Opinions and Reflections

We – of the care delivery and public health community – must immediately begin to shift our attention from primarily a sole focus on managing community and patient care toward a broader focus on also “managing” change – which often requires resisting negative approaches to change. The onslaught of changes occurring in the last couple of weeks emanating from Washington, DC are troublesome. But, it’s not because change is not needed. In fact, it’s anticipated that in shift from one administration to another that change will occur. However, it’s the manner in which change is occurring that is troublesome – along with the likely leadership in many of the areas of change! From the abrupt freeze on publishing the Mobility and Mortality Weekly Report (MMWR) for the first time in 70 years to the sequestration of research and care delivery funds, to the probable approval of Robert F. Kennedy, Jr. as DHHS Secretary, the “change” has been reckless.

While it is not uncommon to experience the change due to a change in administration priorities, “process” is an important component of “change” to prevent collateral damage. If budget reductions occur they are not simply the result of emails sent in the middle of the night. The shift in priorities are articulated. There are generally opportunities for feedback on the reallocation of resources. AND, most importantly, there are government officials charged with responsibility for implementation – not private citizens with no legislated or appointed status of any kind.

Therefore, it is incumbent upon those of us in the greater healthcare community to step up and be heard on the implications of change. For example, the silence of the medical community on the probable appointment of RFK, Jr. is deafening. We must become “change agents” ourselves if we are to be successful in mobilizing our community and the recipients of the care that is absolutely required across the board as a part of societal health care. If we truly believe that “health care is a right” then stepping up means becoming involved both socially, politically, and organizationally.

The fact of the matter is that disease continues to spread throughout the world and it will not wait for government programs to reconvene or be redeployed before invading our country. Delayed care is frequently detrimental to the individual patient. Lack of funding for research will precipitate a dismantling of people resources who will most likely disperse to maintain a livelihood leaving research projects in shambles. Public health is an “economic” issue right alongside “community health” where the lack of funding creates an impact from ongoing, unremitting disease spread across the nation and the world. So, hopefully, it’s clear – we need to stay engaged, get organized, and collaborate across all of the boundaries within the healthcare community!!

We need to maintain our focus on developing, delivering and addressing health with the VERY BEST data available – not solely on contrived opinion. It’s also important to keep in perspective that the entire world is dependent upon many of the public health programs supported in the USA (e.g. surveillance). We are a leader due to our investments in better health for all. And, finally, we must continue our focus on making health care better… And – at the end of the day – by retaining these areas of focus, we will benefit the public – and, the world – as well as healthcare for the community.

Opinions and Reflections

A Slightly Different Fickenscher Files This Week – As you will learn through this week’s blog, I’ve been on holiday in New Zealand for the last 3 ½ weeks. It’s one of those bucket list experiences. First, it’s an absolutely wonderful country and, unfortunately, they are not letting a lot of retired Americans move there 😊(Just kidding! I really love Maine). Long story short, I’ve been a bit on hiatus in keeping up with the “health care” news. So, while I still am offering up my latest thoughts on the health care front, please note that there is a heavy lean toward some learnings while I was in New Zealand. And, I’m under personal contract to propose to all my friends, neighbors and readers that New Zealand should definitely be placed high on the bucket list if you have the resources to allocate toward such a venture. It’s worth it! As such an experience, the country is absolutely beautiful, and the people are exceptionally nice. We could all learn a bit about hospitality through an experience in this wonderfully beautiful country. I feel blessed to have had the opportunity to visit.

A Moment Of Thought – In addition to several multi-mile hikes up, down, and along the shoreline mountains, I also splurged and had a massage while visiting Abel Tashman National Park. Flo – the massage therapist – provided an outstanding experience for my well-worn body with an achy back, arms, and legs after a series of hikes. At the end of the experience, she engaged in a Chakras experience. Chakras are a part of some religions and also an “alternative” health proactively focused on the energy centers in the body and is derived from the Sanskrit word "chakra" meaning "wheel" or "cycle". The basic notion is that certain energy points in the body are thought to be part of the spinning wheels of energy or life forces. The Chakras correspond to bundles of nerves, major organs, and areas of the body that affect our emotions and physical well-being. Balance of these various forces is an important element for maintaining a focus in life and connection to the world in which we live. Seven chakras run along the base of the spine to the head. At the end of the massage, Flo engaged in a very quiet chant and placed seashells along my head, chest, and abdomen.

