MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol VI, No 16, Nov 27, 2007

 

In This Issue:


1.                  Featured Article: English - Whose Language Is It Anyway?

2.                  In the News: Happy Twentieth Anniversary Prozac from 54 Million Patients  

3.                  International Medicine: What Do the British Think of Michael Moore's Praise of the NHS?

4.                  Medicare Secret: MSAs in Medicare?

5.                  Medical Gluttony: Well, You Can Never Have Too Many Tests, Can You?

6.                  Medical Myths: Professional Attire Doesn't Matter

7.                  Overheard in the Medical Staff Lounge: Doctor's Dress, Demeanor and Manners

8.                  Voices of Medicine: When Physicians Are on the Other Side of the Syringe, Scalpel, Oxygen Mask

9.                  From the Physician Patient Bookshelf: Doctor Generic Will See You Now

10.              Hippocrates & His Kin: Class Action Suits Sink Lawyers One Notch Lower

11.              Related Organizations: Restoring Accountability in Medical Practice and Society

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MOVIE AGAINST SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE

Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. This movie can only be made if Clements finds 200 doctors willing to make a tax-deductible donation of $5K. Clements is also seeking American doctors willing to perform operations for Canadians on wait lists. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit
www.sickandsickermovie.com or email logan@freestarmovie.com.

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1.      Featured Article: English - Whose Language is it Anyway?

English has been the International Language of Medicine, Science and Business for the past half century. Now that one-fourth of the world speaks English, how will it evolve? Will it go the way of Latin when it become French and Italian? Will it go the way of German and spin off Dutch, Danish and Swedish? Will it become "Globish?" Or will Mandarin or Arabic replace it? Here's an analysis from the FT.

Whose language? Non-native speakers give a twist to the world's pre-eminent tongue. By Michael Skapinker, Financial Times, November 8, 2007

Chung Dong-young, a former television anchorman and candidate to be president of South Korea, may be behind in the opinion polls but one of his campaign commitments is eye-catching. If elected, he promises a vast increase in English teaching so that young Koreans do not have to go abroad to learn the language. The country needed to "solve the problem of families separated for English learning", the Korea Times reported him saying.

In China, Yu Minhong has turned New Oriental, the company he founded, into the country's biggest provider of private education, with more than 1m students over the past financial year, the overwhelming majority learning English. In Chile, the government has said it wants its population to be bilingual in English and Spanish within a generation. To read more please go to www.medicaltuesday.net/index.asp.

No one is certain how many people are learning English. Ten years ago, the British Council thought it was around 1bn. A report, English Next, published by the council last year, forecast that the number of English learners would probably peak at around 2bn in 10-15 years.

How many people already speak English? David Crystal, one of the world's leading experts on the language and author of more than 100 books on the subject, estimates that 1.5bn people - around one-quarter of the world's population - can communicate reasonably well in English.

Latin was once the shared language over a vast area, but that was only in Europe and North Africa. Never in recorded history has a language been as widely spoken as English is today. The reason millions are learning it is simple: it is the language of international business and therefore the key to prosperity. It is not just that Microsoft, Google and Vodafone conduct their business in English; it is the language in which Chinese speak to Brazilians and Germans to Indonesians.

David Graddol, the author of English Next, says it is tempting to view the story of English as a triumph for its native speakers in North America, the British Isles and Australasia - but that would be a mistake. Global English has entered a more complex phase, changing in ways that the older English-speaking countries cannot control and might not like.

Commentators on global English ask three principal questions. First, is English likely to be challenged by other fast-growing languages such as Mandarin, Spanish or Arabic? Second, as English spreads and is influenced by local languages, could it fragment, as Latin did into Italian and French - or might it survive but spawn new languages, as German did with Dutch and Swedish? Third, if English does retain a standard character that allows it to continue being understood everywhere, will the standard be that of the old English-speaking world or something new and different?

Mr Graddol says the idea of English being supplanted as the world language is not fanciful. About 50 years ago, English had more native speakers than any language except Mandarin. Today both Spanish and Hindi-Urdu have as many native speakers as English does. By the middle of this century, English could fall into fifth place behind Arabic in the numbers who speak it as a first language.

Some believe English will survive because it has a natural advantage: it is easy to learn. Apart from a pesky "s" at the end of the present tense third person singular ("she runs"), verbs remain unchanged no matter who you are talking about. (I run, you run, they run; we ran, he ran, they ran.) Definite and indefinite articles are unaffected by gender (the actor, the actress; a bull, a cow.) There is no need to remember whether a table is masculine or feminine.

There is, however, plenty that is difficult about English. Try explaining its phrasal verbs - the difference, for example, between "I stood up to him" and "I stood him up". Mr Crystal dismisses the idea that English has become the world's language because it is easy. In an essay published last year, he said Latin's grammatical complexity did not hamper its spread. "A language becomes a world language for extrinsic reasons only, and these all relate to the power of the people who speak it," he wrote. The British empire carried English to all those countries on which the sun never set; American economic and cultural clout en­sured English's dominance after the British empire had faded.

So could China's rise see Mandarin becoming the world's language? It may happen. "Thinking back a thousand years, who would have predicted the demise of Latin?" Mr Crystal asks. But at the moment there is little sign of it, he says. The Chinese are rushing to learn English.

Mr Graddol agrees that we are unlikely to see English challenged in our lifetime. Once a lingua franca is established, it takes a long time to shift. Latin may be disappearing but it remained the language of science for generations and was used by the Roman Catholic church well into the 20th century. . . To read the entire article, go to www.ft.com/cms/s/0/e621ff38-8e1c-11dc-8591-0000779fd2ac.html?nclick_check=1.

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2.      In the News: Happy Twentieth Anniversary Prozac

Once we start, we are accustomed to being on blood pressure, heart and diabetes medications for life. Is depression treatment also evolving into medication for life? With patients more involved in their own treatment plans, and 54 million people on Prozac, read an inside story of Jessica Apple's long term love - hate relationship with Prozac.

