I believe I have just witness the beginning of the death of iTunes.  As much as I’ve tried and tried to like iTunes, I can’t express how happy I am to see a true and valid competitor emerge to thwart them.  And, I think this will DESTROY them.

Amazon, you rule.

iTunes Icon
Something Tells Me I've Just Violated A Copyright By Posting This Logo.

Now you can buy Mp3’s from Amazon.com and – here’s the sell – store your tunes to the cloud, not on your own hardware. I’ve been begging (in my head) for this for YEARS.  The cost and hassle of trying to constantly figure out where to store my songs and shows that I’ve downloaded from iTunes has been one endless headache.  This has as much to do with the fact that I’M MAKING A GENUINE EFFORT NOT TO STEAL THEN (in all honesty, this is my big mistake).  Being legit, I’m constantly plagued with copyright protections on iTunes products that makes storing and moving MY copies of digital media almost impossible.

The obvious solution (one that still supports the artists and their decadent renunciation of most human moral codes) is to simply quit making me store the songs in the first place.  Just stream them from some central server that I never even deal with.  Amazon Cloud Player (actually real, actually available, actually currently playing 1 of 100 of the top trance tunes of 2011 that I just bought as a collection for…9 bucks) does just that.  Finally.

One example:  I had a tiny netbook, with virtually zero hard drive space.  So I tried to store all my tunes (and shows) on an external hard drive.  Then I switched computers, and wanted to move that data.  Tough.  Sounds easy, but it ain’t.  To Apple, it looks like I’m stealing them, or selling them in some virtual dark alley, furtively looking over my shoulder and waiting to hear Hugo Weaving bellow, “Mr. ANDERSON!”  If I’d just legitimately STOLEN the damn songs in the first place, I could play them wherever I wanted, moving them like so many Word files.

Zeus with a laurel crown. Gold stater from Lam...
SW101: God Of Ruined Mp3 Players.


Another example:  If ruining ipods (usually by jogging in the rain) was a God-like attribute, I’d be warming up a U-haul for my move to Mt. Olympus.  I just sorta never believe water is actually bad for anything.  It’s a swimmer thing.  Anyway, my iTunes can only be played on 5 players unless I “de-authorize” a player.  This sounds find, but how do I de-authorize a player that has suddenly transformed into really unique thin mint?  I can’t even turn it on long enough to de-authorize the glorified aluminum can.  Same for my original computer that held the results of my first foray into iTunes psychosis.  It suffered a massive “heart” attack at some point.  That’s 1 authorized player I’ll never get back.

Six hard disk drives with cases opened showing...
Hard Drives, Hard Drives Everywhere...


Now it doesn’t matter.  My tunes are floating out there, in the beloved cloud.  Free from the confines of my cheap, inefficient hard drives that never seem to have enough space.  With Cloudplayer, the tunes stream, so presumably, copying them illegally is much harder.  So, I would hope that Amazon will be HELPFUL when I try to use one device or another, or when I mistakenly put my Mac Mini in the microwave, expecting a nice melty pizza in 2 minutes and 30 seconds.

Plus, it’s Seattle busts Cupertino.  Kurt Cobain vs. The Grateful Dead.  The Sound vs. The Bay.

Die.  Die Tunes.  You had your chance, Appletini.

Swine Flu UPDATE!!!

Deaths from swine flu world-wide:  Approx 147

Death from normal flu every year in the U.S. alone: nearly 36,000

It would be nice if the media kept it in perspective. 

The concern at the WHO and CDC is that the virus is a novel strain combining elements of human, swine and bird influenzas that humans MAY not have any natural immunity to.  But so far there’s no evidence that the virus is particularly virulent or more deadly than boring, non-newsy, every day  influenza.

So, it’s too soon to worry much. 

Wear your seatbelt.  Eat your vegetables.  Do the usual, proven, stuff  if you really want to protect yourself from bad things. 

