Author Archives: Reggie Lyell

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About Reggie Lyell

Christian, husband, father/grandfather, and physician- my roles in order of importance.

Cruise 2017

It’s an early August morning, before the sun has peaked it’s head above the horizon. I’m sitting on the port side of a large cruise ship, sneaking up on Grand Cayman Island. In the distance, I can now make out a spattering of lights along the shore of the small island. As we inch closer to the lights, I can start to see a vague outline of land. It doesn’t take long until the first hint of light starts to reveal a large cloud bank over the eastern waters. Fifteen minutes ago, very few of the almost 3,000 passengers were out of their cabins. Now, it seems like every where I look there is a grumpy 8-year-old upset because he can’t get what he wants for breakfast, even though I can’t think of anything they DON’T have. The peaceful quiet has rapidly turned into a rumbling den of activity. The quiet, realaxing music has morphed into a thumping combination of rap and reggae. I’m not sure if the reggae is because of our location, or just an extension of the rap-heavy influence of the crowd on the boat.

I have to say, though, that there are many options available for “people like me”. We had a time listening to a solo guitarist the past two days with real musical talent, literate while vocally and instrumentally gifted. Also, a piano bar sing-along last evening was loads of fun. A production show of Motown hits again revealed talented people, filling their mission of audience involvement and entertainment. Traveling with a recently-turned 21-year-old, it is tough to avoid trying to keep up with him. He wants to be on the go, seeing everything including the casino and every bar on the boat. I quickly realize that age demands moderation, and I am definitely older than on my last cruise. Finding a quiet spot to read, away from the “thumpers”, has been a challenge. We also enjoyed the “Dive-in Movies” on the large deck. The screen and sound system were impressive, even from near the back of the deck. A really cool experience.

It has been a while since I was on a cruise (13 years or so). Our last one was with Royal Carribean on the Navigator of the Seas. While I think the boat size and passenger capacity was similar, the Carnival ship seems much more crowded. Maybe it’s the younger crowd. Maybe it’s the unsupervised teenagers roaming in packs. Maybe it’s my age and growing intolerance of rudeness. But it seems like the crowds close in on you much more than on other cruises I’ve taken. Maybe there should be more supervision or policing of the open areas.  For instance, I ran on the fitness track several times during the cruise and every time there were people standing on the ‘fitness” track smoking though one deck below is a designated smoking area. It’s hard enough to breath while exercising, much more so when running through clouds of smoke. I realize that anywhere you run you have the potential of smoking in your path, but when in an enclosed environment, it could be better monnitored.

I do not remember standing in long lines for food like we did on this cruise. I tried several timing and location options, but it seems that unless rising very early, there was always a long line for breakfast. Lunch was better, and dinners went very smoothly in the dining rooms. The staff in the dining rooms was excellent, making recommendations and taking care of us very well. We enjoyed the dinners and thought the quality and portions were well done. The stewards also treated us very well. There is something soothing about being greeted by name every time you walk down the hallway. They took care of every little detail and when we had issues in our cabins (few and minor) they were addressed very quickly and to out satisfaction.

Shore excursions were fun. We were able to taste a little of the Caribbean culture in the Caymans, Belize, and Mexico. Some of the best moments were tucked away from the crowds, eating in small outdoor cantinas. These alone made the trip memorable. Snorkeling, shopping, touring, and cave tubing were all activities that will be remembered fondly. Even the bus rides through tiny streets and alleys in Belize were interesting with continuous narration of our native guide.

Don’t misread me…I enjoyed the trip. I wonder if this may be the last chance we have for just the four of us to get away for family time. As the kids face completion of grad school and college, we may not get this kind of opportunity again. When Gena and I plan our next getaway, I doubt we consider a cruise. I think that the next time I’ll pick a destination and fly there directly. That way, the only rude person we have to endure is me.

Brooksapalooza 2017

I never knew him. I only met her, years ago, after she had a disabling stroke. So I never really knew them personally. But I have come to know them through their legacy. Ray and Athleen Brooks must have been wonderful people. Through their close-knit six children and their extended families, I have come to see how faith, family, and loyalty can spread like a wildfire.

The origins of the family in the coal mining hills of West Virgina are well known and discussed among family members at regular family reunions. The youngest son is well versed in family and Huff Creek history. Any disputes can be quickly settled with a quick question followed by an authoritative response- a wonderful reference to have.

I, like several others now, married into the third generation that started with Ray and Athleen. We have all been accepted as if we are blood relatives and now we (affectionately known as the outlaws) are engrained with the family traditions. We have been given roles of photographers, cooks, organizers, and referees. We are part of the group.

