Monday, September 29, 2008

That Familiar Smell Is...Janet Reno???

Check out the latest stunt by the devotees of His Worship. You can almost hear the goose-stepping boots. You can almost smell the burning "fundamentalist" compounds. Not so fast, ATF snipers! Your job security just went through the roof! I guess this is the Obama cult we can get used to for the next few years.

Resistance is futile. Dissent will be crushed.

Tuesday, September 23, 2008

Funding Medical Research - the Cruel Calculus of Inequity

The leading causes of death in 2005 (and the number of people who died as a result) in the United States are listed below.

1. Heart disease 652,091
2. Cancer 559,312
3. Stroke (cerebrovascular disease) 143,579
4. Chronic lower respiratory diseases 130,933
5. Accidents (unintentional injuries) 117,809
6. Diabetes 75,119
7. Alzheimer's disease 71,599
8. Influenza/Pneumonia 63,001
9. Nephritis, nephrotic syndrome, nephrosis 43,901
10. Septicemia 34,136

What I would like to point out is that the deaths related to Human Immunodeficiency Virus and AIDS for 2005 totaled 16,865. In 2006, the number of deaths declined to just over 14,600. Please compare to the above numbers.

Now take a look at the U.S. Federal funding and compare.

HIV/AIDS: $2,921,000,000
Heart Disease and all related research: $ 5,510,000,000
All Cancers (including childhood cancers): $ 7,862,000,000
Stroke/Cerebrovascular Disease: $ 342,000,000
Chronic Lung Diseases (including smoking and tobacco research): $ 2,089,000,000
Accidents: $ 729,000,000

You get the idea. There seems to be little rhyme or reason to the funding strategy. In 2005, the government spent nearly over 53% as much on AIDS/HIV research as it did on heart disease research. This, at the same time that deaths due to heart disease were over 38-times as common as deaths from AIDS. When a simple formula is used to compare the amount of money spent per death by each disease (perhaps a better measurement of the tangible emphasis placed on each disease), the results are as follows:

HIV/AIDS: $173,198.93
Heart Disease: $ 8,449.74
All Cancers (including childhood cancers): $ 14,056.56
Stroke (and cerebrovascular disease) $ 2,381.90
Chronic Lung Diseases: $ 15,954.72
Accidents (including childhood accidents): $ 6,187.98

Is this kind of analysis cold and unfeeling? Possibly. Don't believe me? You are welcome to do the math yourself. I got my figures from the National Institutes of Health. Just keep in mind - these are exactly the same kinds of analyses that will be performed by whoever ends up holding the keys to our healthcare alone and without competition.

Another interesting fact about the numbers from 2005: We spent $2.7 Billion on researching "Health Disparities" and another $2.4 Billion on researching "Minority Health Care". I wonder how many lives of all colors this $5.1 Billion might have saved - I am guessing quite a few. It nearly equals the amount spent on researching our number one killer, heart disease.

This same government is the one to which we are asked to entrust our health care under a government-dominated single-payer system. If this should happen, I believe there are two possible outcomes. Either the government will continue this ridiculous and indefensible disparity in the outlays for research funding, out of fear of the rabid special interests, or they will realize that the only pragmatic course is to base funding on the actualities of the impacts of these various diseases. Somehow, I feel sure that those that support AIDS funding well over and above its due will not go quietly.

I ask you to examine yourself. Don't worry, there's nobody around. Let yourself go to the logical place it wants to, without fear of retribution from those who oppose that logic. Ask yourself these questions...

1. How many people do I know personally who have had heart disease, stroke, or cancer?
2. How many people do I know personally who have had AIDS or HIV?
3. How many dollars have I personally seen spent on catheterizations or open heart surgery for heart disease, on MRIs and CT scans for strokes and suspected strokes, on medications for heart disease or cerebrovascular disease, on chemotherapy and/or radiation for cancers?
4. How many innocent children are we willing to sacrifice to childhood cancer?
5. Is it fair that we spend nearly two thousand percent more per capita on AIDS and HIV research than we spend on the number one killer in America, Heart Disease? Or that we spend seventy-three-thousand percent more on HIV/AIDS per capita than is spent on stroke and cerebrovascular disease, a disease that killed nearly nine times as many people?Is this justifiable, by any stretch of the imagination?
6. Is it equitable to spend the same amount of precious federal research funds on researching health inequity and minority health care as we do on heart disease?