Oh, and go ahead and ignore Joe Biden’s advice to avoid airplanes and subways.  What a tool.  If you really want to protect yourself…I’d avoid him.

Half A Delivery

I wouldn’t say we’re competitive, me and ChinaDoc.  If you don’t recall, she was the other FP resident on our trip to Haiti.  Although I’ve mentioned her actual name before, in true blogging fashion I will heretofore call her by a nickname.  Being Chinese, and very small and elegant, I’ve settled on ChinaDoc.

True, she plays Hearts to the death.  And we’re constantly harassing each other about who has more deliveries.  But that’s not real competition…is it?  Just friendly banter.  Or so I thought…

Just as we’re closing up shop on the 4th night of our adventure in Haiti, a woman arrived in labor, but dilated to only 3cm.  Since she needed to get to 10 to be “complete”, we knew she had some work to do.  We thus set up a makeshift labor room out of the flight-line of the bats that inhabited our clinic at night.

Our stellar OB nurse – with something like 30 years experience on a labor ward; one of the best I’ve ever worked with – stayed with the patient to watch her, while the rest of the team walked across the courtyard for dinner.  ChinaDoc and I each had one delivery since arriving in Haiti.  It was thus my turn for this one.

Stretching nonchalantly as we headed up the stairs, I just mentioned to my illustrious colleague, “Hmmm.  Looks like this will be TWO for me.  How many do you have again?  Sorry, I forgot.  Something like…uhhh, ONE, isn’t it?  Don’t feel lame, dear ChinaDoc.  Some doctors are just, you know, more successful than others.”

I can’t recall what mean, snide thing she said then – MUCH to my surprise since I was just trying to make personable conversation (and gently help her feel better for losing the delivery race).  It was something along the lines of, “At least I’ll sleep, loser.”

She made a good point, actually.  I was probably in for a long night.

Since I was “on”, I found a perch along the edge of the balcony where we ate our meals.  From that vantage point, I could see through the door of our OB room and observe things as they unfolded.

About an hour later, my nurse stuck her head of the room and yelled up to me, “She’s 7.  Won’t be long!”

Good, I thought.  7cm.  Our patient had delivered numerous other children, which we medical folk term “multiparous” (multip, for short).  Multips don’t usually hang around at 7cm for very long.

To my surprise, a short time later I saw our patient wander away from her hastily constructed labor room.  Accompanying her were the two friendy/family types who arrived with her.  No nurse.

Here’s the thing about walking while in labor:  It almost always helps things progress.  We encourage it most of the time.  How it works is something of a mystery, but it has to do with gravity, and mental distraction and pain control.  However, I can NOT envision a time when an experienced labor nurse would encourage – nay, allow – a multiparous mom at 7 cm to walk around.

Welcome To Your Delivery Suite, Ma'am
Welcome To Your Delivery Suite, Ma'am

Babies have been known to drop right out of multiparous women.  Into toilets, showers, cab seats, soccer fields, gondolas, dog bowls, ferris wheel benches, classrooms, ski slopes, two-seater airplanes, office cubicles, hot air balloons, the space shuttle, those suction chutes at banks that kids love…

…OK, so I made some of those up, but you get the point.

But for some reason, this woman wandered away from our clinic room – ambling slowly with one hand in the small of her back – into the front courtyard of the building we use daily for the clinic.  From my roost on the ledge, I watched our patient virtually evaporate into the pitch-dense maw of the rural Haitian night.

To describe just how dark it was in the front courtyard, I’ll refer you to the ’80’s classic movie “This Is Spinal Tap”, where at one point the question was, “How much more black could it be?”  And the self-evident answer: “None.  It’s none more black.” (stated by a band-member describing the cover of their new “black” album).

Thomaseau has no street lights.  Or, maybe a few odd ones here and there, but realistically there aren’t any.  Furthermore, the power for this village comes from Port Au Prince, which shunts electrons out there based on some whimsical benevolent prescription that befuddles even the least logical among us.  On this night, there was no power.  So the courtyard was…black.

