healthcare advocate

healthcareOK…

Some of this may be a little gross, but it is important to read this in becoming your own healthcare advocate.

I went to a dermatologist today to have a plantar wart treated.  Plantar warts are unpleasant.  They are warts that grow on the bottom of the foot.  They make every step feel like there is a pebble in your shoe.  As the warts grow so does the pain.

After numerous over the counter treatments and old wives tale remedies that failed to shrink the wart, I decided to have it professionally treated.

I met the dermatologist.  She was a newer doctor and not one that I recognized from the practice when I visited a few years earlier.

She examined my foot and was indecisive about my lesion.  She was thinking out loud and settled on a diagnosis of a callous.

In my opinion she was misdiagnosing my problem.  I have had warts through most of my life and was quite familiar with their characteristics: cauliflower looking skin, black dots in the middle, regrowth after trimming, etc.

When the Dr, seemed committed to the callous diagnosis I had a pit in my stomach.  I don’t go to the doctor often and for me to have my chief complaint minimized felt frustrating.

In a split second I needed to make a big decision… Do I accept the diagnosis that I believe is wrong and leave the office dissatisfied?  Or… do I advocate for myself with the understanding that the doctor will be offended that I am questioning her judgement.  So many things could go wrong for me.  She could think I am questioning her because she is a female (untrue).  She could think I am questioning her because I think she is young (untrue).  None of these are good outcomes and will lead to extreme awkwardness whether I am right or wrong.

I decided to go for it.

I very politely told her…”with all due respect to you and your training, I believe my experience is consistent with a plantar wart.  Can you have a peer consult and take a look?”

She was clearly irritated and left the room as she told me she would ask a partner to look.

After a 20 minute wait, the partner came in and examined my foot.  He manipulated it in a way that was different than her style.  The results from his physical manipulation were different than when she did it.  He looked through a special magnifying glass lined with lights.

When he looked up from the visual exam, he asked her “did you use this?”

She said yes.

But in that moment I knew I was right and she was wrong.

The senior doctor smiled and shook my hand as I thanked him for his time and flexibility.

He said that he and the other doctor would discuss outside and be right back.  Again, I immediately knew that this meant she did not make the correct diagnosis.

When the original dermatologist re-entered the room she said that the senior doctor thinks it “may” be a wart I was not surprised.  We agreed to try freezing the wart and she applied the treatment.

In the end, my decision to break societal norms and question the expert led to a more useful visit for me.  I feel badly that the clinically trained doctor made a mistake.  I also feel badly that she will probably be angry and may telling herself I questioned her because of her gender.  Hopefully, she will be self aware and think about it at the end of the day to learn from the experience.

As for me, advocating for myself was rewarding.  Too often we accept experts as dogma.  In my case the results of a misdiagnosis would not be too impactful, but if it were for a more meaningful health issue the impact could be of life or death.

Don’t be afraid to ask questions, and do not be embarrassed or ashamed to persist until you are satisfied with the answers.

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best man speech, 15 years old

 

champagne-glassesAbout 15 years ago, I was honored to be the best man in my friend’s wedding.  It was a destination event at Walt Disney World in Orlando, Florida.  I remember the day was very hot and we were all wearing heavy wool suits.  I knew I wanted a short toast and the weather definitely solidified my decision….

It went like this.

Friends and family, we are gathered here today to celebrate the marriage of Kevin and Erin.  When Kevin asked me to be his best man I was humbled but excited to fill the role.

I was there the night that Kevin and Erin met so I feel uniquely qualified to send them into wedded bliss.  Watching their relationship evolve from a single dance at a frat party to this wedding today allowed me to also get to know Erin.  She is smart, kind, funny, and most importantly …. tolerant!

Kevin and I met in college.  We were roommates and became fast friends.

I can be judgmental with my friends.  I might rank them and the absolute best friends are those like Kevin.  I know that I can ask Kevin to help me move apartments or bail me out of jail at 2 AM with no questions asked.

And ever since Kevin and Erin’s engagement last year, I have been preparing to to formally give up the title as Kevin’s best friend.  Today marks the final transition of that process as Kevin and Erin pledge eternal love.

But Kevin you know you can always count on me any time.  If you ever need me to bail you out of jail at 2AM I will be there in a flash.

But from now on, you’ll need to call Erin first!

