On the topic of polyamory

 When your parrot falls in love, it's called polyamorous;

When you play games with your parrot, it's called polygamous;
When your parrot leaves you, it's called polygon. ☹️
Some more thoughts on subject of love birds.

1. Everyone craves happiness. Fact.
2. If happiness equates to security, well, seeking security builds walls. Walls lead to isolation. Isolation – spawns loneliness. And that loneliness? The antithesis of happiness.
3. The real secret recipe for happiness? Let go of that 'me, myself, and I' mentality. Drop the need for security. Might sound counterintuitive, but stick with me.
4. Once you embrace the "we" over the "me", not only do you find personal happiness, but your relationships flourish, and anyone coming into your sphere can't help but feel uplifted too.
5. Now, if everyone in a relationship has mastered this art of letting go, polyamory becomes as natural as, say, your craving for midnight ice cream. 🍦
6. But mastering this art? It's a journey, or more like an inward expedition. Some take a lifetime to learn, and others... well, they're still waiting for the stars to line up.
7. Picture this: A group where everyone's let go of their egos, enjoying a wholesome, expansive connection. Sure, it would probably involve more than holding hands.
8. Essentially, polyamory, in its truest form, is for those rare gems who've dived deep into the inner quest of self-surrender.
9. Now, I'm not going to pretend – a bit of polyamory sounds appealing. But am I ready? Given I still struggle with sharing my fries, I have my doubts. 🍟😉 Fries anyone?

Keep the love flowing, everyone. And if anyone knows how to train a parrot not to fly away, DM me. Asking for a friend.

Beyond Privacy: Why Transparency Matters for Canada's Universal Healthcare System

Beyond Privacy: Why Transparency Matters for Canada's Universal Healthcare System

Canada prides itself on its universal healthcare system, a cornerstone of our national identity. Yet even within this publicly funded model, we face a challenging paradox. While patient privacy remains a critical and protected right under Canadian law, overly stringent interpretations and fears around data sharing can sometimes prevent the very collaboration needed for comprehensive and effective care.

But privacy concerns alone don't fully explain the resistance to increased transparency in Canadian healthcare. Beneath the surface lies a complex mix of bureaucratic inertia, administrative inefficiencies, and deeply entrenched political challenges. Although profitability isn't the driving force in a universal healthcare system like Canada's, budget constraints, resource allocation politics, and administrative inefficiencies can inadvertently put bureaucratic goals ahead of optimal patient outcomes.

Improved transparency and effective data-sharing could significantly streamline Canada's healthcare operations, reducing unnecessary administrative burdens and allowing healthcare providers to focus more closely on direct patient care. Ironically, this efficiency might initially appear threatening within a system accustomed to bureaucratic procedures and roles. Reduced complexity can be mistakenly seen as a threat to job security within administrative structures.

Yet, embracing transparency is precisely what our healthcare system needs most. By breaking down silos and prioritizing open data-sharing, healthcare professionals can dedicate more of their skills and attention to preventive care, patient engagement, health education, and improved clinical outcomes. Administrative roles, rather than disappearing, can evolve to directly support patient wellness, contributing more visibly and tangibly to patient satisfaction and system efficiency.

Technologically, Canada has the capability to implement a comprehensive "one patient, one record" system nationwide. However, political barriers and a deeply ingrained cultural resistance to change have impeded progress. For this shift to occur, Canadians need a clearer understanding of how transparency and streamlined data-sharing directly translate into better health outcomes, reduced errors, shorter wait times, and improved patient satisfaction.

Politicians must recognize this is not merely a technical issue, nor simply a question of financial resources. It is fundamentally about aligning Canada's universal healthcare model more closely with its primary mission: patient well-being, equity, and population health. Transparency and patient-centric data management are essential to achieving these goals.

Ultimately, greater transparency in healthcare isn't a threat; it's an opportunity for Canada. By embracing open data-sharing and reducing bureaucratic barriers, we strengthen the very fabric of our healthcare system, ensuring it remains robust, equitable, and genuinely focused on improving health outcomes for all Canadians.

It's time Canada takes the next step in universal healthcare—moving decisively toward transparency and patient-centered care.

Empowering Patients: Can AI-Enhanced Personal Health Clouds Transform Medical Record Management?

Imagine Ms. Green traveling abroad, needing urgent medical care without her physical medical "passport." Instead of panicking or scrambling for paper documents, she securely provides temporary access to her medical records stored in a privacy-compliant personal cloud service. The treating physician instantly reviews her complete medical history, ensuring informed care without delay.

