I was trained by my mentors to sit with and to observe my laboring patients. After some time, I could often accurately estimate the dilation of the cervix without doing a pelvic exam. I could also recognize whether a labor was progressing normally, or whether exhaustion was setting in and some assistance was required. I encouraged my patients to move around and to assume differing positions which were more comfortable. If I left the room, all the nurses, attendings, and residents were at the central station, staring at computers. The fetal monitor tracings of their patients who were paralyzed with epidural blocks were visible on a monitor. The result was that my patients had shorter labors, a very low rate of need for pain medication, and most went home the next day. My Cesarean section rate was 6%. My hospital's overall Cesarean section rate was 35%. None of the other doctors were curious enough to ask why my C-sect rate was so low.

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Very interesting read.

I am not surprised to hear this obsession with algorithms in healthcare exists. I mean who doesn't like algorithms. I like algorithms. Make them, use them, develop them for a host of reasons.

In emergency medicine it makes perfects sense to have them. But algorithms for working with more complex issues? Hmmm I very much doubt they could ever replace free thought. We are not smart enough. Thus neither are the things we program.

As much as I love algorithms, trends and patterns. I equally love outliers.

I love outliers because, well there has to be a reason those things do not conform with the trends most other things do. And the most plausible reason why they don't fit within the observable trend is because our model.. the way we map the trend is wrong.

I think we think we know a lot. But are in a matter of fact arrogant and have much yet to learn.

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I appreciate your insight and commitment to the health of your patients. I recently was introduced to a doctor here in NJ, a private internist who also practices integrative medicine as well as acupuncture. He shares much of what you focus on using a hands on approach and far less favoring allopathic drugs. Interestingly he grew up in Romania during the communist regime where the central rulers controlled every aspect of life. He’s appalled by what he now witnesses daily here which culminates in the decline of health for so many patients all over the place. I’m sharing your writing with him.

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My internist (like a big shot internist) in spring 2022 at major medical center was pissed off one of his patients a retired ER doc treated some 1000 patients with Ivermectin and steroids, and they all got well. He was like, how dare she, while I was thinking bravo!, hero! So...read elsewhere these docs are complicit or mass psychosis... Unvaccinated, yet he still was hardcourt press on shots and boosters spring 2022, and whatever else pharma pushes out I guess...

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You are making my home printer run out of ink and paper! There is so much GOLD in what you have written here that I feel compelled to print the whole thing out, underline key phrases, and go over them again and again. THANK YOU for these wonderful insights. They resonate with me to the core.

Basically, I’ve now opted out of the health care system. I’ll only go to a doctor if I have a specific problem that I am unable to solve/ fix by other means. The feeling of freedom this gives me is marvelous. At age 68, I feel healthier than I’ve ever felt.

If anyone is interested in hearing me discuss my evolving views on these and other subjects, I post on Rumble every two weeks. Here’s my latest post: https://rumble.com/v1259fe--hey-maga-we-are-winning-florida-gov.-ron-desantis-rocks...-episode-95.html

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Medical error and drug injury are the third and fourth cause of death now in the USA.

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Bravo 👏🏻!!!!Great detailed read ! All I can add, is the residents I teach, love EMR (copy/ paste one patient to the next). Orders are placed with a stroke of a button! They have free time to order what they need from Amazon and follow friends on Twitter, Instagram and the like. It’s a whole new world, sad to say. Open philosophical discussion on care and treatment of the patient ( the whole patient, mind , body and spirit ), is gone.

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May 2, 2022·edited May 2, 2022

What a fantastic article! You put into a few pages what took me decades to figure out.

You see, I'm one of those with "the knack" for solving highly complex problems with imperfect solutions. Successfully doing so requires a very curious problem solver, one intrigued by the complexity and puzzle... one who cannot stop until s/he answers, "But WHY did that happen there?!"

I lead a team of engineers solving computer problems that have no perfect answer. I don't know more than 20% of the technical details of the overall system, but I'm an expert and finding and assessing expert opinions in context of each unique problem. COVID was, to me, just another highly complex problem with imperfect answers. I just needed to learn enough about the data to find honest sources and truth-speaking experts.

Three factors I think are common in folks willing to embraces the complexity: great problem solving skills, unquenchable curiosity, and strategic vision.

The more complex the problem, the more important the curiosity and vision are. If you can't see the big picture and remain curious, your problem solving skills will not have enough time or context to work through the data and noise.

When I finally understood what you described here, I experienced a peace that had been lacking my entire adult life. That occurred roughly 2018. And it was key to my looking at the COVID problem and thinking I could learn enough to understand it (since clearly nobody in charge could be trusted to do that for me). It took me a lot longer than I'm used to because I had to learn the biology/virology, figure out who the experts were speaking truth, and where to find the data.

Don't get me wrong. I'm no doctor or virologist or what have you. But I do know how to read data and evaluate expert analysis based on the data. And I know how to cross-check assumptions to validate them. And how to identify conflicts of interest.

As you said, the root of the problem is the controlling "leaders" that care not about us...

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This ordeal has really separated out wonderful doctors, and those that have blood on their hands. There are some who have not incurred guilt thru ignorance, but that excuse is diminishing. Many could face eternal damnation over this. Coercing this experimental, dangerous shot is a mortal sin, so too is remaining silent when you have exalted position as a doctors.

