Write, Wrong, or Whatever

I haven’t been able to write as many blogs lately because I’ve been sitting by my phone or computer waiting for people to send me photos of their latest meal. No! Really! It’s apparently the latest thing.

Okay, actually. I spent the last weekend in Virginia Beach. My wife and I walked miles and miles—on the beach side, on the touristy shoppe side, and everywhere in between. Being local, we did not purchase salt water taffy, T-shirts with semi-obscene sayings, nor even hermit crabs (my weakness on our last trip). We did, however, have a number of amazing meals, and a fantastic time just being together.

However, around the strolls, meals, naps (Excuse me, but once I received my Medicare card, I began to believe that naps are a medical necessity—at least on weekends) I did get a lot of writing done on one of my stories. I have no idea if it is going to end up as a short story, a novelette (which is a contradiction in terms), or perhaps something else. All I can say is that when the protagonist (or, the antagonist, depending upon your point of view) is a not-quite-dead guy, the story takes a lot of writing, rewriting, editing, etc.

Should I blog the story? ePublish it? Try to get one of the n^99 cable channels to make it into a mini-series?

All I can say is, stay tuned!

Fast Food

I grew up in the sixties and worked at McDonalds for a while. Food was cheap, appealed to the teenage palette, and was strictly counter service—no drive through or dining room. I used to say that suffrage—the right to vote—should require proof of having worked in a fast food restaurant. It taught people how to interact with others, what customer service meant, and, yes, a little humility.

Today, fast food is definitely not fast and nutritionally, just barely food.

There are times when I’m either on the road or in a hurry and stop at one of the ubiquitous franchise food stops. I usually go inside because: a) The ham radio antennas on my car don’t clear the overhang, or b) if it’s a road trip, a restroom stop is a prerequisite to eating, and c) I get to see the actual operation. Seeing the operation is best avoided. Today’s fast food routine requires:

  1. Priority number one is to socialize, which in my fast-food days was met with, “Hey! Get back to work—I’m not paying you to play grab ass!”
  2. There are no longer any standards as to how long food is kept. It may have spent three weeks under the warmer, but it still takes 20 minutes to put it in a bag and bring it up to the counter.
  3. There is no reason to worry about keeping soft drinks or coffee available, and no reason to tell a customer when the order is placed that certain items are not available.
  4. Food must be presented in such a way that any sauce, condiment, or other stain causing liquid or semi-liquid is placed on the bun to ensure that at least 67 percent of it will drop onto the customer’s lap.
  5. All French cries must have enough salt to clear 1¼ miles of ice encrusted, six-lane interstate.

Maybe I got it backward. Maybe it’s not the voters who need fast food experience—maybe it’s the elected officials—who should be required to spend 1½ times their tenure in office working fast food after they leave office. It just might change their attitudes a bit.

Just a thought.

Twitter

I can barely keep up on e-mail, so I don’t do much with most forms of social media—especially Twitter.

Why?

Twitter would be the comparative to twit, such as, “He’s more twit than his brother.”

The superlative, of course, would be twittest. Fortunately, so far at least, that is not even recognized as a word.

Oyay! Oyay, ye Rolling Stones!

Who would have guessed that in 1965, the most accurate prognosticators of the twenty-first century would have been the Rolling Stones?

I mean, give me a break!

“Hey, you get off of my cloud!”

Computer technology—which was quite limited in 1965—has today become so cloud dependent—forty-plus years after their warning.

More importantly, today there are hackers at every turn . . . . It’s almost eerie. How did Keith Richards and Mick Jagger know what was coming? They are the two most unlikely people . . .

Unless you’re a fan of Men in Black, in which case, that explains a lot.

On the other hand, Will Smith and Tommy Lee Jones–as much as I love their acting–have always struck me as just a bit different.

Do you know what I mean?

Fixing Healthcare – Part Three

Physician’s Assistants (PAs) and Advanced Registered Nurse  (ARNPs) are helping lower costs and increase access. While some nurse practitioners, can operate relatively independently; other nurse practitioners and most physicians’ assistants, cannot. Why?

Physicians are adamant that they maintain a high degree of control over these and other healthcare workers. This is a throwback to the nineteenth century—which is kind of interesting in a weird sort of way. The story, and I cannot vouch for its accuracy, although all my research seems to support it, is that the country was besotted with traveling medicine shows hawking patent medicines (You’ve seen it in the movies—“One for a man, two for a horse”). The physician industry supposedly promised to get things under control if they were put in charge of medical practitioners, i.e., physicians and surgeons (MD). It, at best, minimized, if not blackballed, osteopathic physicians (DO), chiropractors (DC) and chiropodists, now known as podiatrists (DPM).

A physician, at the time, could authorize any hireling under his license to perform any duty under the concept that the doctor was “the captain of the ship” and was responsible for everything. Therefore, he had authority to authorize any employee to do anything—hopefully, but not necessarily, after some training.

Today, many non-physician healthcare workers are licensed in their own right; in most states this includes nurses (of all levels), therapists (of all varieties), and technologists (ditto). These people are trained and possess technical skills that physicians do not. Generally speaking, only television doctors leave their practice in order to operating high technology devices. It’s good theater but bad economics.

