I just spent a week hiking. Three days in Colorado with my son and 3 days in Vermont with my wife. Among the many reasons I enjoy hiking, one is the opportunity for reflection.
The kind of people who hike seemed to be quite healthy. While that could be a matter of who chooses to hike, I believe it is also a consequence of the hiking. And in areas where people hike, there tend to be a number of other outdoor activities that become part of how people spend their spare time. I was astonished in Colorado to find the number of people on bicycles spending a day riding 5000 feet uphill, only to return down the same winding, spectacularly beautiful road to return home. And the walking, running, bicycling paths were both surprisingly ubiquitous, and wonderfully beautiful. I think outdoor recreation creates more interest in outdoor recreation, which therefore creates more opportunities. On Sunday, July 22nd, fortified by a great cup of coffee and 2 apples from the Winhall Market, my wife and I hiked the Overlook trail in the Jamaica State Park, a delightful 3 mile loop with a view of the West River and the cute town of Jamaica. It’s worth the trip.
So what are the health benefits of hiking? There is the obvious cardiovascular benefit, and calorie burning. Daily exercise is now a core component of recommendations for both maintaining health, and treating chronic disease. The lowering of blood pressure, reduction in weight, reduction in risk for heart attack and stroke, reduction in blood sugar for those with diabetes, all contribute to improved health. In addition, there are the other numerous benefits to outdoor recreation. The ones that appeal to me include the contemplative and even meditative aspect of walking in the woods. My favorite hiking companions (my son, my medical partner, and my wife), all share with me the enjoyment of long periods of silence while experiencing the woods. Something beyond relaxation happens to me at those times. John Kabat-Zinn would describe it as meditation while walking. Then there is passion -- the zeal for life and love. Why is it enhanced by outdoor exercise? Not sure, but it happens.
There is also the opportunity to see wildlife, and learn about the outdoors. This week I saw mountain goats, elk, numerous wildflowers, hawks, marmots, chipmunks, trout, and on and on. I love coming home having learned something new about our environment. Is that a health benefit? I think so … a mental health benefit.
And what about creativity? My brain seems to function better during and after exercise. I am more likely to come up with new ideas for issues I face at work and at home. Is that endorphins? Distraction? Peacefulness?
Communities are creating more built infrastructure to support walking, hiking, bicycling and other outdoor recreation. In Vermont, the Blueprint for Health, a statewide program funded by your tax dollars, brings together improved systems for care of people with chronic disease in doctor’s offices, with self-management education, and coordination with community resources for exercise. Medical studies show that people with chronic disease who exercise regularly experience better outcomes.
And yes, those are hiking poles in the photo -- keeps my knees healthy....
What in the world is a physician executive doing wasting time blogging when he could be seeing patients or recruiting much needed doctors, or even going for a hike? 
In any business (yes, we have to think like a business even though we're a non-profit) where change is happening rapidly, communication becomes ever more important. And in a fast paced world, communication is really difficult. It's hard to get people's attention; we all live in a world of information overload. Communication that is interactive is more appealing to some folks. We also live in a world that is much more flat (The World is Flat: A Brief History of the Twenty-First Century).
The usual forms of communication in complex organizations often feel formal and inaccessible. At SVMC we use newsletters, both print and electronic, announcements at meetings, communications to departments. And management recognizes the responsibility to bring messages from front line employees up through to senior leadership for action. All of those methodologies work, but are not necessarily meeting everyone's needs.
So, I'm giving blogging a try. It's a new way that I can interact with anyone, literally anywhere on the planet. We can engage in a dialogue and comment about each other's views, proposals, or ideas.
This is an experiment in exploring the organization and its relationship to the outside world in a new way. Improving understanding and dialogue enhances our ability to plan for the future, and reduces organizational barriers. Let me know what you think.
I started running while training for the cross-country ski team in high school and college. After a few years of dreading the first few weeks of training in the fall, I decided it was better to train all year round. It was initially a strategy to avoid the pain of those first few weeks in September. It then became a habit, and even a source of pleasure. It's not just the runner's "high"; it's the opportunity to feel my muscles and bones and tendons all working together with my heart and lungs. Call me crazy, but it's kind of amazing how all that works and I really enjoy the feeling of being more in touch with my body then when I sit behind a desk or walk up and down the halls of the hospital. Add to that the pleasure of the sights, sounds and smells of our gorgeous Vermont countryside, and I find it something I look forward to. 
So, like all baby boomers, I'm having trouble adjusting to the fact that I'm no longer 25 years old. I've now had each knee operated on to remove a shredded portion of the cartilage. Knee arthroscopy (the ‘scope’) is quite amazing in a skilled orthopedist’s hands. Each time I was walking the next day and running in two or 3 weeks. However, Dr. Ketterer, my orthopedist, patiently reminds me that I need to cross train and find other sources of activity that are a little less traumatic to my remaining cartilage. When I took up tennis, he commented "that wasn't exactly what I had in mind". He suggested a bicycle, or if I must run -- do it on trails in the woods where the surface is a bit more forgiving and I might get a few more miles out of my knees.
Well, impatient and time pressured clod that I am — I ignored him. However, my wife managed to find a solution that really changed my outlook. I hate it when she does that, but being from Mars does mean I can occasionally learn from Venus (Men are from Mars, Women are from Venus).