This scenario highlights a transformative approach to patient-managed health records—where patients control, own, and selectively share their information through secure, compliant cloud storage solutions.

Addressing Privacy Head-On: HIPAA and DIPPA

Platforms like Google Drive, though popular and user-friendly, often fall short of regulatory standards like HIPAA in the U.S. or DIPPA in Canada. Healthcare data require robust protection mechanisms, secure authentication, audit trails, and strict compliance with legal frameworks that protect patient confidentiality (HHS, 2024; IPC Ontario, 2023).

Thus, the ideal solution involves healthcare-compliant cloud services such as Microsoft Azure Health Cloud, Amazon AWS HealthLake, or specialized platforms like MedStack. These services meet stringent privacy and security regulations, providing encryption, multi-factor authentication, and detailed access logs (Microsoft Azure, 2024).

Patient Empowerment through Ownership

By placing records into compliant personal health clouds, patients retain full ownership and granular control over their data. They manage access permissions, duration, and levels of access granted to healthcare providers, enhancing transparency and autonomy (World Economic Forum, 2023).

For Ms. Green, this means she can confidently travel or change providers without cumbersome paperwork, knowing her sensitive data remains secure and available precisely when needed.

Integrating Artificial Intelligence: The CHART-GPT Approach

The sheer volume of accumulated health data over one's lifetime makes manual searching impractical, especially in urgent care situations. Here, Artificial Intelligence (AI) becomes indispensable.

Integrating AI technology into secure health clouds allows healthcare providers immediate, intelligent querying capabilities. Queries like, "What medications is Ms. Green allergic to?" or "Provide a cardiologist-relevant summary of Ms. Green’s medical history" become possible. AI systems like CHART-GPT could summarize relevant medical information quickly and accurately, reducing time wasted on manual searches and minimizing oversight risks (Nature Medicine, 2023).

AI can also proactively monitor and remind patients about essential healthcare needs such as regular check-ups, vaccinations, or medication renewals. It could identify and alert users to potential interactions between prescribed medications, enhancing patient safety and compliance (The Lancet Digital Health, 2024).

Navigating Risks and Challenges

While promising, integrating AI and cloud storage solutions isn't without challenges. Ensuring data privacy and security is paramount. Risks of data breaches or unauthorized access remain, underscoring the importance of choosing services explicitly designed for healthcare data compliance (HealthITSecurity, 2023).

Patients and healthcare providers must be educated about managing and mitigating potential risks. Transparent data policies, continuous security updates, and user-friendly privacy controls are essential elements in successfully adopting AI-powered personal health clouds.

Conclusion: Toward Patient-Centric Healthcare Management

By embracing compliant, AI-enhanced personal health clouds, we can revolutionize patient record management, giving patients unprecedented control and healthcare providers instant, secure access to vital medical information. This shift aligns with the evolving demands for privacy, convenience, and patient autonomy in modern healthcare.

As healthcare moves towards increased digitization, empowering patients through technology isn't just innovative—it's essential.

References:

• HHS. (2024). "Health Information Privacy (HIPAA)." U.S. Department of Health & Human Services.

• IPC Ontario. (2023). "Digital Information Privacy Protection Act (DIPPA)." Information and Privacy Commissioner of Ontario.

• Microsoft Azure. (2024). "Azure Health Cloud Compliance Overview."

• World Economic Forum. (2023). "Empowering Patient Data Ownership in Digital Health."

• Nature Medicine. (2023). "AI-Driven Patient Data Management: Opportunities and Challenges."

• The Lancet Digital Health. (2024). "Artificial Intelligence in Clinical Decision-Making: Enhancing Efficiency and Accuracy."

• HealthITSecurity. (2023). "Cloud Security Best Practices for Health Data."

Why you shouldn’t use a incentive spirometer after surgery and what to do instead.

Thats an incentive spirometer.  It’s meant to encourage patients bedridden to fill the lungs fully with air periodically to prevent atelectasis (incomplete expansion of lungs)

There is a better and safer way to fill the lungs with air.  

Triple stacked breathing:

1. Sit up straight to free the rib cage.

2. Take three consecutive inspirations (breathing in) stacked upon the each previous one without expiration (breathing out).

3. Hold the fully filled lung for a few second and then let it all flow out.

4. Repeat sets of 3 every hour.

It is not necessary once physical activity is restored.

My challenge with incentive spirometer is that it encourages rapid inspiration which can cause unnecessary aspiration of oral bacteria flora into the lungs and increase risk of hospital acquired pneumonia.  The goal is the fill the lungs fully; speed does not matter.  So try triple stacked breathing instead.