I have already made it clear how I feel. Now I invite you to make your own conclusions. Is AIDS research important? Of course. It is critical, however, if we are to call ourselves a nation that practices "evidence-based" and "outcomes-based" medicine, that we either justify this seemingly ridiculous disparity, or that we correct it.

People are dying as we speak. Let's get this right.

Wednesday, September 17, 2008

How Liberals See Us

Here's a fun column.

It's by the Socialist heroine Maureen Dowd who writes for the NY Times (duh). It's just good to remind ourselves from time to time just how this bunch of insulated New England island-dwelling ivory-tower types see those of us on the outside of their little bubble.

Things like Christianity and the Constitution must be so irritating to a moral relativist like Dowd. They are so...well...rural. Just remember that Dowd would describe you and me in exactly the same sort of sneering, elitist fashion. And then remember also that this is one of the people who claim that they are the champions of the "common man and woman" [read simpleton rubes].

This is the kind of person who loudly champions Obama. And if the old adage is true about the company you keep, then it is as good a reason as any to vote for his opponent. Power to the people, indeed.

Obama's Enigmatic Health Care Plan: Q&A over.

"No need to reply. I'm done with your blog."

Oh, well. Marcia has heard enough of my opinions, and thinks I'm an insensitive, arrogant, "neocon" Bill O'Reilly disciple. What a pity. Self-righteousness is so unbecoming. In typical fashion, she snipes and then runs. Oh, well. It's my own fault. I should have known better than to engage with a 9-11 truther moonbat. All bluster and no substance. Sadly, our country is filled with them.

Their fear is palpable. They are so terrified that the world is beginning to see the futility and selfishness of their "throw money at it to make ourselves feel better" policies.

At least now the nature of the debate can be seen for any who care to see. The response they desire is for those who advocate personal responsibility to wither under the accusation that they are heartless. If we do not, then they snipe and run, snipe and run...

This was actually pretty fun. It's a shame she quit when it got interesting. Guess she used up all her big words.
It's not unlike driving a car, blogging. There is a security in the anonymity - the same phenomenon that makes an otherwise meek and quiet mom become a horn-honking, cursing maniac when behind the wheel. Sometimes people make themselves feel pretty big and powerful despite their insecurities. I probably do that, too, to some degree.

So three cheers for Marcia. She did her good liberal deed for the week. She typed out the commie talking points just like she was indoctrinated to do, peppered with personal attacks and the seething rage and hatred that only the liberals have really been able to perfect.
Da svidanya, comrade Marcia. You will be missed.

Tuesday, September 16, 2008

Obama's Enigmatic Health Care Plan: Q & A (continued)

With your indulgence, Marcia, I'd like to continue to answer the question you posed about what I would suggest as an alternative to Obama's multi-billion-dollar insurance company support fund.

As an aside, I would have to say that I object to the way the argument is typically framed. I may be a dinosaur for feeling the way I do, but I don't think the first step in the debate process has been adequately explored - certainly it has not been concluded to my satisfaction. I'm talking about the central question underlying all questioning of the nature of yours - namely, "Is health care a right?". Following this question is the one, "If health care is a right, who is responsible for providing it?". Finally, the question that liberal progressives jump to, as if all of us are agreed on the first propositions: "Since health care is a right, and there are still some uninsured people, what are you going to do about it???".
Question 1: Is health care a right?
Answer 1: Not in the sense in which it is being used. One's health, much like one's fitness, is one's own responsibility. I do believe people should have equal access to health care without regard to their race, gender, etc. But I make no apologies about the fact that health care in the U.S. is a luxury service. Truthfully, what people are wanting is not free rudimentary health care - the kind that 99% of the world would be thrilled to have. What they truly want is free access to all the bells and whistles we've come to expect from our amazingly technological (and therefore amazingly expensive) system. Want a country where everybody has the same stuff? Take your pick. There are hundreds. But just realize that's not what this country has ever been about. The U.S. is a land of opportunity, but is also a land of risk. You may hit it big, or you may lose your butt. That is what we do here. Want a life free of risks and rewards? Try France, Spain, pretty much any of Europe. Just leave my country alone, okay?
Question 2 is similar, so my answer is similar. Since health care is not a right, it is your responsibility. In cases where the individual is incapable, local religious or service organizations, or individuals should step in to help. If help is still unavailable, the government should provide rudimentary services as a last line of defense.
Question 3: What are you going to do about all the uninsured?
Answer 3: I am going to trust that their survival instinct will drive them to discover what 20-thousand generations of their ancestors did - how to survive. Forced to reckon with the consequences and costs of their actions, people won't require additional taxes as some sort of carbon rods on the nuclear reactor of their bad habits. They'll quit smoking crack because they don't want to spend all their money going to the doctor all the time. Or they won't. The choice (and the power) will be theirs.
Don't let all the hype get to you - I work in this business, and I promise you, there are very few people who actually fall through the cracks. Those that do are much more likely to be helped in a meaninful manner by their neighbors, churches, or civic organizations than by the Feds. Shocking as it may seem, we survived and even thrived in this country without Obama's health care plan. We'll make it without it. I promise.