So she got a dog, over my loud protestations about dog hair, chewed shoes, and the like. And the dog simply loves the woods! So now instead of figuring out how to fit in walking the dog and running, I combine the two. Or even add a third goal -- spend time with my wife, when she joins us. So we go trail running; the dog makes me stop now and then for a jump in the stream, chasing deer scent, or rooting out chipmunks. I am more relaxed, the dog is ecstatic, my knees are less painful.
So boomers -- get a dog!
This is atnother test that will work for they system abd IU think that this will work
Questions and Answers about Pediatricians in Bennington
Members of the Bennington community met Thursday, Jan. 18, with Southwestern Vermont Medical Center physician leaders to discuss their concerns about the possible relocation from Bennington of pediatrician Dr. Philip Schultz. Here are answers from hospital officials to some of the most-asked questions those parents had. What happened?The doctors who make up the Department of Pediatrics have a business relationship. As with any relationship, there can be differences and difficulties with communication. When that happens, all parties share responsibility for how the relationship reached a breach and for working out solutions. The doctors are not employees of the hospital and have private practices and private businesses. It’s not for the hospital to tell what specifically led to this challenge. The result has been that pediatricians have stopped sharing office call (that’s when the doctors take calls to the private practice from each other’s patients.) And one pediatrician has taken a leave of absence from hospital call, so only two pediatricians are sharing hospital call (that’s when a pediatrician is called to the hospital to care for a sick child in the Emergency Room, or obstetric unit, or to care for a newborn). What has the hospital done about this crisis?The pediatricians are not employees of the hospital. The hospital grants privileges to doctors that allow them to care for patients in the hospital and makes sure that the quality of care provided at the hospital meets quality standards. The rules of the Medical Staff say it’s up to the doctors to work out their on-call schedule. That said, the hospital provided a mediator/facilitator at hospital expense to meet with the pediatricians to try to help them work out their differences. The hospital will continue to pay for mediation if the doctors agree to meet. Also, the elected leader of the Medical Staff, Dr. Jim Carroll, and the administrative leader, Dr. Mark Novotny, will meet with the pediatricians and continue to encourage them to work out their issues. In addition, the hospital has located and will pay for temporary pediatricians (locum tenens) to take hospital call when neither of the two doctors doing hospital call now can. However, the hospital does not at this point have access to enough pediatricians in a timely manner to guarantee coverage of 1/3 of the nights and weekends. The hospital is using all available resources to find enough help. Finally, the hospital has begun the physician recruitment process to bring a new pediatrician to our community. Are there similar problems in the obstetrics department? Might we lose providers there, too?
The Obstetrics and Gynecology Department members also have had discussions about what is the best way to organize that department. Hospital leaders are working with consultants, doctors who are experts in the subject, to evaluate the maternity and services at the hospital and how best to provide physician and midwifery care for childbirth and gynecological hospital care. Four obstetrician-gynecologists and three certified nurse-midwives have privileges to provide both obstetrics and gynecology care at SVMC. Those providers share hospital call. Another physician has gynecology privileges.
Where will my care come from if Dr. Schultz leaves?Dr. Shultz's patients hope he decides to stay. We hope so, too. However, if he decides to leave, the hospital and the Medical Staff are committed to ensuring that our communities have pediatric care. If Dr. Schultz decides to leave, we will recruit a new pediatrician to our medical staff. We don't know how long that will take. So, in the meantime, we have plans to cover gaps in care. This coverage will take two forms:
- Family practitioners in our community have always cared for a number of pediatric problems and served as primary care physicians for children.
- We will bring in temporary pediatricians (locum tenens) to fill part of the need.
Why can't the hospital just solve the problem by itself?The pediatricians in Bennington are all in private practice. That means that their offices are private businesses. Private physicians have "privileges" at our hospital: that means they are allowed to treat patients here. The hospital's Medical Staff do not have any say in how private doctors run their offices. The hospital's Medical Staff only have authority over the way doctors treat patients in the hospital. That authority is written down in the Medical Staff bylaws — the rules for how the hospital's Medical Staff works. The bylaws require that the pediatricians work together to share "hospital call." Hospital call ensures that a doctor is available to treat patients in the hospital — either in the Emergency Department or as an admitted patient. The bylaws do not infringe on a doctor's right to work out "hospital call" with his or her peers. In most cases, this system creates a call schedule that is the most flexible for all the doctors involved. Physicians also may have "office call." Office call is usually used by patients who need to speak with a doctor after hours but may not need to go to the hospital. Because office call does not involve the hospital, the Medical Staff bylaws do not address it. As a result, private doctors must decide how to provide that service for their patients. What can I do to help?There are two main ways you can help. First, you can help resolve the problem with the pediatricians by asking your pediatrician to put aside any differences he or she may have and sit down to work through these problems together. Only through honest communication and compromise can these problems be solved. The hospital administration and its medical staff leaders are ready and willing to help however we can. But, the pediatricians themselves have to honestly want to work this problem out together. Parents also must be willing to set aside some of their emotions about specific doctors when their children are ill. If sick children come to the hospital and need pediatric care, we appeal to the community to work with all the pediatricians and accept the care offered by the remaining all call doctors. The on call pediatricians are well trained and capable. Second, doctors in our communities are struggling right now. They can be much more financially successful in other states. Why? Because Vermont Medicaid pays them less than the cost of the care they provide. For example, our doctors tell us that Vermont Medicaid pays them $13 to get up in the middle of the night to attend a c-section birth. You can help by telling your local legislator to fix Medicaid underpayment by paying doctors and hospitals enough to cover the cost of care. Without a fix it will become harder and harder to convince new doctors to come to our area where they will have to struggle to make the private practices financially successful.