The Advocate: Mark Lopatin, MD, FACP, FACR, FCPP

[0:20] Paging dr. cook paging dr. cook dr. Turk you wanted in the o.r. dr. Koh.

[0:27] Music.

[0:51] Hello everyone and welcome to prescription for success.
I’m dr. Randy cook your host for the podcast which is a production of MD coaches providing leadership and Executive coaching for Physicians by physicians.
To overcome burnout transition your career develop as a leader or whatever your goal might be.
Visit MD coaches on the web at my MD coaches.com because you’re not in this alone.

[1:20] My guest today recently retired after 28 years in a very successful Rheumatology practice but he’s continuing to have a big impact on Health Care issues as an activist and as an author.
With a new book called room for.

[1:36] That’s rhe um room for improvement so let’s hear my conversation with dr. Mark Lowe patent.

[1:44] Music.

[1:50] Well I’m looking forward to a really great conversation today with dr. Mark little patent.

[1:56] Who is a recently retired rheumatologist Mark thanks so much for being with us today I’m looking forward to the conversation thank you for having me.
Mark has a terrific book that I have read most of I was only able to acquire my copy just a few days ago mark But parts of it that I have read are really.

[2:15] Very compelling and we’re going to spend some time talking about that
but as we always do on prescription for success I want to begin with your Beginnings tell us a little bit about
how you got interested in medicine and what your early days in training were life
well realistically there was no set incident that caused me to go into medicine and was kind of understood from a young age that I was going to become a doctor I was always strong in the sciences and math and it
naturally LED there there’s no one in my family who’s a doctor so I don’t have a specific answer to how I went into medicine always wanted to quote help
people and quote.
But I never really understood what that meant growing up I really was kind of oblivious until I got to medical school and residency and even thereafter.
Did you learn anything from television doctors by any chance
I watch Marcus Welby growing up and you know it was there you go problem was always solved in half an hour and he’s very caring doctor and there was no bureaucracy and it was totally unrealistic
that’s exactly right well I apologize for the interruption go ahead and tell us about
undergraduate school and and getting into medical school well you know I went to went to college went to medical school frankly I was clueless I knew nothing of.
Bureaucracy I grew up in the 60s time of the Vietnam War the Kennedy Martin Luther King assassinations Watergate.

[3:39] Kent State and I knew nothing about these things growing up my major interest was what were the Eagles going to do that year and you know.

[3:48] How are the Phillies going to play that year I was very into sports and.
I was totally oblivious I didn’t become involved in anything political or anything involving advocacy until much later in my life I was able to vote for the first time in 1976
I didn’t even know what a Democrat or Republican was didn’t know the difference in fact I didn’t learn that until I was in my 40s
totally apolitical until various events in my life caused that to change.

[4:16] Here and I really do want to get into that but I’m also curious to know that.
With that background which I think is fairly common for people who were training in the 60s and 70s as you and I were but the experience of medical school wants you were there was it was it.
More or less like you expected or were there some shocks at that point.
Um there was a there was the first taste of bureaucracy and there’s all kinds of stories I did part of my medical strength school training in my residency at the VA Hospital
I often joke that the only reason the VA exists is so that we have stories to tell later on in life but it began to get it education yeah but I began to get a taste
of bureaucracy I began to get a taste of how doctors are viewed and
it didn’t really register with me at the time it wasn’t until I wrote the book that I’ve looking back on these incidents that I realized oh my God.
This is what I could have learned from that this is what I did.
By default learned from this and I applied it later on in life I didn’t have conscious knowledge of the lessons I learned at the time that I learned them.
I kind of swallowed them but never really tasted them.
Until much later on when I really thought about what was going on and what I had experienced it’s an interesting analogy.

[5:34] I’m also sort of fascinated about your selection of Rheumatology as
a specialty people always ask me why I wanted to Rheumatology and once again it was an unconscious decision that fit perfectly with my personality one I love to solve puzzles and games.

[5:51] Rheumatologist all about puzzle solving puzzles solving difficult problems
two I’m not fast on my feet I need time to digest think things through I
would not have succeeded as an emergency room doc or as a surgeon where decisions need to be made instantaneously I do much better when I have a chance to process information furthermore Rheumatology gave me a chance to
trying to get to know my patients.

