All of us have our quirks. The question is, can the people around you live with them. On most days I think the people around me can survive. Mine is my drive for efficiency. I once was told that the fastest way to get a task done is to do it the right way the first time. If you work with me you have heard that before and you know that my way is the only correct way. Thanks for the indulgence. What motivates me is accomplishing a task in as few steps as possible. In health care that can be a challenge.

In the world of rising cost and decreasing reimbursement the imperative in healthcare is keeping cost to a minimum. My take is that patient safety is the first goal followed closely by efficiency. Some may wonder about that combination but I posit that they are one and the same. If your question is how so, let me expand by looking at one of the most frequent complaints in healthcare. Timeliness. What is timeliness and do you respect it?

The most offensive ‌thing to me is inefficiency. Inefficient use of time is the highest form of disrespect. The fundamental question is do you respect others. As importantly, do you respect your reputation. You first have to show respect for yourself before you can respect others. Respect motivates and challenges. It creates internal expectations that demand attention. The expectation that you must be the best at each task demands attention to the details of the task. Attention to the small details of the task shows others your commitment to success and will reinforce your reputation for succeeding at your goals. We all want the successful and self motivated on our team. Respect for one’s reputation means always doing ones best, including being on time. Respect for time, I posit carries over into ones preparation for treating patients and will result in better care being delivered.

Unfortunately many in our society have come to equate the cost of their time to value. Value is not defined by cost equations, but by the totality of benefit provided to others. Your time is not more valuable than that of others. As a physician I try to respect my patient’s time. However that attribute is not universally acknowledged and  that  leads to delivery of less than optimal care. The lack of preparation for our patients is reflected in lack of respect for the time of patients and results in us going for the easy fixes instead of the optimal. The easy fix is destroying the reputation of the Medical Profession. “ObamaCare” and Government regulation is just the latest scapegoat for the total lack of respect that physicians have for time and timeliness and by extension our patients. This directly affects our reputations, but too many don’t see the connection. Patients have become a number not because of the business of medicine but because physicians have not shown enough respect for our patient’s time. Too many physicians see patients as a captive audience. Even if our patients do not have many options we should still treat them with the respect they deserve. All of natures children deserve respect and humans no less than our cats or dogs. If we do not reverse this trend, one day we will wake up and find that we are not the only ones taking care of patients. Truth be told that reality is already here. Welcome to the evolving world order.


As a city dweller you do not realize that the most beautiful art work is above your head. You do not realize because it is obscured by city lights. Then you visit the countryside and you do not realize that you can look up. Once the night sky has been introduced you wonder why you had not looked up before. Most startling is that so few people look up. There is nothing like the joy of the night sky. The beauty and majesty of the creation cannot be denied. The glorious depth and breathe of our galaxy is beyond our imagination. It is beyond our ability to contemplate. All we can do is dream inadequate dreams.

I fell in love with the solar system in the sixth grade, but it took losing our roof on September 12 1988 for me to appreciate the joy of looking into the depth of the star filled night sky. Being able to live under a sky unobstructed by light pollution makes my heart sing. I feel pride when my princesses ask to go out and see the moon and stars on a dark night. Too few of us take the time to look up.

On most nights when I look up I wonder if we are alone. Most nights I know we are not alone. The universe is too vast for humans to be alone. Nature certainly must have played the life card more than once. Is there a single all-knowing creator or is life a result of chance? On most nights I am not sure, but on most nights I know we are here and must enjoy the beauty of our brief existence.

The lifespan of any human individual is not comparable to the age of the universe. The lifespan of  the human species will be just as insignificant. Too few appreciate that scale and on most nights it gives me pause. On most nights I want to spread the joy I receive from being able to look up and see the past.

The scale of time we can measure and appreciate is so narrow as to be truly insignificant. But on most nights I still love thinking about our place in this great machine called the universe. On most nights I get excited by the fact that there are more questions unanswered than answered. On most nights I am excited that my princesses are starting to ask the questions that need to be answered. On most nights I am happy to have my princesses. On most nights I am excited that they are excited about learning. On most nights I see the joy in their eyes and I am happy. On most nights I am certain we are not alone.
On most nights, do you look up?


I think I spend most of my day considering how I can improve the life of my kids. How can I help them succeed? How can I help them overcome the low expectations that society has of them. As soon as I think I really do not have anything to worry about someone opens their mouth and I despair. Success starts with education and educational success is about expectations. Education is life long and not about getting a job, it is about being equipped to contribute to society. Expectation start at home.

Children need to see their parents making an effort. They need to understand that life is challenging and that they have to push to succeed. They need to experience failure early so they understand that life is not all strawberries and cream. Only by allowing them to fail can they truly understand the joy of success. This joy is what develops confidence. The type of confidence that laughs at a society that does not expect much from them. They need to develop that confidence early. If you are an American of African heritage that development of confidence needs to happen really early because no matter how well you perform the expectation is that you are not good enough. Confidence in spite of low expectations will allow them to take hold of the new experiences on offer at school.

The evidence is clear that good quality preschool is an important part of preparing kids for success. What is good quality preschool and does poor quality preschool damage your kids? The latter question is what concerns me the most these days. I know I am preparing my kids for success. I am confident that they are well prepared. But in spite of what I do at home the need to learn the social rules cannot be taught from a book. They need to learn to tolerate stupidity without resorting to violence. They

The Princesses
The Princesses

need to learn to work with strangers. They need to learn to identify the predators. Socialization at school is where that all starts.

The unfortunate thing is that the quality of preschool in general is low and I am concerned about the low expectations that  the system has of them. Allowing low expectations of minority kids is driving the nail into the coffin of our country. The majority of the popular soon will be from those minority groups for which expectations are low. If they have not gotten a good education, who will be taking care of the country in our old age?
I am mad, not because I care about the in ability to see that my kids intellect is not defined by her skin color, but that we do not see the harm being doing to this great nation.
Our kids are bored and misbehave. They need to be challenged. It is hard work but it can be done. My experience so far does not give me any hope for improvement in the quality of education and specifically preschool. I still think we can turn it around. Expectation is success. My parents expected their kids to succeed and we did. My teachers expected us to succeed and provided us a challenging educational environment. Thanks. I will do the same for my princesses because they deserve to succeed. They will succeed because I expect it of them.
What are your expectations?


I am impatient and stubborn and I am working on it. Well, not really. I like being stubborn more that I like being impatient. In spite of that, I like being both. Both traits may seem to be negatives, but they are only negative if the full breath of human endeavor is not evaluated. My primary impatience is with how little respect many of us have for other people’s time. I hate waiting so I stopped using bank tellers in the late 90’s. Internet banking then was slow but still better than standing in a line.
I always opt to do it myself. It has to be done right the first time so no time is lost. I am not a master of all. I know when to call for help.
The people who work closely with me know I have an opinion on most topics and that I am sure that my way is correct. Truth is I am not always correct, but I am willing to do the work to ensure I am correct. I am accepting the stubbornness label because I have been labeled as such. I don’t really think that I am stubborn. I just know that I am right and I will defend my stance even if I am the only person that holds that position. I have done the work, have you. That’s my view, take it or leave.
One of the weaknesses of these two traits is that I don’t delegate well. I chose to become an Anesthesiologist so I would not have to delegate. I am a doer. The general direction of medicine makes delegation a larger and larger part of the practice. I am not sure what are the benefits, except for potential financial rewards. I would love to think it provides improved quality of care. However, that is questionable. Superior quality of care is provided by better trained providers. I am going to keep on being impatient and stubborn because it’s the only way to deliver a high level of care. Do you have a different answer?