Happy Anniversary, By Jessica Apple, November 17 2007, Financial Times

It is 20 years since Prozac was approved in the US. Now what some saw as a short-term treatment has become a way of life. By Jessica Apple

Nearly a decade ago, on my honeymoon in Venice, I realised something was terribly wrong. I had no doubts that I loved my husband, but I didn't feel anything close to romantic. Instead of seeing the beauty of St Mark's Square, I thought about the public executions that once took place there. I got dizzy from looking up at the ceiling mosaic of the Basilica. The crowds of people made me nervous, and the gondolas struck me as nothing but charmless tourist traps. I didn't even have an appetite for pasta.

On our third day in Venice, my husband and I took a water bus to Murano, the Venetian glass-making island. I leaned against the railing of the water bus and felt the strong wind on my body. When I reached up to brush my long, curly hair out of my face, a handful of it came out in my palms.

The hair wasn't a total surprise. In the two months preceding my wedding, I had noticed that I was losing more hair than usual. In the mornings, I would find 10 stray hairs on my pillowcase instead of the usual two or three, and I would spend the next hour imagining the different diseases that might be causing me to shed like a cat. But on that boat ride to Murano something more than exaggerated worry was happening. As I held my hands over the railing and let the wind carry my curls away, I had the distinct sense I was tossing my own ashes out to sea.

Back home, my doctor could find no reason, other than stress, for my hair loss. He recommended I see a psychiatrist and start treatment with an antidepressant. It turned out that the one disease I hadn't diagnosed myself with was the one I had - depression. To read more, please go to www.medicaltuesday.net/news.asp.

 

The psychiatrist didn't hesitate to give me Prozac, and the change in me was both subtle and dramatic. After a few weeks on 20mg of Prozac, I had energy, not just physical energy, but energy in my soul. Other than the sense of vigour, my body did not feel noticeably different. But what was dramatic was that not only did I stop thinking about death, I began to sing. I sang to my dog and cats. I sang while I washed dishes. A few times, I even sang in the shower. I also noticed that I didn't feel panicky when people looked at me. I didn't even mind it. What happened to me was exactly as Elizabeth Wurtzel described in her bestselling memoir, Prozac Nation. Wurtzel says that after she began to take Prozac, ''something just kind of changed in me* I became all right, safe in my own skin. It happened just like that.'' Just like that, after months of having to force myself to eat, my appetite returned.

Then something else happened. As I was beginning to take pleasure in my daily life for the first time in nearly a year, I wanted to stop taking my pills. Prozac had freed me from depression and from a list of anxieties that included everything from killer bees to rare diseases to radioactive waste, and all I could think of was how quickly I could get rid of it.

The dilemma I found myself struggling with is not unique to me. Although there are no surveys which pinpoint this particular phenomenon, conversations with experts and numerous Prozac users around the world revealed the paradox again and again: former depressives, feeling much better in general, believe they ought to stop taking the very pills they need to live a happy life. We may indeed be a Prozac Nation, but one thing remains clear: we've yet to come to terms with our diagnosis.

On December 29 Prozac celebrates its 20th birthday. When it first became available in the US, no one could have anticipated how radically Prozac would change the way we treat depression and anxiety disorders. Fluoxetine, the scientific name for Prozac, wasn't even originally designed as an antidepressant. Eli Lilly, the company which makes Prozac, first tested it, unsuccessfully, as a drug for high blood pressure, and then, again unsuccessfully, as an anti-obesity agent. But when Fluoxetine was finally approved by the US Food and Drug Administration in 1987, as the antidepressant Prozac, its effect was immediate. Mildly depressed patients were often not good candidates for the tricyclic antidepressants used since the 1950s, or didn't want to risk the potentially severe side-effects of monoamine oxidase inhibitors. Suddenly they had real hope of relief.

Now about 54 million people around the world take Prozac, and many more millions take its sister selective serotonin reuptake inhibitor (SSRI) drugs. With so many people treating their depression this way, the most surprising fact of all may be that anyone could still be ashamed of doing so. And yet not a single SSRI user I contacted for this article wanted his or her name in print.

Depression is a subjective experience. There is no reliable way for doctors and scientists to measure it, and experts still can't agree what causes it. As an SSRI, Prozac is in a class of drugs that includes Paxil and Zoloft among others. Low levels of serotonin can lead not only to depression, but also to a range of anxiety disorders, from panic and obsessive-compulsive episodes to social anxiety. . . 

Depression is an entity, not merely sadness or a rough period that will pass. It lives in our cells and is probably as much a part of being human as death. All cultures have accumulated and dispensed advice about overcoming depression, and Robert Burton in the early 17th-century concluded his book, The Anatomy of Melancholy, with this simple cure: ‘'be not solitary, be not idle.'' It was great advice in Hamlet's time and it still is. But it's even better if you take it with 40mg of Prozac. To read the entire story, go to www.ft.com/cms/s/0/2f9d1686-94b0-11dc-9aaf-0000779fd2ac.html.

Jessica Apple is a writer living in Tel Aviv. She's working on a memoir, ‘'Still Life'', and a story collection, ‘'Artificial Selection''.

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3.      International Medicine: What the British Think of Michael Moore's Praise of the NHS

Quack Michael Moore has mad view of the NHS by Minette Marrin, The Sunday Times, UK

The fourth estate has always had a bad name, but it seems to be getting worse. Journalism should be an honest and useful trade, and often still is. But now that journalism has more power than ever before, it seems to have become ever more disreputable. In recent years it has been brought lower and lower by kiss-and-tell betrayals, by "reality" TV, by shockumentaries and by liars, fantasists, hucksters and geeks of every kind, crowing and denouncing and emoting in a hideous new version of Bunyan's Vanity Fair.

Outstanding among these is Michael Moore, the American documentary maker. He specialises in searing indictments, such as Fahrenheit 9/11 and Bowling for Columbine, and has, without a doubt, a genius for it. Although his films are crude, manipulative and one-sided, he is idolised by millions of Americans and Europeans, widely seen as some sort of redneck Mr Valiant-for-truth.