None more black.

Nervous by this point, I figured my OB nurse had been taken captive and thrown to the yapping Haitian dogs.  She would never walk a multip at 7cm.

Just then, the two women who walked out with our patient came running back into the halo of generator-powered light from our clinic, frantically yelling in Creole.  I knew exactly what they were saying, “YOU LET OUR MULTIPAROUS SISTER WALK AT 7cm AND NOW WE’RE HAVING A BABY IN THE PITCH-DARK!  WHAT KIND OF TWISTED FREAK-SHOW OF AN EXCUSE FOR OB DO THEY TEACH YOU IDIOTS IN AMERICA?”

Already I was bolting down the stairs and running for the courtyard.  I was armed with only 1 tool, perhaps the most valuable physical item a doctor can have in Haiti:  A headlamp.

I rounded the corner, flipping on the light and arriving at a scene that would make the prop crew of CSI envious.  The mother was sitting on the top step of our clinic porch, with a wide pool of blood mixed with clear fluid and thick meconium shimmering from between her legs.  Lying right in the middle of this stark lake of glistening life was a motionless baby, still connected to the umbilical cord, which still curled it’s way into the mother’s body.  The picture of that initial visual moment still glistens realistically in my mind’s eye – the image etched and harsh under the chill glow of my headlamp.

My first concern was the baby.  Motionless, caked in blood meconium and mud from the dirty courtyard, I worried about hypothermia (a real risk for a wet newborn even at Haitian temperatures), and I knew that tactile stimulation would be the best way to try to get “it” (I never even noticed the gender) breathing.

Since I had nothing but the headlamp and clothes on my back, I pulled my shirt off and wrapped up the baby in it.  “It’s dark, I reasoned, nobody will see my rotund beer-gut anyway”.  In the process, I scooped a good amount of the birth-goo onto my bare hands.  I’ve done nearly 100 deliveries, and never touched a newborn with my bare hands.

For the record: it feels exactly like it does in gloves, so there’s no sense in trying it at home, boys and girls.

Dropped Out of my Mom Onto Concrete.  All Good.
Dropped Out of my Mom Onto Concrete. All Good.

Eventually, we got the baby and mom back into their rightful places.  Turns out our OB nurse had been unable to talk the patient out of a walk, and so asked her to wait while she ran up to her room to get her shoes.  The patient didn’t wait, and off she went before our nurse could return to walk with her.  So, no fault of ours, ma’am.

The baby did great.  No head wound from a drop onto concrete.  Breathing fine.  The mom had no vaginal lacerations, and did great too.  We sent them home that night.

ChinaDoc arrived as we were settling the mother back into her cot with the baby, now wrapped in a blanket.  She seemed completely uninterested in the fact that I was shirtless and covered in blood.

“So, I heard the baby was on the ground when you got there.”

“Uh, yeah.  Blood and stuff everywhere.  All I had was my headlamp.  I’m incredibly awesome.”

“So, you didn’t actually deliver the baby, then.”

My eyes grew wide.  “WHAT?”

“Yeah.  It doesn’t count.  All you did was pick it up.  We’ve both delivered one baby in Haiti.  We’re still tied.”

“Here I am, shirtless, covered in blood – look, LOOK AT THAT POOPY, MUDDY, SOAKING FORMER-SHIRT I JUST THREW AWAY – I don’t get credit for a delivery?  I could have AIDS!  I could have an alphabet of hepatitis!  I didn’t even use gloves for God sake, woman!”

ChineDoc sniffed, unmoved.  “You wrapped up a wet baby.  Brilliant work.  But anyone could have done it.  Don’t need a doctor for that.”

Quickly I determined the best way to bend my itinerant classmate to my will was to smear my contaminated hands all over her face.  She backed away quickly at my advance, “OK!” She relented, “Maybe you can have a half a delivery.  Nice job…I guess or whatever.”

