Authentic Medicine Gazette

Enjoy our most current issue of the most popular medical e-newsletter on the internet.

Blogs and Thoughts for Septemeber 14th to Sept 20th, 2017

Here is what we had this past week:

  1. Bureaucracy Killed the Family Physician
  2. The AAFP Continues Their Cluelessness
  3. The Evil Hospital Administrator
  4. ZDoggMD and the Joint Commission
  5. The Only Bright Light Out There by Pat Conrad MD
  6. Friday Fun: Medically Inspired Wedding Gowns
  7. Quote of the Week: Joseph Campbell

 

1. Bureaucracy Killed the Family Physician

Sept 20, 2017

Here is a nice summary in the Medical Economics magazine of why we are having such a shortage of family docs.  All of it, by the way, was predicted by me over the past 15 years with proof in this blog.  It is summarized as:

  • Bureaucracy
  • Red tape
  • More bureaucracy
  • Pay-for-performance
  • Quality indicators
  • Metrics
  • More red tape
  • Even more bureaucracy

All of this was created and imposed upon doctors by the federal government.  And the beauty is that some people think that the one who will fix this all will also be the government.  Really?  Child, please.

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2. The AAFP Continues Their Cluelessness

Sept 19, 2017

At the most recent AAFP yearly meeting, it was decided:

Healthcare is a basic human right and there should be a “publicly funded universal primary care program,” according to resolutions adopted Wednesday by the American Academy of Family Physicians Congress of Delegates here.

The healthcare-as-right resolution stated that the AAFP “recognize that health is a human right for every person, not a privilege.” It was amended to clarify “that the right to health includes universal access to timely acceptable and affordable healthcare of appropriate quality” and was passed with resounding applause.

Good for them.  It is so easy to be the good guy.  It is so easy to say everything is free.  The problem is that the answers are not easy.  They don’t say how it will be paid for.  They have no plan.   Just another wish for the AAFP.

I want better health for everyone.  The problem is that I cannot control what people eat, drink, how much they smoke, or how much they exercise.  Correct me if I am wrong but everyone has the right to do ALL of this.  They just don’t do it.  The AAFP, of course, takes the easy road and mentions none of this.  They do mention that somehow “universal access to timely, acceptable and affordable healthcare of appropriate quality” should be magically created and paid for.  Don’t get me wrong, for a reasonable price, you can actually get this with DPC, which is only attained via a free market. You cannot, however, get it with a government-run, bureaucratically heavy system.  It will fail.

And someone please explain to me why having food, water, and shelter is not a right but yet healthcare is?

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3. The Evil Hospital Administrator

Sept 18, 2017

I often rip on hospital administrators for many reasons.  One, there are too many of them. Two, they think they are more important than they are.  Three, they are getting too powerful.  Want an example?  Here is one from a lawsuit in California:

The suits stems from actions taken Jan. 26, 2016, when the Tulare Regional Medical Center (TRMC) board of directors voted to terminate the hospital’s medical staff organization and effectively remove the hospital’s elected medical staff officers, install a slate of appointed officers, and approve new medical staff bylaws and rules drafted without staff input.

Except for the newly appointed officers, the rest of the staff was then terminated, stripped of their rights as active members and then granted “provisional” status as part of the new medical staff which they had not applied or consented to membership with, according to a post-trial brief filed by the TRMC Medical Staff.

The replacement bylaws also contained a provision, since amended, that physicians could achieve and maintain “active” status by proving their economic value to the hospital, according to the brief—which described that provision as “basically, an illegal kickback scheme.”

All I can say is….wow.  Physicians gave this healthcare system away and we continue to pay for it.  This power play, by the hospital administrators at Tulare, is unbelievable.  And disgusting. And evil.

We need to fight back.  All of us.

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4. ZDoggMD and the Joint Commission

Sept 17, 2017

A few days back I ripped on the Joint Commission pretty hard.  They deserve to be criticized even more so here ZDoggMD gives his shot.

See more of ZDoggMD’s stuff here.