Nothing could be further from the truth. His latest documentary, Sicko, was released in cinemas last week. Millions of people will see it and all too many of them will be misled. To read more, please go to www.medicaltuesday.net/intlnews.asp.

Sicko, like all Moore's films, is about an important and emotive subject - healthcare. He contrasts the harsh and exclusive system in the US with the European ideal of universal socialised medicine, equal and free for all, and tries to demonstrate that one is wrong and the other is right. So far, so good; there are cases to be made.

Unfortunately Sicko is a dishonest film. That is not only my opinion. It is the opinion of Professor Lord Robert Winston, the consultant and advocate of the NHS. When asked on BBC Radio 4 whether he recognised the NHS as portrayed in this film, Winston replied: "No, I didn't. Most of it was filmed at my hospital [the Hammersmith in west London], which is a very good hospital but doesn't represent what the NHS is like."

I didn't recognise it either, from years of visiting NHS hospitals. Moore painted a rose-tinted vision of spotless wards, impeccable treatment, happy patients who laugh away any suggestion of waiting in casualty, and a glamorous young GP who combines his devotion to his patients with a salary of £100,000, a house worth £1m and two cars. All this, and for free.

This, along with an even rosier portrait of the French welfare system, is what Moore says the state can and should provide. You would never guess from Sicko that the NHS is in deep trouble, mired in scandal and incompetence, despite the injection of billions of pounds of taxpayers' money.

While there are good doctors and nurses and treatments in the NHS, there is so much that is inadequate or bad that it is dishonest to represent it as the envy of the world and a perfect blueprint for national healthcare. It isn't.

GPs' salaries - used by Moore as evidence that a state-run system does not necessarily mean low wages - is highly controversial; their huge pay rise has coincided with a loss of home visits, a serious problem in getting GP appointments and continuing very low pay for nurses and cleaners.

At least 20 NHS trusts have even worse problems with the hospital-acquired infection clostridium difficile, not least the trust in Kent where 90 people died of C diff in a scandal reported recently.

Many hospitals are in crisis. Money shortages, bad management, excesses of bureaucrats and deadly Whitehall micromanagement mean they have to skimp on what matters most.

Overfilling the beds is dangerous to patients, in hygiene and in recovery times, but it goes on widely. Millions are wasted on expensive agency nurses because NHS nurses are abandoning the profession in droves. Only days ago, the 2007 nurse of the year publicly resigned in despair at the health service. There is a dangerous shortage of midwives since so many have left, and giving birth on the NHS can be a shocking experience.

Meanwhile thousands of young hospital doctors, under a daft new employment scheme, were sent randomly around the country, pretty much regardless of their qualifications or wishes. As foreign doctors are recruited from Third World countries, hundreds of the best-qualified British doctors have been left unemployed. Several have emigrated.

As for consultants, the men in Whitehall didn't believe what they said about the hours they worked, beyond their duties, and issued new contracts forcing them to work less. You could hardly make it up. . .

One can only wonder why Sicko is so dishonestly biased. It must be partly down to Moore's personal vainglory; he has cast himself as a high priest of righteous indignation, the people's prophet, and he has an almost religious following. He's a sort of docu-evangelist, dressed like a parody of the American man of the people, with jutting jaw, infantile questions and aggressively aligned baseball cap.

However, behind the pleasures of righteous indignation for him and his audience, there is something more sinister. There's money in indignation, big money. It is just one of the many extreme sensations that are lucrative for journalists to whip up, along with prurience, disgust and envy. Michael Moore is not Mr Valiant-for-truth. He is Mr Worldly-wiseman, laughing behind his hand at all the gawping suckers in Vanity Fair. Don't go to his show. To read the entire article, go to www.timesonline.co.uk/tol/comment/columnists/minette_marrin/article2753620.ece.

The NHS does not give timely access to HealthCare, it only gives access to a waiting list.

The waiting list gives access to a NHS in deep trouble, mired in scandal and incompetence.

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4.      Medicare: MSAs in Medicare?

Medicare's Biggest Little Secret by Greg Scandlen, President and CEO. Consumers for Health Care Choices, www.chcchoices.org/index.php 

 

One of the great ironies of public policy in the past few years was that the Medicare Modernization Act (MMA) of 2003, that created the "Part D" prescription drug benefit, also created Health Savings Ac­counts for everyone in the United States - except those on Medicare. The law did, however, reauthorize the old "Medical Savings Accounts" (MSA) provision that was passed as part of the Balanced Budget Act in 1997 but never implemented.

There were many reasons the original MSAs in Medicare never came about. The plan was time limited and restricted to no more than 300,000 beneficiaries. It was unlikely that any private insurer would invest significant Research and Development funds in a program that was so tentative - and none did.

Today conditions have changed. The idea of consumer driven health care is now widely accepted as a major addition to the offerings in the private benefits market. Over ten million people are currently covered by some sort of "account-based" health plan (HSA or HRA), and virtually every insurance company is offering a version of the approach. Banks and information services companies see consumer driven care as an unprecedented opportunity to reform the health care system and open up new markets. And the MMA law removed most of the restric­tions that made Medicare MSAs unattractive to vendors. To read more, please go to www.medicaltuesday.net/medicare.asp.

So, now we have a world in which the vendors are adept at marketing and managing account-based plans, citizens are increasingly accustomed to the approach, and Congress removed the most onerous restrictions to providing MSAs in the Medicare program.

In response, the Center for Medicare and Medicaid Services (CMS) has developed a new approach for Medicare beneficiaries. In 2007, for the first time ever, Medical Savings Accounts were available to people on Medicare. These programs became available during the "open enroll­ment" period in late 2006, but they were not well-publicized, so few people chose them. But 2007 amounted to a test case for the compa­nies offering the Medicare MSAs, and in 2008 they will be available to virtually all beneficiaries in the United States. Existing beneficiaries may select an MSA during the Open Enrollment period (November 15 to December 31, 2007), and newly eligible beneficiaries may enroll in the MSA throughout 2008.


Beneficiaries should take a close look at this option, because it could be a very attractive choice for many people.