What is happiness, complacency and oneness

I am grateful for my life and my life as a family physician.

I tell my patients happiness are transient moments and so are sadness. They are both in the spectrum of human experiences to be embraced and to be enjoyed for now; as they will likely end with death.
I love going to work. I think it really helps that I see patients as part of my “river of life”; a place where I listen and learn about life. I realize my patient’s needs are no different than my own. To be understood, loved and cared for. Isn’t every physician sooner or later also a patient?

As the fear of pain, suffering, illness, existential threats, the fear of complacency can all be motivator. In my experience fear tends to lead to avoidance or at best direct attention to symptomatic interventions and distracts from the root cause of the challenges. I think a personal wellness that arise from a great awareness of oneness is the wellspring of the power to genuine change.
“Those who experiences unity, sees themselves in all beings.” — Buddha
“Everything in the universe is within you, ask all from yourself.” — Rumi
“The kingdom of God Is within you” — Jesus according to Luke 17:21, KJV
“The greatest ability as humans is not to change the world but change ourselves.” — Gandhi
“Ask Not What Your Country Can Do For You” — JFK
“Since our leaders are behaving like children, we will have to take the responsibility they should have taken long ago.” – Greta Thunberg.

This sense of oneness can be a drag. I sense the screaming of my interdependencies — the species and rainforests are disappearing, the oceans are rising, the children are striking, the masses are marching, the legislators must be legislating, the carbon emitters must be stopped, the plastic polluters must be shamed and regulated, everyone must start planting, etc.
As a physicians am I just too busy? So must I just let the CMA make a passionate statement on my behalf so I can get back to my grindstone in our sickness industry?

Stories I love to tell

The other day, a patient came to the after hour clinic; staff told me that he has an expired health-card number and wanted me to know. I introduced myself and mentioned that he hasn’t valid insurance and his regular physician hasn’t been paid for the last two visits. He got irritated and told me he is First Nation and he deserves care regardless. I didn’t agree or disagree. I must say, I thought the situation was quite humorous. I asked him how I might help him. He said he’s been having lots of heartburn after he eats and wants some medications for it. After history (including a dietary & ruling out red flags) and an examination, I told him he was most likely being “poisoned” by processed foods. I asked him how the First Nation people used to eat before processed food. He proudly told me how they lived in harmony with the land and ate what nature provided. I told him that I think many people are ill from poor diet and that we can all learn from the traditional dietary principles. I told him to change his diet and that he might want to avoid taking meds that will only mask his symptoms. He agreed. He thanked me, said good bye and left the room. At the end of the corridor, he turned around and said, “I’ll get that card updated first thing Monday”.

The other day, I got an email from my ER chief (copied patient services) about a complaint from a middle age lady whom I saw in ER. I had seen her for abdominal pain in the evening. I arranged an ultrasound for the following am and follow up with gastroenterologist. She had no complaint about her management; but she thought I was flippant and disrespectful.
I reflected for a moment and quickly realize my mistake. I realized that ER patients are unlike my own patients whom I have know for decades. While certain lightheartedness are reassuring and therapeutic for my own patients; they might seem uncaring to a new patient. I picked up the phone and apologized to the lady for her negative experience. I listened to her perspectives and reassured her that I meant no disrespect and appreciated her feedback. I then enquired about how she is feeling. I explained to her the possibility is of choledocholithiasis. I explained to her the importance of dietary habits that can potentially prevent further problems. She thanked me for calling her. I told her to contact me if she needs any help.

I then emailed my chief and patient services with details of our conversation. The matter was settled the same afternoon; and I learned my lesson.

Use and misuse of pharma

The root challenge is that physicians, leader of health and wellness, have largely grown unaware and apathetic of the important role self-management education and support.  Pharma also has an important role in providing us better technology.  Hence avoidant of pharma presence at FMF (Family Medicine Forum) does not solve the root challenge of unawareness.  

Perhaps, try, for a change, serve a breakfast consistent with Canada food guide 2019 at FMF; then commit at least 50% content of FMF to self-management education and support, physician leadership, community engagements.  Include topics of little corporate interests and consequently lack “evidence-based” support and omitted in clinical guidelines.  FMF is looked up to by physicians and learners.  I think it is important, at FMF, physicians are inspired to eat well, exercise appropriately, develop personal mindfulness and engage their community in wellness conversations.  Who better to lead a population of illness to wellness than physicians?