While I’m a bit skeptical about the Chakras concept or its ability to alter my overall balance – for me, it was striking that the experience occurred on the same day as Jimmy Carter’s funeral. So, why do the two separate and distinct events come together in my mind? It relates to Carter’s focus on helping mankind and the need for all of us to have balance with ourselves and between the affiliated nations of the world to maintain the stability of our relationship with one another for the peoples of the world. While Carter – like all American Presidents – had his pluses and minuses, he stood for making life better for “the people.”

At the end of the day, when all is said and done, helping our fellow man is one of the most important contributions we can make in the world. This is, in fact, one of the core messages that serve as the foundation for the religions of virtually all faiths. It’s also the guiding force of why I pursued a career in medicine – to “make health care better.” While like all of those who pursue leadership roles, I had failures and successes, it was my daily mantra that kept me focused. And, now the times are calling for all of us to maintain our focus. Think about it for a moment. What is your personal mantra? Consider the thought. We are one together in this world…

No Hedging On Hegseth – While I’ve been out-of-country for the last three weeks, I tried to detach myself from the daily news related to the transition in our federal government. While there are a number of major policy issues on the health care front that will no doubt be percolating forward – it was not those issues that raised my ire! My specific concern relates to the qualifications of Pete Hegseth to serve as the Secretary of Defense for the entirety of the American military machine. I won’t review the issues that have been raised at his U.S. Senate hearings. There is plenty of specific information on the results of those hearings available across the majority of the national media. However, I will say that the lack of response by the proposed Secretary to direct questions along with the specific and documented allegations PLUS the absolute, total lack of response by the Republican Senators is appalling at best! If these same allegations came to light for a Democrat candidate, there would thunder – if not howling – in the halls of Congress from my Republican friends and colleagues. Where did this servility come from? Have we only become a nation of groveling, power-hunger representatives rather than keepers of the beacons of liberty? Ai Yi Yi – what have we come to? If similar accusations are made in the future about Democrat candidates I will raise the alarm again as well. Please note my intentions for future reference.

Opinions and Reflections 

First, My Apologies – Over the last decade-plus that I’ve been writing The Fickenscher Files the approach has been to remain apolitical. However, the recent explosion of misinformation coming from all sides – not just politicians – has gotten me agitated, especially as it relates to the health of people, our nation, and the world. So, bear with me…

The Health Of The World And Weather Extremes – If you’ve been listening to the news, you most likely can’t help wondering about the extreme weather hitting Florida. However, that’s not the only area of concern. Some significant weather events in the last 10 years include: 

• 2023: A heat wave swept the Midwest and Southwest of the United States with at least $1.2 trillion in damages from 173 events
• 2014–2023: The warmest decade on record throughout the world, with 9 of 10 warmest years ever recorded during this period plus storms like Hurricane Dorian that hit the Southeast US coastline (2019), the flash floods, and extreme rainfall in December (2018), Hurricane Nate (2017), and the list goes on…
• A North American heat wave killed at least 225 people and brought extreme heat to most of the United States and Canada.

And now, Hurricanes Helene and Milton are following the same path with destruction upon destruction. Next, we’ll probably experience Hurricane Agonia – an extraction from the Greek reference for a difficult struggle and the associated pain that accompanies the struggle – a fitting name for an upcoming storm!

