Authentic Medicine Gazette

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

Blogs and Thoughts for February 14th to February 20th, 2019

Here is what we had this past week:

  1. Is It Time To Fire Your Doctor?

  2. ARB Recall by Steven Mussey, M.D.

  3. Parental Leave for Residents

  4. This Sceptred Aisle by Pat Conrad MD

  5. Ridiculous Study of the Week: Physical Activity in Sick People

  6. Friday Funny: Marco…

  7. Quote of the Week: Willy Wonka


  1. It’s Time To Fire Your Doctor?

February 20, 2019

I was just blown away when I read this article the Wall Street Journal. It is such a perfect example of the disrespect we physicians are getting. The title is It’s Time to Fire Your Doctor by Andy Kessler. Here is Andy’s bio:

Andy Kessler is the author of Inside View, a column he writes for The Wall Street Journal on technology and markets and where they intersect with culture. He is the author of several books including Wall Street Meat and Eat People. He used to design chips at Bell Labs before working on Wall Street for PaineWebber and Morgan Stanley and then as a founder of the hedge fund Velocity Capital.


So, obviously, he truly is qualified to give advice in this area, right? Here is a summary of his thoughts with mine in parenthesis:

  • Let’s say you, like me, are one of the 20 million Americans who work for themselves—no boss, but also no corporate-tax deduction for health insurance. The smart move is to get a high-deductible insurance plan. Now it suddenly matters what doctors charge: $500 to take your blood pressure and bang your knee with a rubber hammer, $1,200 for a blood test that uses pennies worth of chemicals to tell you your hemoglobin levels are fine. Plus four months to get an appointment, and then the doctor asks you to fax an authorization. What? It’s 2019. It’s time to fire your doctor. (Dude, you just made the case for Direct Primary Care. Get a high deducible plan, pay the membership fee of $80, there is no cost for the BP check, $10 for the HbA1C test, and get in the same day with no extra office fee. DO SOME RESEARCH, ANDY!)
  • He has a Fitbit, an Apple Watch, an Omron BP cuff, home labs through WellnessFX, a Beautyrest Sleeptracker and he is all set to fix himself. (I like toys too. It’s what you do with that information that counts, Andy. It’s like someone at home playing the Stockmarket on his computer and calling himself an expert.)
  • When you do get sick, you still need to see a doctor—they have that prescription pad. But insurance companies tired of overpaying for five-minute doctor visits have begun setting up alternatives. Sutter Health runs walk-in clinics for $129 a visit. Online care is cheaper, so Anthem Blue Cross encourages customers to use LiveHealth, a videoconference platform, for $49. Aetna has a deal with Teladoc, a $4.5 billion public company, for $38 consultations. No pain meds, of course, but almost everything else. (Insurance companies are tired of overpaying for five-minute doctor visits? Dude, they caused the five-minute doctors visits! You just proved whose pocket you are in…the insurers. Then you extol their virtues. And your answer are walk in clinics that they want manned by LELTs. You get what you pay for.)
  • Technology has moved so fast that several smartphone-based platforms now function like Uber for doctors: Doctor on Demand, PlushCare, Amwell and MeMD are cutting into primary care. These are gig-economy doctors who provide care on demand for, well, gig-economy workers and others without employer insurance coverage.(Go ahead and keep your “Gig Docs”, who don’t know you and will give you anything you want. I guarantee most of them suck and are just in it for the money. And why is it that tech people always think they are smarter than doctors and that tech will put us out of business?)
  • Taking charge of your health care can be complicated and is not for everyone, but it’s doable for most. I’d stick with services that hire doctors from top 25 medical schools. (Oh, yes, you are so brilliant. The other medical schools are bad, I guess? Your tech is the answer to discover all your medical diseases but it can’t find another way to find better doctors?).
  • For now, when you inevitably and repeatedly fill out the prescreening paperwork, specialists always ask for the name of your primary-care physician. I put down “Dr. Webb.” (What a disrespecting douche you are. A hedge fund guy, who never truly helped anyone else now belittles the most noble profession. Wow.)
  • Data, data, data—the more the better. As I write this, I have a Fantastic Voyage-like capsule near my stomach transmitting pH levels. How cool is that? As this technology progresses, more tests and more capsules will fill databases with personalized information. (More data? How did the full body CT Scan fad go in the past? That was a lot of data. And a ton of false positives. Good luck with your pH monitor. That will tell you a lot. Actually, I can’t stop laughing as I write this.)
  • The revolution is coming. But not from your doctor. (Uh, yeah, there is a revolution coming. It’s called Direct Primary Care, by DOCTORS, where we go back to the roots of our profession and give comprehensive, accessible and personalized care).