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Oh man I've been there! I have a horrific medical condition that you have never heard of, for it has no name and no mention in any medical journal. Dozens of docs I have seen did not find anything wrong, thought I was simulating or just plain coockoo. They like to stress you out to the point they can tell you that this stress is causing your condition so they can get rid of you by refering to a shrink. They MUST come up with a diagnosis within two appointments because next patient is waiting and they just cannot say "I don't have a clue what this is".

Thank god I am extremely stubborn and have no problem sticking to reality like fly paper. I retrieved my medical files with scans and all, did my own research and the diagnostics. Then searched for the best specialist in whatever country and told him what was wrong and what surgery to perform. Three specialists and surgeries later I am OK now. Not cured, but as good as it gets. My stubbourness saved my life. For those of you in the same boat, you need to study and find the one pioneering doc that thinks outside the box, usually in a university hospital or specialized clinic, doing things that nobody else does while still caring about the patients. Really they do exist and some even like to have me as a patient.

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When my son was training to be a doctor in the UK a few years ago I asked what he'd been taught about iatrogenesis. He'd never heard the word.

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Wow, this was fascinating. Thanks for showing us how so many of these issues are connected.

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I've experienced medical gaslighting personally. I experienced sudden muscle weakness down one side of my body and, for the first time in my life, called an ambulance and went to hospital. As soon as they read my medical records and discovered a diagnosis of depression, they decided that that was the cause. Conveniently, that diagnosis meant they only had to write a referral to an equally useless practitioner. Job done, hands washed.

I've been depressed for 50 years and it never caused sudden muscle weakness before. IMO, they were just being lazy. And then lazier ....

A couple of months later, it occurred to me to get a printout of my blood tests. One number was significantly elevated and it explained why I had a clot or bleed that caused the sudden muscle weakness. Once I knew that, I took steps to deal with it and have been fine ever since.

Either nobody looked at the results because they already "knew the answer" or they looked and thought 'sucks for you' and couldn't be bothered to tell me. Equally likely, given how bad the NHS has become.

Beware of automatically trusting doctors. Double-check everything.

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Many years ago I learned an acronym -- MEGO -- from others in an online forum that were dealing with chronic fatigue. It stood for "My Eyes Glaze Over" and it represented one's response to being gaslighted repeatedly by MDs over having a condition that supposedly didn't exist. At the time, I had not learned the word "gaslighting" -- that came into my vocabulary only about 10-12 years ago -- but the connection is clear. So been there, done that, and saw the movie. I can't remember if there was a T-shirt.

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Terrific piece.

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So many thoughts went through my head as I read and so resonated with this! I will just share a few things, yet feel I could fill pages!

Both of my MD's left their professions stating early retirement, just prior to the end of 2019. One, quite abruptly. I could sense she had been seeming disappointed in the medical profession. Prior to one visit, when my son was preparing to enter college and live in a dorm, I had run across some information highly recommending the meningitis vaccine. It was new to me. My son was just entering her care (My whole family was in her care by the time she left- she took on kids once 18- I was so glad as I was ready for sure to fire the pediatrician! Another story....). When I asked her if she thought the shot was necessary, she didn't say a word, but just tipped her head downward, closed her eyes and shook her head. That was all I needed- I so trusted her, and am glad I had.

That same MD had been offering vaccines when she worked with another MD, who she subsequently left, but the only one I would get from her office had been a Tetanus one. When I went for my physical (which I really seldom did- but knew I was "due" for my 10 year "shot"), she asked me why I thought I needed a Tetanus shot. At that time I was not as up on all the shots and dangers- just was learning.....I had been avoiding flu shots, had a religious exemption form accepted at my work. For the Tetanus one, I was concerned as I worked with chicken wire outside in the garden and had heard of rust causing problems (rusty nail story)- really basic word of mouth stuff. She wouldn't drop it and said her records showed I wasn't due for another year- that it had been 9 (I knew for a fact this was wrong- and in retrospect feel she was helping me make a better choice by stating that). She dropped her efforts and I took it, but had some bad effects later (it was the DPT shot by then)....I do believe my symptoms were caused by the shot, but never looked hard into it. Lack of time- I won't get into that now. This MD, I could tell really disliked having to type into the computer while with patients. also. I could so see she was getting disgusted with the system- and the shortened time with patients.....always seeming rushed when previously hadn't. I am glad for her that she was able to leave. I can't help but think she knew something was up. Same with my OB-Gyn- but to a lesser extent.......Then after 2020 came, my Ophthalmologist decided to leave......I have lost my faith in the system too. But that would continue another chapter.

I worked in an allied health profession for 30 years. Also disintegrating in quality. Good MD's were/are hard to come by. I can tell you are a really good one. During this whole COVID situation- I made time to read Judy MIkovitz's trilogy and it really opened my eyes! I could back track symptoms I had to when vaccines were taken....and my own kids' behaviors and gut instincts. I KNOW I was correct in my suspicions. I thank you whole-heartedly for your writings. I feel confirmation in trusting my intuition and less alone. On a side note- the profession in which I worked was speech language pathologist- in neuro-rehab....Many times one has to really read between the lines- many of the patients cannot talk! One must look further and deeper and carefully. then along come the algorithms! Give me a break! No 2 brain injuries or CVA's are the same-too many factors! And the use of computer documentation while with patients!? These ones need face to face contact. I found myself constantly apologizing for having to enter information- and then stating what I was entering- for family members also present sake also. they knew I was sick of it and shared their views. I grew disenchanted very quickly upon EMR entry into the field. I wrote one heck of a long and detailed exit letter which I have subsequently received complements on from trusted individuals. I have over typed- but just had to let you know how grateful I am for your substack!

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