This weekend, over fifty of us through three generations gathered for a time of fun, food, catching up, and just general reminiscing. Though we are now short one sibling through death and another through Alzheimer’s disease, their families were well represented. The companionship of cousins was fun to watch.

Though separated by distance from Chicago to New York to Miami to Virginia to Wisconsin to Indiana and back home to West Virgina, everyone seems to truly enjoy the company of family. I haven’t said it before, so I’ll say it now. Thank you, Ray and Athleen Brooks for giving us this family.

Brown County, Indiana

Living in southern Indiana as an immigrant from Tennessee, I have never been considered a “true Hoosier”. We are about 2 hours away from Brown County (Nashville) and have always heard about what a nice place it was to visit, but in 24 years, had never been there for more than an hour or so when passing through. So when the opportunity came up for an unplanned long July 4th weekend, we decided to take the RV up and see what was there.
Making late reservations and wanting a full-service site, we ended up at Westward Ho. KOA and Brown County State Park did not have sites available for the time period and with the services we wanted. The park, while along a noisy road, is adequate for us. We had a nice roomy site under a tree with room to park our car. Also, there was plenty of grass to walk our dog (she especially liked walks around the lake and listening to the bullfrogs). While the traffic from the main road was a little noisy outside, inside was quiet with no noisy campers. My understanding is that the owners patrol and are pretty good at keeping things controlled. We did not use the bath house, pool  or Wifi but  all-in-all this was a very decent place to stay with reasonable rates and met our needs.
Directly across the road was the Brown County Winery. They were very accommodating and had some surprisingly delicious wines. This is definitely a place to visit. Also, Gnaw Bone BBQ is less than a mile away and has pork tenderloin that must be tasted. The sandwich is large enough for two meals and (word to the wise) don’t get a large order of their homemade chips unless you plan on eating them the rest of the week. Miller’s Ice Cream, Big Woods Brewing Company, and Out of the Ordinary are other eateries we tried and enjoyed. The Quaff On beers at the downtown pub make a nice rest stop on a hot day.
We strolled through downtown shops for a couple of days, browsing and wandering with no set time schedule. Even for a holiday weekend, while parking was a little difficult, the crowds were not as bad a expected.  We did find out that the streets pretty much role up at 7:00 pm on weekdays. It was difficult to find a place to eat after that. Also, if you need wifi or cell coverage for work or just can’t get away from access, there are many dead spots and download speeds are very slow at best. I was able to remote in for work, but lost connectivity several times.
In summary, Brown County, Indian is a quaint getaway spot with loads of interesting shops that have absolutely nothing I need to buy.

RV Stay in Brown County, Indiana

Living in southern Indiana as an immigrant from Tennessee, I have never been considered a “true Hoosier”. We are about 2 hours away from Brown County (Nashville) and have always heard about what a nice place it was to visit, but in 24 years, had never been there for more than an hour or so when passing through. So when the opportunity came up for an unplanned long July 4th weekend, we decided to take the RV up and see what was there. 

Making late reservations and wanting a full-service site, we ended up at Westward Ho. KOA and Brown County State Park did not have sites available for the time period and with the services we wanted. The park, while along a noisy road, is adequate for us. We had a nice roomy site under a tree with room to park our car. Also, there was plenty of grass to walk our dog (she especially liked walks around the lake and listening to the bullfrogs). While the traffic from the main road was a little noisy outside, inside was quiet with no noisy campers. My understanding is that the owners patrol and are pretty good at keeping things controlled. We did not use the bath house, pool  or Wifi but  all-in-all this was a very decent place to stay with reasonable rates and met our needs. 

Directly across the road was the Brown County Winery. They were very accommodating and had some surprisingly delicious wines. This is definitely a place to visit. Also, Gnaw Bone BBQ is less than a mile away and has pork tenderloin that must be tasted. The sandwich is large enough for two meals and (word to the wise) don’t get a large order of their homemade chips unless you plan on eating them the rest of the week. Miller’s Ice Cream, Big Woods Brewing Company, and Out of the Ordinary are other eateries we tried and enjoyed. The Quaff On beers at the downtown pub make a nice rest stop on a hot day. 

We strolled through downtown shops for a couple of days, browsing and wandering with no set time schedule. Even for a holiday weekend, while parking was a little difficult, the crowds were not as bad a expected.  We did find out that the streets pretty much role up at 7:00 pm on weekdays. It was difficult to find a place to eat after that. Also, if you need wifi or cell coverage for work or just can’t get away from access, there are many dead spots and download speeds are very slow at best. I was able to remote in for work, but lost connectivity several times.

