I have been enjoying an hour of reading each morning before work, and Thomas Friedman’s Thank You for Being Late is my latest fare. It is a fascinating book that addresses the many different types of accelerations that we are experiencing in the world right now, and how we had best conceptualize and cope with them in order to survive and thrive.

One thing that Friedman makes very clear, and that other writers are echoing, is that our assumptions, the things that we have always taken for granted and have counted on to be eternal, have started to erode. We have always assumed that if we played our cards right, kept our noses clean, and played by the rules, that life would turn out pretty well for us. We were always told that if we worked hard, went to school, got an advanced degree and met the right people, we would land that nice job with benefits in a company that was too big to fail and that would see our careers through until we could take a retirement package that would let us ride softly and gently into the sunset of old age.

The world is changing. Rapidly. Fundamentally.

Previous assumptions do not hold true any longer. Previous plans, tried and true, that everybody followed, do not work. Traditional training, preparation and thinking that used to get us firmly attached in industry and the world of work now provide little except for artificial trappings that say what we should know and what we should be able to do.

Tradition, once the bedrock of our predictable lives, is changing faster than most of us can keep up.

This is the age of You 2.0, or maybe even 3.0.

You are now the startup. You are the company of one that is making the pitch out in the world. You are the one trying to convince someone important that you have the knowledge, skills, training and flexibility to perform, to produce.

There is now the need not only for a specific amount of schooling and training, but for continuous learning throughout your working lifetime. Finite training and degrees, static and sterile, are entering a phase of obsolescence. Continuous self assessment, pivoting to meet the current needs, retraining and skill acquisition are the watchwords of You 2.0.

You must not only be prepared and properly trained, but you must have fully developed emotional intelligence, the skills necessary to handle groups of people, exemplary communication skills, and flexibility. You must be willing and able to turn on a dime, to meet new challenges and take on new projects that in years past you would have thought were out of your league. Continuous self assessment will be your watchword, and adaptation and skills acquisition will be your goals.

As Friedman said in a previous book, the world is flat. It is also fast and furious, changing at the speed of Moore’s Law and then some.

Those of us who are overwhelmed by this rapid change will fade away, some fast, some slowly.

Those who embrace change, who thirst for knowledge and who adapt to different landscapes and environments will be successful and drive the next wave and the next and the next.

You 2.0 will look nothing like the prototype.

Then again, did we really expect it to?


Monkey in the Middle

Keep away.

Monkey in the middle.

Urban Dictionary defines “monkey in the middle” as the person who is in the middle of two fighting sides. This person is friends with both arguing sides and wants to stay neutral but is eventually dragged into the fight, and one of the fighting sides becomes mad at them. 

I will be fifty nine years old next month. I grew up loving to read. I read everything. I was thrilled when the new Scholastic Book Club circular, or anything like it, came home with me, to be lovingly perused and marked up with all the paperback books,  Dell crossword books and dinosaur books that my parents would allow me to order. I was more thrilled when the shipments came in, giving me hours of pleasure like no other activity I enjoyed at the time. I was ecstatic when my parents bought the complete set of the Collier Encyclopedia, complete with annual updates, though I can now come clean and say that I wish they had bought the World Book Encyclopedia instead. Colliers seemed a bit too stodgy to an elementary schooler. 

I simply loved the feel of the page. I loved the color glossy pages. I loved doing crossword puzzle after crossword puzzle. I loved the feel of the spine of a book nestled in my hands, the way new pages stuck together until you riffled them the first time, opening up the whole new world that was hidden in the infinitessimal spaces between the papers. I loved that tipping point that came when you knew by feel, without even looking at the page numbers, that you were just over halfway through a novel, and that it was all down hill from here. A race to the finish, the climax, the denouement, the satisfying completion of a mind journey that could have transported you anywhere in the universe.

I still love to buy books, to keep books, to shelve books that I just know I will read one day (sometimes do, sometimes don’t, let’s be honest). I still like to peruse the colorful pages of magazines, especially when I am tired and just want to kick back and do something familiar, something comfortable, something comforting. 

I am a product of my age, my upbringing, my schooling, the modeling of my parents and mentors and teachers. I am an analog man in an increasingly digital world. 

Now, I love my technology. 