I am just amazed at the arrogance of some non physicians. People have no problem hammering what we do and then get offended when we defend ourselves. Whether it be these tech idiots or LELTs, somehow we have to be careful pointing out our years of training and education that separate us from them. Can we work together someday? Sure. But when you start out saying doctors are not needed, or we are just as good as them, then you are itching for a fight.

Lastly, Mr. Kessler, why do doctors go to other doctors if they are not needed? You would think we could just use all the tech and our training to remove our own doctor from the equation? We don’t because we are not that egotistical to think we can do it all. And we are not idiots.

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2. ARB Recall by Steven Mussey, M.D.

February 12, 2019

This recall of the ARB’s (Angiotensin Receptor Blockers) is wreaking havoc on doctors and pharmacists. It started with Valsartan.  So, we switched people to Losartan.  Then Losartan was recalled.  We tried Olmesartan but the insurance companies rejected the switch due to costs.  We then tried Irbesartan, which worked… until the recall hit Irbesartan.  Now, all three of the affordable drugs are unavailable.  Uh… Oh, yeah!  Telmisartan might work! Then, the stories came out:  All the “sartans” are suspect!

No one is communicating to the doctors!  We’re out here on our own, trying to figure out how to keep blood pressures controlled without causing side effects or cancer!The FDA looks totally incompetent!

Big pharmacies look absurd with their letters to patients:  “Your drug may… or may not be causing cancer.  We’re not sure.  Ask your doctor!”  (Since when do doctors track lot numbers and generic manufacturers when they write for a medication?)

It is every hour of every day!  Letters in the mail with lists of patients but no useful information!  Calls and faxes from pharmacies and patients!  Everyday, patients are coming in who have stopped ALL their medicine because they don’t want cancer.

This is insanity!


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3. Parental Leave for Residents

February 18, 2019

I run the risk of pissing a lot of people off here but this study just gives me pause. Here is what it found:

Leave policies for residents who become new parents are uneven, oft-ignored by training boards, and provide less time off than similar policies for faculty physicians. 

 Though all 12 schools provided paid childbearing or family leave for faculty physicians, only 8 of the 15 did so for residents (JAMA. 2018 Dec 11;320[22)]:2372-4).

In programs that did provide leave, the average of 6.6 weeks of paid total maternity leave for residents was less than the 8.6 weeks faculty receive.

Okay, this is interesting. For one, I agree that there has to be some unpaid maternity leave for ALL schools. I get that. But who says that it has to be equal to the faculty? This is their full time job. This is their careers. The others are in training. They are residents. They are not equal. I know this sounds harsh in this politically correct climate but not everything has to be the same. Should a surgery resident in his third year get 8 weeks for a his first kid’s birth while the other seven residents get destroyed on their rotations? I know we are trying to be more kind to this situation but there is a bigger picture here. There is only a finite amount of residents doing a ton of work. It’s just not that simple. Residents are just not equal to faculty members. Am I being too harsh here? I would love your thoughts on this.

EDITOR’S NOTE: Obviously this hit a nerve. I want to point out a couple of things. One, see the second line in the paragraph above. “For one, I agree there has to be some unpaid maternity leave for ALL schools”. Ladies, I am on your side!!! My real question is whether residents, who are in training, are the same as faculty in the AMOUNT of time needed off. Should they be equal? Should they get the same pay? The same amount of vacation? The same days off for maternity leave? Or what about paternity leave? Is that different?

Lastly, are we at a point that a question can not be asked without being hammered? People now claim they lost respect for me. What? I openly asked for your thoughts. Can we do this in a civil manner? 

