Tag Archives: Spirituality


I wrote this article in 1994 for the Canadian Medical Association Journal, trying to make a point that in the heat of the abortion debate in Canada, people had staked out ideological positions that missed the point of human suffering.

I am not sure I would completely agree with myself today, given my understanding of the theological and spiritual arguments against abortion. It is fine to stand with women on choice, but the sanctity of human life is not a choice. I have no resolution and so simply suffer, in my own simple way. 

The fourth clinic

There are four clinics on the seventh floor of a downtown Montreal hospital ‘s west wing. Many of those who walk past the first three, headed for the orange door of the family planning clinic, wear an unmistakable look of grim determination of overwhelming sadness in the face of unbearable choice. Abortions are performed behind this orange door.

The suffering these people experience is not in the physical pain of the procedure, nor is it necessarily a reflection of the loss of a potential life. Loss, after all, is part of our lives, and pain can be drugged to the point of numbness. No, the suffering stems from the burden of choice.

In all the debates about abortion, there is little to be found that addresses the psychologic pain that people who choose abortion carry with them. The weight may lighten with the years, but it seems to always remain in some measure. Decades later, memories remain vivid. An abortion is nearly al­ ways an event of immense import in the lives of those who act on their decision.

In my practice, I see women who use abortion clinics repeatedly, almost as a method of contraception. They are often young, and come from unsettled back­grounds or depressed socioeconomic settings. Many others are simply irresponsible. They cannot remember to take their pill, or they forget to use a condom.

Most of the women who choose abortion, though, do so for reasons that are difficult to deny or judge. They are in a vast grey area in which moral judgments must be made as to what society can and cannot accept. It is here that the arguments are salient and eloquent, and yet they are always much too cerebral to count emotion.

The two extremes — abortion must always be available on demand and abortion must be out­lawed under all circumstances — are accompanied by every possible position in between.

Certain simple facts exist regarding the emotional experiences of women who choose abortion, and even the bravest face cannot hide the element of guilt. Even those who firmly believe that an embryo is little more than an in­ significant, nonviable collection of tissue may have to cope with disapproving families or unsupportive males. Women who have abortions must be able to grieve their loss without the usual ceremony and ritual that society provides for mothers who lose full­ term babies.

Perhaps relieving the burden of suffering is one of the missions of medicine. Of course, suffering can mean different things to different people. On one level, there can be no comparison with the       suffering that is survived daily on a global scale: the suffering of war, hunger and needless disease in the developing world. The poorest of Canada’s poor are wealthy when compared with the homeless of Somalia, yet suffering knows no economic barriers. It merely changes character.

The peasants of Delhi know no other life, and neither do the children of affluence. They each suffer in their own way. There seems to be no need to punish someone for the bravura of youth or the failure of contraception.

Moreover, the importance of a woman’s ability to control her own fertility is but the first step in a long process that empowers and emancipates women. There are lessons to be learned from the women of countries where contraception is outlawed and women suffer the pain of inequality or domestic violence.

The easy availability and growing acceptability of abortion alters the dynamics of reproductive choice. The balance of power shifts toward women, as does the burden of responsibility, but our family laws have failed to keep up with the reality of our technologically determined choices. We all have our own attitudes and opinions regarding abortion, culled from our individual and shared upbringing and values, but these matter little in the physician’s office.

The issues concerning abortion are not technical. They are not about numbers of weeks, the method chosen, the setting, or even who pays. They have nothing to do with the individual doctor or even those of the patient. They are about the face of suffering, the face of the human condition.

First Post

I used to write a blog several years ago under a pen-name. I became disillusioned around that time; not with blogging as much as with my job. I stopped writing as my anger was leaking into my writing. I was supposed to be “The Physician Executive” but found myself unable to hold a job, buffeted by my own ego and surrounded by some more than disingenuous people. Nothing in my career as a physician, teacher, manager or self-described policy commenter had prepared me for the foulness of the human struggle.