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5. The Only Bright Light Out There by Pat Conrad MD

Sept 16, 2017

For decades, the American Academy of Family Practitioners has taken a leading role in selling out their members, those members’ patients and communities, and the state of U.S. health care in general.  I trained in family medicine at a very good residency, where I truly received an excellent education from some outstanding physicians, to whom I shall always remain grateful.  Yet the rapid self-abasement and degradation of this discipline has left me with a reflexive disgust.  Esteemed colleagues here have sometimes agreed with my views, while others have thrown a barb or two at them.  Hey, that’s cool, we’re big boys and girls here (hopefully all cis-) and Doug is honest enough not to sanitize away contrarian views like some social media physician voice leaders (ahem) I could name.

But this is nauseating, and I mean splat-all-over-the-rug, run-to-the-bathroom, bile conjuring, vomit-inducing stuff.  One expects that outgoing AAFP president John Meigs Jr., MD was rushed to a local ER after dislocating his shoulder the other night, after the most aggressive display of self-back patting ever witnessed outside of an Oscar’s ceremony.  He arrogantly worked a Bible quote into describing his defense of ObamaCare, while whining about the very electronic records that his establishment helped to force on the rest of us:  “This is the day that the Lord has made. Let us rejoice and be glad in it.”

“’But God doesn’t have to use an [electronic health record],’ he quipped, or to ask insurers for prior approvals, when they think they are God.”

A little personal aside here:  I don’t like it when politicians invoke the Almighty, as there is never, ever any evidence that Providence is on their side.  And make no mistake; Meigs is a politician gaming for special interest gains while extolling his own beneficence.  Meigs met with senators in D.C. this year to argue against repealing the ACA, and said:  “From the beginning we said the ACA is a good start.  It’s not perfect. Prescription drug prices are too high. We need incentives for young people who want to buy insurance.”  This quote alone shows him to be an economic ignoramus, and possibly dishonest as all hell.  Here is his quote:  “We need a public option that will allow people ages 55-64 years to buy into Medicare or obtain a Medicare Advantage plan. We need to require all insurance plans to cover the essential health benefits so that they are available to all.”  None of this would ever bring prices down for consumers, employers, or taxpayers.  As we have seen, it would fatten the Big Insurance profits all the more, and worsen an already irretrievable national debt.

There has NEVER been any mechanism in the ACA that would bring prices down or incentivize millennial basement-dwellers to buy insurance (His panel colleague Hal Lawrence, M.D., CEO and EVP of the American Congress of Obstetricians and Gynecologists, said “The question is whether medical care is a right or a privilege.  Most people would agree that it is a right and that we need to have universal access. We have to find a better way to cover that.”  So these were a bunch of left-leaning huff’n puffs leading the fight to defend the ACA as a better path toward eventual single-payer, proving that they are all economic ignoramuses and dishonest as all hell).

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So family docs, your outgoing AAFP president is a government health care stooge that has supported the very programs that have made life worse and more expensive for you, under the guise of promoting your interests.  Meigs said so himself, bragging how the AAFP was the first specialty to require MOC, and that recertification is a founding principle of the AAFP.  As Meigs explained, “the concepts of professionalism, continued professional development, commitment to lifelong learning and maintenance of certification are at their core principles that family medicine introduced and championed for our profession” (And Dr. Puffer at the ABFM will be glad to cash your check).  And what has this shakedown gotten us, and what proof is there that any patient benefit has been achieved?

In one fashion or another, Meigs has been a supporter of mandatory EHR’s, expanded Medicaid/SCHIP programs, PCMH’s, self-abusive MOC garbage, value-based programs, and emphasis on “diversity and working on the social determinants of health.

Then he gave as his swan song admonition:  ”We must continue to be the disruptive innovators of our profession.”

There is only Direct Primary Care. In fairness to Dr. Meigs, I was pleasantly surprised to read his statement on DPC:  “You’re not on the hamster wheel of getting paid based on the volume you do. Patient satisfaction goes up. Physician satisfaction goes up. Quality goes up and costs go down because you don’t have to prove it to Uncle Sam or an insurance company.”   I can’t fathom how Meigs can square his support for so much of the government intrusions listed above with DPC, but if he wants an actual disruptive innovator, we know where he can look.

 

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6. Friday Fun: Medically Inspired Wedding Gowns

Sept 15, 2017

When you know you won’t get much time off for your wedding why not get something that works for both?  From the minds of the Placebo Journal (2001-2011)

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7. Quote of the Week: Joseph Campbell

Sept 14, 2017

A hero is someone who has given his or her life to something bigger than oneself.