In summary, Brown County, Indian is a quaint getaway spot with loads of interesting shops that have absolutely nothing I need to buy.

Understanding with an Accent

I haven’t figured this out yet, but I have trouble understanding British accents. My wife and I will sit down to watch a TV show or movie and the minute someone starts speaking in a British accent, I find myself losing the plot. For some reason, my brain does not process the conversation. Funny, because I do not have the same problem with other accents. I can follow Nordic, Slavic, Middle Eastern, African, French, German, Indian…most all others. But when I try to follow “Call the Midwife” or “Downton Abbey” or “Sherlock”, I need the TV turned up and no other distractions.

Maybe it’s a type of attention problem. Maybe it’s hearing loss at a certain pitch brought on by years of listening to loud music. I have noticed that I do better with “Sherlock” than the others, but maybe that’s because I like the story line and concentrate more on following the story. Maybe it’s my southern heritage and tendency to hear and speak more slowly. Maybe it’s the idioms. (A boot is something you wear, not put groceries in.)

I try. I will sit down, remove distractions, and turn up the volume. But usually, 15 minutes in to a program, Gena is wishing I would leave. She gets tired of rewinding the DVR to catch what I missed. Oh well, guess I’ll just have to avoid BBCTV. This is something else to blame on my rural Tennessee upbringing.

Productivity Apps

I confess. I am addicted to todo lists. I love the idea of checking off things from a list I have prepared to keep my feeble mind from forgetting things. However, I do take it to extremes. Not the point of a friend I had in residency who would write out a paper list every day and include such items as “brush teeth” and “pick up newspaper”. Back in the day, I was a big fan of the Franklin-Covey method of listing, assigning priorities, and making sure the important things were done first. A few years ago, though, I migrated to using electronic versions and have tried many programs, apps, and systems. I have found myself always searching for one that meets all of my personal (and professional) needs. I have decided that the perfect option does not exist.

Currently, I am using Informant (formerly Pocket Informant, by Fanatic Software). I have used this off and on for years and really like a lot of the options and flexibility it gives. A few shortcomings have made me look at a few other options and I now have Wunderlist, Any.do, Toodledo, and Todoist ALL on my phone, iPads, and computers. I am continuing to refine my search and plan to list pros and cons of each one later this week. I am anxiously awaiting the release of Informant 5 (hopefully today) and would welcome an end to my search. We’ll see.

Here is a running list of pros and cons for the apps/programs I have tried:

  • Informant- I have used this for years with many iterations and have been loyal to the company. The move to primarily iOS has left some of my devices behind, but I have tried to stay with it because of a long-time investment. I have to admit, the recent “upgrade” is what made me sort looking for other options.
    • Pros
      • Multiple priorities for sorting tasks
      • Templates added easily
      • Projects with multiple tasks easily added and copied
      • Easy copying of tasks
      • Easy to skip occurence of repeating task
      • Combines calendar AND tasks, making one app for both- helps me schedule tasks on future days knowing commitments
    • Cons
      • Sync through Toodledo to get to Windows, therefore requires subscriptions to both Informant AND Toodledo for full functionality
      • Possibly too many options. Can take a while to get everything zoned in
      • Search can be confusing
      • Having purchased many versions (Android, iOs, macOS, etc) I admit I am frustrated when a new version comes out and I have to purchased another one. Informant Sync is useless to e because I need to be able to run both macOS and Windows environments. That requires me to run through Toodledo, which requires another subscription. So…the jury is out on the recent changes.
  • Todoist
    • Pros
      • Multiple priorities for sorting tasks
      • Easy swipe actions for updating tasks
      • Simple, straight-forward, easy learning curve
    • Cons
      • No templates
      • Projects with multiple todos difficult to repeat
      • Just added- ability to copy tasks!
  • Toodledo
    • Pros
      • Multiple priorities for tasks
      • Easy to duplicate/copy tasks
      • Lists, Notes, Outlines, Habits functions are handy
    • Cons
      • Sync can be a little slow at times
      • Clunky mobile interface
      • Repeating tasks take several seconds to reset and remain on current date
  • Wunderlist
    • Pros
      • Easy to enter tasks
      • Beautiful interface
    • Cons
      • Only 2 priorities- standard and starred
      • Not enough functionality for me to sort by importance
  • Swipes – This is a new app for me. I am intrigued by its design. I really like swiping off completed tasks as opposed to checking a box, so this is a plus. I haven’t used it enough to understand full functionality, but so far I am impressed.
    • Pros
      • Tasks set by time instead of priority. You can set a priority task, but like Wunderlist, there are only two levels.
      • Easy to schedule
      • Recurring tasks are easy to add
      • Uses Workspace concept to sort (i.e. tags)
      • Easy search functionality
      • Action subsets easy to add
    • Cons
      • Only two levels of priority
      • No integration with Siri, IfTTT or for that matter anything other than Evernote and Gmail. Syncing across platforms or making workflow additions is hindered by this.
      • “Premium” service yet to be added. I’m not sure when this will go to a subscription service, but expect it to be necessary soon
  • Any.do
    • Pros
      • Long list of options when adding task
      • Easy to reactivate completed tasks
    • Cons
      • Clunky to add recurring tasks
      • Free version (trial) doesn’t allow use of recurring tasks, so difficult to evaluate without purchase
      • Web site simple, difficult to find Today’s tasks
      • No way to have untimed daily tasks- must assign a reminder time
      • Can’t experiment with free version by syncing devices to see if it works and how

