Latter-day Doctor: 2018 Year in Review

This has been a transformative year for the blog

by Alan B. Sanderson, MD

Here is our year-end summary!

Top Ten Posts of 2018

2018 review

  1. The Book of Mormon – Alternate Chronology. This post was actually from 2015, but its traffic has really taken off this year and it has gotten twice as many hits as any other post. I revised the chart and the post this year to include hyperlinks to the online scriptures.
  2. Is There Something Wrong? A personal story about love, friendship, and mental illness that happened during my senior year of high school. This post really struck a chord with people, especially when it was shared among my high school classmates.
  3. The Crescent Moon. My neighbor Christie Perkins died in April, and this was my euology for her.
  4. Medical Marijuana. A contentious political and cultural issue, explained from the perspective of a practicing doctor.
  5. A British Summer: My Experience as a Latter-day Saint Missionary. My two years in England really changed my life.
  6. To Be Learned is Good If… This was the first post by Rand Colbert, MD, a new contributor who joined the site this year.
  7. Alternative Medicine. A fairly balanced discussion of another contentious topic.
  8. Ministering for Sociophobes: A Practical Guide. A discussion of social anxiety disorder, focusing on practical advice for sociophobes trying to fulfill church assignnments.
  9. It Becomes You – A Memoir About Medical Education. This was the series of posts which launched the year, describing the launch of my career. If you know someone who is thinking about becoming a doctor, send them to this post.
  10. What Is Death? A discussion of medical and religious definitions of death, and an explanation of Latter-day Saint doctrine about the afterlife.

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Christmas, Upside-Down

Has your Christmas been turned upside-down? You’re in good company.

by Alan B. Sanderson, MD

Christmas Upside DownOne of my family traditions, started when my oldest kids were little, is to illustrate the Christmas story from the Bible, one scene at a time on large paper, and post them on the wall. Each week in December, usually in our Family Home Evening, we do another drawing and read that part of the story together. The little kids crowd around and lean over the paper so that it is hard for me to see what I’m drawing, and at some point early on I started sitting at the top of the paper, across from the kids, and drawing from the upside-down perspective. My rule is that every mark I make on the paper has to be done this way, including the lettering. This is a great mental exercise, drawing and writing upside-down, and my drawings are so bad anyway that they are not much worse when I do them this way.

Over the years I have known many people who have had their Christmases turned upside-down because of illness. I told one of those stories a couple of years ago on this blog. Just two weeks ago I said to a patient, “This will go down in history as your Christmas in the hospital. Just get used to that idea now.” But fortunately this patient improved much faster than I expected, and last week he was discharged home after only five days in rehab. This will go down in history as his Christmas miracle.

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Taking It Religiously

I wish more people would take religion religiously

by Alan B. Sanderson, MD

Taking it Religiously

One day in clinic I was seeing a patient in follow up. At her previous visit I had given her a prescription to help with her migraine headaches. “Have you been taking the medication?” I asked.

“Oh, yes,” she replied. “I take it religiously.”

The literal meaning of her reply struck me, and I suddenly imagined her on her knees, swallowing a pill with devotion and fervor.

“Do you take it at church?” I asked.

She looked at me quizzically. “You just said that you take it religiously,” I explained.

She laughed. “No, I don’t take it at church, but maybe I should.”

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Treadmill Journal, Part 2: Speaking for the Voiceless

“This doctrine is not of me, but is that of the living God and of his divine Son.”

by Alan B. Sanderson, MD

Treadmill Journal2-title

I woke up to the baby calling early in the morning, about half an hour before my alarm was to go off. The house was completely dark, and would have been quiet if not for my baby calling out. He’s not really a baby anymore, but he is the youngest so he gets to be the baby still even though he is really a toddler.


She was still asleep, and gave no sign of changing that. So I slid out of bed softly, trying not to disturb her, and stumbled through the house. I found our little early bird standing up in his crib, looking much more ready for the day than I felt. Sometimes it’s hard to tell whether I am the early bird getting the worm, or the early worm getting eaten alive.

“Hi, Dad!” he said.

“Good morning, Baby.” I gave him a new diaper, a drink of water, and a banana. By that time I had given up on going back to bed.

“Do you want to go running?”

“Yeah! A running!”

On a summer morning I might have put him in the jogging stroller and taken him along for my morning run, but I don’t like to do that when the temperature is below freezing outside. So instead we went downstairs to the treadmill, where he sat on a nearby couch watching a trail running video while I ran a few miles and listened to President Nelson’s third Conference talk.

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Imagining Is Doing

A neurologic perspective on the Higher Law

by Alan B. Sanderson, MD

How would you like to learn to play the piano without having to spend hours practicing at the keyboard? It turns out that you can, although the process requires more effort than you probably hope. Everything worth doing is hard, right?

Imagining is Doing

Here’s how the process works. Some years ago a team of brain researchers did a study to understand more about the process of learning. They took volunteer study subjects who didn’t know how to play the piano, and showed them how to play a simple song. The subjects were then split into two groups, one of which sat at a piano and practiced playing the song for a certain amount of time every day, and the other of which merely imagined doing so, but for the same amount of time. Surprisingly, study subjects who did mental practice alone were able to play the piece almost as well as those who had practiced at the piano. And after spending a few minutes at the keyboard the mental practice group was able to catch up to the skill level of other group.

These results are not extremely helpful for those of us who do not already play piano, because the no-practicing piano method still requires just as much time and motivation as the more traditional way, and therefore does not provide a shortcut to developing this enviable talent. (And I suspect that maintaining the motivation and the discipline to persist in mental-only practice is probably harder than for hands-on practice.) But the implications for learning and behavior are HUGE.

