Archive for the ‘Dr. Bob’ Category

Another Dr. Bob Tale, In the Which Nurse Duane Promotes Weirdness

When we last encountered the intrepid Dr. Bob, he had found himself in hot water with state regulatory agencies (as well as certain powerful medical associations) for his cherry picking proclivities.   And whilst focusing his not inconsiderable energies on dealing with and repairing the damage caused by his peculiar way of looking at data, he found himself in need of help…good help, effective help, image-sensitive help…to see that day to day operations at the clinic went smoothly.

Enter Nurse Swiãtopôłk Plesko. However, since no one at the clinic could actually pronounce his name, for some reason he was dubbed Nurse Duane. And it stuck. Nurse Duane hailed from the town of Wejherowoin in the Kashubian region of Eastern Pomerania, and spoke with a pronounced Slavic accent. Not that he couldn’t be understood, mind you…his English was quite good, actually…but his accent was pronounced enough to let you know that he most certainly wasn’t from “heah.”   Further, with rugged Slavic good looks complete with high cheekbones and thick, dark eyebrows…well…

But he didn’t actually have any eyebrows. Where those thick, dark, Slavic eyebrows should have been were only baldish eyebrow ridges. Sure, his head was shaved…but that was kind of stylish. And it seemed maybe a little odd that his face was also hairless…that he didn’t have a tough-guy goatee to set off his shiny head. But he didn’t have eyebrows, either. His face was completely hairless.   His entire face was bald. And smooth. Like it had been waxed or something.

It was weird. And disconcerting.

But Nurse Duane was a crackerjack administrator! He reorganized, shuffled, cleaned, polished, hired, fired, billed (as much as he could), collected (as often as he could), paid (when he must) and dodged (when possible) with an icy coolness and efficiency that earned him the admiration of Dr. Bob and the respect (but not love) of the entire staff. And after a period of about six months or so, the clinic looked to be well on the way to recovering from Dr. Bob’s cherry picking debacle.

Then it started. The changes. It was like Nurse Duane drew everyone in with his good looks and remarkable efficiency, then started making demands and issuing requirements that seemed a bit…odd. And while the performance of those demands & requirements wasn’t openly spoken of as necessary to maintaining employment at Dr. Bob’s Clinic, it came to be “understood” that if you wanted to work for Dr. Bob, you’d do what Nurse Duane required.

At first it all seemed reasonable enough. All nurses had to wear white, like in the old days. That was a bit of a hard sell at first, because most of the nursing staff hadn’t worn white in, well, forever. Some had never worn white…always those funky nursing scrubs. But, Nurse Duane made a good case…and slowly won the nurses over.

But that wasn’t all. Next, all the physicians on staff had to wear those really old school white tunics that looked like they came right off the set of a 1960’s TV medical drama. That caused a bit of a ruckus because the doctors weren’t used to be told what to do by anyone except Dr. Bob. But Dr. Bob stood behind Nurse Duane. And the fact was that the starched, white uniformity created a kind of efficient, antiseptic image that set off everyone’s South Beach tans to a remarkable degree. So, after a while, they all came ‘round.

Then it happened. One fine Monday morning, Nurse Duane called all the staff together and informed them that in the interests of cleanliness, no facial hair of any kind would be permitted. Since none of them happened to be bearded or mustachioed, they inquired as to exactly what he meant. And in his strongly Slavic yet entirely understandable accent, Nurse Duane told them that he meant they should all shave their heads, including their eyebrows. It was in the interests of cleanliness, after all, he said. In the interests of cleanliness, the android, face-bald look would now be de rigeur at Dr. Bob’s Clinic. And as understanding and gentle as Nurse Duane appeared to be with those clamoring their objections, in his equally understanding and gentle way he subtly implied that those who didn’t comply would find themselves in the unemployment line.

“In fact,” he understandingly, gently, and subtly intoned, “I don’t understand at all why medical professionals would object to such a thing. How is being face-bald hurtful to your profession? Does being face-bald affect your performance as a doctor? As a nurse? Will being face-bald cause you to lose your license to practice? You should just submit to being face-bald and trust me that I know what’s best for this clinic.”

They responded by asking him to show them in some authoritative medical journal or textbook the results of a study, of any study, that demonstrated that being face-bald was in any way indicated for medical professionals.

And with that he told them of how in 1575, in the Kashubian region of Eastern Pomerania, a bloody warlord had risen up to oppress the peasants. He had inflicted unspeakable depredations on the population, and had looted and pillaged at will. With his wild, flowing, black braided locks, and his long, thick, jet beard, and his bushy, beetle eyebrows, he was a terror to behold. And in response to the warlord’s depredations, a local priest had begun to encourage the men of the region to go face-bald, so as to clearly identify that they were not followers of this madman. In time, the women also began to go face-bald as well.