Root cause and solution of rising suicide rate

1. I think individuals are unique. I think instead of standardizing treatment; flexibility of treatment may be more important. 

2. I also think the idea that an intervention can be independent of “who the staff was” may underestimate the therapeutic value of personal relationships. Perhaps one solution that targets the root of the challenge is to start by helping service providers develop mindfulness, overcoming their inner challenges and becoming role models with lived experiences.

3. I believe interventions that neglect the mental health needs of the youth’s family and circle of influence will remain ineffective. 

4. For every youth that present to the healthcare system, there is a multitude suffering difficult thoughts who don’t. For me the greatest root challenge is the ability to engage and help these multitudes. I believe the root solution in healthcare requires engagement of educators.

My suggestion to Canadian Medical Association

CMA might consider doing more than just reiterating popular headliners without a plan. It might take the leadership to campaign for a cultural shift towards a root solution —
1. the consumption of 400 grams of non-starchy vegetables per day
2. national mindfulness training.

This will focus attention and address all stated issues below:
1. Creating a national—rather than provincial—strategy for healthcare. (A cultural shift is a national effort)
2. Leverage the potential of new and emerging technologies. (Social media can be leveraged to change culture; marketer know this well)
3. More support for physician health and wellness. (Show me a physician that eats 1 lb of non-starchy vegetables and meditates each day and I’ll show you a physician leader in wellness)
4. Attract and support more rural physicians. (Inequality in a democracy the size of Canada is the price of freedom; there are ample of benefits in living and working rural)
5. The adoption of pharmacare to address drug shortages and pricing. (Increase patient education reduce substance and medication dependency; “drug shortage” is a consequence of a sickness industry/culture expanding steadily and having reached the verge of the imminent destruction)
6. Acknowledge climate change and the impact on Canadians’ health. (Getting mired in controversy without a plan of action is divisive, irresponsible and only distracting from dealing with the root cause. Attempt to bring awareness to climate change at a luxury retreat of consumerism may be disingenuous and compromise credibility)
7. Work with Indigenous communities. (By all means; and work with all communities. Do the children of settlers deserve any less than those of the colonized? I don’t seem to have to look far beyond myself, family, friends and my practice to find great needs.)
8. Accelerate a national licensing program. (Dealing with expanding demand issue will likely alleviate the supply issue in a safe and sane fashion.)

Teachers have access to all our young. Physicians have access to all who experience pains and sufferings; which is just about everyone. Collectively, these two professions have access to everyone in every demographics, walk and echelon of life. I would suggest, CMA, well positioned and resources to take leadership, begin a national campaign to empower health care providers and educators to take leadership in promoting wellness.

Increased expenditure on prescription drugs

I realize sometime ago I shouldn’t be surprised to meet patients over 90 on very few or no meds. I just don’t think anyone actually thinks meds is a reflection of good health.
“7.4% increase in expenditure on prescription drugs.” It’s interesting that these figures seems to meet certain expectations of rate of capital concentration. “The average annual return of S&P 500 since adopting 500 stocks into the index in 1957 through 2018 is roughly 8% (7.96%).
Does higher prescription expenditure correlate with sickness or wellness or neither? Anyone compared these for different countries?
What’s the healthcare and prescription expenditure of “Blue Zone”? The five blue zones are as follows:
The Italian island of Sardinia; Okinawa, Japan; Loma Linda, California; Costa Rica’s isolated Nicoya Peninsula; Ikaria, an isolated Greek island.
What accounts for these increase in spending? More scripts, more expensive scripts or something else?

Who am I?

Mr. D has been incapacitated by severe chronic back pain depression for as long as I have known him. He was abused as a youth in a group home. He has been on decades and multitudes of psycho-pharmaceuticals. Some were recently tapered only due to significant facial dyskinesia.
His intractable negative outlook in life completely took a turn when he developed prostate cancer about a year ago. He began gardening, painting the house and helping with house work. His wife smiles when she tells me he has been at peace and content for the first time in their life together.

Who am I?

Am I that of yesterday, today or tomorrow?

Am I the body or the mind?

Am I my thought?  Which thought?

What is my body?  Does it end at limit of my skin, my perception or all its interdependencies?

What is pain and suffering?

Why do animal have pain but plants don’t?

Why do human and some animals suffer but oligo-cellular organism don’t seem to?

What is awareness?

Why is it that no one needs to remind me not to touch a hot kettle; yet I often remind myself not to suffer my thoughts?

What is love?

Does anyone ask the right hand to love the left hand?  Or do they just know?