[6:16] I mean I tell the story of one patient whom I met when she was 25 or so she was working independently she had lupus and I met her and diagnosed her and then she asked me that she met a guy
and then she got engaged.
And then she got married and then she had her first child or second Chuck and I got to experience all this with her and basically I took care of her for 25 years and got to know her personally and.
That personal aspect is very much a benefit to Rheumatology it’s not so much of a benefit in some other Specialties and that was very attractive to me although again I didn’t realize it at the time I didn’t realize it till much later how much Rheumatology fit with with who I am.

[6:56] Yeah I think that’s a really interesting observation and I don’t want to over personalize the interview but I had a career in surgery and I didn’t realize how much I missed the continuity of care over a long period of time until
I stopped operating and I became the medical director of a chronic wound care center.
And it was much like Rheumatology the patients either never get completely healed or it takes a long time to do it and I really found that much more satisfying and it sounds like that’s what you’re talking about one of the things I point out in the book is what Samuel Shem.
Talks about in the house of God he talks about the art of medicine as quote being with and quote the patient and that means sharing their life with them sharing their ups and downs being there with them validating them and you know watching your patients have kids.
You know being with them when they experience something great a grandchild or a vacation and also being there to console them when something bad happens when their disease gets worse or we can’t control it and they’re in pain and it’s just that act of being with the patient which is.
Very conducive to good patient care as I said the caring may be more important than the curing and that’s especially true in Rheumatology because we don’t have a lot of cures in Rheumatology doesn’t mean we can’t help people though so it sounds like.
The in that early part of your career after you had finished your Rheumatology fellowship and we’re beginning to establish yourself and practice you probably felt like at least in the beginning.

[8:24] That you were in exactly the right spot and then you begin to come face-to-face with some realities that.

[8:33] I think a lot of us never expect and I will let you pick up the story from there well I assume you’re talking about the lawsuits that would be a good place to stroll yeah well I had two lawsuits within two months apart the first one
I was a patient that I saw with fibromyalgia who did well I saw her total of four visits I didn’t have to do anything with her because
primary care doctor it started on her medicine and she did well on it she later sued me for failure to diagnose her brain tumor.
Now keep in mind as a rheumatologist I’m a joint doctor I don’t diagnose brain tumors and I had asked her the Cardinal question about.

[9:08] Of headache which is the Cardinal symptom of this particular type of brain tumor she told me no so basically I got sued for failure to diagnose something outside my specialty in a patient who denied the Cardinal symptom of that
the problem even though I specifically asked
Rod the plaintiff’s attorney could never get an expert to testify against me in the case went on for two years before my attorney finally filed for contempt and this lawsuit was dropped but I had two years of anxiety over that case
the other one was much worse this was again a lady with fibromyalgia who might treat it
who developed hearing loss she saw an ear nose and throat doctor in Philadelphia who diagnosed with autoimmune sensorineural hearing loss
he put her on steroids and she alleged she had a side effect from those steroids and I got named in the suit simply because I was a treating physician even though I diagnosed the problem that she had which was a vascular necrosis got her off the steroids very quickly
and basically did everything I was supposed to do however the.

[10:07] Beginners and throat doctor was in Philadelphia and the lawsuit was going to be taken to Philadelphia which was well known as a Judicial hellhole
at the time and my attorney said to me your chart documentation is good you’ve done nothing wrong he said now you need to settle this suit because none of that’s going to matter to a jury in Philadelphia
and I had to face the difficult decision of whether to settle a lawsuit knowing I’ve done nothing wrong based on the circumstances with the idea of.
How do I look my kids in the eye and tell them to fight for what’s right when I’m giving in in this particular case because of a number of other circumstances I was at risk for
being the Sole Provider
in terms of paying off this case and the risks were too great so I ended up settling a lawsuit and that affected me tremendously emotionally in terms of future patients I wondered if future patients were going to be potential.
Plaintiffs you know the patient-physician relationship was damaged of that and I ultimately needed counseling to help me get through it
that they really is very understandable everything that you’re saying and I’m going to ask you to go ahead and amplify on that a little bit because
we have young Physicians and and even medical students that listen to this podcast from time to time.
And I would like for you to talk a little bit about that incredible feeling of being the only.

