect do far more to improve student behavior in the classroom than snark and irritation." I've always had a healthy respect for students as well as respected those instructors who have respected other students and me as a student. There is something powerful in the relationship between an instructor and growing health care professional student. I've been amazed at how satisfying the process of teaching is.


I too agree with Professor Dmochowski and her 10 things she loves:

1. Students.
2. Students who come to class with an open mind.
3. Students who come to my class to fulfill a requirement but decide to make the most of the experience.
4. Students who give eye contact during a lecture
5. Students who come to me when they need help.
6. Students who aren't afraid to ask questions.
7. Students who tell me not just that they enjoyed my course, but why.
8. Students who have their own ideas.
9. Students who give me unique and powerful things to say in a letter of recommendation.

10. Students who are fully engaged in the learning process.

The list highlights the important contribution the student must make to the relationship. It is a two-way relationship based on responsibilities of both parties. Students who show up with an open mind, good attitude, pay attention, ask thoughtful questions who have their own ideas are my favorite students. We don't have to love each other, but if we make it a point to like each other, and have a vested interest in the others success, the student-instructor link is a powerful one.

Another Fine Physician Award

Just received this communication from this self prestige publication.

-----------

Dear Dr X [that's me!];

It is my pleasure to inform you that based upon your [insert social media name here] Profile, we've selected you as a Top Doctor to be spotlighted in the renowned publication, The Leading Physicians of the World.

Your candidacy was approved this week, and your prompt response is needed to ensure that only your correct professional information in published.
For accuracy purposes, please be sure to visit your personal application website to verify your biographical information at:

YOUR LEADING PHYSICIANS APPLICATION

LPW highlights and profiles the world's Top Physicians by specialty. The organization has been designed to spotlight physicians that have demonstrated success and leadership in their profession, as well as to provide an opportunity to network, collaborate and share information with other medical professionals from around the globe.

Upon your final confirmation you will join thousands of other highly accomplished physicians, and your biography will appear in The Leading Physicians of the World, where a full color page will be devoted to you, highlighting your achievements, education and offered services. Inclusion in this book is not only a tribute to your success, but it is also a valuable resource for potential patients who are looking for a Top Doctor in their area.

Best wishes for your continued success.
Warm Regards,
Director of Communications

IAHCP

P.S. Remember, there's never a charge for inclusion in The Leading Physicians of the World.

-------------

Really? Based on my social medial profile? I am honored by anyone who raves about me, but I'm skeptical at best of any award based on what I chose to put up on any social media site. So thank you IAHCP for the honor. Instead, send me a free year supply of Starbucks Coffee and we'll call it even. OK? Rather a mocha than a full page color anything.

Happy July 4th, The Birthday of the U.S.

When, in the course of human events, it becomes necessary for one people to dissolve the political bonds which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the laws of nature and of nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness. That to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed. That whenever any form of government becomes destructive to these ends, it is the right of the people to alter or to abolish it, and to institute new government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their safety and happiness. Prudence, indeed, will dictate that governments long established should not be changed for light and transient causes; and accordingly all experience hath shown that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same object evinces a design to reduce them under absolute despotism, it is their right, it is their duty, to throw off such government, and to provide new guards for their future security. --

Such has been the patient sufferance of these colonies; and such is now the necessity which constrains them to alter their former systems of government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute tyranny over these states. To prove this, let facts be submitted to a candid world.

He has refused his assent to laws, the most wholesome and necessary for the public good.

He has forbidden his governors to pass laws of immediate and pressing importance, unless suspended in their operation till his assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other laws for the accommodation of large districts of people, unless those people would relinquish the right of representation in the legislature, a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved representative houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected; whereby the legislative powers, incapable of annihilation, have returned to the people at large for their exercise; the state remaining in the meantime exposed to all the dangers of invasion from without, and convulsions within.

He has endeavored to prevent the population of these states; for that purpose obstructing the laws for naturalization of foreigners; refusing to pass others to encourage their migration hither, and raising the conditions of new appropriations of lands.