Yes, I got involved in a political battle at work and found myself oddly unprepared for the interpersonal and political battles which presented themselves. The blow to my confidence was such that my next job, accepted mostly because I needed a job, went just as badly. Well, ’nuff said.

I have since gotten back on my feet.I worked my way into a private practice, where I am now a principal and am working on developing a medical home and honing our quality performance. During my Master’s, I particularly honed interests in Outcomes and Management with a view to quality management. I feel reasonably well-integrated in the community; I get along with most people, but am already aware of some people who stand in opposition to my ideas, attitudes and practices. That’s OK, nobody in the world only makes friends without being a little obtuse.

Over time, I have regained confidence in my insights and my ability to communicate them. I no longer intend to write just about health care, management and policy items, or be in search of ideas for persuasive essays. This is not a blog with its own brand identity. Writing for a local magazine, I requested republication rights. Everything I publish should eventually come under the umbrella of dinoramzi.com.

My wife and I have started two companies, one was a consulting company that took in some revenue between jobs, and is now a small holding company with investments in several healthcare (and non-healthcare) fields. SanZoe Health is in pursuit of ideas that can improve the delivery of primary care, because it is the best way to improve the health of populations (at least as far as health services are concerned). SavingHealth.com is a web site that will deliver evidence-based medicine (EBM) insights from the perspective of a practicing physician. There was a time I would perform reviews for the teaching program when I was involved in teaching at Emory. I have published an evidence-based review in a large circulation continuing education journal. Now that I am in practice, I find I still use the skills. These skills may be scarce, but they are definitely not unique but nobody is actively blogging them. So we’ll get this one up when we get the time… between patients, you know.

We also started PanZoe, which should begin accepting donations within a month or two to help deliver innovative primary care to uninsured or underinsured Americans. We will begin locally, in the Camas/Washougal area, suburbs of Portland Oregon. This is our status as of June 2013 and I do not intend to update this first entry.

At this time I am also the President of the Clark County Medical Association, an alternate delegate to the Washington State Medical Association, and an active member and delegate to the Washington Academy of Family Physicians.

Politically, I am conservative, but you might not recognize my ideas as conservative given that the current crop of right-wingers are merely radicals to my eye. Many of them would call me a liberal. At the end of the day, I am an Independent who supports No Labels and the Congressional Problem-Solvers. Being a bit of a gadfly and calling out inconsistencies on both sides, I could be regarded as uniter of the parties; both sides can always rally behind the idea of throwing me out of the room!

The simple and effective communication of complex ideas is not at easy thing to do. It is a skill that requires a great deal of practice. I have not invested enough time in doing this, but have become aware that my head is exploding with innumerable multi-step ideas. There is no way to describe the role direct-primary care combined with reinsurance and a disappearing deductible for employers to avoid the Obamacare tax and improve the health of the population without building ideas one by one. I need this venue to develop the articulation of these ideas.

The greatest paradox and struggle of my life is that an intellectual path eventually takes you to a place of uncertainty, unknowing and doubt, which inevitably leads to either a sort of intellectual nihilism or on the other hand, to a succumbing to faith. I came backwards to the faith of my ancestors, to the world of Eastern Orthodoxy, mostly as a cradle Greek Orthodox. I accepted this world because of its inherent mysticism; although there is dogma in this church, there is much we acknowledge as unknown. All revelation is short of the blinding reality of God. I find echoes of Orthodox Christianity in the non-religious methodology of mindfulness meditation and most recently in “happiness” research and the concepts of “flow” and “social altruism.” My old professors are guffawing as I write, but this too is something by which I stand.

If by way of advocating for the things I am most passionate about, I run into something offensive, please forgive me in advance. It is not my primary purpose to advocate for any single entity; not for primary care or family medicine, not for the Clark County Medical Society, the AMA, the AFP or its state affiliates, my wife’s for-profit holding company or my non-profit foundation, EBM, mindfulness meditation or the Orthodox Church. But these things are reflections of who I am and what I care about.

I hope you will enjoy the blog and follow its evolution.