[11:31] Person that this is ever happened to when in reality there are.
People that have been frivolously or unnecessarily sued for malpractice all over the place can you talk about that a bit
but one of the things that this did was it spurred me on to become political for the first time in my life and I joined a politically active Physicians Association I began to get involved with political candidate to support a tort reform and I began to look into the issue
actually conducted a survey of over 1,000 Physicians across the state of Pennsylvania and found that seventy percent of them reported having been sued at least at one point in their life
which was amazing because one of the key things in this that you point to is the isolation the sense that you’re the only one who’s ever going through this you’re not allowed to talk about it.
My partner’s only knew that I was being sued they didn’t know any of the details of it and you’re not allowed to share it with anybody and there’s a sense of feeling like you’re inadequate like you’re a bad doctor even though I looked at the chart and knew I’d done nothing wrong.
There’s still that feeling there’s also the feeling of being violated of having been sued when you haven’t done anything wrong and being taken advantage of.
One of the things I preach to other Physicians when I talk about this is the idea that fer a lawyer this is strictly business this is nothing personal and I preach the lawyers this is a very personal a couple comments on that.

[12:50] One getting sued for malpractice is not the same as getting sued for a car accident when you meet someone at a party you initially judge them based on their age form Impressions about that you
immediately
learn their gender you ask questions like are you married do you have kids one of the first questions you ask is what kind of work do you do because the work that we do our jobs are part of our identity.

[13:17] Driving is not part of my identity so when I get sued for a car accident that’s not a reflection on my character or my identity getting sued for malpractice is it’s deeply personal but I tell.
Physicians that for a lawyer this is strictly business I know of one quickly I know of one case where while the jury was out deliberating the plaintiff’s attorney approached the defendant.
And asked him if he would be an expert witness for another case he had the lawyer had no qualms about the expertise of this physician this is strictly business.
Proposition for an attorney and.

[13:53] It’s nothing more than that and if you can look at it that way as a physician it takes the onus off of the personal nature of this but don’t you think it’s next to impossible for
most Physicians I won’t say all.

[14:06] But don’t you think it’s just nearly impossible for most Physicians to be totally unable to not.
Take this sort of thing as a person on the salt on their integrity and their skill it’s extremely extremely difficult I mean the emotions
override the the logical part of it and that’s why I encourage Physicians to try to use the logic try to use their intellect to think this through as opposed to the emotions because the emotions are very strong
for the reasons I’ve outlined its traumatic it is deeply traumatic I mean there’s a form of post-traumatic stress disorder from this called malpractice.
Medical malpractice stress syndrome I’m convinced that I suffer from that even though I’ve never been formally diagnosed but it is a form of PTSD and it’s very very difficult to get through on I was angry I mean I could not get the venom out of me.
For months or years and even now 20 years later as I talked about this.
I’m visibly shaking because of the emotional impact of it but sometimes you can use intellect to help soften the emotional aspect of it and that’s what I try to tell Physicians to do.

[15:10] But like I said I needed counseling to help me get through this to make me realize that I was not a bad person or a bad doctor just because this happened to me well it’s a credit to you that you were able to come to that realization and
take that step to take care of yourself and I’m glad that you did that and I appreciate you
sharing that information with us I want to move on to a slightly different topic we’ve been talking about
a venue a style of life we’re getting into oppositional debates with other individuals as normal day-to-day business and
we use talked about very nicely how that’s just the way they do business but the next thing that you ran into after you were recovering from the Civil bar is the Board of Medicine in Pennsylvania.

[16:00] And again I’ll just let you tell the stroller well if the prior lawsuits were a hurricane.

[16:09] My experience with the State Board of Medicine was a tsunami it just blew me away basically this was before the opioid crisis existed on state boards were starting to get
concern about opioids and they were looking for a case I had a patient who was a chronic pain patient who was on an opioid when I met her I adjusted
her dosage of medicines upward as was the current teaching at the time I put on a long acting
medicine at the time pain was quote the fifth Vital sign doctors were being accused of not treating pain aggressively enough addiction was viewed as
a substance a function of the patient rather than the drug it was taught that there was no ceiling to opioid dosage generally speaking and I got my patient up to a very high dose
of an opioid Oxycontin and stabilized her she was stable on that dose for 3 years with her pain
much better controlled when she got admitted to the hospital for something else and the doctor they’re question the diagnosis of fibromyalgia said it didn’t exist.
And said she should not be on this much pain medicine he was actually right he said I mean he said that she didn’t have fibromyalgia or that there was no such thing no such thing so he totally discounted her pain and you know
told her basically what that I was a bad doctor for having her own so much Oxycontin even though that was the teaching at the time her husband who questioned her pain.