Understandable as being face-bald may have been in 1575 in the Kashubian region of Eastern Pomerania as a response to despoliations of a hairy, brutal warlord, it didn’t make a lick of sense to the very South Beach staff of a clinic in the Cape Cod region of Eastern Massachusetts in 2014. And they objected. Stridently. In fact, one could almost say that Nurse Duane kicked off another Revolution.  Because, for some reason, the medical staff couldn’t see any connection between not wanting to identify with an Eastern Pomeranian, Kashubian warlord from 1575, and the practice of medicine in Eastern Massachusetts in 2014.

And of course, there was no connection. Being face-bald may have made sense in Eastern Pomerania in 1575, but not now. And for Nurse Duane to demand it of Dr. Bob’s staff showed that, however skilled and efficient he was, in his mind there existed a fundamental disconnect from reality. The upshot of the whole debacle was that after the entire staff of the Clinic threatened to walk out, Dr. Bob fired Nurse Duane.

If you see him, you’ll probably recognize him right away. He’s still face-bald.

And that, my friends, is the story of how Nurse Duane promoted weirdness.

When Dr. Bob returned to his practice, his new found insights gained while cherry picking immediately began to find application in his practice.

When hiring new staff, he “cherry picked”. Not only did he pick the most academically and experientially qualified, and not only did he hire the best “attitude”, but he also hired the best looking candidates. No…not “best looking” in the Hollywood sense, but best-looking in the sense of representing the tanned, toned, South Beach ideal of his practice. And this form of “cherry-picking” worked out so well, that he rapidly expanded his application of the metaphor to many areas of his life, both mundane and professional.

Like photographs. That’s right. Pictures. Whenever publicity pics were taken, Dr. Bob “cherry-picked” the people who would appear in them. So; any candid shots that appeared in area magazines or newspapers, any pics that were posted on his clinic’s Facebook page, etc…all the human subjects of those photos were carefully selected to insure that they represented the clinic’s ideal. And while Dr. Bob was sidling anemic-looking spouses with love handles out of a staff picnic picture, the mantra was running through his mind; “Only the best!”

He applied his cherry-picking metaphor to other things too, chanting “only the best” in his head all the while. Dr. Bob began applying his cherry-picking metaphor to the way he did research. He became so concerned with only picking what seemed to be the best for the clinic that he’d only pick out and publicize research that supported his ideas. If he read something that flatly contradicted his ideas, he’d ignore it completely…even when the article came from the journals he regularly used to support his views.

He even applied the metaphor to medical records! That’s right! Dr. Bob because so obsessed with only picking the best, with only presenting the best image, that he actually began to alter the way he recorded patient data! In fact, it reached the place where it was hard to tell from his records that he ever had a patient who didn’t follow his instructions to the letter, who didn’t make a full recovery, and who wasn’t incredibly pleased with all aspects of Dr. Bob’s care. Weight and blood pressure always seemed (according to the records) to move in the right direction. Unhealthy habits like smoking always seemed to be properly resolved. In fact, among the governing bodies that reviewed such things, Dr. Bob’s clinic began to acquire the reputation of being almost miraculous in its ability to treat the sick.

Then, the state auditor called. Seems somehow she’d heard about Dr. Bob’s cherry-picking, and for some reason, she had an entirely different view of his metaphor. It seems that to her mind Dr. Bob’s mantra of “only the best” wasn’t remotely inspirational or motivational when it came to the practice of medicine. It seems that she thought of it as suppression of contrary evidence, as an example of confirmation bias. In her mind, the application of Dr. Bob’s cherry-picking metaphor led him to ignore facts, data, and information that would not put him or his clinic in the best possible light.

It seemed that the intrepid Dr. Bob had cherry-picked himself into a very awkward situation.

Stay tuned for more Dr. Bob’s heroic adventures…

With apologies to all the Bobs I’ve known.

Dr. Bob was a…well…he was a doctor. He was a mostly caring, charming, accurate, professional, concerned, thoughtful, smart, well-educated, up-to-date, rather handsome doctor of now rather svelte proportions who was also now rather obnoxious about his svelteness. Still, he was a good doctor in his own right. And being a good doctor, Dr. Bob understood the importance of holidays, for him as well as his patients. He knew that everybody needed a break in the routine, a change, a rest from the rat race, and so on. So, he rather religiously scheduled weekends away when he did nothing related to the medical profession.