Perhaps love is the collective awareness of the collective. The journey is of the collective.  The path is free choice.  The tolls are pain and suffering.

“I am not my body. I am not even my mind.” — Sadhguru

“We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.” — T.S. Elliot

MDMA assisted psychotherapy

As I have seen quite a few drugs come into glory and fall from grace; I am cautious to adopt new psychopharmacological interventions.

According to Wikipedia, MDMA-assisted Paychotherapy still remains controversial.

“Adverse effects include addiction, memory problems, paranoia, difficulty sleeping, teeth grinding, blurred vision, sweating, and a rapid heartbeat.^[14] Deaths have been reported due to increased body temperature and dehydration.^[14] Following use people often feel depressed and tired.^[14] MDMA acts primarily by increasing the activity of the neurotransmitters serotonin, dopamine, and noradrenaline in parts of the brain.^[14][15] It belongs to the substituted amphetamineclasses of drugs and has stimulant and hallucinogenic effects.^[6][16]”

Usage may also be associated with permanent damage to neurons.

I see that some short term studies looks “promising”.  I am weary of the unknown longterm risk-benefit ratio.  I think I would perhaps first try some non-pharmacological mindfulness-based interventions.

Just my thoughts.

Tell it like it is.

1. “Should I worry”?
   “Do you want to suffer”?
   “Am I crazy”?
   “Yes you are and so am I”.
   “Am I going to die”?
   “Yes you are and so am I”.
   “I don’t like to eat vegetables”.
   “That’s your mind talking and your body love it. Is your mind more important than your body”?
   “I am too old to eat properly or to exercise”
   “Do you know when you will die”? “Do you want to suffer till you die”?
   “I didn’t know I have kidney failure or cancer, why are you asking me to visit the dialysis clinic and cancer clinic”?
   “Your kidney is actually fine for now and you don’t yet have cancer; I just want you to see what might happen if you continue to eat the way your eating right now.”
2. “Why do I have pain”?
   “I think your body doesn’t like how it’s being treated and is speaking to your mind; and pain is the language of the body. Would you like me to interpret”?
   “Will you give me something to kill the pain”?
   “Would you like me to help you to tell you body to shut up”?
3. “Why are you always feeling so great”?
   “Because no one else suffers more than me when I am miserable”.

What is the responsibility of a researcher?

Physicians are to “choose wisely” and assess the cost-benefit ratio; that is to run a test only if its potential benefit outweighs the cost and potential harm. Perhaps, researchers have a greater responsibility to observe the same principle before committing precious resources. A physician’s poor “choices” may harm a few; but the published work of a researcher may be used to harm many.

For example, a study that presuppose and label any observed disparity in pay between male/female or majority/visible minority physician as “inequity” is imprecise and perhaps fundamentally harmful. It further divides, incites distrusts and most of all distracts from the society’s real need to embrace our TRUE differences – the difference in our neurodiversities and experiences.
Such study can fuel divisive strategies used, knowingly or unknowingly, by politicians seek electoral attention by promote fear, resentment and gross generalizations. Generalizations based on some imagined or “superficially observed differences” (between earlier vs recent immigrants; descendants of colonizer/colonized; subscriber of one religion vs another; rich vs poor; one sexual orientation vs another; one skin color vs another; believers of on dogma vs another; one age group vs another; one social class vs another, one community vs another; one nation vs another; etc.)

I think focusing on superficial and outward differences will only promote inequity. I think the only true inequity is in awareness; and it can only be solved by increasing, through authentic conversations, the collective awareness of our common humanities such as pain, suffering, illness and death.

The inferno we call healthcare

I tell my patients that they may do more good for themselves, theirs family, friends and “circle of influence” than I can with a prescription pad. They can improve health care by being a good lifestyle role model and share with others the benefit of eating 400-500 grams of non-starchy vegetables and fruits per day (WHO, Harvard School of Public Health).
According to Health Canada:
Approximately four in five Canadian adults have at least one modifiable risk factor for chronic disease (self-reported tobacco smoking, physical inactivity, unhealthy eating and harmful use of alcohol)
Canada ranks amongst the worst of OECD countries for adult obesity rates.

Canadians spent $22.1 billion on alcohol (a rise of 3.5 per cent from the same period a year earlier);
16 Billions on tobaccos;
102 Billions on processed food and beverages;
4.8 Billions on pot; rate rising at 1.2% per year.
253.5 Billions on healthcare (< than 3% of that on illness prevention which includes immunizations)
Canada is expected to spend $33.7 billion on prescribed drugs in 2018, according to the Canadian Institute for Health Information (CIHI). This marks an estimated annual increase of 4.2% for drugs, compared with 4.0% and 3.1% for hospitals and doctors, respectively. 