To read more, go to www.chcchoices.org/publications/Medicare.pdf.

 Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5.      Medical Gluttony: Well, you can never have too many tests, can you?

Mrs. Black came in to see me because her previous physician became an Emergency Medicine physician and closed his practice. The charts were sent to another doctor and the patients informed. However, when Mrs. Black called the other doctor, she decided she didn't want to deal with the staff she encountered and came to our office for a new patient evaluation. She also wanted to continue with her gastroenterologist, cardiologist, dermatologist, endocrinologist and gynecologist.

After the medical interview and examination, we suggested that we would make a decision on the need for further evaluation when her records arrived. She, however, insisted that she hadn't had any laboratory studies in a long, long time. In fact, she couldn't remember the last time she had her diabetes, cholesterol, arthritis tests, bone density scan, chest x-ray, and ECG done. So we felt it reasonable, since she was on cholesterol medications, to at least obtain a lipid panel and basic screening tests. We had her sign releases for all her physicians. When she returned in three months, we were surprised to see what her previous records revealed. To read more, please go to www.medicaltuesday.net/gluttony.asp.

Mrs. Black's endocrinologist had been obtaining lipid and diabetic panels every three months. The Hemoglobin A1Cs were all in good range as was her glucose. This is at least twice as often as the most restrictive recommendations. Her rheumatologist had been obtaining extensive collagen vascular testing every six months. There was little change over the past several years. This would also seem twice as frequent as the most careful follow up would require. Her cardiologist had been obtaining lipid and chemistry panels every six months; her cholesterol as well as the remaining lipids were normal and had been for about the past four years, indicating good control with her Zocor therapy. Normally after control is reached and cholesterol levels are stable, yearly rechecks are adequate. Her cardiologist had also done ECGs every six months and ECHO cardiograms every year. Her cardiac function was relatively normal and hadn't changed significantly in the six years she'd been seeing him.

When Mrs. Black was questioned as to why she thought she hadn't had any testing in more than a year, she simply stated, "Well, you can never have too many tests, can you?" Well, she had at least twice the number any major quality program would require; at least a 100 percent excessive health care cost.

To analyze what was happening, let's focus just on the lipid and chemistry panels. These were ordered by two sets of specialists with neither knowing the results of the other. As one speaker at the World Health Care Congress mentioned last year, she normally never gave a second thought to what each of her physicians ordered until she had a Consumer (Patient) Directed Health Plan. As she left her gynecologist office with a lab requisition, she noted some of the same tests that her internist had ordered and went back in to see if she needed a second set. Her gynecologist simply stated that she could have her internist send over a copy and that would be fine. It was the patient-responsibility for basic health care charges that cut those costs in half.

What about electronic medical records (EMR) that politicians are touting as the answer to all our health care woes? Wouldn't everyone immediately know what everyone else is doing? Most EMRs aren't compatible across groups. This, of course, is the politician's mindset of control - shaping up the doctors to be more careful. And if they aren't, just penalize the doctors for quality or utilization issues. If they repeat, then prosecute. Most politicians are lawyers and this is the language they understand. Not the brotherly language of understanding, concern and meeting of the minds of a civilized society, but of prosecutorial hate. At least three-fourths of lawsuits are based on hate and revenge. We don't need to insert this into the health care equation which should be based on need and concern for our fellow humans.

The answer to all our health care woes is getting the patient involved. That can only be done by giving the patient a stake in all heath care decisions. A fixed dollar co-payment is not a stake but just a simple hurdle that can be jumped and then the whole kit-n-caboodle is a free-for-all. (Well, you can never have too many tests, can you?) It has to be a percentage co-payment. That gets all players working together - the doctor, patient, and insurance carrier. The patient will ask the right questions since he or she will have to pay a percentage of the costs. The higher the cost, the more dollars the patient will pay. The doctor will be sensitive to the patient's needs and be the most efficient in ordering the most important and relevant tests necessary for optimal care. The insurance company will benefit since everyone is working to keep costs in check. It will keep health care costs on the open market since insurance companies, including Medicare, will no longer have to limit the price of an office call or a lab test or an x-ray.

The standard response is that the providers, doctors, hospitals, lab and x-ray facilities have no breaks on unlimited charges. Certainly the providers can always increase their charges; but the patient will always know since this creates total transparency of all charges, and if the charge increases more rapidly than the patient thinks it should, the patient will simply find a doctor or hospital or lab or x-ray facility with a cheaper rate. If there are none that are cheaper, then the cost should increase; but it will always be monitored by every patient at all times and thus be reasonable. We will no longer have an exodus of doctors from Medicare or health plans, since all will be based on realistic charges based on competitive costs. Free enterprise is actually rather ruthless in getting the costs of all products and services to their lowest level consistent with every provider making a fair return on his or her investment and education.

This is the only requirement necessary for health care reform. It will eliminate the need for all the political candidates for Congress and president to hoodwink the American people with their power to control doctors, hospitals, insurance carriers. But can they let go of their need to control human beings?

This is something that the adversarial Cost-Controls of Managed-Care and Managed-Competition, including government have not been able to do over the past four decades. It's time to toss them into the dust bin of history.

Patient-directed, market-controlled health care eliminates all duplication in costs and all gluttony.

Wouldn't that be the perfect world?

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6.      Medical Myths: Professional Attire Doesn't Matter

Inside Medicine: A Doctor's Appearance Can Reassure By Dr. Michael Wilkes, Sacramento Bee, November 10, 2007

"If that doctor with the nose stud walked into this exam room to see me, I'd walk out. That's not the kind of doctor I want taking care of me," Mr. M said.

What do we expect our doctors to look like? Would it matter to you if your doctor wore a yarmulke, a burqa, a nose ring or had a tattoo on his or her hand?

The doctor you choose to care for you will likely be your confidant, your partner in making health decisions and your source of reliable information. Does appearance matter to you?

Gone are the days when starched white lab coats - and ties for men, dresses for women - were a requirement for the practice of medicine. Certainly, walking around the hospital, you still can find doctors clad in white lab coats, but it is no longer a requirement, and in many offices, the white lab coat is an endangered species. To read more, please go to www.medicaltuesday.net/myths.asp.