Obama's Enigmatic Health Care Plan: Q & A

I received a comment asking whether I had any better ideas than Obama's. I believe I do, and I've decided to post what I've written so far in response. Pie in the sky? Absolutely. It'll never happen. But it is certainly no more imaginary than the magic solution proposed by the Senator.

marcia said...
And your solution is... ?
September 16, 2008 12:05 PM

mockbadoc said...
I don't know
September 16, 2008 1:31 PM

mockbadoc said...
Just kidding. I have a few ideas.
September 16, 2008 1:31 PM

mockbadoc said...
1. Provide taxpayer-funded health care for children under 18, the TRULY disabled, and the TRULY impoverished.

2. Stop treating the people not enumerated above as idiotic, helpless drones who are either too stupid or too lazy to provide for their own health.

3. Stop punishing those of us who try to do the right thing (by working and making a living and paying our taxes) and rewarding those who don't (by using drugs, committing crimes, being irresponsible, etc.).

Even if you don't believe in the transcendancy of the human spirit or anything so grand as that, surely you can see that human-kind did just fine for tens of thousands of years before the advent of Socialism. Somehow, people survived - and not just the "ultra-wealthy" who make more than $250K/year (fortunately, I and the rest of the primary care docs are hardly in that category). No, even poor people survived. Even so-called "middle-class" people survived. All without a single handout from the federal government. For that matter, without a federal government at all!

4. Obama's plan has no restrictions or increased premiums for people that smoke, use drugs, are overweight, etc. Once again, the responsible are yoked with the irresponsible. Why not make people pass a drug test and a physical examination to gain access to welfare, including Government Obamacare? If I had to take one just so I could get a job and pay taxes, why shouldn't someone have to take one who is basically wanting me to pay for their livelihood, too?

Obama's Enigmatic Health Care Plan

Is there something he's not saying?

I decided to review Senator Barack Obama's health care plan. I already knew that upon election, he plans to "stop the rising of the oceans", but how, I wondered, could he perform his next miracle - the provision of affordable, equitable health care to all Americans without destroying what makes our system great?

I went to the source - I found that his plan consists of three main strategies. Today I will discuss the first of these: "Quality, affordable, portable coverage for all".

I could find nothing new in the Senator's plan, to be honest. I had almost expected to be surprised, I guess. It basically breaks down like this:

1. Everybody will be required to have health insurance of some sort.

2. If you are currently covered, you will be required to keep coverage.

3. If you are not presently covered, your employer will be forced to provide health insurance for you.

4. Your employer (or you) can choose from either the available private health insurance plans, or a new government plan.

5. A new government regulatory agency will be created to make your insurance permanent and portable between jobs.

6. Medicaid and SCHIP will be expanded to cover even more people.

7. Those who make too much money to qualify for Medicaid or SCHIP, but not enough to afford either the "affordable" government insurance or their own private policy will be given a federal "subsidy" so that they can buy either a private plan or the new government insurance.

So there you go. Problem solved. You say there are people without insurance? Obama tells them "Let them get insurance". You say, "But not everybody can afford insurance". Obama replies, "Then I will give them money - your money - to buy insurance". What Solomonic wisdom. I should expect nothing less from the candidate so special, even the Presidential seal isn't good enough. But wait just one minute. I have a few criticisms...

1. Is it just me, or is there something a little intrusive about someone "forcing" you to have insurance. I mean, we can't even figure out if we are gutsy enough to "force" parents to have their children vaccinated or "make" Jehovah's Witness parents consent to life-saving blood transfusions for their children. Are we really going to have the gumption to force compliance with this? Keep in mind that if even one single person "opts out" then the entire thing falls like a house of cards. This is compulsory universal coverage we're talking about.

