Merry Christmas and a Happy New Year 2020


Dear readers and fellow bloggers;

We wish you and your family a Merry Christmas and a Happy New Year 2020. Thank you very much for patiently and loyally following our writings during the past few months. After we take a much-needed vacation to rest, read, travel and cook, we will resume our regular blogging.

May God Almighty continue blessing you and family with happiness, health and work.

Talk with you later!

Hasta la próxima!

A bientôt!

Vi rincrociamo!

Physician and Nurse burn-out – part I

-“If they decide to study Medicine, I won’t pay for it…Should flip burgers for it.”

The unusually radical statement by the successful Miami gastroenterologist—referring to his aversion that his children may eventually follow his career’s path—came as not a real surprise for us. He expressed what most practicing physicians feel. The unrelenting micromanagement of our practices by the payors and the increasing demands of patients on time and attention has literally “burned out” the caregivers. Progressively physicians are becoming strongly disenchanted with their profession.

In a 2008 Health Affairs article, Donald M. Berwick, Thomas W. Nolan and John Whittington coined the term “triple aim” to define the necessary simultaneous pursuit of three objectives—improving the experience of care, improving the health of populations and  reducing per capita costs of health care—to fix the US system. In 2014, Drs. Bodenheimer and Sinsky argued that, considering the increasing burn-out and dissatisfaction of physicians, nurses and other staff with the medical practice, proposed that: “the Triple aim be expanded to a Quadruple Aim, adding that the goal of improving the work life of health care providers, including clinicians and staff.”

Professional burn-out is characterized by this most evident and ignored tragic triad:

  1. High emotional exhaustion
  2. High depersonalization
  3. Low sense of personal accomplishment

High emotional exhaustion – The increasing demands of payors, administrators and patients on the time and resources of the health care personnel produces a generalized dissatisfaction with the perceived quality of their delivered care services. The level of resilient frustration is so pervasively high in our system that physicians, nurses, technicians, receptionists and other ancillary personnel are literally “counting the days” until finally the day of salvation arrives—their retirement date.

High depersonalization – The negative feelings and bad vibe will inevitably foster the emergence of cynicism and sarcasm in the ranks of providers, with the resultant degradation of their rapport with the patients and their families. It’s a vicious circle. Patients complain that they are being ignored and/or mistreated, which triggers more negativity and disdain for the staff. As a result, the latter keeps worsening attitudes.

Low sense of personal accomplishment – For the majority of us who have chosen the medical career, profit and social standing are usually secondary considerations. What we most value is the possibility of helping our fellow human beings and at  the same time enjoy the unique standing conferred by possessing a voice of authority. With the onslaught of “bean counters” and their henchmen in both the public and the private payor system, our maneuvering room is being steadily curtailed in practice. The decreasing satisfaction not only engenders early retirement but also drug and alcohol abuse in the physician workforce plus the very real possibility of Suicide.

Shanabelt et al. studied the prevalence of burnout and satisfaction with work-life balance in the US physician and general workforces in 2011 and 2014 to compare the results and significant trends, using the Maslach Burnout Inventory; they invited more than 35,000 physicians to participate and 19% completed the survey. They said that; “ 54.4 % (n=3680) of the physicians reported at least 1 symptom of burnout in 2014 compared with 45.50 % (n=3310) in 2011.Substantial differences in rates of burnout and satisfaction with work-life balance were observed by specialty.” The researchers found minimal differences in the general workforce between those years. Nurses and residents (physicians in training) show similar or higher levels of emotional frustration with their professions and firm intentions to defect. Almost 2,500 physicians retire yearly in the USA and they are not being replaced fast enough, compromising the delivery of efficient Primary Care services for under-served rural or inner-city communities.

This modern-day drama that is being played out daily in all—we repeat IN ALL— the health care delivery facilities in the USA has major and minor consequences for the well-being of patients, which we will discuss in the second part of our series.

What do you think? Please tell us.

Don’t leave me alone.





Thank you Noel Marie


Dear readers and fellow bloggers:

Good morning. It is with utmost pride that I happily present to you the cover of our new book Emotional Frustration – the hushed plague prepared by my dear daughter Noël Marie.

Thank you very much for using your outstanding skills to prepare a fabulous cover, dear. This endeavor has been only possible due to the sustained, precious support of you and your brother Gian Luca who have infallibly came to my rescue every time I momentarily wavered in this long, arduous quest. Thank you God Almighty for gifting us our children.

Thank you very much!

Muchas gracias!

Merci beaucoup!

Grazie mille!

Celebrating 80 years of the premiere of the most romantic American saga

Dear readers and fellow bloggers:

Good afternoon and Happy Sunday to you all. We were in the focused process of cooking the Sunday meal when something we heard in the TG1 news program stopped us in our track and made us drop the utensil we were holding into the sink. Today we celebrate the 80th anniversary of the film premiere of Gone with the wind in a movie theater in Atlanta, Georgia, which honored the Southern setting of the trendsetting dramatic saga.

That movie has influenced the tastes and preferences of millions of moviegoers all around the globe, including prominent writers, actors, technicians and directors. In ways big and small, many film enthusiasts have followed some of the trendy novelties it had introduced; when  we decided to write a film scrip about a savage prison riot with my son Gian Luca, we envisioned that the opening scene would be a panoramic view of the prison yard after the prisoners’ riot had been brutally quashed by the SWAT team, with all the gore and mayhem reminiscent of the famous scene in the Atlanta train station.

This film was conceived right when the rumblings of Fascism were getting stronger in Europe and all the moviegoers knew that something terribly wrong was already afoot. However, human beings need the consolation of a brighter future, even, or especially, in the midst of disgrace and doom in order to carry along to arrive to a propitious ending. The film provided countless lines that will be remembered by moviegoers, including when Rhett Butler (played by Clark Gable) said with a unique panache to a manipulative Scarlett O’Hara ( played by Vivien Leigh): “frankly, my dear, I don’t give a damn.”

In these turbulent times let us keep some clarity of mind and determination of spirit to do better. Now back to our duties as our children are insolently asking us: “when will it be ready, Dad?”

What do you think? Please tell us.

Don’t leave me alone.