Joseph Campbell

Editor’s Note: For those in the medical field, that’s you!

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UNTIL NEXT TIME, KEEP SMILING, KEEP LAUGHING AND KEEP OUT OF THE SAMPLE CLOSET!

Douglas Farrago MD

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  75 comments for “Authentic Medicine Gazette

  1. Dennis Kabasan
    April 27, 2017 at 10:23 am

    Doug,
    I ordered the Cryohelmet for my sixteen year old daughter, who sustained a concussion, with brief loc, after being struck in the forehead by a soccer ball, in a school match, two weeks ago. She’s been wearing the helmet, as recommended, one hour at a time, since it arrived three days ago. Her pediatrician is following her. She only tolerates a few classes each day, d/t frontal and temporal headaches and extreme tiredness. Sleep helps her. Is there any benefit to longer wear-time? Thanks.

    0
    • Doug Farrago
      April 27, 2017 at 10:31 am

      See my email to you

      0
  2. April 12, 2017 at 2:52 pm

    For some reason, my version of Authentic Medicine is delivered with comments from 2011 and 2012.

    Any notion of what may be going on?

    Thanks.

    1+
    • Doug Farrago
      April 12, 2017 at 3:55 pm

      none

      0
  3. John Comis, DO
    May 30, 2012 at 11:34 am

    Please encourage the KOM to join his friends at QC13.

    7
    (…of the lemons)
    PS the healthcare system is so terrible it is beyond any further comment.
    Peace,
    John

    1+
    • Doug Farrago
      May 30, 2012 at 12:27 pm

      I will try.

      1+
    • au-digit
      January 26, 2017 at 3:33 pm

      The Bush you quote was #41.

      1+
  4. Gary Gaddis
    May 20, 2012 at 7:43 pm

    Regarding our Federal government, Centers for Medicare and Medicaid Services (CMS), Secretary of Health and Human Services Kathleen Sebelius, and the growing gap between CMS perceptions and reality, here is my sarcastic “Sound Bite” suitable for the brief attention span of our electronic news media:

    “Since the Department of Justice is headed by an attorney, and the leader of the Federal Reserve is an economist, then how is it logical that the Secretary of Health and Human Services is also headed by an attorney?”

    Does anyone else agree with me?

    5+
    • Kristina Berger MD
      May 21, 2012 at 7:31 am

      There are too few physicians in politics. Is it because we dont have the stomach for it, or another reason? I know if there were more of us as policy makers, the healthcare system in this country would improve greatly.

      1+
      • Simon Cummings
        May 23, 2012 at 8:59 am

        My vote is for Doug and not the type of physician represented by the Cardiologist who told me that he wasn’t interested in cardiac rehabilitation cos there’s no money in it!

        2+
    • Judy
      May 24, 2012 at 8:58 pm

      No, I think that it is correct for a lawyer to head the Department of Health & Human Services. Only a lawyer can read the volumes of crap they put out as regulations and find a loophole way to still make a living; only a lawyer can repeatedly find a way to let someone die and it be due to no fault attachable to him; only a lawyer can write voluminous policies that effectively help only a select few of his supporters and require the rest of the populace to pay for it except himself; and only a lawyer can sit passively by and provide no useful assistance to a group of sick, needy people but still require them to pay for his service. If you will think on these comments for a few minutes, you may change your opinion.

      2+
      • Bill
        June 4, 2012 at 9:22 pm

        Hey Doug ! I am a lawyer. never made more than $85K /year and spent my entire career in trenches helping people, most who did not have much money, with problems, many of them caused by their own bad decisions and choices. and I love your journal.
        Given the wide range of attitudes, opinions and incomes among doctors do you really want a politically-connected MD in charge ? maybe an orthopedist ? xoxo

        2+
        • Doug Farrago
          June 4, 2012 at 10:43 pm

          The description “politically-connected” should remove that person from contention immediately.

          3+
        • Dr Bonz
          June 21, 2017 at 8:29 am

          Dear Bill.

          F*** You.

          Signed,

          An orthopedist.

          0
    • Jeff
      February 22, 2017 at 3:14 pm

      I agree, absolutely, that HHS should be headed by a physician.