He has obstructed the administration of justice, by refusing his assent to laws for establishing judiciary powers.

He has made judges dependent on his will alone, for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of new offices, and sent hither swarms of officers to harass our people, and eat out their substance.

He has kept among us, in times of peace, standing armies without the consent of our legislature.

He has affected to render the military independent of and superior to civil power.

He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his assent to their acts of pretended legislation:

For quartering large bodies of armed troops among us:
For protecting them, by mock trial, from punishment for any murders which they should commit on the inhabitants of these states:
For cutting off our trade with all parts of the world:
For imposing taxes on us without our consent:
For depriving us in many cases, of the benefits of trial by jury:
For transporting us beyond seas to be tried for pretended offenses:
For abolishing the free system of English laws in a neighboring province, establishing therein an arbitrary government, and enlarging its boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule in these colonies:
For taking away our charters, abolishing our most valuable laws, and altering fundamentally the forms of our governments:
For suspending our own legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.
He has abdicated government here, by declaring us out of his protection and waging war against us.

He has plundered our seas, ravaged our coasts, burned our towns, and destroyed the lives of our people.

He is at this time transporting large armies of foreign mercenaries to complete the works of death, desolation and tyranny, already begun with circumstances of cruelty and perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the head of a civilized nation.

He has constrained our fellow citizens taken captive on the high seas to bear arms against their country, to become the executioners of their friends and brethren, or to fall themselves by their hands.

He has excited domestic insurrections amongst us, and has endeavored to bring on the inhabitants of our frontiers, the merciless Indian savages, whose known rule of warfare, is undistinguished destruction of all ages, sexes and conditions.
In Jefferson's draft there is a part on slavery here

In every stage of these oppressions we have petitioned for redress in the most humble terms: our repeated petitions have been answered only by repeated injury. A prince, whose character is thus marked by every act which may define a tyrant, is unfit to be the ruler of a free people.

Nor have we been wanting in attention to our British brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which, would inevitably interrupt our connections and correspondence. We must, therefore, acquiesce in the necessity, which denounces our separation, and hold them, as we hold the rest of mankind, enemies in war, in peace friends.

We, therefore, the representatives of the United States of America, in General Congress, assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the name, and by the authority of the good people of these colonies, solemnly publish and declare, that these united colonies are, and of right ought to be free and independent states; that they are absolved from all allegiance to the British Crown, and that all political connection between them and the state of Great Britain, is and ought to be totally dissolved; and that as free and independent states, they have full power to levy war, conclude peace, contract alliances, establish commerce, and to do all other acts and things which independent states may of right do. And for the support of this declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our lives, our fortunes and our sacred honor.

Aggressive Teaching

I didn't just see that did I? An older, experienced, clinical instructor made a young medical student cry. What? There is absolutely no reason for a level of teaching aggression that causes a student of medicine, in any discipline, to cry. Remember when you were a new student struggling for your existence? What an asshole!!

How did it become the norm for the bastards of medicine and surgery to rise to the top of the academic medicine food chain? I can't imagine a worse scenario than the halls of medical academia filled with attitudes, agendas, insecurities, child-like behavior, tempers, egos and gross teaching negligence. Yet here we are.

There certainly are teacher exceptions to this observation and movements forward to a new perspective, but I am dismayed by the entropy, the forward motion, making the problem worse than I can ever remember. Assholes have NO place in teaching future physicians, physician assistants, nurses and others. They rob learners of their excitement for a field that is already difficult enough to navigate. They create roadblocks to learning where none should exist.

Do your part today! Kick one of those assholes in the nuts, today!
Ok, not really, but beware and create influence where you can.

Or just become a quality, mentoring, supportive, empowering teacher of young minds.
It robs you of nothing and contributes boatloads to the future of medicine.
It may actually feel good too.

Bullying Culture of Medical School
http://well.blogs.nytimes.com/2012/08/09/the-bullying-culture-of-medical-school/

Neglect

I often think I picked the right profession in the wrong industry. But being a clinician and U.S. medicine are intertwingled and there are no other industries to practice the craft of medicine in the U.S. It would be a tremendous thing to have a path to the practice of medicine more pure in form to the original concept without the trappings of institutionalization.