Partially gratified, I made my way to the showers to clean off the painting of real, human blood from my body.  Turns out Port Au Prince didn’t deign to allow running water that night, either, along with electricity.

Faced with laying around for the next 8 hours in that blood, purified only with a Wet Ones shower, I realized the bald injustice of my colleague’s proclamation.  “Forget it, ChinaDoc!”  I yelled to the parched shower.  “That’s one WHOLE delivery!”

Med Web Yak – December ’08

I read primary care and health related discussions on blogs and discussion forums (fora?) around the web daily.  I figure that when I have the time and energy, I should make you privy a nice digest of those digital meanderings too, since they’re frequently so riveting:

kevinmdOver at KevinMD – a health blog generally focusing on primary care in the U.S. – a good discussion is brewing about making medical school free to anyone choosing to go into primary care.

Kevin says even this likely won’t save primary care in the U.S.  An annonymous poster counters that Dr. Nurses (try not to get hung up on that oxymoron) take over primary care.  I sent in the comment that I can’t imagine being unhappy with primary care if I were completely out of debt.  How can anyone be unhappy with $100,000 a year if they have no debt?!

At iMedExchange (have to be a doc to join, sorry), I’m watching a discussion among family doctors as they ponder quitting the profession if U.S. healthcare goes “socialist” under our new Dem leaders.  Most of the respondents says they’d stick around, but they wouldn’t be happy about it.

I won’t reveal much here because the whole point of a ‘doctors only’ message board is to allow docs to vent and rant among themselves, but the discussion is thoughtful and insightful….and tense.

My thinking is that a socialist system would work fine if it paid well.  The whole problem with socialized medicine is that the workers get ripped off and have no autonomy.

If I told the average family medicine doc that they would make $250,000 a year working 60 hours a week, they’d sign up in droves.  Given all the worthless costs in our medical system, I’m sure we could eliminate just a few things and put up this kind of salary for our primary care providers.

There.  Problem solved.  Everybody’s happy (except insurance billionaires and lawyers, which is fine with me).

wsj2 The Wall Street Journal Health Blog has an extensive discussion here, over frequent comments made by California Democratic U.S. Rep Pete Stark (he’s the author of ‘Stark Laws’ governing hospital interactions with community doctors…I’m not a fan) about how insurance companies are “the General Motors of the American Health Care industry”.  I’m pretty sure he didn’t mean that as a compliment.

One responder, Michael Proffit, claims that Stark is a socialist with no concept of the idea of “profit” (no pun intended, I assume).  A writer named Republican states that insurance companies cost the health care system too much money. macman2 says that Stark is “finally” a politician willing to state the truth that insurance and pharmacy industries have a stranglehold on U.S. Health Care.  So, it’s a nice, occasionally testy exchange going on over there.

My take is that insurance shouldn’t be a for-profit business.  Not with health care.  Everything else, maybe.  But not health care.  Not when the government – and many people – believe health care is a basic human right.  If health care is a right, not a commodity, then nobody should be getting rich by insuring it.

Also at WSJ is an article suggesting that yearly physical exams are useless and expensive.  They mention an article in the NYTimes from 2003 suggesting that the utility of yearly exams aren’t proven.  2003?!

Anyway, they also interview Ned Calonge, a family doctor and chair of the U.S. Preventive Services Task Force.  I use this group’s recommendations all the time to determine what sorts of screening tests a patient should get, and when.

Ned says that yearly PE’s aren’t proven to extend life or limit morbidity (bad happenings), and a patient should develop an individual schedule with their doctor regarding when they should be seen.

The write-in’s seem to generally support the idea that yearly physical exams, like much of American medicine, are added expense with little to show for it.