Healthcare Reform from a Primary Care Perspective

I haven’t written on my blog in quite a while. There are several reasons for this, but I will avoid listing them to prevent your boredom. However, I have come across a recently published book that has struck me. America’s Bitter Pill by Steven Brill is (so far) an excellent book that looks at the politics and policy of recent attempts to fix our healthcare system. As a practicing physician and also a consumer of healthcare, I wanted to highlight some of the statements he makes and occasionally make personal comments. I am in no way an expert on healthcare economics, public policy, or politics. My comments are simply observations from more than twenty years of caring for patients and helping them navigate the healthcare system. Many statements are anecdotal and not backed by science. In advance, forgive my tendency to get on my soapbox. I can be extremely passionate about some things. 
  • “Healthcare is by far the nation’s largest industry, employing one-sixth of the workforce.”
  • “People care about their health more than they care about healthcare policies and procedures.” – I know that when I talk with a patient that has a condition similar to something I (or a family member/friend) have experienced, my counsel is much more appreciated. 
  • “60% of personal bankruptcies result from healthcare costs.”
  • “The US ranks 31st in the world in life expectancy and 28th in infant mortality. This is despite the industry being so large.”
  • “In 2010 the average healthcare policy for a family cost $11,841- one thousand dollars more than one makes at a minimum wage job.”-  This is completely in line with the average healthcare expenditure per patient. I am amazed by this when I consider that there are a lot of young, healthy people out there who spend very little on healthcare and then older, more complicated (more “ill”) people spending a lot more than this. To use round numbers, someone (either you, your employer, the government, or some combination) is paying ~$1000 a month to be sure you have access to healthcare when you need it. 
  • “England’s Healthcare spending as a percentage of GDP is one-half of the US but the results are significantly better.”
  • “Adverse selection (people only buying insurance when they need it) would cripple the system.” Therefore a mandate is necessary. – Without requiring everyone to purchase healthcare insurance, younger, healthier patients would “fill out their insurance applications on the way to the emergency room”. 
  • “Medical costs increase by the equivalent of one Iraqi war per year.”
  • “Romney’s three legged stool (no denial for pre-existing conditions, mandate for all to have coverage, subsidies to help those who cannot afford coverage)” was well-designed.- This plan seems to have worked in Massachusetts and was the foundation for the Affordable Care Act. However, during the politics of policy-making, many of the foundations necessary for it to work on a national level were changed by (who else) “special interest” groups. Not all, but most of these changes, decreased the chance for the reform to smoothly transition into the national platform.
  • “Containing costs is more difficult than increasing coverage (cost containment means cutting someone’s revenue flow).” – Both will be required for it to work.
My comments on Steven Brill’s America’s Bitter Pill.

I will update as my reading and thinking progress.

rdl




Hitting Stride

For the past few weeks, Gena and I have been seeing patients in our new office location. While the cold, icy weather has slowed down patient flow some, it has allowed us to work out the kinks of operations and get things together (as much as possible). Thanks to our wonderful staff (Theresa, Christy, Jessica, Samantha, and Tiffany) we are starting to hit our stride. While we have a few cosmetic issues to work out as well as a couple of computer issues, we are ready to take care of almost anything we plan to do. The transition team from Floyd Memorial Medical Group was amazing in condensing our move. We are grateful to all who have worked so hard to make our new venture possible.

