Family First

Somewhere between 2001 and 2004 (when I was a family medicine resident), I had the great fortune of rotating with Tom Okner and Stuart Cox at Midwest Ear, Nose & Throat Specialists. During that experience, I acquired a slim volume, Primary Care Otolaryngology, that immediately acquired a place of honor in my bookcase.

The authors included life advice and musings about science in the margins of various pages. This one stopped me in my tracks then and remains a guiding principle today.

In the spirit of Father’s Day, I thought that I’d share Dr. Fischer’s wisdom with other parents who are doctors. ✸

J. Gregory Staffel, et al. Primary Care Otolaryngology. Alexandria, VA: American Academy of Otolaryngology—Head and Neck Surgery Foundation, 2000, p. 64

Muse Milestones

Newton observed that a body in motion tends to stay in motion unless acted upon by some outside force. This so-called law of inertia concerns the physical world but also seems to hold true in psychology (and here).

And so it is that I’ve reached the arbitrary Muse milestones of 500 days, 659 hours, 5 million Muse points and three headbands (they’re like running shoes—you eventually wear them out).


As prior, many thanks for InteraXon for bringing such amazing technology to market. Much appreciation also for David Godman for answering my many questions. ✸

Endnote. Some notable books that I’ve read since my last Muse post have included Talks with Sri Ramana Maharshi, Final Talks by Annamalai Swami and The Book by Alan Watts. These concern beyond mindfulness, to which Ramana Maharshi points to here [p73]

What advantage is there in meditating for ten hours a day, if in the end that only has the result of establishing you a little more deeply in the conviction that it is you who are meditating?

Do not meditate—Be!

Do not think that you are—Be!

Don’t think about being—
you are!

Charles Burton, M.D., RIP

Chuck Burton, my most important clinical mentor, died in late 2020. He’s been much on my mind as a celebration of life on September 12th approaches.

Chuck was a neurosurgeon who specialized in restorative spine surgery. He helped thousands of patients by performing surgery, but probably helped even more by refusing to operate.

Chuck Burton, left; David Frenz, right. Glen Stubbe | Star Tribune

Chuck was a disciple of I.M. Tarlov, the famous neurosurgeon and author of The Principle of Parsimony in Medicine. The principle, also known as Occam’s razor, takes many forms including this version on the back of Chuck’s business card

And “less” often meant counseling sometimes desperate patients that they were unlikely to benefit from surgery.

Chuck, more than any other physician who I’ve met, practiced primum non nocere (first, do no harm). This began early in his career and intensified over time as he saw the actual harms of surgery in all of the second opinions that he rendered.

A few other dictums (and here):

  • Osler’s Rule: Treat diseases, not symptoms
  • Gabel’s Rule: Don’t just do something; stand there
  • Holmes’ Rule: Surgery is guilty until proven innocent

where the latter means that the clinical trials need to be compelling and patient selection must be meticulous.

Chuck has left a void in my life—but that void means that I had the opportunity* to be mentored by a great physician and remarkable human being. He’ll live on in the care that I deliver and the students and residents who I mentor. ✸

* I owe that opportunity to Bob Moravec, M.D., former medical director at St. Joseph’s Hospital in St. Paul Minn. It’s a great story and post for another day.


I don’t golf often or well but still have some “muscle memory” from my teen years in Brainerd, Minn. Today, I carded a hole in one while golfing with Ayden, our 13-year-old son*

  • Where: New Hope Village Golf Course, New Hope, Minn. Our first visit!
  • Hole: 4
  • Club: 5 iron
  • The Shot: The green has a wicked slope from right to left with a bunker to the right. An elderly golfer behind us noted that she always plays to the right, which seemed like solid advice. My ball landed on the right edge of the green and rolled downhill into the cup. I was stunned, Ayden was elated and the elderly golfer was absolutely tickled ✸

* For whom I hope to caddie in college—he’s nearly a scratch golfer on youth courses