Our New England Schoolmarms Strike Again

In one of the few rulings by the Supreme Court that has made sense in recent memory, the self-proclaimed Third Branch of American Government ruled last week that a local ban on the keeping and bearing of firearms by the law-abiding, tax-paying residents of the District of Columbia was, in fact, unconstitutional. Duh. Not surprisingly, the academic medical community, much too busy to work to save American Healthcare from destruction by the insurance industry, and complicit in its destruction by the forces of socialism, came out against the ruling in an editorial in the most recent New England Journal of Medicine.

http://content.nejm.org/cgi/content/full/NEJMe0805629

If the sentiments expressed in the article were not so deeply-felt and so dangerous to our way of life, they would be almost laughable. It betrays the Technocratic mindset of so many in power in today's academic institutions - that somehow it is up to them to save us from ourselves. Epidemiological experiment? Hilarious. Liberty must be so incredibly irritating to these braniacs. It is so...untidy. Their silence was deafening as we the people (apparently their helpless, hapless wards) were subjected to other "epidemiological experiments" at the hands of the Highest Court - "Law enforcement officials can not be held responsible for defending people in their homes"; "Your personal property can be seized through imminent domain not only for the good of a community but also for the good of a more profitable tenant".

Where is the outrage at the New England Journal when people are attacked and out-gunned by criminals in their own homes? Where is their scientific input on the true causes of inner city violence, crime, and illiteracy - namely, the irresponsibility and even participation of those communities in those problems? Where is their backing of Bill Cosby when he addresses matters such as these? There is absolutely no doubt that those problems are at the root of the issue, but still the New England Journal remains silent. Well, silent at least until something occurs that offends them personally. Their fear of law-abiding citizens owning the firearms to protect themselves is legendary. They've always sided with the criminals in that regard. In their world, the law-abiding, ignorant sheep are supposed to look to the increasingly impotent government for everything, and remain victims of circumstance. This ruling was a slap in the face.

Their statement shows how utterly despicable and irresponsible they have become. They care nothing for the residents of Washington D.C., or any other city, town, or rural area in the country. If they did, they would use their power as the leadership of a (previously) highly-respected medical publication to educate our most vulnerable citizens about how to work and fight their way out of illness. They instead use their power to push their ultra-liberal agenda using the mantle of medical expertise to hide their true intentions. Their ridiculous opinion is thus given artificial credibility. What cowards. They know that their beliefs are losing traction, so they must package them as the "advice of the experts".

The New England Journal of Medicine thus continues to lose much of its credibility, hijacked, like so many of the great institutions of our nation by the socialist parentalism of the academic community. They are not welcome to speak for me. They should be ashamed.

Country Doctors Finally Get Their Just Desserts

After decades of exploiting the inept rural masses through their subtle manipu-lation, the so-called Family Doctor has finally been positioned for eradication by American Medicine.

Until recently, among the various interests that run this multi-billion dollar industry, there had been disagreement about the best way to snuff out the last remnants of what all agree is an anachronistic, generally unnecessary barrier between these patients and the sub-sub specialists they so desperately need and want. Finally, through a combination siege of decreased reimbursements, federal regulations, paperwork, and public criticism of the lack of professionalism of these "people's doctors", it appears that at last, each medical problem can and will be cared for by a different physician.

The American Medical Association, long-time supporter of the Sub-Specialist cause, applauds the progress. In a series of steps that began with demanding board certification for Family Physicians, then failing to act while "Physician Extenders" (Nurse Practitioners and Physician Assistants) took over the role previously played by the country doctors, they virtually assured the end for Family Medicine. This victory is especially good news for the other major player in the medical industry, the insurance lobby.

With primary care services provided by nurses and medical technologists, the costs are expected to be significantly lower on the front end. Diagnosis is expensive, and by limiting the role of the primary care provider to filling medications and gathering data for the specialists, it is expected to create what is already being gleefully predicted as an "Insurance Boom".

There is an another possible unexpected benefit to this sea-change in the way medicine is practiced. By centralizing medical expertise in larger and larger medical centers, then relegating the data collection duties to physician extenders where the patients live, it should pave the way for the eventual socialization of healthcare. In fact, insurance executives and the government are already looking ahead and working together to find a solution to the next big problem - the glut of subspecialists. With advances in telemedicine, a future with one cardiologist per state seems finally within our grasp.

Patients seem to love this new, less personal style of care. Family doctors and medical schools have been trying for years to force their gentle, relationship-based, preventive-minded approach down their throats. The public has answered with a resounding silence as their methods have been discredited and the practitioners of this ancient art have been put out of business. Finally, it appears that we can say, along with the insurance lobby, the American Socialist Party, and the (for now) safe subspecialists, "Good riddance".

http://www.aafp.org/online/en/home/policy/familymedvalue/mostcited.html

An open letter to cokeheads

Dear Friends,

You know that doctor that calls you to talk about your drug test? Well, there's no easy way to say this...I'm that guy. I'm what we in the party-pooping industry call an MRO - a certified Medical Review Officer. I know - sounds made up. Anyway, yes, I am the one who calls you and - well, I have to assume from the way that you usually sound when you answer - interrupts your good time with friends to notify you that you will not be funding your habit with a real job any time soon. This isn't the most pleasant work sometimes. Despite what you might think, I take no joy in calling. But I've noticed something you should be aware of. You guys are making this too easy for me. It's almost like you're all reading from the same playbook. Just know that if it seems a logical way to counter me, believe it or not, somebody else already thought of it and has tried it. About a thousand times. Do you have any idea how difficult it is to truly invent something unique???