2. If there is any solution to this problem that is less palatable to me than the complete take-over of healthcare by the idiotic Washington beaureaucrats, then it is this plan, which basically allows the already-overindulged insurance industry to gain monopoly access (aided by a government fiat) to each and every American. The government health care plan as Obama envisions it would be administered by insurance companies. Big, fat insurance companies. The exact same insurance companies that Obama trusts so little that he feels it necessary to create yet another giant government agency to watch them to make sure they don't rob us all blind. Talk about putting the foxes in charge of the henhouse.

3. Your employer will be compelled to provide insurance for you. Sounds nice, right? Finally those smug bastards will get their just desserts. Employers. How they disgust us. But wait a second. However distasteful work might be, it is, of course, the way we are able to make a living - at least those of us who are not already completely dependent on the government's handouts and therefore helpless. Our employers make our personal freedom possible in a very real way. What if buying health care drives them out of business? What if they decide it's more economical for them to let me go? Am I worth what they pay me? These are questions that should be asked and answered before we throw the yoke of responsibility squarely on the necks of our employers. After all, Obama is only saying they have to provide health care. He's not saying they have to hire us or keep us on. At least not yet.

But Obama has an answer to this, too. Well, at least a partial, Obamesque answer. He plans to give a tax credit to "small businesses" so that these new expenses won't ruin them. Unfortunately, he has yet to define exactly what constitutes a "small business". One presumes that it means a company with less than $250K/year in income. Anyone making more than this has already been defined as "filthy rich" by Obama, deserving of a large tax increase to pay for their crimes. He also has yet to define how big this tax credit would be.

If I'm an employer, I think I might just opt to save myself the trouble and do everything myself.

Monday, September 15, 2008

Oh, for the love of Pete. Is this for real???

Okay, everybody. I want to prepare you for this. Normally, I wouldn't spread around pseudo-science of such a low quality, but I wanted you guys to see what gets passed off these days as legitimate scientific research. Now you tell me. Is this a sound basis for the growing standard of "Evidence-Based Medicine"? Or should we be looking backward to the allegorical for guidance. I'm pretty sure that we're staring in the wrong direction.
Cold And Lonely: Does Social Exclusion Literally Feel Cold?

ScienceDaily (Sep. 15, 2008) — When we hear somebody described as “frosty” or “cold”, we automatically picture a person who is unfriendly and antisocial. There are numerous examples in our daily language of metaphors which make a connection between cold temperatures and emotions such as loneliness, despair and sadness.

We are taught at a young age that metaphors are meant to be descriptive and are not supposed to be taken literally. However, recent studies suggest that these metaphors are more than just fancy literary devices and that there is a psychological basis for linking cold with feelings of social isolation.

Psychologists Chen-Bo Zhong and Geoffrey Leonardelli from the University of Toronto’s Rotman School of Management wanted to test the idea that social isolation might generate a physical feeling of coldness. They divided a group of volunteers into two groups. One group recalled a personal experience in which they had been socially excluded—rejection from a club, for example. This was meant to tap into their feelings of isolation and loneliness. The other group recalled an experience in which they had been accepted into a group.

Then, the researchers had all the volunteers estimate the temperature in the room, on the pretense that the building’s maintenance staff wanted that information. The estimates ranged widely, from about 54 degrees F to a whopping 104 degrees F. Here’s the interesting part: Those who were told to think about a socially isolating experience gave lower estimates of the temperature. In other words, the recalled memories of being ostracized actually made people experience the ambient temperature as colder.

“We found that the experience of social exclusion literally feels cold,” Zhong said. “This may be why people use temperature-related metaphors to describe social inclusion and exclusion.”

In another experiment, instead of relying on volunteers’ memories, the researchers triggered feelings of exclusion by having the volunteers play a computer-simulated ball tossing game. The game was designed so that some of the volunteers had the ball tossed to them many times, but others were left out.

Afterwards, all the volunteers rated the desirability of certain foods and beverages: hot coffee, crackers, an ice-cold Coke, an apple, and hot soup. The findings were striking. As reported in the September issue of Psychological Science, a journal of the Association for Psychological Science, the “unpopular” volunteers who had been ostracized during the computer game were much more likely than the others to want either hot soup or hot coffee. Their preference for warm food and drinks presumably resulted from physically feeling cold as a result of being excluded.

“It’s striking that people preferred hot coffee and soup more when socially excluded,” Leonardelli said. “Our research suggests that warm chicken soup may be a literal coping mechanism for social isolation.”

These results open up new opportunities in exploring the interaction between environment and psychology, such as the study of mood disorders (e.g., Seasonal Affective Disorder). Research on Seasonal Affective Disorder has focused on the idea that lack of sunlight during winter results in feelings of depression in normally healthy people.