But, the question is: When are we going to do something about it? It was very disturbing for me to learn that the House Committee on Oversight and Accountability and the Senate Budget Committee jointly investigated Big Oil, issuing a report in September 2021. The report is disturbing at best. Here’s an excerpt: 

“Our investigation revealed how Exxon, Chevron, Shell, BP, API, and the Chamber worked in concert to mislead the public, policymakers, and investors with public promises to reduce emissions and meaningfully contribute to the transition away from oil and gas, while privately seeking to lock in continued fossil fuel production for decades into the future…The investigation also demonstrated that the fossil fuel industry continues to knowingly obfuscate the dangers of natural gas, which they have billed as a clean and green fuel.  This evidence, combined with the entities’ failure to comply fully with validly issued congressional subpoenas, suggests that further investigation by the executive branch is warranted.”

“Our investigation into the fossil fuel industry calls to mind the historic congressional investigation into deceptive practices of the tobacco industry and its trade associations, which led to investigations and litigation by several state attorneys general and the Department of Justice (DOJ)…is well situated to pursue further investigation and take any appropriate legal action, as it has in similar cases involving the tobacco and pharmaceutical industries.” 

Health is both personal and global. The information I share is primarily focused on the personal side. However, if we are all truly concerned about the “health of the people” a natural concern should also concern the state of the world we live in! The health of the world will not subside as an important attention getting noticed on all of the news outlets because there is no cycle where it ends – like the upcoming election. Rather, the problem is only getting worse. Perhaps we in medicine should start training “Globalogists” to focus on the issue of global warming and its effect on the environment. Just a thought…

Political Misinformation – People are suffering, homes are destroyed, displacement is rampant, and – on top of all that – we have irresponsible and reprehensible disinformation being spread indiscriminately on the airwaves by certain individuals. Examples include accusations that funds are being taken from FEMA to support immigrants coming into the country to “vote” for candidates (Democrats, of course). The accusations are categorically incorrect and, in fact, dangerous. Anyone can fact-check the real information at the FEMA website, a responsible governmental agency. It’s disturbing at best that such disinformation would be spread in an effort to grasp power! Our political discourse has fallen into the gutter from my perspective. Let’s get back to arguing about the direction for the country and the world, the policy ideas and disagreements rather than gutter discussions that take us nowhere.

When I feel I must share my thoughts and perspectives on a burning issue…

On Narcissistic Behavior – the events of the last couple of months in various forms have heightened the number of behind-the-scenes conversations among healthcare providers related to Narcissistic Collapse that occurs when a narcissist’s ability to uphold their grandiose, confident image is threatened. When challenged or confronted, individuals with the disorder will often become enraged, resulting in impulsivity, intense lashing out, or harm to others. While this reaction isn’t typically intentional, it’s a way for the narcissist to re-establish a sense of control. I encourage all of my readers to check out the above-noted hyperlink on the disorder. In brief (and, I quote) from the site highlighted above:

“A narcissistic collapse happens when a narcissist believes that someone (or something) is threatening their ability to maintain their superficial inflated ego. People with narcissistic personality disorder (NPD) often look down on others to maintain the positive images they hold about themselves. If their behavior is called out or challenged, their fragile self-esteem is damaged, resulting in intense reactions and abuse toward others.¹

“Narcissistic collapse isn’t an official psychiatric term and hasn’t been extensively studied. However, some researchers and psychologists argue that collapse essentially disarms the false self associated with narcissism.² Because narcissists are so insecure, they often feel empty and hollow–they need admiration from others to feel validated.³”

 The issue is coming to the forefront as part of our national conversation. As healthcare providers, all of us need to offer the best analysis and perspective on what we see and hear in the ongoing debates about the future of our nation.

Citations:

• Kowalchyk, M., et al. (2021). Narcissism through the lens of performative self-elevation. Personality and Individual Differences, 177, 110780. https://doi.org/10.1016/j.paid.2021.110780
• Vaknin, S. (2020). Narcissistic Mortification, Shame, and Fear. SunText Review of Neuroscience & Psychology. https://doi.org/10.51737/2766-4503.2020.006
• Speaking of Psychology: Recognizing a narcissist. (2016). American Psychological Association. Retrieved fromhttps://www.apa.org/research/action/speaking-of-psychology/narcissism.