Sunday, July 26, 2009

A Great Press Conference

I can't believe I ever thought i would have a difficult time coming up with material to write on this blog. I contemplated several topics this week but I felt I had to write about the most successful press conference I have ever seen. By that I mean, what is the purpose of a press conference? To inform the press and public as to what is going on in the administration and what the president is thinking and planning. Well BO certainly informed the public on two issues that are very enlightening. Unfortunately for him, these two topics were not in his planned comments but he brought them up anyway in an unscripted manner. It certainly demonstrated his true feelings as to where the problem lies both in the escalation of health care costs as well as in race relations. A disaster for BO but a truly informative and eye opening conference.

I also felt obligated to write about this press conference since I learned during this conference that I am personally responsible for the dramatic escalation of health care costs in the United States. Not only that, but I am unethical, I decide treatment based on reimbursement, and I border on criminal activity by performing unnecessary surgery on children. Yes, I admit it, I perform tonsillectomies. Just put the handcuffs on me already and ship me off to Alcatraz. BO is really smarter than I thought. He is fully knowledgeable in the field of Otolaryngology and understands all the criteria that go into the decision as to when a tonsillectomy is appropriate. He knows exactly what goes through my mind when I decide to operate and he has determined that I am performing unnecessary surgery on children just for the money.

This knucklehead with a law degree doesn't consider the amount of training I went through to be qualified to perform tonsillectomies and to understand when it is indicated and when it is not. He doesn't consider the thousands of children that benefit from the surgery as many studies have concluded and he has no clue as to the indications to perform such surgery. He has concluded that the parents of the children undergoing tonsillectomies are complicit with the surgeon and are not smart enough to ask the doctor whether the surgery would help their child so they allow their children to undergo unnecessary surgery (don't you worry the government will come to your rescue). He hasn't considered that the risk of doing unnecessary surgery carries with it the risk a lawsuit which is always in the back of any surgeon's mind. He also hasn't considered that in cases where the indication for tonsillectomy is recurrent tonsillitis that in fact health care costs are reduced by the surgery as the patient's need for doctor visits and antibiotics are greatly reduced.

It is sobering to know that BO considers the doctors as the source for the nation's healthcare problem. He clearly said as much at the news conference and he will likely bring this opinion to the restructuring of our healthcare system. Doctor beware, you are the problem. The only doctor that is safe in the restructuring is the abortionist. The only surgery that BO approves of and promotes is an abortion. I, who try to improve the lives of children through medical and surgical treatment, am the problem but the doctor who destroys life is revered. Truly a bizzaro world.

Briefly, the other revelation during the press conference was his determination that it was the fault of the police officer in the Gates arrest. BO is a genius. He admits he doesn't know the details but is smart enough to know that it was the police officer who acted stupidly, according to BO, who was at fault. In fact, this clearly demonstrates his view that police officer, you are the problem. The facts do not matter, your training doesn't matter, your years on the job do not matter, and your previous behavior regarding race relations do not matter. The knucklehead with a law degree (BO) has predetermined that you are a racist just like he has determined that I am a unethical, money hungry, deceiving physician.

So lets add two more sets of people to the list of groups who should definitely regret their votes for BO (See entry 5/25/09). Doctors and the law enforcement community. The fact is any doctor that voted for BO should have his head examined. There were plenty of indications during the campaign he was going to reform health care on the backs of doctors since it is them who are problem. Now we know the full extent of his feelings towards doctors. And anybody who makes their living in law enforcement you should know you will never get the benefit of the doubt. You are predetermined to be racist and will be judged as such.

I would like to thank BO for expressing his heart felt opinions on these matters and really detailing his true beliefs. We need to have more press conferences with BO so we can learn more about his honest opinions in all matters. Biden has got nothing on BO when it comes to public missteps.

Friday, July 17, 2009

Job Creation (?Job Saving) Obama Style

It has certainly become a lot more clear what Obama meant when he said he was going to create or save thousands of jobs. It turns out the jobs he is saving are jobs that are funded by the taxpayer and not private sector jobs. With his massive "stimulus" bill he is pumping money into state and municipal governments to help balance their budgets without any conditions. Instead of these local governments making the hard and necessary choices of cutting back their payroll and unsustainable benefits they are just continuing to suck the taxpayer dry by taking federal funds which will be payed for by higher federal taxes as well as by repaying debt by our children and grandchildren.

The other job that Obama has decreed as worth saving is the union employee. He is bailing out the car companies which are clearly not based on a profitable business model. But nevertheless the taxpayer will be burdened by the perpetuation of these union jobs. Instead of the car companies making the tough choices and the government forcing the companies to make those choices the union is able to protect their jobs at the expense of the taxpayer. It is unfair that with unemployment at 9.5% and with millions of people having lost their jobs that these auto workers are supported by tax dollars and artificially maintained in their positions. The administration is bought and paid for by the unions. Of course this is a payback by Obama for the union support during the campaign.

