John M. Talmadge, M.D.

A Blog Covering Many Topics

The Painter and the Poet

The painter is Pablo Picasso, and the poet is Wallace Stevens:


Wallace Stevens, "The Man with the Blue Guitar" (excerpts)


The man bent over his guitar,
A shearsman of sorts. The day was green.

They said, "You have a blue guitar,
You do not play things as they are."

The man replied, "Things as they are
Are changed upon the blue guitar."

And they said then, "But play, you must,
A tune beyond us, yet ourselves,

A tune upon the blue guitar
Of things exactly as they are."


I cannot bring a world quite round,
Although I patch it as I can.

I sing a hero's head, large eye
And bearded bronze, but not a man,

Although I patch him as I can
And reach through him almost to man.

If to serenade almost to man
Is to miss, by that, things as they are,

Say it is the serenade
Of a man that plays a blue guitar.

Dr. Talmadge Speaking at 21st Solutions Annual Banquet

I'm brushing up on my public speaking skills and, for the first time in years, I'm probably going to write a speech before I deliver it. This spring I will be the guest speaker at the 21st Annual Banquet celebrating the success of Solutions Outpatient Services, and this is quite an honor. I haven't homed in on an exact title or a topic, but this is an event that brings together hundreds of people from the recovering community, the world of alcohol and addiction treatment, and the professional world.

Lois Jordan, Bill Jordan, and Mary Donna Noack have been among my best friends and most treasured colleagues for over twenty years. Lois and her husband Bill started working with alcoholics and addicts before the field was even well known, much less fashionable. To see the biographical sketches of the great people at Solutions, click here.

Their practice, Solutions Outpatient Services, remains one of only a handful of facilities that remain owned and operated by its original owner. Solutions Outpatient Services is an Intensive Outpatient Program (IOP) licensed by the Texas Department of State Health Services to treat alcohol and drug problems. In September 2013, Solutions extended its services to include Soul Food, an adult IOP for the treatment of anorexia, bulimia, binging, and compulsive eating. Soul Food has quickly developed the same highly acclaimed reputation as Solutions’ substance abuse IOP.

As Lois says, "If there is one word to describe Solutions, it would be Family. Solutions is Family owned, Family run, the staff is Family, the clients become Family, the family members become Family, and the professional community is embraced as Family. Individuals and their families come to us so broken by addictions that they cannot even imagine that they can heal." That's pretty special. You don't see language like that in corporate brochures or typical business advertising!

She also writes: "At Solutions, we not only help clients and their families gain the tools to deal with their addictions and codependency, but more importantly, we give them the tools to live life in a meaningful way. We believe that addiction is about an unhealthy relationship with a mood and/or mind-altering substance and/or behavior. Therefore, we help clients develop relationships with themselves, their Higher Power, their families, their 12-Step communities, and their community-at-large in a meaningful and sustainable way."

Congratulations to Lois, Bill, Mary Donna, Deborah, James, and all of those who have contributed to the success of Solutions over the past twenty years!

The Wisdom of Playing "Small Ball"

About 20 years ago my professional life encountered hard times. Four hospitals where I worked had simply folded and closed their doors under the pressures of managed care and reduced Medicare funding. The costs of practice continued to rise, and economic pressures on families increased as various “bubbles” began to burst in major economic sectors—real estate, technology, oil & gas, and so on. I was driving a car with 275,000 miles on it and no air conditioning. One afternoon I visited a lawyer friend, a fellow soccer dad with whom I had founded the Dallas Inertia FC, a soccer team for middle-aged men, telling him that I needed advice. Quoting a pilot I had known in Vietnam, I told my buddy Hank that I was out of “altitude, air speed, and ideas.” Hank had practiced law for years, and I admired his work ethic and positive attitude.

Hank said that he had been through similar times in his law practice. The solution, he said, involved learning how to play “small ball.” He explained the concept in simple terms. “If you’re not big and strong,” he said, “then you have to be fast, quick, and agile.” If you can’t compete with a big company (like a hospital system), it’s important to find a strategy related to your signature strengths. This conversation took place several years before Martin Seligman at U Penn popularized positive psychology and confirmed much of what Hank was telling me about using the skills and talents that come with our basic makeup.

Always the baseball fan, he described the ascendance of the 1951 Chicago White Sox, a team with weak hitting and very few big innings. Under manager Paul Richards, the strategic focus became speed and strong defense. When you have trouble scoring, Richards declared, you have two options: keep the score low (defense) and advance your base runners at every opportunity (speed). He cited the legendary Dodger trio of Sandy Koufax, Maury Wills, and Don Drysdale. Pitching kept their team in almost every game, and Wills stole over 100 bases in the 1962 season. 

I’ve worked with some professional athletes who describe their success in similar fashion. One PGA pro has a reputation as a “grinder,” one of those golf pros who doesn’t win majors, but who consistently finishes in the money and makes a very good living. “You don’t have to be a world-beater,” he says. “Sure, it’s deflating to the ego when you see what some other people are able to do, but that little white ball doesn’t care whether your name is in the paper. And that paycheck for a 15th place finish turns into cash that’s good at any bank.”

Some people scoff at sports metaphors, but on that afternoon the advice sounded good to me. Over the next two years I changed my approach to practice entirely. I discovered that I didn’t need a big salary or a high-visibility office with a lot of overhead. I realized that seeing someone on short notice (speed) and using creative intervention strategies (agility) produced consistently better results. Beyond the immediate benefits financially, I found professional practice much more stimulating, enjoyable, and satisfying. The principle of small ball brings with it a significant multiplier effect.

In the past twenty years I have never hired office staff, nor have I paid someone else to answer my phone. I used small ball skills to develop highly successful programs for a local non-profit community mental health center. When others noticed our success, I was recruited to the medical school to replicate the strategy in our mental health services for veterans. As a professor in the Department of Psychiatry, I began to teach these skills to young physicians. Our treatment programs have been honored as the outstanding teaching services at the medical center. There are many teachers and practitioners I admire, and I’ve had many experiences of professional envy. When you’re a grinder, or just a good base runner, it’s natural to be jealous of those who are just simply better at the game. What I try to remember is to use the talent I have, not the talent I wish I had.

Few single individuals become rich or famous playing small ball, but prosperity isn’t measured in dollars alone. What counts in life is the importance of what we care about, what we really love, what motivates us to show up for practice. Playing small ball doesn’t mean thinking small or dreaming small. It reminds us that the important step is to show up for practice and to keep our heads in the game, so that good things happen, one day at a time.

Dr. Talmadge joins UpToDate Advisory Board

This week I was honored to be selected as an UpToDate Advisory Board member. The nomination and selection process involved interviews with hundreds of physicians worldwide. I should add that this is not a paid position, and I have no financial ties to the publisher or the organization. I have used UpToDate for many years, like over one million other doctors around the globe. It's the #1 subscription resource for physicians. I will be a consultant in psychiatry and addiction medicine.

What is UpToDate?

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