4.9 Billions on vegetables.

I think the issues of insufficient physicians, inadequate resources, physician burnout, low patient satisfaction, long wait-time, poor distribution, the lack of effective collaborations or the need to protect “family medicine” are all symptoms of a collective conditioned to blindly follow and remain unaware.

I think directing attention only at blazes of symptoms while allowing the root cause to smolder is the greatest challenge in our society.

I think the medical profession has been earnestly putting out fire. As a physician, I have been trained and conditioned to direct my attention at the flickering flames and I have obeyed for 30 years. It appears to me that the fire has now spread out of control; and many other, for one reason or another, by one means or another, all want to get in on the action. I think, for the balance of my career, I need to redirect my attention away from distractions and take aim at the base of the fire before we all go up in flames.

Inner metamorphosis

4 C’s of addiction

Craving leads to
Compulsion acted out of
Control without regard for
Consequences.

Cravings arise from imprecision in judgement
Compulsion is unmanaged attention to a thought
Control is lost in a reaction
Consequence is more cravings.

Equanimity is precision in judgement.
Mindfulness redirects attention to object of choosing.
Freedom is won as control is gained.
Synchronicity is the consequence.

She told me she recalls some seriously down days which she pulled through only because she did not want to let me down.
I am amazed how people need so little... just someone to genuinely believe in them, few words of encouragements and a little time and space.  The truth has miraculous power.  I am blessed to be a witness to these beautiful inner metamorphosis.

Funerals

I was 5 years old. I wore a beige colored Kasaya. She peacefully took her last breath at a very old age during her daily bath. As the great grandson, my job at the funeral was to sit cross legged beside the monks and strike a wooden fish every 5 seconds. I never asked why. I think I must always knew it was just the way it is.
I was never afraid of funerals. I have been to only a few since. I enjoyed them. My friend’s son; my secretary of 25 years, my uncle. Never yet attended a patient’s funeral; I don’t know why. I think I will go one day when I have more time. I think I will really appreciate the moments to reflect.
The other day, I went to visit a friend at a cancer respite care. She was sleeping; so I had a chat with a young volunteer. I was surprised when she told me she was glad when her name finally came up on the waiting list for people who wanted to volunteer there. I think perhaps being able to share moments with people dying with cancer is a privileged opportunity to almost touch death and understand life just a little better.
I don’t know if I’ll die suddenly or slowly. Perhaps the advantage of dying slowly from something like cancer is that it might give me just enough time to realize life does have a last page; and decide what I want to write in my final chapter.
I now realize what’s in my bucket list:
1. Surprises
2. Blessings
3. Vividness of each moment

Thank you for the moment!

Two most common type of challenges in medicine

My patients mostly only have just two challenges:
1. Not paying enough attention to what the body needs; (Eg. 400 grams of non-starchy vegetables and fruits per day; appropriate physical activities)
2. Paying excess attention to what the mind don’t need. (Eg. suffers craving or aversion that is self-inflicted; a past that is unchangeable; or a future that may never happen).

Pain, suffering and illness opens up tremendous opportunities to redirect their misdirected attentions.

I ask my patients what is pain? After they have a brief moment to ponder I offer my take. The body has real need but often the mind is busy paying attention to some imagined needs. Pain is how the body speaks to the mind. Let’s say there is a bright orange warning lights on your dashboard and you decided to visit the mechanic. The mechanic sees that you are in distress and covers it up with some duct tape. You are then reassured that the tape has been shown by research to stop the annoying orange light. You are also offered alternative class of duct tapes in the event that the firrst-line doesn’t work well enough and should you be able to see the light come through the tape.

The other day, at the after hour clinic, a patient was in the exam room waiting when I entered. I noticed the near-empty prescription bottles of Percocet and Celebrex in front of her on my desk. She had pain from back to her left foot. After a detailed history, I explained to her that her “pain” is alerting her mind of three challenges.
1. Sciatica from nerve root compression in her lower back partially due to poor posture and weak core; solution: posture exercises and intra-abdominal compression lumbar-decompression exercises guided by pain.
2. Gluteal claudication likely due to iliac vessel disease as she had history of MI and the body wants to redirect her mind from cigarettes using pain. I sent her for doppler and lab studies but encouraged her to focus, in the mean time, on lifestyle management till a treatment plan can be made after the tests.
3. Osteoarthritis of the right knee due lacrosse injury when she was younger. I reminded her that the body is a miracle and has fantastic potential to self-heal provided it receives the proper care; and that the pain is the constant reminder to help the mind stay attentive to the essential nutritional substrates found in 400 grams of non-starchy vegetables and fruits per day, redirect attention from the thought of cigarettes and discover the “appropriate” posture and activities that prevents repeat injuries and permits healing with time.
She thanked me for the explanation and the plans; and asked me if I would dispose of the unfinished prescriptions for her.