The jobs that BO has decided are okay to lose are those of small businesses, the true generator of the majority of jobs in this country. In fact he is contributing to the loss of jobs by small business. By increasing taxes and mandating employee health care coverage or a fine, any bozo can see this will lead to further unemployment. He fails to appreciate the critical role small business plays in the economy. What small business owner will hire in this environment? The small business owner will cut back on payroll to maintain profitability.

So union jobs and municipal jobs are in and small business jobs are out. BO has decided that preserving these jobs are more important than stealing from future generations. And on the flip side losing the small business jobs is okay even if it tanks the economy. This is a very bad trend for our economic future. Although we are seeing a slight bounce back from the lows in the economy I cannot see a scenario that would lead to a significant expansion of the economy. We will likely see a jobless recovery and a protracted period of economic stagnation.

Friday, July 10, 2009

Where's Hillary?

I don't know if you've noticed but Hillary is nowhere to be found. I haven't seen her on the news, on any news shows, or quoted in the newspaper as far back as I can remember. One would expect in light of the recent uprising in Iran, a major and historic moment, the secretary of state would have weighed in with her opinion on the matter. There are two possibilities, either the administration is controlling the situation and limiting her exposure so she doesn't outshine Obama. I think this is unlikely as I doubt she would be quieted by her previous foe. More likely she is purposely remaining under the radar screen. But why?

I have no doubt that Hillary is still seething from the primary battle and feels she should have been the nominee. She must be second guessing her campaign constantly since she knows she was the more qualified candidate. She was given the position of secretary of state but then all these special envoys were appointed to deal with specific regions. An envoy to the middle east (Mitchell), an envoy to Pakistan and Afghanistan (Holbrooke), an envoy to Sudan (Gration), an envoy to Iraq (Hill), etc. All the hot spots were taken by appointed envoys. So what's left for Hill? Not much, just a very sore, frustrated, vengeful woman.

I think she has every intention to run against Obama in the 2012 primary. If she appeared on the news she would have to follow the party line and back up all of Obama's decisions and policies. She doesn't want to be seen doing this as this would negate her ability to criticize his policies in the next primary. She is waiting for the perfect time to resign her position and this will likely be in some response to an Obama position that she will say she cannot support. This recent episode was perfect since Obama did not immediately support the uprising in Iran. Hillary could have stepped in and said I support the freedom fighters and stood against Obama. This makes her look to be the candidate who supports democracy in a theocratic regime while Obama looks to be the guy who wants to schmooze with the Mullahs and Ahmadinejad.

The problem was it was too early. She has to wait for about another year until she makes her move. His approval numbers will continue to deteriorate over the next year while she is in the background with a low profile quietly building support. As his numbers go down there will be splintering within the democratic party. He will be on the liberal side and she will dominate the moderate wing. The liberal agenda will be seen as an absolute failure both domestically and with regards to foreign policy. There will be major defections from Obama supporters to the moderate wing of the party ie. Hillary. Her approval numbers will soar as the dems look for a less liberal representative. She is a very intelligent, calculating woman. I have no doubt we have not seen the end of the Clinton machine.

Saturday, July 4, 2009

Lessons From MJ

The king of pop, Michael Jackson, was a highly talented entertainer who was blessed with many skills that propelled him into an extremely privileged life. He attained worldwide fame, his music was recognized around the globe, he earned a large fortune but despite all that, the evidence points to the fact that he was an extremely unhappy individual. It seems clear that he was conflicted about his heritage, his blackness. His desire was to reject being black. By reshaping his nose through repeated surgeries, chemically altering the color of his skin, and straightening his hair it appears his goal was to remove his negroid features. It seems unusual that the black community has embraced MJ to such a great extent posthumously even as he appeared to reject that community during his life.

This is no way a slight on people of color but rather a manifestation of someone who is unhappy with who he or she is and is searching for a path to happiness. He likely thought if he could just lose certain ethnic features he would achieve fulfillment through a new appearance. He bought into the notion that it was his blackness that was preventing his ultimate desire of self-fulfillment.

He also demonstrates that regardless of endless possessions it was not enough or able to satiate his quest for self fulfillment. Regardless of an enormous mansion, endless furnishings and anything that his heart desired he remained unfulfilled.