      What about having an advanced practice nurse in that role?

      But (God help us) not an attorney, a chiropractor, a homeopath, a naturopath, a shaman, or a faith healer!

      On second thought, a shaman would be better than a lawyer any day.

      1+
    • Jeff Palmer
      February 22, 2017 at 3:16 pm

      I agree, absolutely, that HHS should be headed by a physician.

      What about having an advanced practice nurse in that role?

      But (God help us) not an attorney, a chiropractor, a homeopath, a naturopath, a shaman, or a faith healer!

      On second thought, a shaman would be better than a lawyer any day.

      0
    • John A Goldman, mD
      March 4, 2017 at 3:10 pm

      thank goodness in 2017 it is a physician

      1+
  5. Alan Levine
    May 9, 2012 at 9:03 am

    You have bemoaned our lowly position in hospitals, commenting how few recognized our contributions on Physician Recognition DAY. In what I feel is a further diminution of what we do, my hospital is now celebrating Nurse Recognition WEEK!!!! How far we have fallen………….

    1+
    • Doug Farrago
      May 9, 2012 at 2:53 pm

      I agree

      0
      • Jack Forbush
        May 23, 2012 at 12:10 pm

        Ditto

        0
    • Common Sense
      May 30, 2012 at 4:54 pm

      So you’re denigrating nurses in an attempt to rally support for your plight? It is just as easy to argue that since nurses spent 7 times more time with patients, theyre deserving of their week.

      Or, you know, we could all just stop getting butthurt over who has the longest display of solely symbolic “appreciation” and get back to working as the team we were intended to be.

      We’re your knights and you’re our Earls. There is nothing to be gained by making besouring diatribe. Be good to your staff and your patients and you’ll have more appreciation and recognition than your little heart can handle.

      0
      • Doug Farrago
        May 30, 2012 at 5:11 pm

        You really need to have read the thread completely before making that comment. Please check out the blogs on how Doctor’s Day has been totally dismissed. Maybe then you will understand how we feel. This is NOT about doctors against nurses. It really is about administrators.

        1+
      • Doug Farrago
        May 30, 2012 at 5:12 pm

        You missed the point on this. It is about Doctor’s Day being totally dismissed by administrators. Please read those blogs.

        0
        • Alan Levine
          May 31, 2012 at 8:56 am

          That was exactly my point. In recognition of out efforts several years ago my hospital–a level 3 teaching hospital–gave chocolate bars (small ones) to the docs. Nurses this year received flowers and other shows of appreciation.

          0
          • JoAnne Fox
            June 8, 2012 at 7:23 pm

            Acknowledgement of a job well done would have been nice. I got a scoop of hot cocoa mix, repackaged in a baggie, with a little note attached telling me how wonderful nurses are.

            0
  6. Doug Given
    April 25, 2012 at 5:29 pm

    What a screw job from the lovely IRS on the Mandate.

    1+
  7. Judy
    April 18, 2012 at 10:05 am

    think you should run for President, as long as you will continue to keep up this site after you win!

    1+
  8. Dave Hoffman
    February 29, 2012 at 11:20 am

    Great thoughts as always, Doug!

    Is there a way to start new comment threads each time you post a new entry?

    0
    • Doug Farrago
      February 29, 2012 at 12:31 pm

      Each entry is a blog and has their own comment section

      0
      • t mcglone
        April 4, 2012 at 8:25 pm

        Having “served” for 15 years, those are finely edited comments fit for civilian consumption .

        0
  9. February 29, 2012 at 8:53 am

    today’s (feb 28, 2012) gazette was one of your best. some might say that your gazette is merely entertainment. i however, enjoy the articles with their kernel of truth/fact at the center and your encouragement for us to critically examine the field of medicine that we are a part of. the top ten signs that a hospital stay isn’t going well is what we see all our careers. uphoric for gout patients who like beer and ujerky for cardiac patients and the statin report were particularly good reading. i don’t know how you find the time or energy to do this. i was usually totally exhausted by the middle to end of my workday. thanks again.

    0
    • Doug Farrago
      February 29, 2012 at 9:06 am

      thanks, dennis! I appreciate the feedback and I am truly flattered.

