Authentic Medicine Gazette

The Authentic Medicine Blog has grown and we now have 13 writers.  All are doctors or “doctors to be”.  Because of this, we will be having about two posts EVERY DAY!  The Authentic Medicine Gazette will be more of a newsletter highlighting the top blog posts of the week as well as adding some other things.  You will still get links to each post that was done.  So, enjoy our most current issue of the most popular medical e-newsletter on the internet.

Here are the most popular blogs from September 16th, 2021 to September 22nd, 2021


A Note to Dr. Sircar

by a Russell Kamer MD


But They Look Good…

by Pat Conrad, MD


Big One Coming

by Pat Conrad, MD


All the Blogs for September 16th, 2021 to September 22nd, 2021:

  1. Songs Announcing Implants as Christmas Presents #2
  2. Big One Coming
  3. A Note to Dr. Sircar
  4. Are You Going Through “Changes?”
  5. But They Look Good…
  6. Friday Funny: Stick
  7. Quote of the Week: Dale Carnegie

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107 thoughts on “Authentic Medicine Gazette

  1. 22

    Hi Doug,
    As a reader for a number of years, I much prefer the old format, where I could see all the articles for that week and read them directly. Now I have to click on the title to view the article in that week’s Blog. It’s an extra step, that takes extra time. Thank you for consideration of my comments.
    Dennis Kabasan, MD

    1. 3

      It’s the best system I could come up with. All you have to do is hit the Daily Blog on the menu header

      1. In addition to hitting the daily blog, we can hit the unsubscribe button.
        I, too, liked the “old” format. Sorry Dr Doug, but you can do better
        tom walsh

      2. Doug, you don’t understand! Dennis liked the other way better. Next time, check with Dennis before making any changes.

  2. 6

    CBS NEWS Reported tonight 4/18/2019:
    ” Dozens of people, including 53 medical professionals, have been charged for their alleged participation in the illegal prescription and distribution of opioids and other narcotics, Justice Department and Department of Health and Human Services officials said Wednesday. Federal law enforcement and health officials held a press conference in Cincinnati where they announced charges resulting from the Appalachian Regional Prescription Opioid Strike Force takedown operation that began only four months ago. ”

    I wonder if these “Doctors” were “Board Certified by ABMS”? Board certification would have prevented all this would in it ???? It has to, doesn’t it? Anyone certified by the American Board of Medical Specialties confers the Goodhousekeeping seal of approval. It is like United Laboratories that approves electrical wiring. It is like Apple Pie and America. A Board Certified
    “doctor” would never prescribe 800 vicodin tablets per month in exchange for money and sexual favors from his patient. Board Certification from ABIM or ABFM prevents all this! Doesn’t it.


    1. 4

      You can easily determine if they were board certified by visiting the ABMS website.

      I don’t understand how board certification has anything to do with this matter. Board certification, MOC and recertification evaluates a physician’s body knowledge, in a specified specialty, at a certain time. Although it would be nice to think so, board certification does not affect or measure their (physicians) ethics, honesty, integrity or morals.

    2. The ABMS certified thousands of physicians that have “life” certification. Thus they never have to recertify.

      ABMS, although it’s the largest, is not the only legitimate physician board certification organization in the U.S.

      Board certification has absolutely nothing to do with a physician’s ethical or moral integrity or character. Board certification denotes that the successful candidate successfully demonstrated he/she possessed a certain level of understanding and knowledge, at a specific time, period.

  3. 2

    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 . . .

    1. 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.)

    2. 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.

    3. 1

      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.

      1. Practicing medicine is a worthy and rewarding profession and way of life.
        Working for The Man is a mental, emotional and moral catastrophe.

  4. 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.

      1. I am happy to report that now, in June of 2019, I am getting the new comments with this new format, althuogh the old posts like this one are tagged on to the end of the comments. Almost as cooperative as moving from Dairyland to EPIC. 🙂

  5. 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.

      1. The Placebo Journal was “right on the money” for years. As it evolved, and as non-clinical people became aware of the publication, the parody/farce/realities of clinical practice lost their bite. The anger and outrage at what we physicians had to endure as we lost control became replaced by the banal. I loved the Journal and the earlier editions of the Gazette for their genuine expression of what I was experiencing every day. Now, anger and outrage have been replaced by despair for many of us. I quit practice five years ago.
        The blog has nothing of what the Journal had. The laughs are gone along with the decision trees. The newest incarnation of the Placebo Journal is boring and trite. I will stop reading your publication, because it has none of the originality of the Journal. Since I will not be reading any response by you, there is no reason for you to respond. It WAS fun for years. Thank you for that.

        1. Hope you feel better about yourself now that you got that off your chest. Reading this again it seems you probably changed. You were probably fun and even laughed. Now you are a bitter, boring, douchebag. So what you wrote was actually about yourself. You’ll be missed,

          1. Sorry Doug….but I have to agree with Gerals S. For you to cal l him out as a bitter, boring d….bag crosses the line. I am gone to. I used to read all the time….but Gerald is right.

        2. There is NOTHING better to read than JANE ORIENT who edits the J of the AAPS. She has such tremendous perspective.

  6. 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?

    1. 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. 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. 1

      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.

      1. 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

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

    3. 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.

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

  7. 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. 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.

      1. 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.

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

        1. 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.

          1. 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.

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

  8. 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.

  9. 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.

  10. 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.

      1. 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.

    1. 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.

      1. 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.

    2. 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!

  11. 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?

  12. 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.

  13. 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).

  14. 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.

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

  16. 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!

    1. 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.

    2. 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.

    3. 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.

  17. 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.

  18. 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.

    1. 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.

  19. 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. 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.

    2. 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. 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!

        1. 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)

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

          1. 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?

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

          3. 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.

          4. 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.

          5. 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.

        1. 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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