Thank you and Cheers!!!!

when in doubt, do right

Over the past couple of weeks a number of major venture capitalists have written mea culpa articles apologizing for the ways that the contributed to a misogynistic culture in Silicon Valley.  The first was a bit vague and general but seemed to focus upon inaction in the face of adversity.  This individual recognized that he was silent as others created an environment of fear and hostility among his female peers.  The second VC acknowledged that he was a “creep” (because creep sounds better than serial predator) and had a hard time expanding his dating pool beyond his coworkers and subordinates.

Each of these folks garnered a lot of feedback following their admissions.  Some of it was negative as many people boiled the message down to “talk is cheap”.  While others praised the authors as “brave” for opening a dialog about current injustices and taking accountability for their actions.

I felt that both were weak, somewhat public relation stunts borne of white privilege.  It seems that each character entered into this foray under his own volition and control. They were able to craft their own message and own the sentiment.  One of the authors resigned his post at a VC but coincidentally, the other guy retired only a month prior…dubious timing.

The thing that bothered me most about the apology tour is simple.  It should have never been necessary in the first place.  We all make mistakes in life so no stones are being thrown in that glass house.  However, when you participate in a pattern of systemic and prevalent culture of hatred and dehumanization of half of your co-workers, a simple apology essay doesn’t cut it.

I can tell you first hand about this because I lived it and I did the right thing and it was one of the times in my life that I look back upon as a watershed moment.  It solidified who I am as a person and gave me the moral high ground to expect more from people around me.  It also provided the experience to teach my future children that being kind and just is simply not that hard.

I was in a fraternity at college and during rush season we held a number of parties and open houses to meet potential members before offering them bids to pledge.  Of course looking back, fraternities were the dumbest and juvenile organizations at my college but I digress.

One individual came to all of your events.  I’ll call him NP.  He was interested in the culture of our fraternity which had no prevailing identity.  We weren’t jocks but we had athletes.  We weren’t service oriented, but we volunteered.  We weren’t an academic fraternity but we had future doctors.  We were just a group of regular guys who liked to hang out and drink beer.

NP met all of the current brothers.  He was Indian and had a stutter at times and went out of his way to put himself out there.  I liked him but we weren’t friends yet.

At the end of rush season the fraternity meets to decide whom to invite into the group. Names are read and discussed and votes are taken.  Sadly it is very similar to the scene in “Animal House” as each pledge is reviewed on a projector screen.

When NP name came up, there was limited conversation and he was to be skipped for invitation.  It was at that moment I became the man I am today.  I stood up and said something to the effect….

“I am disappointed to hear about the direction that this vote is going.  NP has been to all of our events.  He has made efforts to meet every one of you, although you have not done the same.  He looks different than you.  He sounds different than you.  If you want to still vote no, that’s fine by me, just be honest that its because you’re racists and that it doesn’t have anything to do with the effort NP has shown getting to know you all. ”

And then I sat down.

The vote flipped and NP was a new inductee.

Eventually word got back to NP about the meeting and thankfully he focused more on the fact that I had his back over the dismissal he was about to face without it.

I think that the meeting had just as big as an impact on him as it did for me.  As he learned that I stood up for him against odds and put my reputation on the line to do the right thing made a lasting impression on him.

Now if you have read this far you may be asking yourself…how does this compare to the VC problems with misogyny?  How dare I compare a simple fraternity membership issue to something as big as wide scale discrimination?  The answer is simple to me.  Culture is derived by the actions that are praised and punished within an organization.  Little interactions turn into medium interactions that turn in to larger interactions.  When micro agressions are tolerated, it builds the foundation for more absurd activity.  When people can comfortably treat others as inferior without repercussions a snowball effect can take place.

Alternately, when people do the right thing in small ways such as hold doors open and keep elevators open for rushing staff a culture of respect can follow in meeting rooms.

Good begets good and bad begets bad.  I think it is really that simple.

So to the VC on their apology tours, its good that you recognize your roles in creating this mess.  But talk is cheap and I look forward to hearing from those who you now help to right your wrongs.