      0
  10. Angi Wall DO
    February 9, 2012 at 9:18 pm

    I’m with Doug on the dietary/diabetes. It’s not often you catch those guys looking good in a bikini and munching on carrots.

    0
  11. Dr. Veronica Friel
    January 25, 2012 at 4:20 pm

    More! More!! Doug, keep it coming!!!

    0
  12. Robert Bosl, MD
    January 25, 2012 at 1:27 pm

    Regarding relationship of AD & DM, and comment that DM is dietary–too simplistic and likely wrong. We know about dysmetabolic syndrome & PCOS etc. which is genetic, DMS causes weight gain and subsequent DM. Consider whether strong relationship of DM to increased risk of AD is also genetic predisposition to both rather than one causing the other.

    0
    • Doug Farrago
      January 25, 2012 at 2:06 pm

      100% disagree. Predisposition is not a certainty. How can you NOT think DM is dietary related?

      0
      • Robert Bosl, MD
        February 1, 2012 at 4:12 pm

        My earlier comment may have been oversimplified–just tried to point out that some legit. MD’s believe in insulin resistance as a cause of some obesity issues than the result thereof, and it is conceivable that the “insulin resistance gene” may also play a role in development of Alzheimer’s.

        0
    • Bridget Reidy
      March 8, 2012 at 6:49 am

      Ever consider the relationship between Alzheimer’s and diabetes might be iatrogenic brain damage from hypoglycemia? I’m always shocked at how lightly my patients consider the risk of it.

      0
      • March 16, 2012 at 12:13 am

        May I suggest that the dementia with chronic diabetes isn’t Alzheimer’s, it is more likely to be due to the vasculopathy that accompanies non-well controlled diabetes or elderly age + diabetes. So the relationship is between DEMENTIA and diabetes, not Alzheimer’s Disease and diabetes. The fact that most elderly diabetics are vasculopaths, and the recurring theme in medicine that the brain depends on a constant supply of glucose and oxygen to function well, and that vasculopathy impairs oxygen and glucose delivery, is much more plausible than recurrent hypoglycemia.

        0
  13. Scott Miller, MD
    January 25, 2012 at 12:34 pm

    I work in urgent care and when I get home at night I am too tired to exercise. I find that the exercise I get from going back and forth in order to finish the articles in your journal gives me the physical exercise I need to stay healthy and sane. Thanks, Doug! Could you get me a beer when you go to the kitchen?

    0
    • Doug Farrago
      January 25, 2012 at 2:08 pm

      You got it!

      0
  14. Allyagottadois
    January 18, 2012 at 8:55 am

    If I can print it out in its’ entirety, I can leave it casually around the hospital. Mailroom, Medical floors, ICU, ER, surgical suites, administrative offices, JACHO. Because All I’ve got to do is: everything everybody tells me to do.

    0
  15. Dr. Bill Ameen
    January 1, 2012 at 11:31 am

    Hey Dr. Doug,
    To start the new year right, this ticks me off! I was belatedly reading the 11/4/11 issue of THE WEEK, an article about the Top 1% wage-earners. It takes annual earnings of $516,000 to qualify. Guess what? One out of six of the Top 1% is “in medicine”…I suppose some could be CEO’s of Big Pharma, but I suspect a large number are like the pediatric surgeon who heads the AMA and lives overlooking Central Park, and probably every orthopedist. Sorry, but I believe that anybody who makes that kind of dough either 1) inherited it, 2) stole it, or, as with most surgeons, sports figures and actors, 3) was grossly overpaid (as by insurance companies).

    0
    • Doug Farrago
      January 1, 2012 at 12:32 pm

      agreed

      0
  16. bill lorentz
    December 28, 2011 at 11:25 am

    I am a recent professor emeritus from a well known university medical school. For a number of years I worked with administration as an associate chief of staff. We spent considerable time and effort reviewing patient satisfaction scores using a well known national company and were quite excited that ours were consistently higher than most othere and certainly higher than I thought was reasonable.
    Bottom line-we discovered that the administrator in charge of managing the satisfaction suvery was “doctoring” our results. When we changed over to a more honest effort our scores dropped significantly. However, no one in administration was happy with our new lower scores and the subsequent need to address the outcomes.

