maximizing potential

Monday, January 29, 2018

It was an event filled weekend in sports, with the NFL Pro Bowl, the NHL All Star Game, the Australian Open, and more. Roger Federer defies the calendar and continues to win an age when many of his contemporaries have been retired for years. Tom Brady didn’t play in the Pro Bowl only because at age 40, he is leading his Patriots to another Super Bowl appearance and James Neal at 38, is an All Star again with the Vegas Golden Knights. The ability to perform at the highest level as one ages is a combination of persistent effort, some opportunity and a dollop of good genetics. In elite competition, with age comes wisdom and the knowledge that there is a 20-year-old who possesses almost the same skills and wants your job.

We all are athletes in our own ways. Once upon a time, when manufacturing was king, workers’ bodies were considered tools, things to be used until they wore out. While safety in the workplace continues to be addressed, the concept of spending time and effort on improving the workers’ bodies is less widely stressed. We forget that building a widget in the factory, cleaning a home, or shoveling a driveway, requires power and movement. The ability to maintain the body’s machine-like work depends upon preventive maintenance that too often is neglected.

Most athletes spend the majority of their time in preparation and not competition. An NFL player will spend hours every day in the training room, studying film and pursuing a healthy diet, just for the opportunity to participate in a total of only 50 or 60 plays on a Sunday afternoon. An NHL player plays more games in a season but may be on the ice for only 15 minutes per game. In the real world, there must be a concerted effort to look after the only body given to you. If it wears out or breaks down, replacement parts are hard to come by.

Unfortunately, the rules for looking after your body are complicated and experts keep changing their minds. Whether it is blood pressure recommendations, foods that are good and bad, or alcohol use, it seems that a new study is making the headlines every week, touting the positive or negative effects of some intervention. Add that to the information overload of direct to consumer advertising by pharmaceutical companies and those who promote dietary supplements to cure almost everything and the ability to decide what really matters can be tough.

The best coaches seem to maximize athlete performance. The best primary care providers need to have the people skills to motivate their patients to continue lifelong positive behaviors. Those providers need to be well read and up-to-date to help their patients navigate the confusing and ever changing medical information overload. The toolbox for disease prevention and management has gotten bigger, but it’s useless if the patient (and family) choose not to seek routine care. People spend more time researching a plumber, or a restaurant review than their care provider.

Brady, Neal and Federer compete and perform because of the effort invested to maximize their potential. That effort includes finding the coaches, trainers, physical therapist and nutritionists that meet their needs both from a physical standpoint but also from an emotional one. It’s easier to follow the message if you trust and believe in the messenger.

The decision to find a good provider should happen early in life. Becoming independent involves getting a job, renting an apartment and developing a social life. Finding a good primary care provider rarely is on that checklist, but it should be. It’s easier to keep a body healthy rather than fix one that is beat up, especially for chronic illnesses like high blood pressure and diabetes.

As opposed to that first new car, you’re only given one body and it needs to last a lifetime. For the elite athlete, when good genes meet good training, magic happens. For the rest of us, when healthy lifestyle meets prevention and disease maintenance, a good life happens.




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domestic violence

Sunday, August 3, 2014

Players know the rules and understand that violence needs to be contained within the sidelines. A great hit on the football field is flagged as a penalty if it happens out of bounds. But the violent actions that are celebrated and relived in slow motion replay, are not the real world. In the real world, violence should never be an accepted or explained, but for too many people, violence is their normal. The Ray Rice domestic violence story perhaps allows an opportunity for us to understand the depth and pervasiveness of this disaster, which is not limited by national border, race or social class.

Briefly, Ray Rice, an NFL running back, plead not guilty to third degree aggravated assault charges after police were called to a dispute at a New Jersey hotel and video showed him dragging his unconscious, soon-to-be-wife out of an elevator. By entering and completing the terms of a diversion agreement, the charges will be dropped but the arrest record will remain. The arrest might have been forgotten, it happened 5 months ago, except for the two game suspension levied by the NFL under its personal conduct policy. There was no Goldilocks scenario for the NFL ruling. People felt it too harsh or too lenient but none thought it just right, except perhaps for the NFL Commissioner’s office.

Domestic violence continues to be a hidden public health crisis, not only in the United States but worldwide. It is estimated that 1.3 million women are abused in this country every year. There are no firm numbers, because victims of domestic abuse often do not step forward to report the crime. For a variety of reasons, even after seeking care for major trauma in the ER, women hide the true cause of their injuries, even when confronted with indisputable proof.

“Violence against women is often accompanied by emotionally abusive and controlling behavior, and thus is part of a systematic  pattern of dominance and control. Domestic violence results in physical injury, psychological trauma, and sometimes death. The consequences of domestic violence can cross generations and can truly last a lifetime.”

–National Coalition against Domestic Violence

Leaving an abusive situation is complicated and decisions that victims make may not seem reasonable to an outsider unfamiliar with the situation. Often it is because options are lacking. Children may be put at risk, there may not be any money to help leave and then there is always the fear of retribution. Even with police protection, the use of women’s shelters or relocation, there can be the fear that the batterer will stalk the victim and the next attack could result in death. There is usually a next attack.

In medicine, prevention is always preferable than diagnosis and treatment, but for victims of domestic violence, major societal change will need to occur before an individual assault can be prevented. Poverty and unemployment, economic stress, low educational achievement and weak community infrastructure, where neighbors are unwilling to intervene, are risk factors that an individual victim cannot fix. The spiral of marital instability, a history of being abused or watching abuse occur when growing up leads to behavior repetition. But we should not presume that domestic violence is only a class issue.

Victims come from all neighborhoods, all jobs and all ethnic and religious backgrounds. There is no typical victim and there is no typical abuser. Last month, John Michael Farren, former White House lawyer and general counsel for Xerox, was found guilty of attempted murder of his wife, after breaking her face with a flashlight and strangling her. She was able to escape with her two children from their mansion in Connecticut. It took 4 ½ years to get the conviction after the domestic assault in 2010. Most victims cannot hide and live in fear for that long.

The story of Ray Rice is yet to be written. He is a first offender. His victim is now his wife. He stood in front of the press and explained his commitment to family including his 2 year old daughter. He has returned to the Baltimore Raven training camp, where fans wore his #27 jersey and cheered loudly as he made his entrance. One act of violence may not define a person but regardless of the performance during a game, the decision as to whether an athlete should be cheered and considered a hero needs to be based upon their actions away from the field of play. And no matter how many yards rushed or passes caught, Ray Rice will not be a hero.




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