My vision is to bring the DOC (Direct your Own Care) principles into mainstream consciousness. It has become clear that the DOC project is one that is best implemented by primary care physicians. Back in Control is a wellness book, not a “solving chronic pain” one. Most of you know that you can’t solve chronic pain because your attention is still on your misery. You have to move toward your vision of how you want to live your life with or without your pain. Paradoxically, as you become healthier, your pain will abate or resolve. We have witnessed this phenomenon hundreds of times. I also practice these concepts daily.

My focus will be in several areas:

• Building a business structure that scales the DOC process to reach a much wider audience.
• Teaching medical providers in any realm how to treat chronic pain. Only about 20% of physicians are comfortable treating chronic pain and less than 1% enjoy it. We aren’t trained correctly in spite of recent neuroscience research providing many answers.
• Educating the public to take responsibility for their own care. This requires learning about chronic pain.
• I am writing three more books:
  • Do You Really Need Spine Surgery?
  • Chronic Pain and Your Family
  • Optimizing Performance In and Out of the OR Applying Athletic Performance Principles
• We are scaling the workshops that we have held at the Omega Institute. It turns out that the group setting is a powerful resource we have seen to move people out of pain.
• I am starting a movement around physician wellness. The burnout rate among physicians is between 50-60% and steadily rising. It has a tremendous impact on patient care. The DOC process is just a framework of care that allows productive discussions to occur and the patient is able to create their own solutions. However, the doctor/ patient relationship is a critical piece of it. It is hard to reach out to patients when you are trying to personally survive. Physicians have 2-4 times the suicide rate of the general population depending on gender and specialty.
• Finally, my biggest focus is on changing the fee structure for medical care. Many recommended interventions in spine care and other specialties have been documented to be ineffective while most effective treatments are generally not covered by insurance. The most necessary part of care is for your physician to listen and you to be heard. It is the one aspect of care that that has been taken from all of us. Creating a fee schedule that allows providers to take the time to get to know you will change the nature of medical care.

Grassroots effort

I am asking for your help. It’s clear that change is going to have to occur from the ground up. The business of medicine has firmly embedded a production approach to your care. It is not going to change. Here is a quote sent to me by one of my mentors.

A new scientific truth does not triumph by convincing its opponents and making them see the light; but rather because its opponents eventually die, and a new generation grows up that is familiar with it.

–Max Planck

How can you contribute?

People often ask me how they can pass on what they have learned. Here are some suggestions that would be of great help to my efforts.

• Continue on your own healing journey. The concepts presented in the DOC process are ones that need to be practiced for a lifetime. Patients often feel well enough that they stop at Stage 2. Stages 3 and 4 are the creative parts of it and where it all really happens. Don’t stop.
• Your personal transformation will have a strong healing effect on those you are close to. There is a direct mirror neurons effect.
• Encouraging friends and family to sign up for the weekly email updates on backincontrol.com.
• Share links on social media.
• Write a quick review of Back in Control on the Amazon or Barnes and Noble websites.
• Let your providers know about the DOC concepts and that they can contact me. My intent with the combination of the book and website is to enable the patient to take control of his or her own care and form a partnership with your physician and other medical professionals. Not only are your visits productive, but are more enjoyable. There isn’t a day in clinic that I don’t emerge more energized and inspired.
• Share your personal success on the “Stories of Hope” section of this website. Hope is a powerful force in healing pain.

Thanks to all of you for your interest and support. It’s what keeps me moving forward. For me, it is truly a new horizon and adventure and I am looking forward to seeing how it evolves.

The post Moving Forward – A New Horizon first appeared on Back in Control.

The post Moving Forward – A New Horizon appeared first on Back in Control.

Florence is an insane place to drive with people and motorcycles darting in front of your car every few seconds. It is part of the experience. From the moment we left the station he began to curse at everyone in his way. “They should be using the tunnel under the street. Get out of my way. Don’t you know cars to have use the road?” He did not stop his tirade until we reached our piazza. He clearly was more than burned out and had no interest in any conversation. The stress in his car was palpable.