The lab coat is a symbol that in the past signified a learned, microbe-free and esteemed professional. However, many attribute the white coat with creating a symbolic barrier between the doctor and patient wherein the coat fosters a bygone notion of the doctor as powerful, unapproachable and all-knowing. . .

While opinions about white lab coats are mixed, opinions are far stronger with regard to other ornamental attire. Nose studs, earrings, tongue piercings and even the wearing of sandals have the potential to create strong feelings in patients. It seems clear: Many patients do not want their doctor to express personal aesthetic tastes in the office.

So, what policy should govern attire of medical students and residents in a hospital? These young doctors are, after all, the most likely to want to express their individuality, and their preferences run the gamut. And at the same time, since they are new doctors, patients might need even more reassurance of their capability, so attire might carry greater weight. . .

The choice is easier with nose rings and the like, which can be removed during the workday. Tattoos and other more permanent choices are there to stay.

Discussions about appropriate physician attire are hardly new. A generation ago, medical school faculties had similar discussions about the appropriateness of beards, bell-bottom pants, long hair and beaded jewelry. And long before that, Shakespeare observed, that "the apparel oft proclaims the man" ("Hamlet," Act 1, Scene 3).

While there are limits to what the doctor needs to do to accommodate a patient's taste, in the name of building a trusting relationship, it may be wise to forgo extreme expressions of individuality in our outer appearance and recognize that this type of conformity might be required to ensure that our patients feel comfortable with us. To read the entire article, go to www.sacbee.com/107/story/479859.html.

To read Dr. Wilkes responses to letters, go to www.sacbee.com/107/story/496172.html.

Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at drwilkes@sacbee.com.

[I've had patients come back from consultants say "He didn't even look like a doctor - no suit coat, no tie, or no white coat. Send me to a doctor that dresses like one."]

Yes, professional attire does matter.

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7.      Overheard in the Medical Staff Lounge: Doctor's Dress, Demeanor and Manners

Dr. Edwards: Did you see Dr. Wilkes' from UC Davis column in the Sacramento Bee on professional appearance last week?

Dr. Milton: Good write up. We used to see Doctors and Nurses in scrubs and when their dirty work was done, we'd see them in professional dress.

Dr. Dave: Those were the days. They're gone forever. Patients don't seem to mind.

Dr. Rosen: I think there are two issues here. One is our professional long white coat or a doctor's uniform and the other is what we wear under it. To read more, please go to www.medicaltuesday.net/lounge.asp.

Dr. Edwards: What we wear under it is very important. A nice starched shirt and tie or a nice dress or pants will always carry more prestige and authority and trust.

Dr. Yancy: But I think patients rebel against authority. That's why I leave my surgical scrubs on most of the day. Patients think their doctor is in the operating room saving lives and just came out for an urgent visit to the patient on the ward.

Dr. Milton: Remember our grand rounds last week and it was mentioned that ties are a big cause of infection.

Dr. Rosen: I think he gave the data. It was only about a quarter to half that had positive cultures. It was suggested we wear bow ties.

Dr. Edwards: Or wear a tie clasp or pin or keep them tucked into our shirts or over our shoulder during ward procedures. Of course they're off if we're in an endoscopy or operating room.

Dr. Sam: It was the PDAs that he said were 95% infected. And we all seem to wear them now, don't we?

Dr. Rosen: Yes, they seem to have replaced that little ring binder we always carried in our white coat pocket. At our medical school, we always referred to them as our peripheral brain.

Dr. Edwards: Amazing how we've progressed. It's easier to load, drop whole reprints into it, even the basic PDR, and now we have e-scripts.

Dr. Rosen: It will be easier to replace ties than the PDA. I don't see anyone giving those up. I guess it means that medicine poses all kinds of risks. It is our job to be aware of all of them and follow the best precautions.

Dr. Milton: A related topic is how we address our patients. I see so many of the younger set calling patients by their first name.

Dr. Edwards: Doesn't familiarity breed contempt?

Dr. Rosen: And a lot of other things. One of my professors said it also breeds malpractice cases when things go sour.

Dr. Milton: A lot of patients request to be called by their first name. Some say, my friends call me George.

Dr. Patricia: Wasn't it Hippocrates who said something like he who goes to a friend for a physician has a fool for a physician?

Dr. Edwards: I think the same thing was said about going to a relative for a physician and you have a fool for a physician.

Dr. Milton: A psychiatrist once told the class that when a patient says his friends call him George, he tells the patient, but I'm Not Your Friend. I'm your doctor.

Dr. Patricia: Yes, there is a huge difference between being a doctor and a being a friend. It seems so many docs forget that. They want to be one of the boys or dare I say girls?

Dr. Rosen: Looks like Medicine is changing. We should all exercise caution in our relationship to patients whether in attire or manners. One can never be too careful - or professional.

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8.      Voices of Medicine: A Review of Local and Regional Medical Journals

Bulletin of the California Society of Anesthesiologists, Summer, 2007; Physicians on the other side of the syringe, scalpel, oxygen mask

Under the Blanket, By J. Kent Garman, M.D., M.S., CSA Past President, Associate Editor of the CSA Bulletin, President of the Stanford Medical Staff

 

I'm going to waive my HIPAA rights, whatever they may be, and tell you what I saw on the other side of the syringe, scalpel, oxygen mask, and the rest of the gadgets we physicians use with patients. It's a personal story, but I hope it transcends the self-indulgent hospital tale we all prefer to avoid. My professional and personal worlds collided and gave me some thoughts as a practitioner. In February I responded to an advertisement seeking normal controls for an MRI study sponsored by vascular surgery. Since I was older than 55, without aneurysm or spinal cord disease, I was eligible to have a free MRI of my abdominal vasculature. What a deal. Why would I not do this? (By the way, they may still need some "normal controls."