[17:37] In the first place and they had a rocky relationship subsequent reported me to the State Board of Medicine I found out later after all this one.
Down that the State Board of Medicine had a political agenda.
They were looking to set an example of someone prescribing opioids and wanted to put post my head on a stake and parade me around town for all to see this is what happens to you if you prescribed opioids to do so they hired a
quote expert and quote witness who had done one year of a family practice
internship in the 1960s he did no residency he had no training in Rheumatology and he made his living testifying against doctors he reviewed my chart and made at least 25 errors of fact.

[18:22] In his report now.
We can talk about errors of opinion where I say I start a patient on 20 milligrams of a dosage and he says you should only start the dosage at 5 milligrams
that’s a difference of opinion and you know you can argue who’s right or wrong when he says you should start the patient on 5 milligrams of
of medicine and I was remiss in not doing that and my chart.
Documents that I did start the patient on 5 mg that is an error of fact he misinterpreted the facts he said I didn’t have a history of physical in the chart he didn’t I didn’t document fibromyalgia tender points 25 errors in the chart
we pointed this out to the State Board of Medicine they didn’t care they needed someone to testify to what they wanted to testify
and the facts were not going to get in the way of this
in fact I wrote an article on this case in 2017 which was published in the Journal of Medical Practice management and the title the argument was the facts didn’t matter they weren’t interested in the facts so I was up against someone who was literally lying.
To make a point the most telling
thing that happened to me was at the trial of a couple things one he was on the stand for a day and a half as our attorney asked him questions I was on the stand for only 20 minutes because every question they asked me I had an answer to
they want to get me off the stand but the most striking thing in the most lesson I learned about this.

[19:42] While I was at the trial I met this man for the first time and he extended his hand to me and by default I took his hand and shook it
I’ve regretted that moment ever since how could I take the hand of someone who is out to destroy me without regard for the truth and what I think probably because you’re a decent person that’s what do you ask will do but I learned that civilities should not.
Be the default behavior when someone morally does not deserve them and I learned from that and it made me much stronger in terms of my own assertiveness in terms of not just engaging in civil behaviors with people who are just unethical.
Which is what this man was.
Again I’m a little I’m sorry again I needed more counseling to get through this yeah I bet you did I’m curious how does one
earn a seat on the Board of Medicine in Pennsylvania this I’m really surprised at the behavior of this group given you know the facts.
You examine any idea I don’t know that come from and why they get there I can tell you it’s not all doctors there are lawyers on the board oh dear.

[20:48] I don’t know the answer to that question but I know that they were not interested in the facts and.
Interestingly there was legislation passed in Pennsylvania in 2003 which would have made this case
unacceptable the expert witness did not have the proper criteria he was not board certified in my specialty he had done he was not seeing patients he was not qualified to testify and we
call the State Board on that and said we don’t have to follow those guidelines this isn’t a malpractice suit
so they were totally uninterested in anything fair or the truth in terms of this they were trying to get their point across about prescribing opioids
yeah I’m completely blown away by that reality that they were just it appears there was no.

[21:34] Tip to be fair at all and the other thing is that you and I both know that there are scores of Physicians who in fact are.

[21:44] Bad guys.
That are out there doing the wrong thing day in and day out and the evidence to expose them is readily available and yet they chose to pick on you
has the State Board in Pennsylvania changed at all since that time or are they pretty much the same I bunch of I can’t answer that actually what I think I can’t answer that for sure you know I do know that this was a political.
Game for them this case fell into their laps of something they were trying to do and I found that out from one of my political cohorts who was very
knowledgeable about the state board and informed me of such they were trying to make a point they weren’t going to let the facts get in their way
hi I’m Rhonda Crow founder and CEO for empty coaches here on RX for Success we interview a lot of great medical professionals on how they grew their careers
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[24:37] Well that is terribly unfortunate and I and I’m grateful to you and all Physicians should be grateful.