A commenter named Evidence suggests that “other countries” don’t give annual PE’s but their populations live just as long as ours.  That’s a little vague for me, but I do agree that we do lots of fairly dumb stuff in our medical system, often for no other reason than to be able to say we did it when the lawyers come calling.  And data does show numerous countries with similar or better health markers like life-expectancy, infant mortality, etc while our’s costs nearly three times more.

studentdocI’ve been a reader and contributor to Student Doctor Network since I was a med student weenie.  Their family med and general residency forums are throwing sparks, as usual.

Of the many topics I’ve scanned, a couple of primary care threads caught my eye.  One references an article written by an apparently bitter ER doc decrying primary care as a field of medicine.  The letter, an Op-Ed in Emergency Medicine News, is written by an ER doc at Case Western U – read here if you like ignorant propaganda.

The responses from the primary care docs and students on the SDN thread are rather level-headed and polite.  In particular, I appreciate the response by Ted Epperly, the current president of the AAFP.  You can read his letter in the discussion thread at SDN – to read it at AAFP you need to log in as a member (why would they do that?).  I’ve met the guy and he really is as cool as his response letter suggests.

Another concerning discussion thread is open at SDN citing an LATimes article that describes a failing FP doc in California.  The discussion is here, the Times article is here.

My opinon on this one is that the lady in the article just isn’t much of a businesswoman, and in today’s medical marketplace you need to be just that to survive.  If you want to provide medicine as a product or commodity, you better be able to work a balance sheet and pro forma.

The Times describes her pulling out her wallet and giving a patient cash for food, for example.  While kindhearted, that kind of gesture is colossally stupid from a business perspective.  You can’t survive in business with this kind of mentality, and in fact, this doc’s practice didn’t.  However, I don’t think the story really gives a good perspective on the state of primary care in America.

Ideal Micro Practice

I’m spending time with two different family doctors in town who recently graduated from my training program. They both run what is called the “Ideal Micro Practice”. This style of medical care is quickly gaining national attention and is becoming something of a national movement.

The basic idea is to return family medicine – any primary care specialty could do this, though – to the days where most of the visit is comprised of doctors working with their patients. The way to achieve this is to cut out ALL middle-men. And I mean everybody. As you might imagine, there are LOTS of people who make enormous amounts of money on doctors. The doc I was with today said that he’s pretty sure M.D. stands for people on whom you can “Make Dough.”

So, here’s how his practice works: He sees patients for anywhere from 30 minutes to an hour. There is no receptionist, no nurse, no medical assistant, no biller. The office is the same room as his single exam room. The computer is connected to a second monitor that faces the patient while s/he sits in a comfortable easy chair and talks about the medical issues they’re working on. Any labs, imaging or handouts are visible on the screen right in front of the patient, and all of them can be printed out or emailed at the patient’s request. The doc is available by email virtually all the time and has data-enabled cell phones that allow them to upload patient information when they are not in the office. Patients make their own appointments on-line. The cost is roughly the same as any doctor.

If the patient goes to the hospital, a staff hospitalist will do the admission and in-hospital care; the micro-practice doc will come see them socially. Both docs will have no more than about 400 patients on their panel, and they know each patient or family personally.

One of the doctors has limited his practice to ONLY the best insurance companies, which according to him is 4 of them. The rest suck. They don’t pay on time, they often don’t pay at all, and generally have no incentive to be honest with how they work with doctors. The flip-side is that he doesn’t have a full patient panel yet, but has no urge to allow anything but exactly the preferred companies because he works part-time for another practice that more than pays his bills. So, he is building his practice slowly and keeping total control over how things progress.  The other doc is subsisting only on his private practice and has thus taken on crappier insurance payers.  He recently acquiesced and hired a biller to deal with the paperwork and administrative overhead those insurance agencies generate.

Both doctors believe deeply in the IMP model.  They’re evangelists for the cause and they believe this will be the wave of the future.  Certainly I can see that they are both making money, although probably not as much as they would if they were pounding through 20-40 patients a day in a high-overhead typical practice.  In general, their revenues are miniscule to the typical family practice, but they keep so much of what they bring in that the differential is negligible.