So, I signed up and got the contrast injection MRI. When the researchers finished the study, I learned I was no longer a "normal control." First, the good news was that there was no obvious adenopathy or renal vein invasion. My CXR was normal. The bad news: I had a large (6-7 cm) left renal cell carcinoma, and in an instant I went from being as healthy as possible for 67 years to the victim of a potentially lethal cancer. To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp.

Symptoms? I had no hematuria (the most common symptom). I did have left back pain, more severe after working a full day in the OR, but otherwise, I had nothing that would have made me seek medical help.  So, in late February, I elected to have surgery and underwent a radical left nephrectomy. The final cell type turned out to be a chromophobic carcinoma instead of the more common and more lethal clear cell carcinoma. But before that answer came down, I learned a number of things about Stanford patient care delivery: in the clinic bed, but not bedside. . .

Noise and Sleep and More
The complaints I've heard from other patients seemed to be true. I was in a double room converted to a "private room" by installing a plywood panel and door so thin you could easily hear quiet conversation on the other side. And overall, the alarms going off continually, conversations, footsteps, motors and the like persistently inhibited any attempt at solid sleep. But the distractions didn't stop there. I had the misfortune to wear compression boots from foot to knees. These inventions of the devil at first seem like a good idea (after all, who wants to get DVT?). However, after several hours, the constant inflation/deflation cycle coupled with the noise of the compressor motor started to drive me crazy - not to mention contributing to sleep deprivation. The incessant noise, however, is a serious problem, and perhaps we should take a look at some corrective measures.

I was placed on a hydromorphone PCA, and at least this component of my stay was quiet - but only at first. I was offered from 0.2 to 0.4 mg of hydromorphone with a lockout of 10 minutes and no basal rate. This is where the rubber hit the pavement for me as I transitioned from anesthesiologist to patient. Although I should know better, I hit the button whenever I felt any pain. I became confused and had a number of very bizarre dreams and nightmares.  Yet, whenever I awakened, I hit the button again. Then it got noisy. Strangely, I discovered that whenever I took off or lost my nasal oxygen cannula, the pulse oximeter alarm would go off and wake me up. Fortunately, I could stop the alarm by keeping my nasal oxygen cannula in place. The next morning I felt absolutely terrible - confused, disoriented, nauseated, with pain. That's when I figured out that PCA was to blame, so I decided to stop using the device. Things cleared rapidly after I made that decision. 

But even after discovering the truth about PCA, I continued to play doctor. I turned the pulse oximeter around so I could see it. My saturations were not good. On room air, my sat would drift down to the mid 80s. With supplemental oxygen, they came up into the mid 90s. If I used the incentive spirometer vigorously (and that hurts), I could get the room air sat into the low 90s for a short time. It took me concerted effort with deep breathing for several hours to get rid of the atelectasis I had developed during the night and maintain room air sats in the mid 90s. Good thing I know what I'm doing, I guess. Most patients would simply lie there and be miserable. 

Interestingly, a recent article by the Anesthesia Patient Safety Foundation points out a high incidence of morbidity caused by hypoventilation with atelectasis, hypercapnea, and respiratory acidosis from the effects of PCA and epidural narcotics. The APSF says that monitoring oxygen saturation with a pulse oximeter gives a false sense of security when supplemental oxygen is administered. The O2 sat will be OK, but everything else is going south. The bottom line is that the APSF will probably recommend that exhaled CO2 monitoring should be added to pulse oximetry as mandatory monitoring for postoperative patients receiving narcotics. Unfortunately, our technology is not quite good enough yet to do this well on nonintubated patients. 

Playing doctor on myself probably contributed to stress, but I'm convinced the stress would have been worse if I had remained ignorant. Think of the anxiety a patient without a medical background must feel. Trust the doctor? Easier said than done when you are feeling terrible in a noisy bed. 

So after one night as an inpatient, I decided if I were to get some sleep, I'd have to leave. Fortunately, I was able to do so. . .

Nurses and COWS
I have only the deepest appreciation for the nursing staff and nursing aides I came in contact with. They all were genuinely concerned and helpful.  However, they did seem to be struggling with the new wireless mobile data entry devices, called COWS, which they wheel from patient to patient to use in lieu of carrying a clipboard. Fancifully, I imagined we could put a bicycle seat and pedals on the COWS so the nurses could maneuver them more easily. . .

Thanks very much for reading. Go ahead and use my thoughts to apply to your more general musings and discussions. I welcome your comments about this article.

To read the entire insightful, sometimes amusing story, and view the author's photo, go to www.csahq.org/pdf/bulletin/issue_17/garman072.pdf.

© Copyright 2007. This article first appeared in the Stanford University Medical Staff Update, April 2007, Volume 31, No. 4. It is reprinted here [CSA Bulletin] with the permission of the author.

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9.      Book Review: From Our Archives

Doctor Generic Will See You Now - 33 Rules for Surviving Managed Care by Oscar London, MD, WBD. Ten Speed Press, Berkeley, CA, 133 pages, $11.95, paperback, 1996.

                What the Public Health Doctor fails to prevent, the Private Doctor tries to
                cure; what the Private Doctor fails to cure, the Specialist tries to improve;
                what the Specialist fails to improved, the Mortician beautifies.
                                                                                                        -- Anonymous

Dr London, author of Kill As Few Patients As Possible and Take One As Needed opens on a philosophical note. "We're all going to die. Getting there, of course, is half the fun. It should be all fun, but life, especially in this century has become a killjoy... American medicine had greatly enhanced our ability to reach three score and ten in reasonably good shape and in pretty good humor. Then along came Managed Care, and the prospect of an untimely death suddenly became, if not attractive, certainly cost-effective." London then welcomes us to the world of Managed Care--health care managed by business school PhD's to save bucks and fill their coffers, rather than by medical school MDs to save lives and heal their coughers. To read more, please go to www.medicaltuesday.net/bookreviews.asp.

London agrees that Fee for Service medicine was very expensive. It paid doctors according to how many patients he saw. Now doctors are paid a fixed sum per patient per year, whether or not he sees the patient or orders any tests.