[24:45] To you for exposing the fact that these sorts of things.
Go on because it’s something that we all should be well informed about and we should be very angry about it and.
With that as a segue at least as I interpret your writing in room for improvement that was.
The real launch button for your entry into the world of
activism am I correct about that actually the second lawsuit was but this just Amplified at that much more I mean this was like a
The Crucible I went through and I cannot galvanized on the other side the old expression that which does not kill you makes you stronger I came out stronger I came out more outspoken more assertive
and more willing to speak my mind about the things that were wrong in medicine throughout the.
2000’s up until 2010 the main issue was tort reform and I spoke quite a bit about that but then other issues began to take precedence over tort reform in Pennsylvania.
Prior office shoes maintenance of certification scope of practice surprise billing then you etcetera.
And I became very active speaking out on a number of these issues both in writing articles and in lecturing and so forth and and can you tell us maybe.

[26:02] Couple maybe two or three instances where you were actually able to see that you are actually having an impact.
Individually it’s tough in that regard it’s you have to throw it up against the wallet you know
you know I have one voice this is kind of like Horton Hears a Who you have to have everybody shouting out.
Some examples occurred in mates of certification the American Board of internal medicine has made some changes to their program which are beneficial they still have not gone far enough and they still
I still am very outspoken against them but they have made some changes for the better they just need to go further there’s legislation looking at prior authorization people are aware of prior art
authorization legislators are more aware Pharmacy benefit managers in the conflict of interest that they have in terms of drug prices so it’s.
Publicizing all this and making people aware of it but there are tremendous lobbies on the other side the insurance Lobby you know arguing against changes to prior authorization and there’s a tremendous back and forth with the idea.
Keeping doctors in their place as corporate entities try to control the healthcare dollar well speaking of keeping doctors in their place so to speak I know that one of the bullet points in your.

[27:20] Section on Revolution is scope of practice.
Which is something that is creating a lot of interest amongst Physicians I’m learning and I would I would like for you to.
Go ahead and elaborate on that a little bit kind of Define the problem for us and tell us what we should be doing scope of practice looks primarily at the practice of nurse practitioners and whether or not they should be able to practice.
Without the supervision of a physician 24 states have allowed this with the idea that there’s a physician shortage and that nurse practitioners can fill the Gap nurse practitioners have.
Push the agenda that they can practice medicine as well as a physician on the one hand they say they can practice as well as a physician on the other hand they say they’re not practicing medicine they’re practicing advanced nursing and they want to talk about being able to practice at the top of there
field the problem is that the training for nurse practitioners is much different than for Physicians whereas by the time a physician finishes residency he’s engaged in
approximately 12 to 15,000 hours of clinical care a nurse practitioner only requires 500 hours of.
Clinical time to meet their requirements which if you think about it is a 40 hour week.

[28:35] For three months is all that that takes and so they don’t have the quantity of training that a physician has further more nurse practitioners when they go to nursing school are trained
in nursing not in medicine and they’re completely different disciplines one is not better than the other but they’re different.

[28:51] Nurses tend to look at the whole patient they look at their their resources they look at their support system they look at them.
More holistically than Physicians do because Physicians are trained more in terms of.
The diagnosis of disease the pathophysiology of disease and the treatment of disease we need both of them too.
Optimally take care of patients one does not replace the other and nurse practitioners are saying that they are equivalent to Physicians and it’s not true based on the quality of training and the quantity of training they quote a number of studies which show the equality but these are all for nurse practitioners
who are working under the supervision of Physicians and
you know when you look at some of the things that are looked at you know do nurse practitioners check hemoglobin a1cs as well as doctors yes they do there’s no reason for a diabetic patient of nurse practitioner can’t check hemoglobin a1cs as well as a physician can the questions are they going to be able to pick up on the diagnosis of diabetes in the first place is easily as a physician
and you know the nurse practitioner would argue yes the Physicians would argue know interestingly if nurse practitioners do get.
Independent practice and they’re pushing for it in Pennsylvania it would be under the auspices of the Board of Nursing not the Board of Medicine so they want to do everything The Physician does but they want to call it nursing and the hypocrisy is just stunning in that regard so
for all the arguments the basic argument is simple 5:00 does not equal 15,000 and this is really a common-sense issue but.