What amazed Dr. Bob was that on these weekends that were a total break from his profession, he almost invariably learned powerful concepts that he could apply to the practice of medicine. Almost invariably while hiking over a mountain, or deep sea fishing, or diving among coral reefs, for example, Dr. Bob’s head would be filled with ideas about the activity, and about life, that seemed to be metaphors for aspects of his profession. And it was wonderful! While he’d only meant to do something that involved a radical break from the rigours and stresses of his practice, he actually wound up achieving a 60 watt form of enlightenment that made him a better doctor. (Hey…to be fair…60 watts of enlightenment is better than none.) It was really incredible! He returned from these little jaunts not only rested in body, but intellectually invigorated as well.

That’s not to say that all the thoughts that roiled through Dr. Bob’s head on these little adventures were sensible. That’s not to say that all the metaphors that were suggested to him had any real-life application. And it’s not to say that those few ideas that actually seemed to work in real life were always applied in the wisest way. But hey! He was trying…which was more than many of his peers were doing. Or so it seemed to him.

Take, for instance, the time that Dr. Bob went to British Columbia for a long weekend of cherry picking. Sure, there were places that were closer, that would have involved less expense, but these weekends were special. Spending a bit of money to ensure that the trip was memorable was well worth it to Dr. Bob. And of course, we plebs need to remember that he was a doctor. So, off to the south-eastern region of BC went Dr. Bob to pick cherries for a local orchard, anticipating all the wonderful thoughts he would think in the process.

It wasn’t an easy, devil may care kind of weekend. He had to be up quite early and into the orchard, because the cherries had to be picked before the heat of the day set in. Then, he had to be careful as to how he handled the cherries in the picking process; grip the cherry’s stem carefully between thumb and forefinger, up near the “fruit spur”, then twist gently. Then, one had to handle the picked cherries carefully to prevent bruising. And probably most importantly, Dr. Bob had to be very careful about which cherries he picked; only the ripe ones, no discoloured or worm eaten cherries, please. All in all, it was time consuming, slow, exhausting work. Yet true to previous experience, once he got the hang of it his mental juices began to flow. A mantra of sorts formed in his mind, and he chanted mentally as he worked through the weekend; “Only the best! Only the best!”

To be continued…

Dr. Bob Tries to Persuade

When we last left our intrepid hero Dr. Bob, he was beginning to put the squeeze on all of his patients whom he deemed as carrying too much weight for their own good. Never mind that all the markers of their health told anyone paying attention that they were actually in very good condition, Dr. Bob was insistent that his more chunky patients do their best to make themselves as South Beach as he’d become.

At first, Dr. Bob…the mostly caring, charming, accurate, professional,somewhat concerned, thoughtful, smart, well-educated, up-to-date, rather handsome doctor of now not-so-ample proportions and fairly obnoxious attitude…did his utmost to convince his hefty patients that it was in their best interest to adopt his strict weight loss & diet program. He provided materials for them to read, links to health-oriented websites, and even a DVD or two. He set up seminars on weight loss & diet, engaging famous health experts from across several disciplines to provide instruction. Surely if these chubby people could just be made to understand how much better they could feel, how much better they could look, they’d want to sign on!

But it seemed as if they didn’t get it at all. It seemed that the fact that their blood pressure and blood chemistry were perfect was good enough for them. It seemed as if the knowledge that their heart rate and lung capacity were amazing was good enough for them. Apparently they felt fine, and all the health markers discussed in all the medical journals said they were in excellent health. And, just as apparently, Dr. Bob’s urgent need to form them into his own newly svelte image didn’t impress them at all. They were healthy, and the few extra pounds they carried didn’t really concern them.

Dr. Bob Cranks Up the Pressure

So, when his more plump patients didn’t yield to his thoughtful, inventive, and scientific efforts to convince them of their need to lose weight, Dr. Bob ratcheted up the pressure by acting stern toward those who weren’t accepting his advice. He was wonderfully attentive to those who’d joined his program, but acted more distant and cool toward those who still didn’t really understand what all the fuss was about. That was enough for some…they left Dr. Bob’s practice and found another physician.

You’d think Dr. Bob would have been concerned about the loss of patients…but no. He was so obsessed with weight loss & diet being the answer to all health issues, even when there were no health issues, he didn’t really care if some patients dropped off. “Their loss!” he told himself and all his staff who inquired about the missing ones. “This clinic is here to help people get healthy! And if people don’t want to be healthy, this isn’t the clinic for them!” And when his nurse told him that those who left were healthy, healthy indeed, just a bit heavy, Dr. Bob would only sniff and comment that if they were really healthy they’d understand the importance of his weight loss & diet program.