 

assume a can opener

The phrase assume a can opener comes from an old joke almost all economists can relate to.  Here is one of the most common versions:

” A physicist, a chemist and an economist are stranded on an island, with nothing to eat. A can of soup washes ashore. The physicist says, “Let’s smash the can open with a rock.” The chemist says, “Let’s build a fire and heat the can first.” The economist says, “Let’s assume that we have a can-opener…”

I have been thinking about some of my own core assumptions recently and how they have been painfully wrong.  I am not talking about “Black Swan” type of events but I have been alarmed at my own bias and the possible ramifications.

Allow me to explain….

When gasoline hovered around $4 per gallon right before the economic crash of 2008, I believed the cost would never go down again.  I mean gasoline is a finite resource, growing world economies were putting a drain on production, and suburban sprawl continued to expand.  Although a true black swan event did occur in 2008 and the price of fuel plummeted due to decreased global demand, it eventually recovered in 2011 when the price of a gallon of gasoline returned to approximately $4 per gallon.  I was right!

Wrong.

Since the recent highs in 2011, gasoline has dropped to prices not seen since the Great Recession of 2008.  I have recently seen prices near $2.10.

I did not assume such volatility in a commodity of gasoline when considering a new car purchase.  I expected high gas prices to remain high.  Even when I consider the increased fuel economy of modern cars I didn’t expect gas to remain affordable to drive a giant SUV compared to my fuel sipping Volkswagen.  The assumptions that I made in 2011 were stunningly wrong.  I don’t normally regret buying the smaller car, but parts of me yearn for a big truck like everyone else around me.

The chart reflects @RBOB regular unleaded gas future prices prior to taxes and deliveries to the consumer..

historical

In another instance of incorrect prognostication I considered purchasing solar panels for my house.  I ended up not making the deal, but part of my data in consideration was the assumption that electric prices would always rise.  Well, I just got a notice from my local provider that they are dropping rates for the summer during the time of peak usage! How could I be so wrong again?

I think it is high time I start to re-evaluate some of my core beliefs.  On one hand, the cost of energy come may down due to increased efficiency, but it may also be offset by increased delivery costs as aging infrastructure.  Gasoline cost may continue to drop as US natural gas production rises and we import less oil.  Governments may take advantage of low cost gasoline to raise fuel taxes to support roads and bridges projects.

We all know the joke about when we ass-u-me things.  It is up to us to be more thoughtful about evaluating them to make sure our core beliefs still align with reality.

One assumption we may all agree on is that taxes will always rise…or will they?

Do you have any assumptions that were incorrect?  Tell us about them here!

 

so I am not Knute Rockne

The pregame talk to my U12 soccer team started with “ok guys, we are playing short handed and we are not supposed to win this game”….

Not a very awe inspiring introduction but as I kept talking I looked at each of the players right in the eye and gave each of them a specific goal for this game.  I told them that in the face of great adversity there are great rewards.  If we lose, we are supposed to.  But if we work hard, support each other through our mistakes, and execute what we have been learning in practice we will have our best chance for success.  I was hoping they believed me, because I was not sure I believed myself.

I was hoping to merely survive the game and keep the score respectable.  We had lost to the same team 4 weeks earlier when we also played short handed.  My squad had 8 players due to baseball conflicts and the other team played with 9 and had a few on the bench.  Mathematically the team with more players should win most of the time.  They have more space to execute as well as substitutes to relieve tired players.  I had none.

As our game progressed, I sensed something pretty magical happening.  The selfish players were passing.  The timid players were going in hard on tackles.  The negative kids were encouraging their teammates.

My team played a perfect game and won 3-0 in a game they were almost guaranteed to lose.

As a leader and a coach I thought about my pregame talk long after the game had passed. Was I able to relieve some apprehension about being shorthanded by encouraging the players to focus more on the things we were in control of over the fact we were shorthanded?  Did I do the wrong thing in showing less than 100% confidence in them? Did the talk even matter at all?

At the end of the game I realized that coaching sports, managing teams, or parenting children are all pretty similar.  You try to teach to the best of your ability, do everything in your power to make sure the learning takes place, and then encourage proper execution.   When the kids took my message to heart and played the way I intended, they overcame great adversity and were rewarded with a great win.

Take Your Child to Work Day… ruined

Just about one year ago, I was terminated from my position as a Technology Director.  I never saw it coming.  All of my performance reviews exceeded expectations for 16 years, and every annual bonus was above my target range.  There were no performance improvement plans or constructive feedback session.  I heard what HR told me in the exit meeting, but I’ll never know the real reason.