[30:21] A lot of people
corporate entities are pushing for Independence for nurse practitioners because they can then hire them without having to hire a doctor they can still see patients they can still reap the benefits of seeing patients but they don’t have to pay as much so you’ve got entities like Minute Clinics at CVS.
You’ve got hospitals who are pushing for nurse practitioners who are cheaper to employ that Hospital Physicians
so a lot of this is geared towards the corporate practice of medicine how can we provide medical care
as inexpensively as possible but the question is is that Medical Care equivalent to the medical care that will be provided by doctors my response is no it’s not.
And you’ve been very vocal in your opposition to.
That movement and you’ve been very vocal about a lot of things you have been very involved and it’s it’s worth it to read your book room for
just as an opportunity to find out how many opportunities are available for Physicians to make themselves heard and
that as I say that alone is good enough reason to.

[31:26] To read the book and I highly recommend it I would like to give you a chance before we close it out to talk about part 3 of your book.
The resolution where you get into some of your ideas about how we make things better
well the way we make things better is we have to focus on the
Healthcare is not focused on the patient right now it’s focused on the populations and how can we patients are widgets
one of the main themes of This Book Is that Health Care should be a human endeavor between a patient and their physician rather than a business transaction between a consumer and a provider and I point out even the use of the word provider is meant to diminish Physicians
to make them you know equivalent to those with less training it’s all the same it doesn’t matter there’s no accounting for the different skills that different.

[32:16] Professions within the Healthcare Community have nurses are different than physicians physical therapist are different than Physicians and if you lump them all together you negate
the unique qualities of each one in terms of providing unique care to an individual patient so the main thing that
Physicians need to do is they need to raise their voices and this is very difficult apathy has set in there is a learned helplessness amongst the physician Community where.
Many Physicians feel like why bother there’s nothing we can do it’s been written it’s already you know.
Sealed what’s going to happen and we can’t change it and my response to that is yeah if you don’t say anything the quote I like to use has been attributed to Michael Jordan and a Wayne Gretzky and it says you miss 100% of the shots you don’t take.

[33:06] And.

[33:07] As I say I will go to my death bed knowing I may not have a you know compost anything in effecting change but I will know that at least I went up to bat and took my swings I’m a strikeout
but that’s much better than being afraid to step into the batter’s box in the first place.
And I encourage all Physicians to speak out to your legislators to write articles for the newspaper letters to the editor I’ve discovered that insurance companies and others hate the publicity of what they’re doing they don’t want patients to know what they’re doing.

[33:36] Push for transparency is being resisted by hospitals and pharmaceutical companies who have actually sued to prevent transparency.
Corporate powers that be don’t want patients to know what’s going on and they don’t want Physicians to know what’s going on and we have to shout it from the rooftops and make people aware of it
so that’s what I point out
you know in the book some of the areas that we can talk about transparency is key education is key education is a problem right now because of the political world where in trust is
going out the window so the question is who do you trust and the ideas most people trust the individual person that they deal with.

[34:12] Whether it be their doctor their account their lawyer they may speak generally about doctors accountants and lawyers but they trust their own
individual one so it’s up to doctors to push this message
even if it’s not through legislators to their patients one at a time to explain to them what’s going on in healthcare and what they can do only if we raise our voices do we have a shot at making meaningful change.
The other thing in resolution that I talk about is the humanity of medicine and it’s easy to lose track of that when you’re restricting you only have
15 minutes to see a patient and you’ve got all this paperwork to fill out and you’ve got to document all this unnecessary stuff it’s easy to lose track of the idea that.
Healthcare is inherently a human profession we’re dealing with people their faults their foibles their flaws there
strength our own strengths our own flaws and we need to recognize that if we can recognize that Health Care will be better for all of us Marc I really love that.

[35:09] Term that you invented actually I don’t know if you invented it or not but I’m going to ascribe it to you every time I.
Use it in that is learned helplessness now that doesn’t I think that yeah I think that I think that describes.