I don’t know him or anything about his life. What I do know is that being chronically angry is a strong factor in creating burnout and depression. How could it not?

Physician Burnout

The burnout rate in every state survey shows that 50 – 55% of physicians are burned out. My spine fellow recently put an article on my desk showing that 65% of neurosurgeons are burned out. It’s both disturbing and predictable. There is a tremendous amount of stress in medicine and we are not trained how to process it. Additionally, the medical culture often engages in behavior similar to the cab driver in that we frequently become upset about things that we have no control over.

Dr. Fred Luskin, in his book, Forgive for Good, describes this phenomenon as the “unenforceable rules.” When you’re frustrated about any situation or relationship that you have no control over you are wasting your time and destroying your quality of life. An example might be that you wish your spouse would watch less TV or treat you better. It is fine to wish it but when that wish becomes a demand in your mind it has now become an “unenforceable rule”. If you write down a list of upsetting situations or people, you might be surprised at how long it is and how unsolvable they – at least by you.

The Emergency Room

One classic example in the medical field is in the emergency room. I worked in the ER throughout my residency when I had a few gaps in my schedule. The vast majority of ER visits are not emergencies. Examples include sore throats, back pain, neck pain, a low-grade fever, stomachache, etc. All of which could wait to the next day to be seen in a doctor’s office. These patients frequently show up around two to three o’clock in the morning. It is about time when the on-call physician is trying to grab some sleep. Many ER doctors become upset about a patient showing up with a minor problem at that hour. It’s understandable and frustrating. However, he or she might  tee off on the patient, letting them know that they shouldn’t be coming to the ER with a non-emergent situation especially in the middle of the night.

First of all, the on-duty physician is expected to work a full shift and be available the whole time. Second, is educating that one patient going to stop the other thousands of those who will be following? Why spend one second being upset about a runny nose at two o’ clock in the morning? Why not just take care of it and move on? Talk about an unenforceable rule. It is fine to wish that patients were more aware of what constituted an emergency but when you become upset that all of them don’t, then you have turned this wish into a demand. Indeed the burnout rate in ER physicians is as high as any medical specialty.

What are your unenforceable rules?

What are some of your unenforceable rules? “My claims examiner is not responding to my needs. I wish my spouse would lose some weight. I hate bicyclists in my way to work. My boss isn’t that nice to me. I want to be free of pain now. My son needs to be more serious about school. I just want my life back.” Take a few minutes to write them down. It will be long list in that there are many things wrong with this world and life is imperfect for everyone.

With age and repetition, many of these legitimate wishes will turn into “demands”. Unfortunately, becoming upset about them not only drains you, but worsens the problem. For example, people suffering from chronic pain commonly become socially isolated. One reason is that anger is not attractive, which pushes others away. One wish, of course, is to have more friends and become frustrated when they don’t seem to want to spend as much time with you. There is also a tendency to complain others about your pain and situation, which becomes old quickly. Are you sabotaging your wish?

Remaining upset about situations you have no control over will drive you into the ground and bury you. The first step is to become aware of your own unenforceable rules and how they play out in your life. Develop your own tools to process these “wishes” and truly move on.

Listen to the Back in Control Radio podcast The Unenforceable Rules

Your book is bullshit

The post “The Unenforceable Rules” first appeared on Back in Control.

The post “The Unenforceable Rules” appeared first on Back in Control.

I am on a much-needed vacation this week in Italy.  From 1980 until 1990, my wife lived in Florence.  We have many friends in Italy we like to visit as much as we can.  It is a unique opportunity for me in that she is fluent in Italian and we are able to spend time in our friends’ homes in the heart of Tuscany.  There is nothing quite like sitting down to a home-cooked Italian meal overlooking a beautiful valley.