A purely mental exercise, just thinking about movement, has the power to change the parts of our brain which execute that movement. In fact, imaging studies which can detect brain activity, such as fMRI and PET scans, show activation of the motor areas of the brain when subjects are asked to think about performing an activity without actually moving. From the perspective of the brain, there isn’t much difference between doing, and thinking about doing.

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Treadmill Journal, Part 1: The First Miles!

Putting a few exclamation points behind the Prophet’s words.

by Alan B. Sanderson, MD

Treadmills are boring. Running on a treadmill is only slightly better than not running at all.

Treadmill Journal-1

But sometimes the treadmill is my best or only option, because of inclement weather, family responsibility, or some other reason. This time of year when it is getting colder and darker outside I sometimes retreat to the basement to put a few more miles on my creaky old hamster wheel.

How does one occupy the mind during such a meaningless task as running nowhere? There are various tricks, almost all of which involve distracting yourself with some kind of audiovisual experience. I almost never listen to anything on headphones while running outside, but without music my treadmill workout would only last about 5 minutes.

A couple of weeks ago I went downstairs for a treadmill run after putting the youngest kids to bed for the night. I was listening to some pretty good swing jazz, an old Benny Goodman recording with a killer Gene Krupa drum solo, but within the first mile I was suddenly struck with the thought that I was wasting my time. Wasting my time?

“Yes,” says my conscience.

But I’m getting a good workout, and listening to some great music! These activities are of good report.

“You could do better. You should listen to Conference.”

Hmmmm. But I’m really enjoying this music.

“But Conference is better. And I will keep nagging you until you do it.”

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Between Their Loved Home and the War’s Desolation

The human cost of war, and those who pay it

by Alan B. Sanderson, MD

Vietnam was a hard war to come home from. My dad was told to change into civilian clothes as soon as possible after the flight home in order to avoid some of the abuse that returning Vietnam veterans were put through by an ungrateful public. He went on with his life, never mentioning to anyone the fact that he had spent a year overseas in the army. In the mid 1980’s he saw an announcement and invitation for a special dinner for Vietnam veterans, hosted by the Vietnamese refugee population in the state where we lived. Immediately he was skeptical and didn’t want to attend, thinking that there must be some sort of deception involved, but my mom insisted that he go and take the whole family with him. Attending that dinner was an intense emotional experience for him, as he had been home from the war for over a decade and this was the first time anyone had thanked him for serving. Because of this I make it a point to thank all of the veterans who come to my clinic.

There is a long tradition of military service in my family. Sylvanus Sanderson fought in the American Revolution. Henry Sanderson marched in the Mormon Battalion in the Mexican-American War. My great-grandpa George Sanderson fought in World War I, and his son Ivan served in World War II. My dad served in Vietnam. All of these veterans in my family were members of The Church of Jesus Christ of Latter-day Saints, with the exception of Sylvanus, who died around the time the Church was organized (and before photography was widely available).

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Persuasion and Choice

Thoughts on brain plasticity and the doctrine of agency

by Alan B. Sanderson, MD

persuasion and choice - title.pngI once received a letter from a woman informing me that her son, my patient, had died. Her letter was written to thank me for the way I had spoken to him about his addiction during his appointment in my clinic. She wrote:

“I know you only saw my son once but he felt so comfortable with you. He said I think he really cares for me and will help me get better. (sic)

“I was impressed that you treated him with such compassion, not judging him by his alcoholic past. You saw the person!”

This letter saddened me because my patient’s death was unexpected, but it also made my day. Seeing addiction as a medical illness instead of as a moral failing is important to me, and I love learning that I made a positive difference in someone’s life.

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The Operating Room and the Temple

The temple is like the operating room; it has a special purpose, and special preparation is required to enter it.

by Alan B. Sanderson, MD

operating room and temple.png

On the first day of my medical school surgery rotation I set foot inside of an operating room (OR) to participate in a surgery for the first time. The patient had a rectal tumor, which my team was cutting out. She was positioned in stirrups on the table, and I had a front row seat to watch the work of the surgeons as I stood between her legs holding a retractor. I had seen human anatomy before in the cadaver lab, but I had never seen a living person’s bowels before that day. A loop of her intestines was hanging out of the surgical incision, and I could see its slow, squirming peristalsis movements. There was also blood, which we never saw in the cadaver lab because embalmed corpses have long since stopped bleeding.

After a short time I started to feel lightheaded. This was a familiar feeling for me, as I have a condition called vasovagal syncope which has caused me to pass out many times after receiving shots, experiencing minor injuries, or giving blood. Standing in the operating room that day I tried to fight against it, but when it became clear to me that I was going to faint I decided that it would be less embarrassing to speak up and let the surgeons know that I had to sit down than it would be to pass out and possibly fall forward into the sterile surgical field.

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Depositions and Testimonials

I tried it, and it worked for me

by Alan B. Sanderson, MD

This week I had to testify in a court case, and it got me thinking about the various uses and forms of the word “testimony.”

Legal Testimony

Depositions and TestimonialsIn a legal setting, the word “testimony” refers to statements made by a witness under oath. This may be done in a court of law, or in a deposition. A legal testimony for a doctor involves discussing memories about an episode of patient care, and these tend to be episodes where something bad happened to the patient.

Testifying in a legal case is an experience which every doctor is likely to have before getting too far into their career, no matter how good of a doctor you are, how conscientious you are, or how much you care about and try to help your patients. It is not a very pleasant experience to be scrutinized in this way, and it is hard not to practice defensive medicine afterwards. The paranoid thought that every patient might want to sue you for malpractice can be rather damaging to the doctor-patient relationship and to the medical decision making process, so I try not to think about it very much. This may be an ostrich’s approach to the problem, but I would rather focus on the task of trying to do what is right and building consensus with patients. Continue reading

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