Between workload, external and imposed stress, sleep deprivation on call, self neglect and double standards that condone bullying and bad behavior...I don't know that I have much more time to avoid burnout and fall into cynicism. Although, I might be already there.

Instructors Prayer

Dear God, PLEASE hear my prayer. I pray that, as an instructor of young clinical minds, I never become the subject of a "what the fuck" moment. Amen.

Feedback in Medical Education

There are so many things wrong with graduate medical education from selection to the educational process itself. Working with newly graduated residency trained physicians and surgeons for many years and having been involved in the process, I see how completely dangerous the current process is. But one thing stands out as a real problem with the process - Feedback.

Clinician educators are awful at feedback to students and residents eager to learn. Diatribes of instruction and learning are lost in the incomprehensible feedback that many receive in inappropriate ways and places. It's not a skill we are born with, but learning how to provide quality feedback to students and residents is paramount to creating a learning environment that doesn't have a counterproductive effect on the learner.

1. Feedback should be private. Feedback in the midst of working events in front of the health care team of others is so damaging to young minds eager to learn. The damage, the breaking down, can easily turn the eager into the frustrated.

2. Feedback should be timely. Like spanking a dog 3 weeks after he/she has pooped on the carpet, the timing of feedback should be contemporary to a behavior, skill, attitude or belief. Instruction designers suggest within 24 hours but depending on the situation, may be sooner.

3. The learner should know that feedback is being provided. Sounds simple but feedback should be prefaced with that introduction. "I wanted to give you feedback on [such and such]".

4. The learner should be able to articulate exactly what he or she need to work on to improve a skill, attitude or belief when it is completed. Those providing feedback should give the learner time during the private feedback session to re-state the issue and formulate a learning plan for the future; the "what now".

5. Providers of feedback should be open to learning how to provide feedback from learners. Formal pathways for providing learner reaction and comments to feedback is necessary to continually improve the process. With "student" feedback, instructors need to continually ask themselves and seek information about how well they accomplish feedback and what they need to improve. Instructors need continuous self assessment as they learn to provide feedback and teach: What should I keep doing? What should I start doing? What should I stop doing?

6. Feedback should be a conversation not a mini-lecture series. Feedback in post doctoral graduate education should be a two way, professional discussion that helps to reinforce and correct. In that, the student needs to understand and be able to speak about his/her perception of the issue and process to change or learn. The conversation should include a discussion about how to move forward and what the student needs to do differently in the future.

7. Feedback should be based on concrete examples and date driven/specific actions otherwise it becomes an attack on the person (which should NEVER be the intention of feedback). Feedback is best received and most effective when it involves changeable behavior that can be achieved converting feedback from the instructor into behaviors in the learner. This must be based on something the learner can understand based on concrete examples and situations in a timely manner (see 2 above).

8. Feedback should conclude with an action plan with a conclusive agreement between learner and instructor on a plan for improvement. That plan (and agreement) should be specific to who, what where when and (most importantly) how. Consequences should be completely understood (both natural and imposed consequences). Learners need to confirm that understanding and the plan.

I shutter to think how many bright, young, positive minds have been squashed violently by feedback given wrongly, inappropriately and poorly in wrong ways and with wrong means. Graduate medical education needs to change in so, so many areas, but improving feedback from existing clinical and skill education based faculty can start now.

Yet most educators that read this or similar text will ignore it's message and continue to believe that their "style" is God-given, natural and always right. From a learner, get a clue. In many cases, nothing could be further from the truth. Providing feedback is a learned, developed skill.

System Failures

I have no illusions about medicine and it's ability to intervene in people's lives. It is necessary for our world to have a resource to go to when the body doesn't cooperate or fails.

Yet, I am constantly reminded of the failures of the system to manage the simple tasks presented. The system has become so ruthless, inefficient, redundant, pedantic and cost ineffective and I see no way out except out.

Once again I see greater attention to money, building monumental buildings and processes than I do to people and human resources. I become more and more saddened by the system and it's results. Health is not really about symptom management.

"Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. and above all, it takes a willingness to try." - Atul Gawande

I'd throw in that it takes enlightened leadership unscathed by systems, predetermined notions and despotic cronyism. But I digress.

Interview with Medical Expert

Q: Doctor, I've heard that cardiovascular exercise can prolong life. Is this true?
A: Your heart only good for so many beats, and that it...don't waste on exercise. Everything wear out eventually. Speeding up heart not make you live longer; it like saying you extend life of car by driving faster. Want to live longer? Take nap.

Q: Should I cut down on meat and eat more fruits and vegetables?
A: You must grasp logistical efficiency. What does cow eat? Hay and corn. And what are these? Vegetables. So steak is nothing more than efficient mechanism of delivering vegetables to your system. Need grain? Eat chicken. Beef also good source of field grass (green leafy vegetable). And pork chop can give you 100% of recommended daily allowance of vegetable product.

Q: Should I reduce my alcohol intake?
A: No, not at all. Wine made from fruit. Brandy is distilled wine, that mean they take water out of fruity bit so you get even more of goodness that way. Beer also made of grain. Bottom up!

Q: How can I calculate my body/fat ratio?
A: Well, if you have body and you have fat, your ratio one to one. If you have two bodies, your ratio two to one, etc.

Q: What are some of the advantages of participating in a regular exercise program?
A: Can't think of single one, sorry. My philosophy is: No pain...good!

Q: Aren't fried foods bad for you?
A: YOU NOT LISTENING! Food are fried these day in vegetable oil. In fact, they permeated by it. How could getting more vegetable be bad for you?!?

Q: Will sit-ups help prevent me from getting a little soft around the middle?
A: Definitely not! When you exercise muscle, it get bigger. You should only be doing sit-up if you want bigger stomach.

Q: Is chocolate bad for me?
A: Are you crazy?!? HEL-LLO-O!! Cocoa bean! Another vegetable! It best feel-good food around!

Q: Is swimming good for your figure?
A: If swimming good for your figure, explain whale to me..

Q: Is getting in shape important for my lifestyle?
A: Hey! 'Round' a shape!


AND,
For those of you who watch what you eat, here's the final word on nutrition and health. It's a relief to know the truth after all those conflicting nutritional studies.

1. The Japanese eat very little fat, and suffer fewer heart attacks than us.
2. The Mexicans eat a lot of fat, and suffer fewer heart attacks than us.
3. The Chinese drink very little red wine, and suffer fewer heart attacks than us.
4. The Italians drink a lot of red wine, and suffer fewer heart attacks than us.
5. The Germans drink a lot of beer and eat lots of sausages and fats, and suffer fewer heart attacks than us.

CONCLUSION:
Eat and drink what you like.
Speaking English is apparently what kills you.

Competition

The story of my medical career: competition with way smart yungins

Medicine

The unknowing, leading the unwilling, despite the ranting and raving of the self serving, attending to the ungrateful.

Just another day in paradise. Deja moo!

Tunnels Found

Presidio, TX - 5 Mexican nationals were killed this morning emerging from a tunnel opening within the city of Presidio today. Police say the individuals, armed with rocket propelled grenades and automatic weapons, were confronted by two local farmers returning from the downtown market in the area of the mall. Emerging from the tunnel at the edge of the parking lot, a gun battle ensued when farmers John Smith and Bob McCall saw the men, dressed in camouflage, exit the tunnel opening.

Armed with 2 shotguns in the rifle rack of Mr. Smith's F250 Ford pick up truck, the farmers held the Mexican nationals at the tunnel exit until police arrived 4 minutes after the 911 call from Mr. McCall. Texas Highway Patrol, country deputies and city police responded with enough firepower to neutralize the invaders at the tunnel exit. All of the armed Mexican nationals were killed and no injury was sustained by the farmers or responding law enforcement officers.

During the gunfight that lasted approximately 15 minutes, the surrounding area including 2 schools and the mall were placed on secure lock down. It is apparent from the location of the tunnel as well as maps found in the possession of the Mexicans that the mall and one of the schools was to be the target of their invasion. The investigation continues to and has been turned over to the U.S. Border Patrol, Texas SBI and the FBI. 

