News

Vital Signs Are Truly Vital

I’m looking forward to presenting at the Minnesota Sheriffs’ Association’s Correctional Health Division Conference on October 13th. I’ll be discussing the use of clinical decision rules in assessing inmates for chest pain, head injuries and other high-risk presentations. You can find my PowerPoint here.

My title is a riff on the National Early Warning Score (NEWS), which has good negative predictive for really bad stuff like cardiac arrest, ICU admissions and death. I previously wrote about it for Today’s Hospitalist (and PDF version here).

Many thanks to Heather Qunell and the other conference organizers for inviting me to participate! ✸

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Postscript [10/18/2021]. Here’s a PDF of the final program.

Eat Move Sleep

I recently contributed a “lunch and learn” to PreferredOne’s annual health fair. We talked about some key topics related to behavioral change, including process thinking, end-gaining, means-whereby and indirect methods. Please see my PowerPoint for more.

The health dimension is a 30-day challenge based on Tom Rath’s Eat Move Sleep (book) and companion website. I encouraged the audience to make some small choices that could lead to big changes in both their quality and quantity of life.

Many thanks to Donna Larson, Shelley Markve, Susan Bernstein and PreferredOne’s Wellbeing Committee for pulling together the event and making the book available to employees. ✸

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Postscript [10/07/2021]. Nell Hurley brought my attention to James Clear’s Atomic Habits (book). Looks like fantastic read that syncs of up with Rath’s work. BTW, Nell was recently featured in a Star Tribune article on the contemporary sober movement.

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Postscript [10/10/2021]. For those intrigued by the Alexander Technique, I suggest booking a few lessons with Brian McCullough or another qualified teacher in your area.

The Wisdom of Father Steve

I was surprised and delighted to run into Father Steve LaCanne at a celebration of life over the weekend (he officiated). Those with a HealthEast connection may recall that he was the longtime Director of Spiritual Care at St. Joseph’s Hospital, in downtown St. Paul, Minn.

Photo: Joan Frenz

And direct our spirits he did! Father Steve shared the following passage from Thomas Wolfe, which is a great meditation for the week:

To lose the earth you know, for greater knowing; to lose the life you have, for greater life; to leave the friends you loved, for greater loving; to find a land more kind than home, more large than earth—

—Whereon the pillars of this earth are founded, toward which the conscience of the world is tending—a wind is rising, and the rivers flow.

Father Steve is now semi-retired and splits his time between Minnesota and Florida. ✸

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.

Ace!

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 ✸

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

Naperville, July 2005

Life has ways of surprising you when you least expect it. One of those moments occurred for me in a Fairfield Inn in Naperville, Illinois. We were visiting Joan’s relatives in Chicago and I hung back at the hotel while our kids napped.

I had purchased a copy of Parabola at a nearby Barnes & Noble. This passage from T.S. Eliot (cribbed, actually, from St. John of the Cross) jumped out at me:

In order to arrive at what you do not know
You must go by a way which is the way of ignorance.
In order to possess what you do not possess
You must go by the way of dispossession.

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This was both startling and counterintuitive. Up until that point, life seemed additive—knowledge and experiences building on a foundation of prior knowledge and experiences, stretching back years into childhood. Eliot was suggesting otherwise and I knew in that instant it was true. ✸


Postscript [08/09/2021]. Here’s a related passage from Anthony de Mello: “They didn’t teach me how to live at school. They taught me everything else. As one man said, ‘I got a pretty good education. It took me years to get over it.’ That’s what spirituality is all about, you know: unlearning. Unlearning all the rubbish they taught you.”

WYNTK Finale

We filmed the tenth and final installment of Hazelden Publishing’s What You Need to Know (WYNTK) Series today. Our set was at the beautiful Westminster Presbyterian Church in Downtown Minneapolis.

Many thanks to Wes Thomsen, Sylvia Jaurez, Brad Hadsall, Chris Dougherty and Jennilee Park for conceiving and producing the series. I’m looking forward to our next adventure! ✸


Postscript [08/03/2021]. “Where are you in the program overviews?” Please see Alcohol starting at 1:17 and Nicotine & Vaping starting at 2:20. And, there is much more in the full products.

Happy New Year

I just completed a year of mindfulness* meditation with Muse, the brain-sensing headband. And what an amazing, consciousness expanding year it was! Many thanks to InteraXon for developing and bringing Muse to market. Also much appreciation for Stephan Bodian and Sister Mary White, my meditation teachers.


* Sort of. My practice has evolved from mindfulness to awakened awareness. (Please see Stephan Bodian’s masterful Beyond Mindfulness for an exploration of both.) Accordingly, I’ve adapted the way that I use Muse: I’ve turned off Feedback, Birds and Background (Session Volume Settings), which reduces the temptation to manipulate attention. Muse mainly serves as a meditation timer when configured in this way, although, as a doctor, I love to review the resulting EEGs.

Summer Institute for Medical Students

I’m privileged to serve as faculty for another year of Hazelden Betty Ford’s Summer Institute for Medical Students (SIMS). Here are my PowerPoints and some additional resources.

Many thanks to Kari Caldwell for involving me in SIMS and also the Professionals in Residence (PIR) program!


Postscript [07/30/2021]. I’ve long advised medical students and residents to acquire some psychotherapy skills, regardless of their eventual specialty. Motivational interviewing (MI) and cognitive behavioral therapy (CBT) are relatively easy to learn and have broad clinical utility.

Some MI resources include:

  • Miller WR, Rollnick S. Motivational Interviewing, 3d ed. New York: Guilford Press, 2013 [classic textbook]
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 1—brief intervention and motivational interviewing. Aust Fam Physician 2009;38(11):885-888 (PMID: 19893835; and here)
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 2—motivational interviewing approaches. Aust Fam Physician 2009;38(12):986-989 (PMID: 20369152; and here)
  • Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques—facilitating behaviour change in the general practice setting. Aust Fam Physician 2012;41(9):660-667 (PMID: 22962639; and here)
  • Searight HR. Counseling patients in primary care: evidence-based strategies. Am Fam Physician 2018;98(12):719-728 (PMID: 30525356)

In terms of CBT, I highly recommend the professional trainings at the Albert Ellis Institute, starting with the primary certificate practicum. Some other resources include:

  • DiGiuseppe RA, Doyle KA, Dryden W, Backx W. A Practitioner’s Guide to Rational Emotive Behavior Therapy, 3d ed. Oxford: Oxford University Press, 2014 [classic textbook]
  • Harden M. Cognitive behaviour therapy—incorporating therapy into general practice. Aust Fam Physician 2012;41(9):668-671 (PMID: 22962640; and here)
  • Stuart MR, Lieberman JA. The Fifteen Minute Hour, 6th ed. Boca Raton: CRC Press, 2019 [please see, in particular, Chapter 4]
  • Frenz DA. Another Arrow for Your Quiver: REBT for SUD. Minneapolis: David A. Frenz, M.D., 2018 [PowerPoint presentation]