Everybody’s trying to either fix American medicine, or they’re running scared as fast as they can to other fields.  I applaud these docs for trying to come up with a new world order.  I think the biggest drawback to practicing medicine in America today is the lack of freedom, largely due to influences outside the sacred doctor-patient relationship.  If I have to be kept from spending time with my beautiful children and wife, I would like it to be because I am working with a patient.  Most other reasons – generally some version of paperwork – just aren’t worth it.  IMP’s provide hope that medicine can return to it’s roots – to the days when doctors helped their patients, and nothing more.

Saturday Night Quotes I Like – March 1

A compendium of quotes I’ve noticed over the past week that were provocative, thoughtful, interesting, funny or patently absurd.  Sent out (’Lord tarry and the creek don’t rise’) every Saturday:

  • Health nuts are going to feel stupid someday, lying in hospitals dying of nothing. – Redd Foxx
  • Astounded, I pointed out the obvious. “Your wife died, you stopped eating, cried or slept all the time…and prayed to God that you would die? Sounds like you are very depressed.””No, I’m not depressed,” [my patient] said. “I just don’t want to live anymore.” – Fat Doctor
  • After saying she found her “voice” in New Hampshire…we’ve had Experienced Hillary, Soft Hillary, Hard Hillary, Misty Hillary, Sarcastic Hillary, Joined-at-the-Hip-to-Bill Hillary, Her-Own-Person-Who-Just-Happens-to-Be-Married-to-a-Former-President Hillary, It’s-My-Turn Hillary, Cuddly Hillary, Let’s-Get-Down-in-the-Dirt-and-Fight-Like-Dogs Hillary. – Maureen Dowd
  • buck.jpgBuckley was arguably the most important public intellectual in the United States in the past half century. For an entire generation he was the preeminent voice of American conservatism and its first great ecumenical figure. – George H. Nash, American conservative movement historian.
  • “Even if one takes every reefer madness allegation of the prohibitionists at face value, marijuana prohibition has done far more harm to far more people than marijuana ever could.” – William F. Buckley, Jr.
  • “I won’t insult your intelligence by suggesting that you really believe what you just said.” – William F. Buckley, Jr.
  • Buckley’s greatest talent was friendship. The historian George Nash once postulated that he wrote more personal letters than any other American…He showered affection on his friends, and he had an endless stream of them, old and young. – David Brooks
  • Faith, which is the belief in the supernatural despite lack of evidence, is, in the terms of some theologies, a gift from God. It is the belief in things not seen…Anyone can believe in a God who walks the Earth. – PalMD
  • A physician who treats himself has a fool for a patient,” – Sir William Osler.
  • …New physicians view medicine more like a job than a calling [while]…politicians and the public have decreasing respect for the profession. In addition, the constant siege by the lawyers is taking its toll…in such hostile times, why should doctors sacrifice more to the profession than they already have? – Kevin, M.D.
  • Today, thanks to the Internet, we are all physicians. And potential fools. – Andre Picard
  • Intubated COPD patients are generally stable patients..[with a] protected airway…[in a] controlled environment… Except when they aren’t.Happy Hospitalist
  • When I was a child, it was an easy time to dream. When you turn on your television set and men are landing on the moon, anything is possible, and we should never lose that spirit. – Randy Pausch, professor at Carnegie Mellon currently dying of pancreatic cancer. See his final lecture on following your dreams here.