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(no more comments on this on. It’s all been said and there is no point)

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4. This Sceptred Aisle by Pat Conrad MD

February 17, 2019

It’s sort of shooting low hanging fruit in a barrel, but is there ever a wrong time to make fun of production-line health care?

The land that brought us Monty Python and is now banning scary-looking knives is also an epoch leader in the “health care is a right” thought disorder, and as ever is short of cash.  The United Kingdom National Health Service has overbooked and overworked their GP’s to the point that they are making plans for group visits, in groups of up to 15, and included in the new 10-year plan.  Patient advocacy groups say that patients would feel “incredibly uncomfortable,” to which I say Thhhhhffffbbbpppptttttt!  The taxpayers have felt incredibly uncomfortable for years funding this expenditure without end.  And what about the GP’s?  How exactly did a shortage occur, if they were trained and paid appropriately?  Patients are getting more of the consequences of the public policy they have chosen since 1945, and they deserve these rewards. 

 “Doctors at the Royal College of GPs’ annual conference yesterday said the groups were a ‘fun and efficient’ way to carry out consultations with patients who shared the same conditions.”  Which is proof that the AAFP has a branch office in London. 

 “Doctors using group consultations said they had proved far more efficient at dealing with a host of heath complaints, including arthritis, diabetes, obesity, and even treatment of erectile dysfunction.”  Oh, I’ll bet!  “Gladys, you’ve stuff down any more boiled kidney pie and you’ll weigh 3 stone more, priming yourself for the arthritis Beatrice keeps complaining about all the while refusing to exercise, and Gertrude here can’t get any wink-wink, nudge-nudge from ol’ Tom, who’s just joining us today because he can’t wake up his old fellow, isn’t that right Tom?” 

“Under the system, patients will spend much of their time with a “facilitator” – a receptionist, clerk or healthcare assistant with a day’s training – who can point them to advice on their health condition, the conference was told.”  That sounds familiar.

 Okay, now everyone take a deep, calming breath before this next, realizing that it isn’t parody:

 “GPs said patients were given forms telling them to respect confidentiality, and told: ‘What’s said in the room stays in the room; don’t go discussing it with the postman and his dog.’”  By now Tom’s troubles have made it around the pub.

 Before we laugh too hard, we should remember U.S. voters watched this mess unfold – and then instituted Medicare.  We saw it get worse in Britain, and we expanded Medicaid.  We have several decades of experience in embracing bad ideas incrementally without arguing against their central flaws.  Which makes us dumber than people who habitually eat kidneys and deliberately watch soccer.

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5. Ridiculous Study of the Week: Physical Activity in Sick People

February 16, 2019

Okay, so you are not going to believe this, but:

Participants with chronic disease undertook 9% or 61 minutes (95% confidence interval: 57.8–64.8) less moderate activity and 11% or 3 minutes (95% confidence interval: 2.7–3.3) less vigorous activity per week than individuals without chronic disease. 

To be clear, it is not saying that those who exercise less may get more diseases. That would be interesting. No, this study says that people who are sicker undergo less moderate and vigorous exercise. No shit!

And that is why this is this week’s winner of of “Ridiculous Study of the Week”. Congratulations. 

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6. Friday Funny: Marco…

February 15, 2019

I did not make this up. It’s scraped from the Internet.

Please Leave A Comment HERE

7. Quote of the Week: Willy Wonka

February 14, 2019

“A little nonsense, now and then, is relished by the wisest men.”

Willy Wonka

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  84 comments for “Authentic Medicine Gazette

  1. Wandal
    January 31, 2018 at 10:57 am

    Love the Gazette, Doug. One thing: We see lots of fads in society, including in medicine, and the latest one is “physician burnout”. Seems every medical publication now has to have a feature on that . . . or at least a comment or letter to the editor. I’m sure there is an element of truth in all of that BUT part of me wants to say ‘what a bunch of cry babies’. There are a LOT of people out there that just don’t get it: They see the salaries of physicians consistently near the top (especially specialists!!), look at the income they and their friends/family/neighbors have and get pissed off. Life and work are hard on a lot of people; more so than on physicians. Income disparity is very wide and growing in this country and it is causing a lot of ??? anger, envy, voting for Trump ??? Just saying . . .