London considers the immensely popular Health Maintenance Organizations (HMOs) and Managed Care synonymous. He states that millions of unsuspecting patients have signed up for HMOs, enticed by low premiums and the promise of comprehensive care. The low premiums are real--the promise of comprehensive care is science fiction.

He cites statistics that the biggest for-profit HMOs use up to 27% of their revenues from premiums for administrative costs and profits compared to only 4% reported by not-for-profit Kaiser Permanente. Also for-profit paid an average of $7 million in cash and stocks to their CEOs. And then there are the dividends paid to shareholders of MCO's that are publicly traded.

One of the great contributions of Managed Care, in the London's estimation, is that you must take charge of your own life before entrusting it to a doctor. He offers his own list of "33 Rules for Surviving Managed Care" which should guide your personal health care decisions before you see your doctor or visit an emergency room. "Your physician can best help those who help themselves."

To read more about these 33 rules, please go to www.delmeyer.net/bkrev_DrGeneric.htm.

To read more book reviews, please go to www.delmeyer.net/PhysicianPatientBookshelf.htm.

Or to wander about topically and sample, go to www.healthcarecom.net/bookrevs.htm.

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10.  Hippocrates & His Kin: Class Action Suits Sink Lawyers One Notch Lower

Merck & Co had a $4.85 billion settlement with thousands of Vioxx users. Many plaintiffs voiced mixed emotions. One said, "I had arthritis and Merck gave me a heart attack." Nonsense.

People get heart attacks primarily because they have high lipids, hypertension, diabetes, were obese, or didn't exercise and happened to have taken Vioxx shortly before their coronary. Most likely they would have had a heart attack, although perhaps somewhat later, even if they had not taken Vioxx. I still have patients requesting the drug and asking if I didn't save some samples. There are two other Cox-2 inhibitors still on the market with a similar adverse profile. Remember Baycol, the favorite cholesterol drug used in the military and the VA, which was pulled off the market? It had a 6 percent incidence of liver toxicity. Only it got caught. Other statin drugs have a similar profile of 2-6 percent liver toxicity and are still on the market. All drugs have an adverse profile with the side effects varying from one to six percent with adverse reactions on the heart, liver, bone marrow, and other organs. Patients know that every time they take a pill, any pill, they have a risk of side effects. This is not a suing matter. The lawyers have difficulty containing their glee. They will be splitting between $1.6 and $2.0 billion dollars. There was nothing accomplished for the benefit of human beings. This huge cost in health care just makes it more expensive for the rest of us.

This Was Just A Travesty Of Justice For The Benefit Of Attorneys.

To read more, please go to www.medicaltuesday.net/hhk.asp.


Asbestosis Class Action

I had a patient with asbestosis who worked for John Manville. The attorneys destroyed that company. My patient thought he would get rich with the huge settlement. One day he came in and said that his award was for $15,000. Later he told me the attorney's got $5000 and lawsuit costs for the plaintiffs were about $5,000 and he might get $5,000 after all these years of hostile litigation. He said it was supposed to pay for his health care costs for the rest of his life. However, the award wouldn't even approach one hospitalization when he needed it. He had to apply for Medicaid for his future health care. He said it wasn't worth the many years of hassle and suspense and anger. He now wished that he had never signed on to the action.

As usual, only the attorneys benefited from this class action in courts paid for by taxpayers.


Medical License Renewals Have a 30-Day Grace Period - for Everyone Except the Government

Medical licenses are renewed every two years. On the renewal application, it says to pay by the renewal date or within 30 days thereafter. It also says do not expect to see the new license for up to 60 days after receiving the funds. Hence, the renewal may take up to 90 days if paid the last day of the grace period. All private hospitals accept this reality.

The government does not allow their doctors to work even one day into that grace period. Salary stops until the confirmation is received.

They will call the Medical Board every day to see if the license has been renewed. Every day the Medical Board has an employee answer this phone call and make the search. Both parties are paid by taxpayers. Assuming a minimum pay scale of $20 an hour, the government employee and the Medical Board employee may cost about $2 for each inquiry. For this to go on for even 30 days means that Medical Board costs could be $60 for each doctor and Government costs could also be $60 for each employee required to make the inquiry. The Medical Board will just increase their fee by $60 to recover the costs. California Medical Licenses have gone from $15 to $805 during my 30-year career.

Another Example of Unnecessary Bureaucratic Costs with the Associated Harassment.


Maryland schools get tough on vaccinations By STEPHEN MANNING - Associated Press Writer, November 16, 2007

Two months into the school year, more than 2,000 students in this suburban county outside the nation's capital had yet to get the shots they needed to attend class. So the school system decided it was through playing nice. Parents in Prince George's County have been ordered to appear at a special court hearing Saturday where they will be given a choice: Get their children vaccinated on the spot or risk up to 10 days in jail and fines. . .

At the courthouse, the health department will have a makeshift clinic to administer vaccines. Parents will be given the chance to offer the judge an excuse for why they didn't get their kids vaccinated. Under Maryland law, parents can obtain exemptions for religious or medical reasons. Those who fail to show up - and those who fail to offer a valid excuse and still refuse the shots - could be prosecuted under truancy laws and face possible jail time and fines of $50 per day.

According to long standing criteria, if two-thirds of students have vaccinations, there will be no epidemics because children will generally have a vaccinated student on either side. Voluntary vaccinations have always exceeded this minimum number. There is no need for children to experience the force of guns in your back, handcuffs and jail for their parents. Let's restore reasonable freedom - at least in schools.

To read more HHK Archives, please go to www.healthcarecom.net/hhk2000.htm.

To read more HMC Archives, please go to www.delmeyer.net/hmc2002.htm.

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11.  Physicians Restoring Accountability in Medical Practice, Government and Society:


 

                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.


 

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.

                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

                      Arthur Asterino, MD, Founder of Americans for Free Choice in Medicine, www.afcm.org/. America's only grass-roots organization devoted to individual rights in Medicine AFCM promotes the philosophy of individual rights, personal responsibility and free market economics in the health care industry. AFCM advocates a full, free market health care system by promoting health savings accounts (HSAs), tax equity for the individual, and AFCM teaches the history of HMOs, which were instituted by a long, incremental process of government intervention. To read a history of the organization, go to www.afcm.org/afcmhistory.html. To read some of Art's initial OpEd articles, written a decade ago, go to www.afcm.org/fmca.html.