The current study indicates that the cold temperatures may also contribute to feelings of sadness and isolation felt during the winter months. In addition, this study suggests that raising the thermostat a bit might be an easy method of promoting group interaction and cooperation in social settings.

Thursday, September 11, 2008

Outrageous Democrat Comments - Chapter 1

I've decided to start a running record of ridiculous comments made by Democrats. I make no claims about how many Democrats and other leftists agree with these comments, but I can only imagine what would happen if roles were reversed, and statements of this sort were made by Republicans or Independents.

I also offer this as "Exhibit A" to those who would have me approach Democrat ideology with an "open mind".

“If you want change, you want the Democratic Party. Barack Obama was a community organizer like Jesus, who our minister prayed about. Pontius Pilate was a governor.”
-- Rep. Steve Cohen (D - Tennessee)

[John McCain has chosen a running mate (Sarah Palin)] "whose primary qualification seems to be that she hasn't had an abortion."
-- Carol Fowler, South Carolina Democratic Party Chairwoman

"It's funny that New Orleans will get a hurricane. That's funny because it is due to hit when President Bush is scheduled to speak. Isn't that cool?"
- and -
[Sarah Palin is] "Dan Quayle on steroids".
- and -
"Other than the fact that she is a female, [Sarah Palin] has nothing to offer."
-- Don Fowler, former National Chairman of the Democratic National Committee and husband to Carol Fowler (above), overheard (and recorded) speaking to South Carolina Congressman John Spratt (D - South Carolina) on a plane after the Democratic National Convention in Denver.

"The government gives them the drugs, builds bigger prisons, passes a three-strike law and then wants us to sing 'God Bless America.' No, no, no, God damn America, that's in the Bible for killing innocent people! God damn America for treating our citizens as less than human! God damn America for as long as she acts like she is God and she is supreme!"
-- Reverend Jeremiah Wright ("one the 10 most influential pastors in America", according to the Obama campaign)

"We bombed Hiroshima, we bombed Nagasaki, and we nuked far more than the thousands in New York and the Pentagon, and we never batted an eye. We have supported state terrorism against the Palestinians and black South Africans, and now we are indignant because the stuff we have done overseas is now brought right back to our own front yards. America's chickens are coming home to roost."
-- Reverend Jeremiah Wright (five days after the attacks on 11 September 2001)

"We should also examine the foreign policies of the the U.S. to make sure that we occupy the moral high ground in these conflicts. In particular, we have to examine some of the root causes of this terrorist activity...For nations like Afghanistan, Pakistan, Indonesia, or much of the Middle East, young men have no opportunities. The only education they are receiving is that provided to them by religious schools that may not provide them with a well-rounded view of the world.”
-- Senator Barack Obama, Chicago Defender, 17 October 2001 (Making excuses for the terrorists, only 36 days after they killed over 3,000 American citizens. Apparently, it was our own fault.)

"I would say that, as an ardent practicing Catholic, this is an issue that I have studied for a long time. And what I know is, over the centuries, the doctors of the Church have not been able to make that definition. And St. Augustine said at three months. We don’t know. The point is, is that it shouldn’t have impact on a woman’s right to choose."
-- Speaker of the United States House of Representatives, Rep. Nancy Pelosi (D - California), when asked when life begins. She actually answers "We don't know when life begins, but a woman should be able to choose to end that life anyway, regardless of what the Church says." Don't make any future Sunday plans, Nancy.

"God has given us, each of us, a free will and responsibility to answer for our actions. And we want abortions to be safe, rare and reduce the number of abortions. That’s why we have this fight in Congress over contraception. My Republican colleagues do not support contraception. If you want to reduce the number of abortions, and we all do, we must, it would be easier to support family planning and contraception, you would think."
-- Rep. Nancy Pelosi (further digging a Vatican-sized hole for herself when challenged on her statement about the inability of the Catholic Church to decide when life begins).
"You don't have money to fund the war or children. But you're going to spend it to blow up innocent people if we can get enough kids to grow old enough for you to send to Iraq to get their heads blown off for the president's amusement."
-- Pete Stark (D-CA)

“Al Qaeda really hurt us, but not as much as Rupert Murdoch has hurt us, particularly in the case of Fox News. Fox News is worse than al Qaeda -- worse for our society. It’s as dangerous as the Ku Klux Klan ever was.”
-- MSNBC anchor Keith Olbermann, in (of course) Playboy, October 2007 (sour grapes???)