What is virtual care?

To me virtual care can mean one of two things. First, virtual care(1) may mean a collection of tools that can be used to increased the ability to communicate over distances; but like most tools it can be inappropriately used; and used to replace the often much needed in person engagements.
Second, virtual care(2) may represent care that does not really solve the root challenges. It’s virtual in the sense that it only puts out the symptom but allows the root cause to smolder.
“A death knell is the ringing of a church bell immediately after a death to announce it. Historically it was the second of three bells rung around death, the first being the passing bell to warn of impending death, and the last was the lych bell or corpse bell, which survives today as the funeral toll.”
So perhaps virtual care is more like the “passing bell to warn of impending death”. I don’t think the death of our universal health care will be the real tragedy; rather it is the premature morbidity and mortality of a naive and misguided people blessed with all the resources but lack resourcefulness. I think introduction of private or hybrid care is a forced consequence of the growing appetite of the Golden Calf of “healthcare” which exist for one reason and one reason alone – sustain its ROE (return on investment)
Virtual care(1) is perhaps a valiant resuscitations attempt to meet the insatiable virtual needs not met by virtual care(2); or perhaps just another innovation of the Golden Calf that shall hasten the death knell.
Regardless of universal, private or hybrid, in my opinion, genuine and effective health “care” only begins when individuals are empowered to think critically and pay attention to real needs rather than perceived (virtual) needs. Who should be more capable and well positioned to take the lead than the physicians? Doesn’t the funeral bell ring for everyone?

What did I learned on a foraging meetup?

Two commonly passed around  “health advices” makes little sense to me.
1. Take lots vitamins and supplements such as gelatin, shark cartilage as they can only do good and no harm.
2. Avoid eating nightshade vegetables as they are inflammatory and worsens arthritis.

I think my common sense says too much of anything can be harmful.  I don’t agree with the notion that too much vitamins can’t hurt.
Only evidence I am aware of on vitamins and supplements is that other than 1000 units of Vitamin D per day; others are unnecessary.
I am of the opinion that vitamins can not and should not replace a healthy diets containing 400 Grams of a sufficiently diverse collection of non-starchy vegetables and fruits.

As for avoiding nightshades such as tomatoes, peppers and eggplants.  This made no sense to me either.

I don’t know and I don’t believe messages that is “pushed” to me.  There is usually some sort of hidden agenda: promotion of a vitamin, a supplement, a book, a website, etc..
I prefer to pull data from multiple sources.  So I googled and came up with the following.

The four predominant flavonoids in most tomatoes cultivars are:
https://www.ncbi.nlm.nih.gov/m/pubmed/18318499/

phloretin, quercetin, kaempferol, chalconaringenin

Phloretin:
In an animal model, phloretin inhibited active transport of glucose into cells by SGLT1 and SGLT2, though the inhibition is weaker than by its glycoside phlorizin.[5] An important effect of this is the inhibition of glucose absorption by the small intestine[4] and the inhibition of renal glucose reabsorption.[3] Phloretin also inhibits a variety of urea transporters.[6][7] It induces urea loss and diuresis when coupled with high protein diets. Phloretin has been found to inhibit weight gain and improve metabolic homeostasis in mice fed with high-fat diet.[8]Phloretin inhibits aquaporin 9 (AQP9) on mouse hepatocytes.[9]

Quercetin:
Quercetin has been studied in basic researchand small clinical trials.[28][2][29][30] While quercetin supplements have been promoted for the treatment of cancer and various other diseases,[31] there is no evidence that quercetin (via supplements or in food) is useful to treat cancer[32] or any disease.[2][33] The US Food and Drug Administration has issued warning letters to several manufacturers advertising unauthorized health claims for treating diseases on their product labels.