I have bought more iPads that I care to admit to. I have owned every desktop and laptop computer from a Micron to a Dell to an HP to a Radio Shack to Apples. I have lusted after the newest Sony PDA, upgraded to a Treo with a stylus, and was fascinated when I first heard about the marvelous little machine that was to be the first iPhone. “I’ve GOT to have one of those,” I remember saying when seeing the image of the prototype on my laptop screen. I have owned virtually every model of iPhone since 2007. 

I get excited when thinking about moving next month and setting up a new wireless system in the condo. I am already salivating over wireless security systems and what might best serve our needs. I am constantly looking for the next excellent podcast, digital newspaper, newsletter, or blog to read. I love audiobooks. I listen to music on three streaming services, only one of which I actually have to pay for. I watch movies on my iPad, which has more pixels and a much better picture than my widescreen television. 

I am a product of my age. I am a digitally connected man in a world that is watching analog constructs fade slowly into history. 

I am the monkey in the middle. 

I am listening to a fascinating audiobook right now that I would recommend to everyone. The Inevitable, by Kevin Kelly, looks in some detail at where we are headed, and why, in the next three decades. While I do not delude myself into thinking that I will still be around forty or fifty years from now, thirty is definitely doable. I get very excited when I think about the world that my grandchildren will be running, of which I may still be an active, though peripheral, part. The book speaks to the way that society and all its wonderful parts is morphing and continues to change over time, cataloging and saving and curating and dispersing and sharing and annotating knowledge and creativity and thought of every conceivable kind. It also speaks to the generation, MY generation, that finds itself squarely in the middle of two camps, one whose tenets are inscribed on cotton paper, and one whose bits and bytes are blinking and beeping into the future. 

I am friends with both sides. I want to remain neutral. 

It is going to be a fun ride for the next two or three decades, that is certain. I want to keep up, to remain relevant, to learn, to continue to produce and create and to learn to access the new technologies and the new paradigms as they present themselves. I very much want to keep working, to keep helping people through my vocation, to educate myself continually about advances in my field. I want to enjoy music and art and books and the vast amount of information that is the collective knowledge of our increasingly connected world. I do not want to become an old man who is too intimidated to reach out and try something new out of fear or ignorance or apathy. 

I don’t mind being the monkey in the middle, as long as the game of keep away does not turn into a game of dodge ball. 

Thunder Lizard

Okay, so I had this thought, not for the first time I’ll admit, but today at any rate.

I acknowledge that I am a dinosaur.

Now wait, wait, don’t get all up in arms and start spouting stuff at me about being so young and handsome and witty and smart and all that (well if you must, go ahead. I’ll give you a few minutes to get that off your chest, then we can move on.)

I’m actually three dinosaurs, a hat trick for my hockey loving readers in Canada, a trifecta for you gamblers out there. And this is not necessarily a bad thing, but something that I’ve just had to come to terms with, starkly and unavoidably, in the last few weeks as things change in the world of medicine in general and psychiatry and mental health specifically.

My first dino-personality fragment is the Deny-o-pod.

You see, I trained in what I now know and wistfully acknowledge was a golden age for young psychiatrists. We were young and idealistic and had the best of both worlds in our books, our patients, our supervisors and professors. We learned all about psychodynamic theory and we were on the cutting edge of the “new” age of psychopharmacology. We had it all, loved it all, discussed it all in a haze of cigar smoke (yes, Dr. McCranie, I’m thinking of you, wherever you are) and good feelings that made our training class feel more like a very small, tight cadre of lifelong friends than wet-behind-the-ears psychotherapists.

The Deny-o-pod in me wants to think that that time and that feeling will never change, when in reality that train left the station many, many years ago. Oh, we still see the faintest of glows from the tiny red taillights on the caboose, but the freight train that carried the likes of Anna and Sigmund, Adler and Jung, Skinner and Kernberg is fast approaching the roundhouse and will not be sent back. I like to think that I can still take three hours to see a new patient, write my notes at my leisure anytime in the next day or two or three after the visit (or better yet just jot down one sentence, sign it and be done) and have plenty of time to read about the things I see and think on them for a time.

That never happens any more. Visits for new patients are crammed into thirty minutes if that, follow ups can be as little as ten minutes, and the new collaborative documentation standard looming by the new year says that notes are typed while the patient is in the room, with input from the patient and buy-in for the treatment plan in real time. This is supposed to make mental health workers happier, healthier, have loads more hours free to see loads more patients and spend more quality time outside the consulting room doing other things. Time will tell. Deny-o is skeptical at best.