"Through every Abu Ghraib and Haditha, through every rape and murder, the American public has indulged those in uniform....We pay the soldiers a decent wage, take care of their families, provide them with housing and medical care and vast social support systems and ship obscene amenities into the war zone for them, we support them in every possible way, and their attitude is that we should in addition roll over and play dead, defer to the military and the generals and let them fight their war, and give up our rights and responsibilities to speak up because they are above society?...[T]he recent NBC report is just an ugly reminder of the price we pay for a mercenary -- oops sorry, volunteer -- force that thinks it is doing the dirty work.”
-- William Arkin, military columnist

Insurgents “are running out of people to kill,” and “There are fewer targets of opportunity.”
--David Obey (D-WI), November 2007, as to why deaths in Iraq had decreased

“I think a draft produces a better Army than the one we would have with all volunteers, because I think you get average Americans if you have a draft. And if it’s an all-volunteer Army, you get people who join up because of some problem in their own lives. They don’t have anything else to do, they don’t have a job, or they can’t find what they want to do, so they join the Army. And it doesn’t produce the best Army.”
-- CBS’s Andy Rooney, March 2007. As a veteran, thanks, Andy. I guess McCain gets to be the "crazy old man" instead of you. Pity.

"Sure, there's less violence, but that's because we've ethnically cleansed most of Baghdad."
--Jim Moran (D-VA), December 2007

"You have to make your own decisions about what the President knows, this war is lost, and that the surge is not accomplishing anything, as indicated by the extreme violence in Iraq yesterday,"
--Majority Leader of the United States Senate, Sen. Harry Reed (D - Nevada), April 2007

"It's not surprising, then, they get bitter, they cling to guns or religion or antipathy to people who aren't like them or anti-immigrant sentiment or anti-trade sentiment as a way to explain their frustrations."
--Senator Barack Obama

"We are going to take things away from you on behalf of the common good."
--Senator Hillary Clinton

"God bless the America we are trying to create."
--Senator Hillary Clinton

"You think people can work all day and then pick up their kids at child care or wherever and get home and still manage to sandwich in an eight-hour vote? Well Republicans, I guess can do that. Because a lot of them have never made an honest living in their lives."
--Democratic National Committee Chairman, Gov. Howard Dean (D - New Hampshire)

Monday, September 8, 2008

Falling in love again???

I have been moonlighting. On the weekends, I've been working at an urgent care clinic in the area. I admit that I've been avoiding family practice. I'm not sure why. As usual, of course, I've done lots of self-examination about it.

Part of the reason I fled was my inexperience. Medical school and residency teach you lots of things. As most people can agree, however, they do little to teach you about communicating with sick people. That's actually the hardest part. I had a very naive vision of my role and the sorts of relationships I would have with my patients. I was looking backwards, to a much simpler time, when people either liked or at least wanted to like their doctor. It's different now. We often have to fight the perception that we are cheats, liars, thieves, or all of the above. I had no idea how in the world to answer that. My feelings of disappointment led me to act defensively - to assume the worst.

Another problem I had was the feeling of being overwhelmed. "General medicine" is such an inocuous term for what it really is - never being surprised by anything. There is a difference, though, between "never being surprised" and "always knowing the answer". With time and more experience, I've found that there are ways of breaking this fact to the patients that don't make them feel that they've just thrown away a co-pay.

In a funny way, it was immersing myself in exactly what I feared that allowed me to grow. Unwittingly, the doctor who feared and resented the attitudes of his patients and who feared having to say "I don't know" placed himself in the one job in the world where that is almost all there is - Occupational Medicine. I don't just have occasional bad interactions now - they are constant. And this conversation happens nearly every day:

"Well, Mr. Smith, I've reviewed your MRI and the results are negative. That means there appears to be nothing wrong with your knee"

"Well, I can tell you there is definitely something wrong with it!"

"Well, unfortunately, sir, the last three examinations I've performed on your knee were negative, the examination by the physical therapist was also without objective findings, and now the MRI fails to show anything. There may very well be something wrong with you, but it is so subtle as to be invisible to me, other health professionals, and the MRI machine."

"So what's wrong with my knee?!?"

So when I started back with the general medicine stuff, it didn't seem so bad this time. I also found that the things I was most afraid of - the emergency medicine things - aren't nearly so daunting as they used to be. And even though I'm exhausted after working basically 21 days straight with five more to go before the first real day off, I think I might be able to do this GP thing again after all. Have Medicine and I reconciled? It's a bit too early to know for sure, but it's a good start.