Dr. Bob Succeeds

For those few heavies who remained, Dr. Bob increased their patient fees to motivate them to join his program, promising a reduction as they lost weight. Instead, he lost a few more patients. Finally, Dr. Bob was outright rude, openly mocking his remaining tubby patients as they sat in the waiting room. At last Dr. Bob managed to have every patient at his clinic looking just as tanned, toned, and South Beach as he did…but only by making the otherwise perfectly healthy chubbies feel so pressured and unwelcome that they had to find another physician to care for their needs.

We end our parable with a picture of Dr. Bob, standing in the centre of his waiting room, looking contentedly around at all the toned, tanned, appropriately slender patients of his practice. And he’s smiling…

…at his success.

 

I begin this post with a disclaimer of sorts. Or more accurately, with apologies to all the Bobs, Bobbys, Bobbies, Roberts, Robs, and RRRRRobbies I have known. Most of them have been great guys; one was an incredible artist, another was an erudite intellectual…and one was simply mahhhvelous!) In any case, I apologize for blaspheming your name. “Bob” just happens to work really well when trying to tell this sort of story.

Introducing Dr. Bob

Dr. Bob was a good doctor. He was a caring, charming, accurate, professional, concerned, thoughtful, smart, well-educated, up-to-date, rather handsome doctor of ample proportions. That’s right. Dr. Bob was fat. Not jumbo-large fat, but chunky. Girthy. Chubby. Hefty. Big. Heavy. Porky. You get the picture. It’s not like he spread out everywhere, but when he walked into the room you noticed that he was a good sized guy.

Sadly, in this era obsessed with image & appearance, some people judged his professional ability based on his chunkiness. Since he didn’t match their image of a TV doctor, since he wasn’t toned and tanned, they judged him to be a less than competent physician…which simply wasn’t true. And yes, some of his patients who were more conscious of image & appearance razzed him a bit from time to about his weight. Yet, even though they would have preferred him more on the slender side, they knew he was a good doctor.

For years Dr. Bob was a very effective physician, and his weight was no impediment to his effectiveness in his calling.

How Dr. Bob Changed Greatly

Then he got sick. Well, that’s an overstatement, really. He had a little flutter in his chest. Being a doctor, he knew he should go to a doctor, who told him that while he didn’t have heart disease…yet…he needed to make some changes in his lifestyle. He had to lose weight. Dr. Bob left his doctor’s office with a determined set to his jaw; he was going to do this.

Overnight, Dr. Bob changed his diet and established a rigorous exercise regimen. He became “clean” in his eating habits, “organic” completely….almost a vegetarian. He walked, then walked fast, then jogged, then ran. He rowed, went rock climbing, lifted weights, took vitamins, and got lots of sun. His weight dropped dramatically, his muscles toned and his shoulders broadened. Even his skin took on the sheen of health. He looked great, he felt great…in short, Dr. Bob was a new man! And, joy of joys, no more chest flutter!

But then a strange transformation took place. Well, maybe not so strange when you consider how radically Dr. Bob’s life was altered for the good by his weight loss… Dr. Bob became a diet-Nazi. (You know what I mean. You’ve known one.) Since his choices had worked out so well for him, and since his life had been so radically transformed for the better by them, Dr. Bob seemed to assume that weight loss was the answer to just about every issue of general health. And if it wasn’t the answer, it certainly was supportive of the answer. And in a remarkably short period of time, Dr. Bob began inserting “weight loss & diet” into just about every remedy he issued or prescription he wrote.

Dr. Bob Obnoxified

Sadly, he also began looking at some of his patients the way some his patients had looked at him, back in the “chunky-bob” days. He thought they were less, that they were somehow inferior, because in his eyes they seemed a bit too heavy. Even if their blood pressure was perfect and their blood chemistry was all in order. Even if their heart rate was great and their lung capacity was amazing. Even if they were perfectly healthy in every possible way…if they didn’t fit his new estimation, his new image, of what a healthy human being should look like, then he wasted no time preaching to them his gospel of weight loss & diet.

In short, Dr. Bob became obnoxious. While he was still a mostly caring, charming, accurate, professional, concerned, thoughtful, smart, well-educated, up-to-date, rather handsome doctor of now not-so-ample proportions, one would have to add “obnoxious” to the list of adjectives describing him. He became so focused on what had worked well for him, he seemed to lose touch with the idea that the same prescription may not be what’s needed for everyone.

So what if Jenny-Sue is a little heavier than you think she should be, Dr. Bob? Is she otherwise healthy? And if she is, how can you suggest that weight loss is what she needs? Maybe, Dr. Bob, Jenny-Sue’s extra pounds aren’t really the issue. Maybe your obsession with weight loss & diet reveals more about your needs, about your weaknesses, and about your fears, then it does about your patients…who may be otherwise perfectly healthy, if a little on the heavy side.

(This is the end of Part One of the Parable of Dr. Bob. Part Two will follow soon!)