The truth of the matter is that I was unhappy in the job for a few years.  My commute was terrible, and there was not much opportunity left to grow my career in the small company.

I had built such amazing teams, that they made my job very easy to do, perhaps a little too easy.  I was lacking challenges at times but was always able to keep my interest going by creating new projects and evolving the responsibilities of the teams as a way to innovate and stay fresh.

It didn’t occur to me until late in that day that this change of employment status happened a day before Take Your Child to Work Day.  This was the absolute worst part of my day.  My youngest son had been expressing a lot of interest in finance and we had made plans to visit the Stock Exchange where I still had credentials, friends, and co-workers to visit.  I planned a big day out in the city when we would take the train in, go to work, and have lunch.  My ex-coworkers were going to show him all about pit trading, technology, and let him wear the brokers jackets for pictures.

Truth be told, I could have still made the visit, but I didn’t want to put my reputation and more importantly my severance at risk.

Through the whole embarrassing and frustrating ordeal of losing my job, the sabotage of taking my son to work was the part that hurt the worst.  Explaining that the trip was cancelled was the only time I ever got choked up through the whole ordeal of job loss.

Although the day trip was cancelled, I still held him out of school.  We watched CNBC and Bloomberg.  We reviewed the basics of stocks and public companies and even ventured into the world of options as I drew upon my previous work experiences.

Even after a year since the job loss, I think about it almost every day.  Being “ghosted” after a 16 year career was confusing and deeply painful.  When that loss impacted my child, I felt embarrassed and ashamed.  But in the end it led to great conversations about why owning a business can be better than working for someone else and stoked a fire in him at a young age to not become beholden to a boss, but to be his own boss in the future.

 

Jams, 35 years in the making

Having been raised in a WASPy home that was typically on the reserved side, I have developed a silent laughter.  When I find something really amusing you’ll see my mouth agape, eyes squinting and perhaps tearing up, but never emitting a single sound.  It is an odd characteristic and one my wife teases me about from time to time.

Imaging her surprise when I told a story of my childhood that left me in uncontrollable laughter.  I mean real belly laughter that resembled and asthma attack.  I couldn’t even catch my breath as I wove my childhood story of the Jams.

For those of you who are not children of the 80s, Jams were a floral print pair of shorts. The brand had captured national attention and was strong enough to even make a foot hold in New Jersey.  The colorful shorts were the “gotta have it” item for young boys who would proudly wear them on the beaches and boardwalks of the Jersey Shore.  As my sister pined away for Cabbage Patch Kids, Jams were my equivalent.

I grew up in a comfortable middle class household and was fairly spoiled, but for some reason my Mom drew a line in the sand on Jams.  They were expensive by standards and she felt that the cost was for the label and handed out a firm “no”.

I was disappointed.  Like any good Mom she felt bad about depriving her son of something he really wanted, but she couldn’t pay those prices for a pair of shorts.  But she had a plan!

I came home from school one day and she was beaming.  When I asked her what was up she said “I know you really wanted some Jams but I just can’t spend that kind of money to buy them.  SO here is a pair that I made for you!”

When she showed me the shorts I was horrified.  They floral pattern looked like something from my grandmother’s curtains and the elastic waistband was nothing like the tied up look of the real board shorts.  For those of you who have ever heard of Eddie Murphy’s routine about MacDonald’s Big Mac versus the Houseburger on white bread his mom made, I felt the same way.  Of course I was disappointed but wore the shorts that summer, and was probably made fun of a lot.  I say “probably” , because I think I blocked out that summer from my memory.

Fast forward 35 years.

I was telling my story of the Jams to my wife and could not control my laughter.  I could barely get the story out.  I then called my Mom to repeat the story to her and again could barely get the words out through the hysterical laughter.  Oddly she also had no recollection of the home made Jams, but she also laughed as hard as I was because the absurdity of the story was contagious.  We all had a good laugh and a fun time reminiscing.

On my 44th birthday, my Mom invited us over for a family dinner.  She handed me a box, and she was beaming with anticipation.  I knew something was up when my sister took out her camera to capture the moment forever.  When I opened the box, the glowing colors of REAL JAMS reflected off my smiling face!!!  It was one of the most thoughtful gifts I have ever received.  After 35 years of waiting, I am complete!jams