So what is it we are doing? Many of my patients have questioned me over the past couple of years with concerns about who there doctor will be under the new healthcare system. Many have fears that they would not have access and would not be able to keep their doctor as “their’s”. We want to combat that concern and give patients some assurance ( as much as we can give) that they can know who “their doctor is”. When a patient chooses me ( or Gena) to take care of their healthcare needs, they get us…24 hours a day, 7 days a week, 365 days a year. During regular office hours they can schedule appointments with either of us. After hours, they can call the office and are given instructions on how to reach me if they need me. I answer the phone almost all of the time, but will occasionally use voicemail and messaging to allow me to go to church, movies, school functions, etc. When patients call, they will be given a short time frame in which I will call them back. They will hear from “their” doctor…the one who knows them best.
Some people have asked how we will be able to have any kind of lifestyle and do this. Well, we think our patients are reasonable people. We don’t mind answering the phone and advising patients when they really need us. Now, if someone calls at 3 a.m. Sunday  with a hangnail they have had for three weeks, I might ask them to start seeing someone else. But if one of our patients needs us, we want to be there for them. We don’t mind helping decide if something can wait until the next day or needs an emergency room or urgent care visit. We don’t mind helping someone know what to do with a child that has a fever.
Also, when someone chooses us, we will take the responsibility to be sure they have all of their preventive issues addressed. We will remind them of recommended tests for screening, immunizations, and lifestyle modifications to improve their chance of a better quality of life. We will also attempt to coordinate care with specialists that they need. Using our computer systems we will be able to monitor tests, medications, specialty visits, and hospital stays, even when we are away from the office.
Talking with a patient this week, he said, “It sounds like you have a 1950’s doctor-patient relationship with 2014 technology”. I couldn’t have summed it up any better. We are proud to let you know “who your doctor is”.

The New Normal

Two days ago, I spent my last day seeing patients at Harrison Family Medicine. After 19 1/2 years, it seems strange to not be going in to the same office setting. As Gena and I embark on our new journey, I would like to thank all of my former colleagues and co-workers. We have been blessed to have worked with you and appreciate the friendships and collegial relationships that we have developed. We are excited about our new opportunity and anticipate many more changes as we ALL struggle to provide excellent patient care through different methods and models. We hope Harrison Family Medicine continues to thrive and are assured that you will all do well. Continue in your efforts to put patients first and you will be extremely successful.
When my father died, I remember someone telling my mother that things would never be the same, but that she would start to develop a “new normal”. As we move in to our “new normal”, we hope that we can come close to providing the same care and service that our patients have grown to expect. Here we go…

Tough Decisions

Well, the word is starting to get around, so I thought I’d put out something that is somewhat official. After almost 20 years at Harrison Family Medicine, I will soon be leaving the practice. Later this month, Gena and I will be starting our own practice, still in Corydon, still a part of Floyd Memorial Medical Group. Letters to all of our patients will be sent out within the next week or so and information about location and phone numbers will be included.
This decision has been a deeply personal one. While I have greatly enjoyed and benefited from my association with Harrison Family Medicine, I have decided to make some slight changes in the way I take care of patients. I have been blessed to have a wife who shares my vision and works diligently beside me every day, making for a wonderful working relationship. Soon to become empty-nesters, we plan on taking some weekends to spend with children who are away and use remote access to care for patients when we are out of town. Having worked most weekends for 38 years, I am excited about being able to recharge my own batteries, and still provide care with our available technology. I hope our plans do not disappoint you.
While our new facility is being finished, we will begin seeing patients in Northfield Plaza (our current building), on the first floor (Suite 130) starting later this month. While change is not always good, we are excited about the opportunity to continue to serve our patients and hope to provide the same high-quality care and access you have had through Harrison Family Medicine. Whether patients continue to see us in our new location or choose another physician within HFM, we want to facilitate the continuity of your care. Where you choose to have have your care is your choice, and we respect that. Current and future appointments will be transferred and we will do everything we can to insure the timely transfer of health information. There may be some bumps, but we will do our best to work through them. Bear with us as we continue to assemble our healthcare team and set up our facilities to care for you.
If you do not receive a letter and want one, please let us know through email or other access (including my personal Facebook, Twitter, Google+, and emails. New social media pages will be up and running soon and will have our new phone numbers and contact information.. Please be on the lookout for Corydon Family Care on Facebook and CorydonFamCare on Twitter . We will also soon be able to be reached through the Floyd Memorial Hospital web site and Floyd Memorial Medical Group.
Wishing you a happy and healthy 2014!

Reggie D. Lyell, MD