                      Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis".

                      To read the rest of this section, please go to www.medicaltuesday.net/org.asp.

                      Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS - Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25-50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com. 

·                     Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

                      Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.

                      David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm. To read Physicians Make Lousy Advocates, go to www.healthplanusa.net/DGPhysicianAdvocate.htm. Or click on his name at www.ssvms.org/magazine/sep_oct_07.asp where you can also read the original pro and con debate.

                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.

                      Semmelweis Society International, http://www.semmelweis.org/, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.

To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net. At this site, you can also read some very interesting advice for all "wanna be doctors."

                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.

                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is on Battle Over Mandatory Vaccinations Heats Up.

                      The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to scroll down on the left to departments and click on News of the Day in Perspective: District Attorney asked to investigate Texas Medical Board officials or go directly to it at www.aapsonline.org/nod/newsofday474.php. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read HillaryCare, Take Two. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents of the current issue. Don't miss the thought provoking articles on Is Physician Income Too High, or Too Low?, or the extensive book review section that covers three great books this month including Dr. Mike Savage' Liberalism Is a Mental Disorder and David Gratzer's The Cure: How Capitalism Can Save American Health Care. Dr. Gratzer spoke at the annual meeting of the AAPS last month.


 

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Del Meyer       

Del Meyer, MD, Editor & Founder

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608

Words of Wisdom

Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.

Paul of Tarsus in Thessalonians 3:10: When we were with you, we gave you this rule: "If a man will not work, he shall not eat."

Mark Twain: The only difference between a taxman and a taxidermist is that the taxidermist leaves the skin.

Some Recent Postings

Restaurants for the hearing impaired. http://medicaltuesday.blogs.com/

Shoot Him if He Runs by Stuart Woods www.delmeyer.net/PhysicianPatientBookshelf.htm

Physician Make Lousy Advocates by David Gibson, MD www.healthplanusa.net/DGPhysicianAdvocate.htm

In Memoriam

Norman Mailer, pugilist of American letters, died on November 10th, aged 84

Gristle and gravel
He talked and wrote of fighting more than he did it. Short and stocky, he was liable to be upended pretty fast. But he boxed a bit, and proudly jogged once with Muhammad Ali until his breath gave out. Instinctively, he put up his fists. In 1957, in an essay called "The White Negro", he recommended that white Americans should live like inner-city blacks, hip and cool as cats on the edge of violence, rather than fall into the deadness of post-war conformity.

The shock tactics sometimes misfired badly. He stuck a kitchen knife (or a pair of scissors, or a "three-inch dirty penknife") into the neck of his second wife, the second of six, all of whom loved and forgave him as long as their alimony was paid. He acted as literary sponsor to a talented murderer, Jack Abbott, who murdered again when Mailer had helped to get him out of jail. He revelled in gross, boastful or mechanical descriptions of sex ("a hard punishing session with pulley weights, stationary bicycle and ten breath-seared laps round the track"), not least because this outraged the women's libbers with whom, in the 1970s, he was permanently at war. Once Mailer, with a sparkle in his eye that was maybe aggression, maybe fun, acting his usual part of the hollering Jewish leprechaun, proclaimed that all women should be locked in cages. To read more, please go to www.medicaltuesday.net/org.asp.

On form (as in "Miami and the Siege of Chicago", about the 1968 political conventions, or "Of a Fire on the Moon", about the first moon landing) he was a gloriously evocative, generous, sprawling writer, worthy of the scale of his country and his subjects. But Mailer dismissed these books as journalism, that ceaseless scavenging for "tidbits, gristle, gravel, garbage cans, charlotte russe, old rubber tyres, T-bone steaks" that went to feed "that old American goat, our newspapers". Despite his founder-role on the radical Village Voice, he took little pride in that craft. The Great Novel was his quest: a quest that became weirder and more abstruse over time, taking him to Pharaoic Egypt and the corridors of the CIA and inserting Mailer (sometimes the very Son of God, sometimes the Devil) into the made-up lives of Jesus and Hitler.

By general consent, though not by Mailer's, his best book was "The Executioner's Song" of 1979. It won him his second Pulitzer. In it he told the story of Gary Gilmore, the first man to be executed after the ending of the moratorium on the death penalty, in sentences as spare and unadorned as the Utah desert in which it was set. The style was almost reminiscent of his great hero, Hemingway. Those short, declarative sentences, he wrote once, had a suicide's dread in their silences: dread that "at any instant, by any failure in magic, by a mean defeat, or by a moment of cowardice, Hemingway could be thrust back again into the agonising demands of his courage." Mailer's short sentences carried a more pugnacious message: he was the champ, and would be until someone braver and better knocked him off.

To read the entire obit, go to www.economist.com/obituary/displaystory.cfm?story_id=10130501.

On This Date in History - November 27, 2007

On this date in 1901, the US Army War College was authorized. It was a form of recognition that the art of warfare was becoming more complicated. And this was before either World War or any of the major 20th century wars, which continue into the 21st century.  See  http://carlisle-www.army.mil/about/about.shtml. Also, see the Navy War College (NWC) at www.nwc.navy.mil/ and Air War College (Air University) at www.au.af.mil/au/awc/awchome.htm.

On this date in 1874, Chaim Weizmann, the first president of Israel was born in Russian Poland. He was an émigré scientist from Russian and director of the British Admiralty laboratories. He was a brilliant scientist who helped synthesize some of the ingredients for vitally needed explosives in World War I. He was also an active enthusiast for the idea of a homeland for the Jews in Palestine being himself Jewish. Years later, when the Jewish homeland became a reality, Chaim Weizmann was elected the first president of Israel, and today a great scientific institute of world wide fame bears his name. He established that scientists can also be political animals and that positions of leadership today are not the exclusive domain of politicians.

After Leonard and Thelma Spinrad