Delay-o-saurus is the second of the Jurassic trilogy that lives in my head and heart.

Even when I think of the fact that times are changing, radically, and that we will never go back to those golden days, and even if I tell myself that I must change along with everyone else if I want to keep working, I manage to tell myself that it is perfectly fine to delay and stall and do things the way I’ve always done them until someone, most likely my boss, drags me kicking and screaming into the next decade with a new set of standards and expectations. This is fallacy, of course, and I know it. I have to get on board just like everyone else, especially my staff, who I must motivate to change too.

The third scaly and lithe beast is one who flies, the screeching, soaring Dive-o-dactyl.

That part of me knows that the only way for me to really get my head in the game when change like this happens is to dive right in and go for it. I know what I have to do. I also know that I don’t like being told what to do! That doesn’t matter in this kind of situation. The change is coming, and it cannot be ignored. It’s time to put my head down and dive right into it.

I’m fifty-seven years old. I would like to work at least twenty more years if I stay healthy.

I know I must change and adapt, or I won’t survive.

At least I know my fate won’t be the same as the dinosaurs of old.

There are no asteroids in South Carolina to my knowledge, and I don’t smoke.


Cartoon by the one and only Gary Larson.


It’s a stressful day.

I’ve tried to deny it, but I can’t. I’ve tried to say that enough time has gone by, that finances demand it, that peace of mind is coming, that the overall stress level will go down soon, all of which are true in their own way. I’ve tried to convince myself that moving on from the physical backdrop for roughly one third of my life will be easy, that it’s expected even, and that it will lead to other positive and enjoyable things. All true, too.

It’s still a stressful day.

I’ve buffered it with cognitive effort in meetings. I’ve taken half a day off. I’ve come to one of my favorite coffee shops and talked travel with my friend the owner, then had some goodies and excellent coffee. I’m writing this post. All of these things will usually help when I’m feeling upset or down or stressed.

It would be helpful if I had a ready doppelgänger to jump in right about now. To take the reins and guide us the rest of the way in. A ghostly counterpart of me, a double, an alter ego. He could even wear dorky glasses and jump into phone booths ( if we still had those) and change into costume before helping me make sense of the changes I’m going through. I wouldn’t mind.

Unfortunately, I look around this coffee shop and see only students, middle aged ladies chatting each other up, and busy employees roasting and pouring good coffee. My body double is not here. I have no highly trained stunt man. I have no understudy. I have to play this part to the end, say the lines myself, and take my own curtain call.

Lord knows I’ve had worse days. Haven’t we all? Days I can’t even remember, so bad and so painful that the memories of them have been stored away in the deepest recesses of my brain, filed and kept, most likely never to be accessed again. This is different. This is everyday pain. This is generic angst, something that humanity takes in stride and moves past collectively, but not without damage to the individuals in its ranks.

I know what to do. I know what has always worked, and it will work today.

I will show up.

I will listen, process, ask questions as needed, and make sure I understand what I need to understand.

I will sign here and here and here and here and here.

I will see the process to the end, because it has gone too far not to.

I will walk away a little lighter in obligations, but a bit heavier at heart.

I might turn back one last time, hoping to catch a glimpse of myself where I used to be, just for old times’ sake.

And there I will be, a ghostly me, smiling faintly, waving as I turn and walk away into a bright, warm, sunny almost-October afternoon.


Good morning, Facebookians, Tweeple, and other assorted readers. 

Today, your brain is going to have a lot of fastballs thrown at it.

There are going to be requests made of you that you may not be able to handle. You’re going to have to juggle multiple to-do lists and not drop any of the items or their due dates. New ideas will be foisted upon you before the old ones have been adequately processed. People will screw things up and come to you, expecting that their messes will become your emergencies. Deadlines will loom large, and setbacks will inevitably make their way into your workflow. 

What to do?

Throw your brain some changeups.

Now, if you’re not a baseball fan, let me bring you up to speed, as it were. A fastball may come at you, the batter, at ninety five miles per hour. Blindingly fast, hard to see and even  harder to hit. The brain processes this fact, gets your arms around and the bat with them and tries to make contact with the little round object whooshing past you in the strike zone and often into the catcher’s mitt. 

