I have big dreams and I am sure you do too. Those dreams are what we all live for. We work hard and push to attain new heights. Those heights attained are the source of stories for our grandchildren. The joys of the effort and the intensity of our victories are what we will remember. I think I have lost that drive for big accomplishments.

Now all I think about is how am I going to make life better for my daughters. At Sarah is 4 years old and Samantha is 3 years old and they only ask for my time and attention. That is easy to give, but what happens once its time for more substantive investment. My love will not pay for college nor will it be enough for that first car. So, like all parents I have to save. Will it be enough? I am sure I am worrying for no reason, but without planning for those events I will not be ready. I promise them I will be ready.

When my oldest was born, I was reborn. They are my world and no one comes ahead of them. Making them strong, confident and productive is my goal. The question of how to accomplish my goal is both harder and easier than it seems. Easier because I have my parents play book to look at and harder because of the same. Picking from what I think worked and not repeating their mistakes is a tough challenge.

Sarah, my oldest taught me a lesson this weekend. She is already strong and confident. I watched her perform under the big lights with her cheer team and she was perfect. She performed with intelligence, poise and confidence. I am a proud dad. At 4 years old she is already setting a great example for her 3-year-old sister. I had to smile when my 3-year-old said to me, “Daddy, next year I am going to win like my sister”. I am going to keep loving them and allowing them to dream big, while I dream of their success.


We all at some point will and have questioned the meaning life. The content of the question maybe different, but the aim is the same. We all what to clarify the reason for our existence. We all want to prove the existence of a higher power. What is the purpose of life? For a long time I firmly believed there was  a higher power and tried to convince others to believe as to did. The imperative to evangelize is strong if we are convinced of the exclusivity of our belief structure. Therein lies the problem. The conviction of exclusive attainment of insight  often paves the path to dangerous attitudes and behaviors.

As I have gotten older and gotten more influenced by a non religious milieu I have come to the conclusion that the higher power is us. It is us that will create the future of mankind and it is us that have created the present. Our world is what we make of it and not a result of divine intervention. The mythical power of belief and prayer is deceptive and dangerous. If only we spent as much time delivering care and less on praying for that change. We have to deliver the change we deserve and expect. The power of belief to affect the physical world is not in doubt, neither is the fact that the claimed results are of biologic processes. The strength of the evidence is that belief is a powerful agent of chance, but itself is not the change agent.

Some suggest that there is nothing lost in believing, but I would suggest differently. Belief is wonderful as long as it does not detract from the facts. The loss of focus on the present and the fatalism of the religious is a consistent and persistent drag on society. Thankfully, we live in a country that for a long time has professed religion without allowing the religious to impose their will and fatalistic determinism on the rest of us. This escape has provided a fertile milieu for development. The dependence on evidence is and continues to be the basis of a properly functioning society. As noted in our current political debate the more religious the participants the less our leaders get done. The lack of productivity from the political class is a win for many believers, but only highlights the fatalism of their belief structure.

The troubling trend is that the religious and the professed have gained power and are attempting to reverse our gains. I hope we realize this troubling trend before it completely changes our country for the worse. I hope logic, reason, and evidence continue to guide us.


As a consumer and provider of health care services I am not impressed with the level of service I see. I am disturbed by the lack of empathy and the poor efficiency of the system. Providing health care services can be a very stressful occupation, but if we have chosen to be participants we should put our best face forward everyday. The empathy and sympathy we show are major components in conjunction with efficiency and competence in providing the care that is required and that our patients deserve.

The system as currently constituted allows for wide variance in the quality of the service that is delivered. This is a problem that is often overlooked and under appreciated. We get distracted by the politics of our work environment and neglect to critically assess our function in it. I see providing great care as delivering the correct service in a timely manner. I do not consider giving the patient options as a service to them. Patients want us to tell them what the best choice is and why it is so.

Very few patients are equipped with the knowledge to make great choices. We need to refocus our discussion to providing the evidence that support our recommendations. We need to provide our patients with the option that the best evidence supports. When there is no known best option then we need to use our medical judgment and provide clear direction.

Discussing the best option is great, but only makes a difference if that service can be provided in a timely efficient manner. As a service providers I have the impression that many of us are not as concerned about the efficiency of the service provision. This lack of attention to the details of delivery is poor form on our part. We may think that providing the correct service is the important factor and we would be correct. However, providing the correct service is only as good as how timely that service is provided. We need to deliver quality service with empathy and efficiency.

The current system we have will never be able to provide this type of service delivery as long as providers are not engaged fully. We complain about the rules and regulations that hinder us, but they are not the problem. The problem is us. Instead of saying how can I get my job done, we have defaulted to how am I going to make them see that this rule is bad for patient care. This attitude is detrimental to patient outcomes.

I do not have hope for any improvement in the system. The irony is that the more we protest and passive aggressively resist the more change we induce. Providers are so lost in the echo chamber of passive resistance that we cannot see the good or the bad in the current system. We have given over control to the money changers while we are fighting for the crumbs. We are distracted from the essentials of our service. Let us be reminded that we will be patients too.


I will argue that the world is a better place for the arrival of free trade. The system we currently have is not exactly free or fair, but we are getting there. The problem with the drive to free trade is that it is not our default nature. If we examine our evolution and specifically we look closely at the development of language we will see a very different direction. Nature trends towards diversity and chaos. The current struggle to create a unified and equitable economic system is thus in contrast to natures default.

As we examine the development of language a counter intuitive balance can be seen. This can be seen where areas with the most population density have the greatest density of languages. Often these languages are so different as to make communication impossible. Why would that be so? I propose that evolution developed language as a defense mechanism for each language community. For language to be communicated effectively context and history need to be common knowledge. In that way the outsider may learn the words but is not likely or will not easily attain the necessary historical context to truly understand. This barrier is what protects each language group. The knowledge of the group is passed on by language in context that only those born into that language are likely to understand. In language we have evolution of the first system of protectionism. For thousands of years language isolationism as protected the economics of each group. This protectionism was also the primary barrier to truly large-scale growth in many language groups. Those groups with the most economic power have always been those with greatest command of language. This fact remains the same today. With the spread of the English language we can see the development of a truly global language that is giving every group the possibility of participation in the a maturing economic system. We are evolving a unitary language system, that will be beneficial to the economic system.
The current economic system is deep into the transition from local and regional to global. The system is growing by breaking down the barriers between countries, ethnicities and tribes. The continuing withdrawal from protectionist measures is the basis of our ever-expanding global economic system. We are participants but we haven’t noticed the evolution from a community of languages to a community language. The global is now a small community evolving a common language to ensure our protection from outsiders.

With the transition came a complex problem. What will be our common language? English in its many forms is that currency of communication. The form of English you speak will not be the Queen’s but we will understand each other without much difficulty. It is the nature of evolution to have competing systems, but I would suggest that as of now English is ahead. Once this acceptance as occurred and the language becomes rich with local context and history we as humans will have attained the necessary skills to become a galactic people. With a common language and economic system we will become more productive. How long will it take us to get there? If the twentieth century  is our guide I’d suggest that the twenty-first will be that final stage of our transition. Will your offspring be ready to take advantage of the opportunities to come?