An expanded group of medical societies has released an update to last year’s Choosing Wisely list of common but often unnecessary tests and procedures, a host of cardiovascular no-goes among them. Announced Thursday, the new list includes almost 90 tests and procedures, with 17 medical groups as signatories, including, for the first time, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, and the Society for Thoracic Surgeons, among others.
As reported by heartwire, this year’s list takes particular note of a peculiar kind of patient—the one without symptoms. No fewer than 12 of the guidelines issued as part of the American Board of Internal Medicine Foundation Choosing Wisely campaign caution physicians that asymptomatic patients probably don’t need a given treatment. A few examples pertinent for cardiologists, along with the society that recommended them, include not screening for carotid artery stenosis in asymptomatic adult patients (American Academy of Family Physicians). No routine pre-discharge echocardiogram after cardiac valve-replacement surgery (Society for Thoracic Surgery). Avoid using stress echocardiograms on asymptomatic patients who meet low-risk scoring criteria for coronary disease (American Society of Echocardiography). Patients who have no cardiac history and good functional status do not require preoperative stress testing before noncardiac thoracic surgery (American Society of Echocardiography). Don’t use coronary artery calcium scoring for patients with known coronary artery disease, including stents and bypass grafts (Society for Cardiovascular Computed Tomography). Don’t repeat echocardiograms in stable, asymptomatic patients with a murmur/click, where a previous exam revealed no significant pathology (American Society of Echocardiography).
American Board of Internal Medicine president Dr Christine Cassel advises such rules of thumb seek to change the mindset in physicians and patients alike that more are better, which leads to wasteful spending and sometimes puts the patient at risk. The watchdog organization Consumer Reports is working with other consumer-oriented groups such as AARP, the Leapfrog Group, and the National Partnership for Women & Families as well as Wikipedia to spread the Choosing Wisely guidelines to patients. This public outreach seeks to educate Americans that not every test and procedure is appropriate for a particular condition. Sometimes, patients request a treatment they don’t need. It takes much longer to dissuade a patient from asking for test than actually ordering the test.
I have forced myself to contradict myself in order to avoid conforming to my own taste. Don’t think you understand It. On the other hand, don’t think you don’t understand It. It? What is It, a pronoun capitalized this way? What is It, pronounced with the kind of emphasis that communicates great significance? Alternatively, it is called the Great Matter, Enlightenment, Emptiness, Suchness. These are ways we refer to different aspects of It. When I write these words, what do you think to yourself? You probably think to yourself either that you don’t understand these things, “Wow, I wish I understood those things, maybe I will someday.” Or, perhaps, “I will probably never understand,” or when you hear these words you have a sense that you do understand these things, at least to some degree; the words conjure up for you a memory of an experience, a mind-state, an insight, or you think of images or sensations that you find comforting or inspiring. It is difficult to say which of these – a sense that we don’t understand, or a sense that we do understand – is more detrimental to spiritual practice.
Buddhist understanding – prajna paramita, the perfection of wisdom – is completely different from ordinary understanding. It is so different that even though it is here under our noses all the time, we miss It. Even though this Understanding is free and available, we revere Shakyamuni Buddha as a once-in-a-universe amazing person because he came to It without even having a teacher who pointed it out to him. This is the central teaching of Buddhism – that there is a kind of wisdom, a kind of insight, “which removes all suffering, and is true, not false.” The Buddha studied suffering – old age, disease, death, loss, dissatisfactions – and asked whether there was any way out of it. He was not the first to ask this question by any means. Almost every religion and social movement has tried to offer people a remedy, a way out, at least a mitigation of this human experience of suffering.
What the Buddha realized was, in a sense, its all how you relate to it. It’s all how you see it and understand your place in it. However, this is not about adopting some arbitrary positive outlook! Well, you could look at things that way and suffer, but if you adopt this philosophy or view things don’t look so bad…This is about seeing the true nature of reality. What is it that we see? A textbook answer would be something like, “we see that we, and all beings and things, are empty of inherent, enduring self-nature.” But this description is so inadequate to convey what we end up understanding. We could also say “we see that things-just-as-they-are, without the filter of our self-concern, are precious.” Or we could say “we see that there is only this moment, and this moment is free from suffering.”