    • bobby garrison
      February 7, 2018 at 3:30 pm

      up yours. way to blame the victim. I can’t have a problem ’cause other people have problems too?? I can’t have a problem ’cause other people don’t make as much money as I do?? Are you out of your mind? Please tell me you are not a physician as you seem to have lost all empathy (and possibly sympathy.)

    • Frank J. Rubino MD
      March 8, 2018 at 10:48 pm

      I don’t think “burn out” is the issue. It is anger. Deep seated anger to the nonsense in health care.
      Meaning less metrics , meaningless MOC crap, Quality measures, etc. ANGER.

      • Mary Lang Carney, MD
        March 28, 2018 at 9:38 pm

        Frank: I totally agree with you!! When will the stupidity end?

        • Frank J. Rubino MD
          April 16, 2018 at 7:38 pm

          Hi, good to hear from you.

    • James Tinsley
      January 30, 2019 at 1:28 pm

      I would also like to add a hearty up yours. What do you do for a living? I just finished working 11-12 hours a day for over a year. No lunch and 2 bathroom breaks. My daughter cried to me twice and said I was never home. Once on fathers day. I missed all my son’s track meets and half his boy scout meetings. My boss and a rep from the Chief of staff said it didn’t matter and to take work home with me. I was going to quit my childhood dream of being a family physician until I found DPC. You say this is endemic in society? I say BS. I burned out like many of my associates. Please tell us what your job is. If it’s a doctor tell us what specialty and how many hours a week you are working.

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

    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.

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

      See my email to you

  3. 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?


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


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

    Please encourage the KOM to join his friends at QC13.

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

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

      I will try.

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

      The Bush you quote was #41.

  5. 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?

    • 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.

      • 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!

    • 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.

      • 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

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

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

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

          Dear Bill.

          F*** You.


          An orthopedist.

    • 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.

    • 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.

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

      thank goodness in 2017 it is a physician

      • John A Goldman
        July 21, 2018 at 4:23 pm

        But now we are screwed – It is a Pharma CEO who wants more part D (His company drugs are injectables) -what a farce

    • James Tinsley
      February 6, 2019 at 1:52 pm

      Great observation. Shows how little the government really cares about the health of the individual.

  6. 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………….

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

      I agree

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


    • 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.

      • 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.

      • 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.

        • 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.

          • 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.

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

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

  8. 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!

  9. 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?

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

      Each entry is a blog and has their own comment section

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

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

  10. 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.

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

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

  11. 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.

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

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

  13. 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.

    • 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?

      • 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.

    • 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.

      • 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.

    • William Braswell MD
      December 13, 2018 at 11:23 pm

      DM2 is the metabolic syndrome caused by simply sugar in the pie-hole that does not belong there. But if we forbid the sugar then the statin industry will bankrupt and crash the stock market. Reboot yourselves by reading HDL in wikipedia. Simple first year pathophys that is brainwashed out by the end of residency. It takes about 6 years of solo practice before the lights start going off and we wake up. If you never solo practice then all your 1/4 milion in loans were a waste of time and you will forever be stuck in an inbreeding circle of backbiting fearmongering arogants sucking your life out. No one is denied pain! My name is Bill and I am arogant and angry! My only hope has been the Serenity Prayer. Beautiful rant, huh!

  14. 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?

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

      You got it!

  15. 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.

  16. 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).

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


  17. 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.

  18. 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!

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


  19. 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!

    • 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.

    • 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.

    • 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.

  20. 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.

  21. 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.

    • 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.

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

        Hopefully you will find them in the future

  22. 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.

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

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


    • 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.

    • 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.

      • 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!

        • 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)

  23. 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

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

      Ok, will work on it.

      • 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 >>>

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

          LOL. Will work on it

          • 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?

          • 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.

          • 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.

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

            Done and done.

          • 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.

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

            Thank you, Tom!

          • 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.

        • 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

      • Ariel
        December 8, 2011 at 8:58 pm

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

        • Sharon
          December 28, 2011 at 10:10 am

          I totally agree with Chris!

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