    0
  17. David Devonis
    December 16, 2011 at 11:17 am

    Impressed that a lot of teachers are reading this material. Your site is the Writing on the Wall. Keep it coming!

    0
    • Doug Farrago
      December 16, 2011 at 1:35 pm

      Thanks!
      Doug

      0
  18. Dr. Bill Ameen
    December 15, 2011 at 10:46 pm

    Hey Dr. Doug, Heard that due to droughts affecting the peanut crop the price of peanut butter will go up. There’s a worsening shortage of PCP’s, so guess what? They’re paying us less..and less…and less. Also, latest Medical Economics has lead article about MOC. I was gritting my teeth reading remembering when you published the ABIM chief’s salary at $600,000. I’m sure ABFP CEO’s isn’t far behind. Where are the studies showing MOC (or even boards) make any difference in our performance? Finally, get “The Parking Lot Movie” on DVD. It’s a hysterically funny documentary about the parking lot behind The Corner at U.Va that will remind you of your days there!

    0
    • Doug Farrago
      December 16, 2011 at 5:04 am

      Thanks for the great points, Bill! Will need to get that DVD, as well. On one of my first dates with my future wife she remembers me checking all over the ground for parking lot tickets that were cheaper than the one I had in my hand. I was a class act.

      0
    • Dr. Veronica Friel
      January 25, 2012 at 4:16 pm

      Peanut butter prices going up? At COSTCO, the price of the large-size Jiffy Peanut Butter remains the SAME – the large-size is simply 8 oz. smaller.

      0
    • Connie Severin
      February 8, 2012 at 1:06 pm

      Thanks so much for adding that bit about the movie. I just ordered it off Amazon. I worked at UVa Med Cen from 1980-1985 and remember the strip and the parking behind it (apparently pre-Farina days). I remember some sort of parking honor system and some lot Nazis from back then too, but obviously predating when this documentary is set. It was about the only parking within a mile of campus too, so finding any spot at all was a miracle. I’m looking forward to the video. Thanks for the heads up.

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  19. Mary K Freel
    December 9, 2011 at 7:08 am

    RE: Grading Dr. on patient performance. Can you grade me if I work in a factory stamping out parts? Absolutely!! If the part doesn’t meet specifications then I’ve failed. Can you grade me on my patient’s health performance? Absolutely not!! I can only control a small part of what goes into a patient’s health and as studies have shown patients often pay for the dr. advice and then do nothing or the opposite. What a wonderful world it would be if when the dr. told his patient to lose weight and quit smoking they went right out and did those things. I was a nurse for 22 years and a teacher for 10 and in both professions I was the one who got blamed for whatever didn’t go right–whether it was poor scores on tests and the patient not getting better faster. Until people take ownership in their own health and realize that they are the number one reason that their health doesn’t improve the overall health of this nation will not improve and so our health care costs will continue to rise.

    0
  20. Bridget Reidy MD
    December 8, 2011 at 10:44 pm

    I agree with the teacher and have always been suspicious of both of our “quality” grading.

    The recent issue of AMA News gave opinions of practicing docs on lots of little issues but NONE on their main article on why small practices (aren’t they usually run by docs?) aren’t getting EMR’s. Gee 15% more pay for 50% more work – why wouldn’t we bite? I wonder if it’s a censored rag. Thank you Doug for validating our voices.

    0
    • JoAnne Fox
      June 8, 2012 at 7:32 pm

      Where do you find doctor owned small practices?? Most everyone around here is owned by one of the two hospital systems, and one has the gall to proclaim itself “not for profit” – I guess if you don’t mention the wholly owned subsidiaries they don’t count.

      0
      • Doug Farrago
        June 8, 2012 at 8:27 pm

        Hopefully you will find them in the future

        0
  21. Pat Nagle
    December 7, 2011 at 11:45 am

    I enjoy your site. I appreciate your heartfelt concern for patients and your irritation at the “solutions” suggested/mandated by outsiders (e.g. politicians). What strikes me most of all are the similarities between the world of medicine and the world of education, in which I spent 40+ years, working from K-graduate schools.

    Although the history, dynamics, and focuses are different,
    healthcare and education get pushed around by folks who don’t know what the hell they’re talking about, from Presidents, Congresspeople, media, on up, and the bottom line is always the bottom line, not the needs of patients and students.