Leaving The Kids

I’m currently involved in a back-and-forth commentary in our local newspaper with some other readers regarding a story depicting a mother who has been arrested for leaving her children alone for 3 hours while she visited a neighbor. Read a quick story here, if you want, but I’ll lay out the facts for you:

– Kids were 7, 6 and 6 months
– A pot with chicken was cooking on the stove the whole time
– Mother put in jail, being investigated for child abandonment (would be CRIMINAL charges)
– Kids to CPS and foster care

v.jpgI think based on what we know (hopefully there is more to the story), this little event should not sit well with the public. Yes, leaving children that young is irresponsible and needs to be addressed if it happens on more than one occasion. But a government entity identifying this situation in the span of 3 hours – and imprisoning someone for it – should not be taken lightly. This is totalitarian stuff. Think KGB, Gestapo, Frumentarii, Norsefire kind of stuff.

Aside from that, I personally harbor the notion that our society spends too much time majoring in the minors…especially when it comes to raising kids. They can barely go outside anymore. Everything kids touch is padded, rounded, rubberized, sterilized, foamed, disclaimered and softened. I grew up without helmets, seat belts, multi-vitamins, car seats or hand sanitizers. I rode in the back of pickups, stuck my fingers in light-sockets, ate with my hands and rarely washed them, drank out of streams, ate uncooked cookie dough and burnt leaves with a lighter (o.k., my Dad didn’t know about that one).

Profoundly, irrationally, miraculously I survived. So did these kids. Now they have no mom and are probably separated from each other.

But, hey, maybe it’s me who is out-of-touch with real middle-America, right? We Americans like to think of ourselves as safe. Really safe, even. Never mind that the U.S. is one of the most violent societies in the history of history. Never mind that living in America is more dangerous than living in almost every other country in the world, including nearly all of the 3rd world. Did you know it is safer to live in Israel, even with their conflicts with Lebanon, Palestine, Syria, Jordan, Egypt, Iraq and Iran than it is to live in the U.S.? Do you know how many kids wear bike helmets in Israel? (read: barely any) Disclaimers on 5 gallon buckets and hyper-shredded rubber playground mats fail to address the bigger dangers in our society, and they don’t make us truly safer; neither does throwing parents in jail for poor judgment.

veal2-copy.jpgSooh, ‘when in Rome…’, right? I’ve decided that, my opinions notwithstanding, I’m going to contribute – definitively – to child safety in America. And I’ll make a buck doing it, too.

After a little research and tinkering, I’m proud to say I’ve developed the first ever child veal crate, available exclusively here at SW101. Basically, you put your kid (no pun intended) in there, close the gate, feed them daily and don’t open it until you’re legally-obligated to free them somewhere near their 18th birthday. Just imagine your child where that cow is in the picture to the left. I promise you a soft, perfectly-living, completely safe once-child. If you’re interested in your very own child veal crate, let me know and I’ll put you on the waiting list – demand is already outstripping supply. I’m working on a side-by-side model too, if you intend to sprinkle a little highly-regulated social contact into the mix.


A few months back, I entered this blog in the Healthcare 100, a ranking system for health care blogs. I figured one day this lovely little work-of-life might end up on their list. Some of the very top blogs on the net are in their ranking system.
Turns out I didn’t have to wait as long as I expected. SW101 has just been ranked at #73! There are currently 783 listed blogs in their ranking database. To all who read the blog and offer comments, my sincere thanks for your support.

Saturday Night Quotes I Like

A compendium of quotes I’ve noticed over the past week that were provocative, thoughtful, interesting, funny or patently absurd.  Sent out (‘Lord tarry and the creek don’t rise’) every Saturday:

“What Mrs. Clinton has that Mr. Obama does not have, Mr. Obama can get. What Mr. Obama has that Mrs. Clinton does not have, she can never get.” – Alec Baldwin

“I have much to thank God for this week. For one, I have so much support for all of my life’s struggles. Secondly, I’m not a patient in the hospital. For another, I’m not on trial for murder.” – Fat Doctor

gaza.jpg“And let’s face it kids, despite the shows on the television, medicine is not sexy. Unless you are a pediatrician, the majority of your patients are going to be elderly and pushing their expiration date.” – Panda Bear, M.D.