"There is likely other tunnels to be located along the Texas-Mexican border" said Border Patrol Capt Sam Remington. The formerly unknown tunnel is confirmation that the nation of Mexico, and particularly the radicle fringe of the Mexican Anti U.S. Army (MAUSA), is likely to be a continuous concern for border citizens of the U.S. When asked for comment during his recent trip to Camp David, President Obama said he is considering sending Army and Marine troops into Mexico to flush out the MAUSA and it's tunnel system.

- Imaginary Press Release. But if you are in Israel, this scenario is your reality. Just imagine.

Surgery Leadership Lessons

Dr. Kevin J. Tracey is the president and C.E.O. of the Feinstein Institute for Medical Research of the North Shore. He spent a lot of time in operating rooms over his medical career and learned some leadership lessons from that experience:

"I've seen the best of management and the absolute worst of management.  The worst is when the team fears the leader, so when someone sees something going wrong, they're afraid to point it out. I've also seen the best. It's about clearly stating the purpose and asking people how they're doing and really listening if someone needs something different that day. If the operating team can accommodate the needs of that person without deviating from the plan, that person will be a better member of the team.

Too often I've experienced surgery teams that have little interest in the team members. It seems to be all about the surgeon, then about the patient and then everyone else…if there is time. And there usually is not. Teams are, by definition, made up of talented, qualified members and without member support and care, the team disintegrates into a dysfunctional anarchy. This is the worst of leadership where fear dominates and frustration abounds.

So has been my recent history and I am becoming more and more disgusted with the environment created by its leaders lacking leadership. It's really very simple: "accommodate the needs of [the team member] without [disrupting the plan of care for the patient]" What exactly is so difficult about that concept? Team members really don't need, want or ask for much. And why are so many surgeons being turned out of training not knowing this simple concept. 

It's not about you, really.

Just Ring the Bell!

"Why don't you just ring the bell?" - Anonymous Surgeon

He didn't really say that and tell that story did he? I may not want to work with this ego maniac any longer, but this has to be the funniest conversation I've ever been involved in. I'm speechless. But that didn't stop me from chuckling out loud.

The average United States Navy SEAL spends over a year in a series of formal training environments before being awarded Naval Special Warfare (SEAL) position.

In 2005 a 4-man SEAL team, deemed Operation Red Wing, is sent in to capture or kill a Taliban leader in Afghanistan. They were discovered soon after landing in the area and forced to fight a fierce, futile battle.  Most of the team and all of a chopper full of would be rescuers, are killed leaving a lone survivor. The lone survivor is Marcus Luttrell, Navy SEAL. One of my colleagues recently watched the movie depicting these events, “Lone Survivor”.

Because of its particularly challenging requirements to become a SEAL, many candidates begin questioning their decision to volunteer for this training and a significant number Drop (from the program) on Request (DOR). The tradition of DOR consists of dropping one's helmet liner next to a pole with a brass ship’s bell attached to it and ringing the bell three times. The training and the bell DOR event is captured and shown during the opening credits of the movie.

Now, surgery can be a difficult environment and challenging but it’s not SEAL school. And surgery is patriotic and something we do voluntarily, but it’s not SEAL school. And being a healthcare provider is challenging and giving to the community we serve, but it’s not SEAL school. There is no DOR process nor should there be. It’s a career, and a calling, but not a life or death gunfight.

So to use the “bell” ritual as representative of whether to work with someone or not in surgery is ridiculous at best. Maybe even psychotic. Individuals have nothing to prove to anyone in their medical career except to themselves and their patients. We don’t have anything to prove to other providers who for whatever reason feel they are vastly superior to everyone else around them. Sometimes excusing one’s self from the company of others is better for the team, and the patient. Really no reason to stay in that working relationship or prove anything to myself.

It’s not a matter of “sucking it up”, not "ringing the bell" and continuing to work with just anyone.  That should be reserved for firefights against the Taliban.