Kaempferol:
Numerous preclinical studies have shown kaempferol and some glycosides of kaempferol have a wide range of pharmacological activities, including antioxidant, anti-inflammatory, antimicrobial, anticancer, cardioprotective, neuroprotective, antidiabetic, antiosteoporotic, estrogenic/antiestrogenic, anxiolytic, analgesic, and antiallergic activities.[2]
Anti-cancer effects
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In vitro studies along with some animal testinghas demonstrated the wide range of potential anti-cancer properties of kaempferol. It has been shown in malignant cancer cells to interrupt cell growth, limit angiogenesis, induce apoptosis, and to reduce their available energy and ability to metastasize. Kaempferol has also been shown to reduce MMP-3 protein activity inferring potential ability to reduce metastasis.[2]
Breast cancer
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Estrogen receptors are important in both maintaining a normal mammary gland, and in the development of primary and secondary breast cancer. Kaempferol has been shown to interact with the estrogen receptor pathway and alter signaling in order to help slow growth. This compound exhibits ability to lower levels of Aromatase.[11] Kaempferol has also been found to induce apoptosis in breast cancer cells through extracellular signal-regulated kinase ½ activation [12] and up-regulation of p53.[2]
Ovarian cancer
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Available evidence has shown that kaempferol can “inhibit VEGF production and suppress ovarian cancer cell metastasis in vitro”.[13]
Leukemia
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Kaempferol has been shown to reduce growth in pro-myelocytic leukemia cells through altering the cell cycle.[14]
Bladder, prostate, and colorectal cancer
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Various studies have shown that intake of kaempferol containing foods is not significantly associated with decreased bladder cancer, prostate cancer, or colorectal cancer risk.[2]
Gastric cancer
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A case controlled study found that “consumption of kaempferol-containing foods was associated with a reduced gastric cancer risk”.[2]
Pancreatic cancer
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An eight-year study found the consumption of three flavonols (kaempferol, quercetin, and myricetin) correlated with a lower risk of pancreatic cancer among current smokers, but not non-smokers or ex-smokers.[15]
Lung cancer
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In A549 lung cancer cells, kaempferol up-regulated pro-apoptotic bax and bad genes, while it down-regulated anti-apoptotic bcl-2 and bcl-xL expression. This resulted in an increase in apoptosis of the cancer cells.[4]
Diabetes
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A correlation was found between increased levels of kaempferol in the diet and a reduced relative risk of type 2 diabetes in a cohort study in 2005.[2] Additionally, 6-methoxykaempferol-3-O-β-D-robinobioside was shown to have significant inhibitory activity of aldose reductase, which plays an important role in diabetic complications.[16]
Cardiovascular disorders
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A cohort study in men showed that consumption of flavonoid containing food decreased the risk of mortality from coronary heart disease. Another cohort study showed that high intake of tea is inversely associated with myocardial infarction.[2] Kaempferol has also been shown to have a protective effect on the apoptosis induced by the ischemia/reperfusion of cardiac cells. Due to this, it has a promising pharmacological role in preventing cardiovascular disease.[17]
Anti-bacterial activity
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In a four-week study, kaempferol and its glycosides decreased the number of Helicobacter pylori colonies in gerbils. It also has been shown to work synergistically with antibiotics.[2]
Anti-viral activity
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Kaempferol has been shown to inhibit or decrease the activity of enzymes that partake in viral infection such as reverse transcriptase, viral proteases and neuraminidase.[2]
Antioxidant effects
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Kaempferol has been shown to have an array of antioxidant effects in vitro and in vivo. At low concentrations, its acts as a super-oxide scavenger, specifically against the highly reactive hydroxyl radical and peroxynitrite species. At high concentrations it increases the activity or expression of antioxidant enzymes such as superoxide dismutase, catalase, and heme oxygenase-1. Kaempferol can prevent the oxidation of low-density lipid proteins indicating a potential protective role in atherosclerosis.[2]

Chalconaringenin:
“...naringenin chalcone showed the strongest inhibitory effect of the polyphenols of the tomato skin extract. These results indicate that a tomato skin extract could inhibit allergic reactions.”  https://www.ncbi.nlm.nih.gov/m/pubmed/15322354/

Tomatoes are rich in lycopene, a carotenoid.

A 2017 review concluded that tomato products and lycopene supplementation had small positive effects on cardiovascular risk factors, such as elevated blood lipids and blood pressure.[29] A 2010 review concluded that research has been insufficient to establish whether lycopene consumption affects human health.[30] Lycopene has been studied in basicand clinical research for its potential effects on cardiovascular diseases and prostate cancer,[31][32][33] although results through 2017 have not changed the prevailing FDA view that evidence of benefit remains inconclusive.[28]