    Your tirades against administrators parallel my feelings about the “consultants” and “foundations” who infest educational policymaking at every level. The last ones consulted are the frontline teachers and docs. And of course, the politicians and business moguls take no responsibility for the culture and economy they’ve helped create which lead to the problems in both areas.

    I don’t always agree with you (I’m adamantly for universal/single payer healthcare), but I appreciate your struggle. Keep up the good work.

    1+
    • Doug Farrago
      December 7, 2011 at 12:39 pm

      Thanks for some great feedback! And the similarities are eery.

      Doug

      0
    • Frank J. Rubino MD
      December 14, 2011 at 6:55 pm

      We do have much in common. “No child left behind” where the teacher is held responsible for the sucess of each and every child no mater how functional or dysfunctional is the child’s family.

      “Pay for performance” reguardless of how cooperative a patient is with diet & exercise and with their medication regimine for hypertension, diabetes etc.

      If one wants to make a lot of money in a short period of time, one should become a “consultant” to to school districts or to health care organizations. Expensive advice with out the responsibility. Charge a lot and then get out of town.

      1+
    • pat nagle
      December 21, 2011 at 12:50 pm

      Pardon me for doubledipping, but I forgot to mention that no legislator/congressperson has ever begged to be put on merit pay/pay for performance. Obviously, legislating doesn’t lend itself to factory models of evaluation. So why do medicine and education? The things that count aren’t measurable, and the measurable things don’t count.

      1+
      • Judy
        January 4, 2012 at 9:26 am

        hey, Pat, hope you don’t have a patent on your last line! that is about to become my ‘signature statement’ on my sign-offs!

        2+
        • Richard W. Mondak
          March 28, 2012 at 1:56 pm

          I think several of us are going to “borrow” that line (of course we’ll give credit to whomever coined that phrase — whoever that is)

          1+
  22. John Chase
    December 7, 2011 at 9:11 am

    I would prefer your stories to run in their entirety rather than “read more”. Very irritating to have to go back and forth

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    • Doug Farrago
      December 7, 2011 at 10:08 am

      Ok, will work on it.
      Doug

      0
      • Greg Salard
        December 8, 2011 at 2:35 am

        I have to agree. Not only is it irritating, it can be confusing when you have to …

        Read More >>>

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        • Doug Farrago
          December 8, 2011 at 3:31 am

          LOL. Will work on it

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          • thea
            December 14, 2011 at 8:00 am

            Would like more written stories/blogs etc, do not have sound card on computer so can’t hear any of these videos..they kinda lose their punch without sound?

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          • Doug Farrago
            December 14, 2011 at 8:14 am

            Understandable. I had some videos done already and needed to get out a few extra this week. Won’t always be like that.

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          • Chris
            December 15, 2011 at 11:20 am

            Dear Doug,

            Not only do I want full articles on the page and written articles instead of videos, but I also want to have $100 deposited into my bank account each time I click onto your sight. And world peace.

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          • Doug Farrago
            December 15, 2011 at 11:25 am

            Done and done.

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          • tom walsh
            January 11, 2012 at 7:52 am

            These same people who can’t fathom going “back and forth” to read an article are the same ones who had difficulty with ‘butterfly” ballots in the 2000 elections in Florida.
            I have been enjoying your articles for quite a while and have no problems with the layout. Keep up the great work!! And, thanks.

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          • Doug Farrago
            January 11, 2012 at 7:54 am

            Thank you, Tom!

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          • Connie Severin
            February 8, 2012 at 1:09 pm

            Thanks for the new format! Jumping between responses and articles was a nuisance. I like being able to read everything in only one, maybe two spots at one read. It also makes it easier to check on new entries to the comments all at once, rather than having to check for each separate article.

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        • Richard W. Mondak
          February 22, 2012 at 12:21 pm

          I have a short attention span, so reading part of the article and assuming I know what is being stated is par for the course for me. I often shoot par – 36 on the first 5 or 6 holes – so why play more?

          I don’t mind procrastining to READ MORE>> later

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      • Ariel
        December 8, 2011 at 8:58 pm

        Agree with Mr. Chase. Thanks for looking into it!

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        • Sharon
          December 28, 2011 at 10:10 am

          I totally agree with Chris!

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