Intellectual understanding of these descriptions or faithful belief in these descriptions, do not convey the release from suffering that the Buddha found. They must be personally and directly experienced for that to occur and once they are personally and directly experienced we are forever changed, but no experience in the past conveys lasting release from suffering either. Perhaps when you hear It – the Great Matter, Prajna Paramita (Transcendental Wisdom), Enlightenment, Emptiness, Suchness – you recall the spacious, unself-conscious feeling you experience in the wilderness. That’s not It. Perhaps you think of the “zone” you get into while doing a body practice or artistic activity. That’s not It. Perhaps you think of how vast space is, or how we are made up mostly of space, between our tiny atomic particles. That’s not It. Perhaps you think of how everything changes, so you can’t really draw a boundary around who you are. That’s not It. Perhaps you think of how it is impossible to trace all the causes and conditions and beings that brought you the meal you eat, and how dependent you are on all these different aspects of the universe. That’s not It.
Now, it would be good for all of us, myself included, if I left you with that message and shut up. But in the West, especially in Soto Zen, they explain things. It is the gentle way. It is so easy to be satisfied with just an intellectual understanding. It is so easy to fool ourselves that ours is not just an intellectual understanding – after all, if it is associated with emotions, it’s not just intellectual, right? It is so easy to allow what was once a real experience to devolve into a mere memory, a mere view. Most of us walk around with a largely intellectual understanding of It. As Dogen would say, we are “playing in the entrance way.” This is why Zen Masters through the ages have pulled out all the stops and done all kinds of strange things to try and wake their students up from their dreams. They yanked their students’ noses, offered riddles, put slippers on their heads. What is that about? Some kind of ridiculous code? A contest to see who was least inhibited? No. It says Right Here, Right Now, Do You See? In a sense it doesn’t matter what is said or done to express it; if both people can experience It, the arrows have met in mid-air. This is extremely important. There is no god in Buddhism that is going to condemn us or even be disappointed in us because we just play in the entrance way. But what a shame.
But thinking you do not understand is just as bad. When I think like that, I am here, and understanding is over there – in that [other person’s] head, or in the past, or in the future. This can be one of the most painful beliefs. It can also be one of the biggest obstacles. We are intimate with It every moment of every day. It is never anywhere else. We experience the perfection of wisdom when we stop looking anywhere else. When the Zen Master comes and challenges us, we answer her in kind. Perhaps we say, “Yes! Buddha caught the pillow!” Perhaps we throw the pillow back. Perhaps we laugh. But the challenge does not send us off in our minds to abstractions or memories, concepts, images, metaphors or teachings. We know the Buddha is nowhere else, and have dropped the self-concern that wonders how “I” relate to Buddha.
Being at home with oneself like that is an immense relief from suffering. We must struggle to understand, unfortunately there are no shortcuts. But what we do in that struggle is exhaust all of our dreams until finally there is no place left to go. Then we see It is something we have understood all along. We just didn’t know what kind of understanding to look for. And a final note – having answered the Zen master’s challenge one day does not mean we will be able to do so the next. This is not an understanding that is of any use to us in the past.
We avoid people who look sick—even if they are not.
The common cold results in more than a sore throat and a runny nose; new research shows that illness can actually change our personal prejudices. When we are sick, we become more aware of and repelled by people who seem unhealthy, whether or not those people are actually contagious.
Researchers at the University of Kentucky and Florida State University found that study participants who had just been ill paid more attention to pictures of disfigured faces than did healthy subjects. Those with recent illnesses were also quicker to push the images of disfigured faces away than they were to pull the images toward them. The results are consistent with other studies showing that prejudice toward people who are obese, elderly, or disabled is higher among those who have recently been sick.