Last night was one of those evenings.  Our friends not only put us up in their apartment, they had us over to dinner with several other friends.  The conversation drifted towards medical care.  One of the guests had experienced some medical problems of a moderate nature that required several physician visits and a couple of procedures.  He said that the aspect of his care that most struck him was that at no point during his care did anyone from the receptionist to the doctor ask him how he was doing.  Additionally, when he was asked some detailed questions about his condition, he was asked if he was a doctor.  When he replied that he was not, he was told that he had been informed enough and that he should not ask so many questions.  You might imagine his frustration.

I have witnessed a lot of success with the DOCC protocol, but it has become increasingly clear that the protocol is just a framework. It helps organize both the physician’s and patient’s thinking about chronic pain and therefore makes it much easier to create a treatment plan.  It is the patient who organizes and implements the plan. The physician is more in the role of a “coach” as well as being continually aware that there might be a potential structural problem.

About a year ago, I was talking to the pain psychologist I work with about what we were doing that seemed to be more helpful to our patients than either of us had historically observed.  She kept insisting that I was the factor that made the difference.  I was sure it was the DOCC protocol and the work she does.  After more and more positive results, I finally agreed that I played a major role in their recovery.  To clarify, I don’t believe that I have a special gift or am the world’s best doctor.  I simply stay committed to my work with the patient.  With increased attention over the last couple of years, I have seen more patients who had been in pain for decades become pain free.

Through my numerous difficult experiences, I have had many layers of my own personal labels stripped off.  Physicians, especially surgeons, are perfectionists.  It gives us an early competitive edge in high school and college.  It is somehow held up as a virtue by our medical culture and demanded by society.  Unfortunately, it is a complete disaster with regards to our ability to connect with our patients.  By definition a perfectionist is continually judging himself or herself by an unattainable standard.  As I have labeled myself, I have labeled others around me.  As it has been my reality for over 50 years I had no clue that this process was taking place.  I recently wrote an article, “The Cry of Chronic Pain—No One is Listening.”  The essence of the article is that once you have a label of a “chronic pain patient” placed on you, the world, including you, feels that it is just “something you have to live with” and your care becomes essentially palliative care.

I recognize that labeling is universal but it is not constructive.  I am aware that I label people constantly. As I work to become aware of the label I am placing, I am able to eventually see who you truly are.  You are a whole person.  Neither you nor I are the labels we place on each other.

The energy for your healing journey comes from you, not me.  What I contribute is that I am able to see you as a whole person and you are somehow able to remember that part of you that is really you.  When that part of you “wakes up,” there is no stopping you.  You are your own oasis in the middle of the desert.  I cannot ever tell who will engage or when.  The DOCC project is just a rough framework and every journey is completely different.  I am continually energized and inspired by the incredible obstacles you overcome to return to a rich, pain free life.

I recognize that essentially all physicians are compassionate.  Many physicians have figured out this journey and most have not had to experience burnout to learn it.  I am continually humbled by numerous examples of deep compassion by my colleagues.

I always thought I was compassionate. I was very well intentioned and always gave every patient my best shot.  However, the physician burnout rate is around 50% and we truly have a life full of more stress than you can imagine.  If you are just trying to survive, there is only so much you can give.  Additionally we have no resources or tools to help us out.  The safety net is a concrete floor.  It has been shown in several studies that it is during the third year of medical school that compassion takes a dive.

I am not writing this post for you to begin looking for a physician who is compassionate.  It is not a bad idea, but it is not necessary for you to heal.  Remember this process is about you taking full responsibility for every aspect of your care and your life.  You don’t need me.  You don’t need the DOCC project.  You just need to connect with that part of yourself that is whole and wants to thrive. The person who you need to experience compassion from is you. Use whatever means you have at your disposal to figure this out.  It will probably take some outside help but there are multiple resources. Quit trying to “figure all of this out” and just go.

NH, BF

The post Compassion and an Italian Dinner first appeared on Back in Control.

The post Compassion and an Italian Dinner appeared first on Back in Control.