Anyway, I have decided to write this letter in order to save you the trouble of embarrassing yourself in your attempts to convince me that some terrible mistake has been made. There are a few of you that are really, really good. Keep that up, folks. You are almost (almost) believable. It makes this much more entertaining for me, and believe me, the money isn't all that good so entertainment is about all I'm getting out of this. So here is a little help for you. If we are going to have to spend this time together, we might as well sort this out.

First of all, you must realize how alike you all sound. So much so, in fact, that I have decided that it is not even you talking. It is cocaine. I don't know you, it's true. But cocaine? Ah, I know cocaine very well - at least from a distance.

Cocaine is one gregarious character. You just find yourself wanting to believe cocaine. He has a zest for life that is infectious. To be sure, he usually outlasts all his friends, leaving them a miserable, tired wreck. But they love him all the more. Oh, don't try and cover for him. You'll only look silly. Cocaine does a fine job protecting himself, thank you very much.

Cocaine is also the eternal optimist. No matter how many times we've spoken, he always insists on playing our little game...I let him know I've found him in someone's urine, he vehemently denies it, cursing me, the prospective employer, etc. He is especially fond of threatening to call his attorney on me. In typical fashion, I assume that his attorney is Mark Geragos or someone high-profile. Why wouldn't it be? This is cocaine we're talking about here, right?!?

But, in the end, cocaine knows I have him dead to rights. He'll talk a good game, but he knows when he should leave the party. After all, only amateurs make principled but doomed stands. And cocaine has been around this block a time or two. At least.

So the next time you get a call right after you've gone to sleep at one-o'clock in the afternoon and you don't recognize the number - that is, if you still have your phone - just answer it, okay? I won't be a jerk. And save yourself the trouble and exhaustion of feigning outrage and bandying your threats about. I know who I'm dealing with here. And tell cocaine I said hello. I'll catch up with him later on.

Close the door! And put something heavy against it!

There is definitely something about the full moon. Or maybe it is some other cosmic phenomenon; I don't know. What I do know, and what just about any emergency room employee will tell you, is that there are times when it seems that the flood gates of craziness open and pour directly into your place of work. Yesterday was such a day.

I know that nuttiness is out there somewhere. You run across it from time to time so you know it exists. The law of averages would seem to suggest that you should have a homogeneous mix of craziness throughout the year - some percentage of your total - but that is not the case. They lurk, out there in the world, until the time is right. What I can't figure out is what sort of signal causes them to attack en masse.

Rather than tackle this weighty issue, which is definitely beyond me, I choose to describe these people. I am in the process of creating a sort of taxonomy system so that all of us who deal with the public can simply name them instead of wasting our precious time and energy describing their activities. No one would bother describing how a tiger took down a gazelle in detail - that's just what tigers do. I welcome your input during this process. I think a dictionary or encyclopedia of misfits might be in the pipeline. I will try to add to this list as I am reminded of other types.

Class One - "The squeaky wheel":

These nuts have discovered that they can raise the stakes in a conversation or interaction to a place where no sane person would dare follow. They have become masters of manipulation - using our own common sense against us. They bait us into interaction, usually by appealing to our genuine desire to help others - only to bring the axe down when we are within their grasp. They have discovered the secret of social blackmail - that if they are the most irritating person in the room, they often get served first and best in order to avoid a scene.

Class Two - "The Mr. Wilson":

A little advice - just because you are advancing in years does not give you the right to be a grumpy, uncompromising jerk. I know, I know. I'm not doing my job the way you would. I'm sure I'm not doing it the way doctors used to. And I'm sure that you, like me, disapprove of the majority of what you see going on in the world these days. None of that, however, is the fault of me or my staff. So lay off, dude.

Class Three - "The Over-Protector":

I actually had one of these yesterday, too. It is usually a husband, but may also be a parent. Whether for desire for some sort of secondary personal gain or because they are maniacally self-centered, believing that no one can care for the object of their affection the way they can, this type is disposed to violent outbursts that take on the appearance of legitimate concern. The problem is, their nuttiness drives a wedge between the patient and the person who has the ability to help them. My feeling is, if you could do this yourself, then why are you here right now? Back off and let me do my job. Please.

Class Four - "The Shape-Shifter":

This is one of my personal favorites. This looks somewhat like what we doctors have termed Borderline Personality Disorder. You start out as "the best doctor in the world", then slowly become the Adolf Hitler of modern American Medicine as you consistently fail to live up to the ridiculous expectations and demands of the patient. These people are exhausting, especially if you make the common rookie mistake of trying to reason with them and prove that you really are not the evil anti-Christ they accuse you of being. Listen to the voice of experience, people.

This is so much fun, I really hate to stop. I'll try to add some more later. Thanks for your patience.