[35:24] Physicians exactly you know we’re trained in The Sciences we’re trained in The Healing Arts.
But we get no training whatsoever and dealing with conflict and.
It really has put us in a very vulnerable situation and the way you have written about it is brilliant I can tell you I have
found it nearly impossible to put this book down I have not quite finished it entirely but what I have read is quite compelling it’s called room for improvement
and by the way the room is rhe um which I just love that little pun room for improvement the evolution of a Healthcare Advocate by dr. Mark Lowe patent for like I’ve really enjoyed our conversation
and what I would like to do at this point is step out of the way.

[36:18] Hi and let you have the floor for yourself so I’m going to close my mic and.
Sit quietly and dr. Mark Lowe patent is going to give us his personal prescriptions for success
before I do that I have to give credit to where it’s due expression learned helplessness comes from dr. Martin Seligman who is one of my psychology professors in college and he used learned helplessness as a model for depression stating that when you learn that your actions don’t.
Have it affect it’s the identical to what people experience in depression so I got to give props to him in that regard as far as my prescriptions for Success 1 is 2.

[36:57] Create realistic expectations for yourself and your patients that means in telling patients what they can expect from a treatment or diagnostic test or whatever
make it realistic because patients are going to suffer if they expect too much and
many patients have been told by the media and so forth to expect perfect health care 100% solutions to all their problems at no cost with no risks and that’s unrealistic
we also have to set realistic expectations for ourselves we are human as Physicians we need bathroom breaks we need food and we put tremendous expectations upon herself to solve every problem
um all the time for every patient that’s not realistic.

[37:41] R2 we have to recognize that Health Care is inherently a human endeavor we have to be conscious of the emotions of our patients and conscious of our own emotions the things that we do well and we don’t do well and recognize that we are not going to be able to
to achieve 100% efficacy and everything we do when we have to be able to forgive ourselves a third thing that was really important for me is to get help.
When you need it whether that be asking a colleague for advice on a case or getting.

[38:12] Counseling help for the emotional aspects that we deal with.
That is very important it’s Taboo in our society we’re afraid to do it I’ve done it twice it was very beneficial to me I wouldn’t be where I am today without that counseling so I encourage people to not be afraid to get help when they need it.

[38:30] And the last thing is what I call is make sure you’re aware of the sleep test
and the sleep test the typical example of it is when I get a phone call at 11:00 at night for a patient who wants advice and I’m debating do I send them to the emergency room or not can this be managed
you know with just medicines or whatever or wait till the morning I ask myself the question if I give them this particular piece of advice
am I going to be able to fall asleep again or my going to be sitting there worried about it and that’s not just at nighttime it comes during the day when you give advice and you look back at what you said do I feel comfortable with this advice and I guess a simpler way to put this is
trust your gut instinct you know in terms of what feels right and what doesn’t feel right because your gut instinct.
Most of the time it’s going to lead you in the right direction so those are the tips that I would have those would be my prescriptions for success.
Mark those are very wise and we’ll described and enlarged and enlarged upon very nicely in what I think is.
One of the best books I may be the best book that I have come across so far with respect to the subject of.

[39:42] Surviving as a.
Practitioner of medicine in the United States I promise you audience if you read it you will see yourself all over the place and it is really.
Worth the time so thank you so much for that Mark thank you for being here with us today thank you for your kind words.

[40:03] You’re so welcome and I want to give you an opportunity to tell the audience you can tell them one more time about where to find the book and
those sorts of things and also where to find you whether it be on social media or whatever you would like to share the book is available on Amazon it’s also available at Barnes & Noble I am on
Twitter I am on at low patent MD I am on Facebook my email is m Lo patented comcast.net.
I love to hear from people and love to hear what people think of the book I welcome input and I hope people will spread the word because
as Physicians we need to open our mouth and Shout from the rooftops what’s happening to our profession our profession is being destroyed and.
We have to do everything we can in our power to prevent that the patients are the ones who are going to suffer if that happens.
Well I have to say you can not only find Mark on social media and the usual places but you can.

[41:05] You can probably find him from time to time in newspapers and on television and mass media of that sort because he’s making a difference in people are paying attention
and we’re grateful for that Mark can I and I’m really grateful for you taking the time to be with us today thank you so much for having me I very much appreciate it.

[41:23] Thank you so much for listening with us today as always we really appreciate a review from you and a five-star rating helps us a lot.

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[42:01] As always special thanks to Ryan Jones who created Aunt performs our theme music for the show and remember be sure and fill your prescription for success with my next episode.