A changeup may come in ten to fifteen mph slower. To the batter, the pitcher is winding up and holding the ball about the same and delivering it with the same motion he always does, but there is one difference. He is holding the ball just a little differently. Just enough to take something off of it as it makes its way toward the strike zone. Just enough to get the brain off balance, to make it rethink what it is seeing in front of it.

Work and life can be like that. Fastball after fastball. Strike after strike. No connection. No contact. No hits. No home runs. 

Give yourself a few off speed pitches today. Slow things down. Fool your brain. Break the monotony. 


Simple things can jumpstart this process.

Change your wake up time. If you normally sleep until thirty minutes before you have to run frantically out the door, get up an hour early and give yourself plenty of time to get ready this morning. On the other hand, if you normally get up at five, sleep an extra hour tomorrow or the next day. 

Take a different way to work this morning. Walk or drive a different route. Take the bus instead of the train. Walk or bike if you can. Use the back roads instead of the interstate. Challenge your brain to figure out how to get to a familiar place in a very different way. 

Park on the other side of the lot and enter a building through a completely different door. Sound stupid? Try it. This simple action will change your perspective on the whole day. 

Use your computer mouse with your non-dominant hand. The first time I tried this my left forearm was actually sore and tired at the end of the day. A couple of days later it felt like I had always been a lefty Mouseketeer. It is fascinating how fast your brain will rebel against this little change at first, but them will retool its approach to get the job done. 

Cook a sumptuous breakfast for dinner. The wonderful smells of bacon and eggs and coffee and cinnamon rolls will confuse your brain and your palate at six thirty PM, but the novelty and the way your house smells will more than make up for it. 

Sleep on the other side of the bed. (If you have a partner, please check with them first. They may already think you’re a little off base, but I’ll bet they enjoyed the bacon.) Again, it’s all about perspective and how you get the same job done but just coming at it from a slightly different angle. 

Try a few of these simple ways to shake things up over the next day or two. See if you feel different. 

Challenge yourself. Get out of your rut.

Hit it out of the park.




Have you ever found yourself beating your head against the wall? Acting out the definition of insanity (doing the same thing over and over expecting different results)? Feeling that you just can’t solve a problem no matter what angle you attack it from?


King Kong versus Godzilla. An irresistible force meets an immovable object. 

Do doctors get frustrated? Of course they do.

One of my online friends, Dr. Mike Sevilla, got so frustrated that he recently decided to bow out of social media all together. Another friend, Dr. Jordan Grumet, has gotten so frustrated and fed up with the status quo in medicine that he has launched a new type of practice, a concierge model of sorts, and is now sweating the details in hopes that it works for him. A third friend, Dr. Rob Lamberts, is a few steps ahead of Dr. Grumet in establishing a different kind of practice that focuses on his patients, their needs, and how he can give them excellent customer service with a limited amount of external oversight and hassle. 

Me? Well, you know what I’m struggling with. I don’t like the way psychiatric patients are treated in emergency rooms, in clinics, in hospitals, by the medical establishment. I’m trying in my small way to make a difference, to effect change in my small corner of the universe. 

Frustration is an emotional response to opposition. Whether one is trying to change a system, change an attitude or create a new paradigm, meeting with resistance and seeing that one’s will is not going to be easily imposed leads to an inevitable state of frustration. The greater the external obstruction and the greater the internal will to get it done, the bigger the frustration. 

Now, I happen to believe that with doctors, myself included, the frustration is often internal and self-imposed. We doctors are prone to putting on hair shirts disguised as button-down Oxfords in the morning. We self-flagellate with stethoscopes instead of cat o’ nine tails. We poison ourselves slowly with alcohol and drugs and food instead of quickly with cyanide. 

We doctors are taught that everything can be understood, parsed, categorized, and diagnosed. By extension, it can then be wrangled, manipulated, excised, zapped, and annihilated.

Doctors are healers. Fixers. Doers. Changers. 

Sometimes, the irresistible force of our indomitable wills and boundless energies rush headlong into the immovable objects of government oversight, social change and inertia.

We want to turn the aircraft carrier on a dime, to change course one hundred eighty degrees now. A big ship can technically be turned around in just a few minutes. The problem is, the deck will pitch at an angle of thirty degrees and everything that’s not tied down will slide off into the sea. 

How do you handle the day to day frustrations in your life? Are most of them external or do you fight internal frustrations that only your closest friends see? Do you really expect to turn your ship around, and what things in your life will slide into the sea and be lost if you turn things around too fast?