Many of the other healthcare careers such as nurse practitioners, physicians’ assistants, etc., have made significant advances Unfortunately, old attitudes die hard, and there are too many physicians who try to maintain an inordinate control over everything, including these other professionals. Nurse anesthetists and physicians’ assistance must be “supervised” by a physician, although such supervision does not require actual observation or even the presence of the supervising physician.

Efforts to keep others under control have led to some bizarre arrangements. In radiology, for example I’m told that the technologists are now required to periodically retake the examination that initially proved their competence even though there has been continuing education requirements for 40 years. If true, I believe this is a unique requirement, but a warning to all others. Of all the physicians’ assistants, only those specializing in radiology are not permitted to interpret x-ray or other diagnostic images.

Why?

Some blame the American Medical Association, a very powerful organization with effective lobbyists. However, it apparently speaks for a self-selected group of physicians. Out of 923,308 practicing physicians, the most recent numbers available indicates that only 228,000 belonged to the AMA. If you don’t round, that’s just less than 25 percent.

Nobel Laureate Milton Friedman and his wife, who wrote the book Free to Choose, asserted that the AMA functions more like a guild with the goal of increasing physicians’ wages and fees by limiting both the supply of physicians and the competition from non-physician groups.

This is yet another issue that must be addressed if we are truly interested in fixing healthcare.

To Err Is Human—To Really F*** Up, You Really Need a Computer

I admit that life demands a place over blogging. I admit that faith, family, friends, work, and keeping up with laundry, mowing, etc. get in the way, too. However, over the past few weeks, I have actually written a few blogs, but my computer would not let me post them, and then they disappeared.

Eventually, I realized the truth.

Whenever I arrive home—early, late, whatever—Louis (our dog) expects to eat. Whenever Adam, my son is gone, his cat demands attention from me—lots of attention—just so long as I don’t try to actually pick her up and hold her.

OMG*, my computers have developed similar traits. If I don’t pay them adequate attention, they act out—obvious passive aggressive actions.

First, it’s a slowing of all functions followed by lost files. Something like:

Me: “Open blog May 2, 2017”

Computer: “                                                                                        Huh?

Okay.”

Then the computer moves to:

“I can’t locate the file.

What application do you want to use to open the file?

The file is corrupted and cannot be opened.

Ooops! The dog ate my files—I mean file not located.”

I’ve been busy looking at new computers online—using the offending computer—but it has such an inflated opinion of itself, it doesn’t seem to care. It just might be in for a big surprise. Feel free to castigate my offensive hardware.

 

 

*Others May Question (my sanity)

 

Medical School Rationing

Fixing Healthcare – Part 2 — Doctors

I’ve known many intelligent, talented, committed young people who aspired to become doctors, but couldn’t get into medical school. Some were resigned to their fate and used their degree in biochemistry to become medical technologists; others made arrangements to attend medical school outside the United States—primarily in the Caribbean. In one case, in order to study at a school in the Caribbean, the aspiring medical student’s parents sold virtually everything to finance her education. She’s nearly complete with her rotations back here at US hospitals and plans on serving rural or tribal underserved areas.

While we don’t have enough graduates of United States medical schools, we grant 85,000 special visas to foreign medical graduates every year because it’s a “critical shortage.” Today, roughly one quarter of all practicing physicians are foreign medical graduates. I’ve worked with many, and while their initial desire is to return home, after about six months the sports car and the arm-candy significant other appears. When I ask if their plans have changed, I’ve been told, “If I return home, I will be paid in chickens and melons. If I stay here, I will be paid in dollars. I like dollars better than chickens and melons.”

So, we import thousands of non-American doctors every year even though we have many Americans who want to study medicine but are turned away.

A decade or so ago, when more students wanted to study law, the educational industry had no difficulty in adding seats—even if they had to build new schools. Why won’t (not can’t) we do the same for medical schools?

Some claim there wouldn’t be enough residency opportunities if we graduated more doctors from US schools, yet foreign medical graduates can and do get residency positions at US hospitals. In any other industry, this might be viewed as restraint of trade.

I suggest that the goal of US medical schools should be to increase their capacity so that by 2030 ALL US residency openings can be filled with US citizens who graduated from US medical schools.

Next, I would change the entry criteria to include the following:

  1. Accepting students with a commitment to actually practice medicine; better yet a commitment to practice whatever type of medicine is in short supply, wherever needed, for at least three years. After that, every accommodation should be made to place that individual in a residency or fellowship of their choosing for which they have the talent, without a decrease in salary.
  2. While academic achievement is important, the ability to work as a team is critical. History is full of brilliant people who didn’t succeed because they could not work with others, and medicine is now a team sport—whether the person with MD or DO after their name likes it or not, they are teammates with the nurses, technologists, therapists, etc. No one is a superstar.
  3. Children of doctors or other elites should have to prove themselves more—not less—than other medical school candidates. They’ve grown up exposed to the field, often in an environment of privilege, so they should demonstrate their desire to serve, not their pedigree.

In short, we need more doctors, but our current method of selecting them is less than optimal.