Scientists speculate that once the immune system has been kicked into gear, it triggers cognitive processes that set off mental warning bells when we see someone who looks ill. Our brains, however, may be unable to discern who is actually a threat. Our minds evolved to solve problems associated with survival. But the system trips up when we start assuming that anyone who has any health issues is contagious.
Dementia comes in multiple forms, but in the early stages of mental decline, they all look pretty much the same. Swedish researchers recently developed a new technique that can distinguish between types of the disorder, which might allow patients to get the most appropriate treatment when it can do the most good.
One has to start early, before the brain is too severely damaged. Researchers have identified biomarkers in cerebrospinal fluid that can discriminate between Alzheimer's disease and vascular dementia, the two leading causes of severe cognitive decline. They also identified those who were on their way to developing dementia but still asymptomatic, making the biomarker technique a method that could facilitate early detection, not just differentiation.
Next in line is to try and understand what kind of neurological damage these biomarker profiles really represent. Mapping the biochemical differences between the various forms of dementia will help us understand what causes these specific diseases and how they should be treated.
Mental health disability is on the rise. The prevalence of mental illness is notoriously hard to track. But a new study of hundreds of thousands of 65-and-under Americans finds that mental health disabilities are on the rise, even as physical disabilities are declining.
Participants rated their difficulty with tasks like walking and shopping, and then identified the underlying causes from a list of conditions including arthritis, obesity, and a single mental health category defined as depression, anxiety, or emotional problems.
The rate of mental health disability climbed by a third, from 2 percent of the non-elderly population in 1997 to 2.7 percent in 2009. Americans are beginning to understand that psychic distress can be debilitating and that ailments like depression and anxiety often come with physical symptoms.
If anything, the study highlights the need for more integrated health care, so that a patient who visits his doctor for migraines, say, could also get treatment for the depression that might be causing them. The increase in self-reported mental health disabilities may not be an ongoing trend; however, but a temporary uptick created by the success of awareness campaigns.
I share my transformation from surviving to thriving to inspire and wish you do the same. You open to the world of spirituality and alternative healing modalities. Trust in the unknown forces of nature, the energy field and quantum physics. Learn to allow the flow of grace to nurture and heal you. Healing is a process of releasing old messages stored in DNA. Learn what it means to have the courage to love your self enough and trust that you deserve best life and healthy existence. That’s when your entire body starts to shift into wellness.
Learn to “let go” and follow your inner guidance. In following your inner guidance, you allow your heart to be guided by intuition and grace, not by mind/ego; which for the most part is driven by fear. You slowly and steadily unlock self from the only existence you have known and begin to envision a new life filled with joy and acceptance. The healing journey helps to identify the energetic root of dis-ease and realize if your heart heals, your body would heal as well. Learn the incredible power of words and how you receive exactly what you ask for. Learn everything in life offers us the opportunity to grow. Most importantly, learn that by seeing through softer eyes there is no longer room for anger.
Trust you have the power to make choices and be the co-creator of your destiny. You can remain locked in old stories, trapped in past belief patterns and behaviors that no longer serve you, or you can create a new story – one that resonates with your authentic self. It’s about saying yes to your desires, your higher self. Learn that forgiveness + compassion = healing. When we forgive ourselves, and others, we heal the hurt and discomfort that lies dormant in our cellular makeup. Learn to drop weapons and pick up angel wings. When we are compassion and grace, we attract the same. Healing is based in the heart, not the mind. As a result of this learning, you will absolutely transcend the dis-ease and live each day in joy and gratitude.
My offering to you:
Know on the deepest level you deserve a life filled with joy, ease and grace.
Open to the unknown – step away from the rigidity of the past and welcome in non-traditional methods of healing. Trust in the invisible lines of connection – even when you are clueless to what will happen next.
Release or relinquish old belief patterns that no longer serve you.
Listen deeply to what your heart is telling you.