“Welcome to America, where your government will pay for both your tracheostomy and your cigarettes.” – Happy Hospitalist

“Life can go by quickly, and if you’re not careful, it will be gone before you have a chance to enjoy diversifying your assets into stocks, stock mutual funds, corporate and municipal bonds, bond mutual funds, international funds, cash equities, exchange-traded funds, life-cycle funds, and U.S. Treasury securities.” Joseph Reed, The Onion

“Our message is clear. It is to break the siege imposed on the Gaza Strip and to motivate the Arab, Islamic and International Community.” – Jamal al-Khudari, leader of the Popular Committee Against the Siege (PCAS)


Recently I began providing my email address to my patients.  I’m not the only one, either.  You can read about how surgeons are starting to stay in touch with their patients, and how both parties are generally happier about it.  There’s a quick article about this issue here.

One of the big-time medical blogs out there, Kevin M.D., also weighs in on the subject and points out that there are some problems with this new practice.  One of the big ones he mentions is that email communications are probably often not HIPAA compliant.  If you don’t know what HIPAA is, I recommend that you NOT educate yourself.  HIPAA is classic D.C. armchair policy-making that is meant to protect patient privacy, but in reality does less for this goal than intended.  I’d prefer the acronym HIPPO.  The policies are minute and voluminous, arcane, endless, cumbersome and impossible to follow perfectly.  Worse, they’re meant to apply to every single health system in America.  No regional variation.  No State individuality.  EVERYBODY. 

In general, of course, the idea (initiated in ’96 by Bill Clinton) is a good one.  Nobody wants their health info on YouTube.  But while health information certainly is sensitive, the frank truth is that it isn’t high-value stuff.  I’d be much more worried about someone using my identity information than my medical history to ruin my life.  HIPAA policy – and the enforcement of it (they call it compliance) – has become an entire career field…all to protect information that is almost never interesting to anybody, even to the guys in ski-masks and dark glasses.

privacy_lock_72_jpg.jpgAt any rate, it appears that doctors may not be able to talk to their own patients by email unless the system is hyper-encrypted to keep bad guys from getting the info and…oh, selling it on the medical info black market in Paraguay or whatever. 

You can see that I have a dim view of government policymaking.  I think government policy is often nothing more than a cathartic exercise for people with an above-average need to feel important.  Writing stuff – even stupid stuff – that other people have to obey will make you feel important.  In fact, the more stupid, the better.  You’re in control.  “DO IT!” you can demand, “Even if you think it’s dumb.”  You’re The ALPHA.

Government wonks do this all the time, resulting in thousands of rules – which fulfills their own subconscious needs – that tend to be laughable and illogical when applied to every single human in America.  HIPAA is supposedly in place to protect patients from losing their info.  With respect to email correspondence between doc and patient, shouldn’t the actual patient themselves have the right to correspond with their doctor however they choose?  No.  You, dear ignorant patient (and doctor).  You have no idea what is good for you.  We here in Rached, D.C. will take care of you, whether you want us to or not.

The truth is that doctors, me included, HATE making phone calls.  They take forever.  The number is invariably wrong.  You have to find somewhere to talk where your conversation isn’t going to be overheard.  You NEVER get paid for them (unlike lawyers, who must have listened in their business classes).  And often the patient isn’t there and you have to fret over leaving a message or not, never knowing who is going to hear the message, etc. (violating HIPAA, again)  Ultimately, I feel bad that it takes me so long to get back to a patient when they leave me a message.  Email is a perfect solution. 

Or was…until policymakers totally remove this option from patients and their doctors. 

The number of people edging themselves between patients and their doctors over the past 30 years is truly amazing – government, lawyers, insurance agents, pharmacy, to name a few.  The evolution of this new army of medical middle-men, I believe, will be what is remembered about American medicine 100 years from now.  And I think it will be looked upon as a largely aggressive and capitalistic change that generally harmed patients, not helped them.