Finally, he demonstrated that a life of fame does not necessarily correlate with a life of happiness. I recently heard a survey conducted amongst college aged kids as to what is there greatest desire. It wasn't wealth or health but the desire to become famous. As demonstrated by MJ and numerous other celebrities, fame is no guaranteed pathway to a content life. We live in a society where celebrities are placed on a pedestal and are adored, and kids want to attain that adoration to the exclusion of everything. Maybe that is why we have so much depression in this country as people buy into the idea that if they were better looking or richer or had more stuff or famous then only then would they be happy. And since this not attainable to most it becomes a source of dissatisfaction that leads to depression.

So MJ has shown us that fame, wealth and appearance are not necessarily a pathway to a fulfilled life. Despite his many gifts he lacked the one gift that would allow him to be content. The greatest gift one can receive is to be happy with what one has, what one looks like, and with one's lot in life. This is not to say that one should not strive for greater things but to be content with one's station in life is truly the greatest gift.

Thursday, June 25, 2009

GP Versus Specialist

In the recent discussion about reforming health care much has been discussed about the lack of primary care physicians and the plethora of specialists. It seems that the specialist is being demonized as the source of waste and overspending in medicine while the GP is praised as the saviour. I would like to dispel this myth by describing two recent cases.

The first case is that of a 54 year old male who came to see me complaining of a sore throat. He had been to his primary doctor several times over the previous 4 months complaining of a sore throat and was given an antibiotic each time. This time he decided to see a specialist. His examination revealed a large advanced malignant tumor in his throat.

The second case is a 33 year old female who came to see me for a wax buildup in her ears. I asked her if she had seen her primary care physician to deal with this problem. She answered that her doctor told her he doesn't clean out people's ears and anyway she preferred to see the specialist.

These cases demonstrate the critical and indispensable role of the specialist in today's health care and three forces that ensure this trend continues. The first is simply patient preference. A significant portion of the population want to see a specialist who has greater expertise in a specific disease or region of the body than a GP. The public believes they will receive better and more up to date care from a specialist who deals specifically with their problem. The woman preferred to see me to clean her ears because this is a regular part of my practice and the assumption is that leads to greater skill.

The second force is that in this era of major advancement in medicine the GP is unable to be fully knowledgeable in all disciplines of medicine. He or she will have a cursory knowledge in many subjects areas but cannot attain the depth of knowledge a specialist would have who just deals with one specific area. Therefore, the GP refers his/her patients to the specialist because they are unable to deal satisfactorily with all their patients complaints and ailments.

Thirdly, the GP refers his/her patients to the specialist because they do not want to take the risk of missing a diagnosis as was done in the gentleman I described. They are covering their behinds because they know if they miss a diagnosis they will be sued for a delay in diagnosis.

So what should be the role of the GP? He/she should coordinate the care for the patients by referring them to the appropriate specialist and then oversee and integrate the recommendations of the varied specialists. The other main role of the GP is to be the disease preventer. Instead of being called a GP he should be the DP (disease preventer). All preventive care (obesity, cigarette cessation, immunizations, etc.) and screenings (mammograms, blood pressure, blood test screening, etc.) should be the responsibility of the DP. The role of the specialist is to treat disease as they have greater expertise in the treatment of ailments effecting their specialty than the DP. And this is often preferred by the patient.

So specialty care often translates into better care and this is likely to continue as the patients and the primary care doctor demand it. Yes it is more expensive care but higher quality often comes at a cost. It is similar to the situation where a transmission breaks. Who would be the preferred person to repair it. A general repair shop or a shop that exclusively fixes transmissions. Or a situation where a pipe bursts. Do you call a general handyman or a plumber. The plumber may be more expensive but the outcome is likely more reliable.

Instead of demonizing the specialists they should be recognized as a product of the incredible complexity of modern medicine. They serve a critical role in delivering state of the art care. Both the primary care and specialist need to work together, in their appropriate roles, for the benefit of their patients. The patient must be seen as a series of complex parts (treated by the appropriate specialists) and also as a whole unit (managed by the DP). Specialty care without the oversight of the DP or primary care without the expertise of specialists is substandard care.

Tuesday, June 16, 2009

Self Definition

So my mother has been reading this blog and I recently asked her what she thought. She answered, somewhat critically, that she was hoping I would write something more from the heart. To which my wife responded that I have no heart. She was kidding. I think. Well, I thought I would try to write about something less dry than politics.

I was watching 60 minutes last week and there was a segment about the repercussions of the Madoff scandal. They interviewed an elderly man who supposedly lost his entire fortune, which was reported to be in the seven figures. Surprisingly, he didn't appear despondent. His main disappointment wasn't about the money he had lost but the money which friends and relatives had lost who invested with Madoff based on his recommendation. The impact of the potential loss of his relationships with others were more important than his own actual financial loss.

Naturally, it made me think how I would feel if I were to lose everything and then started pondering what defines a person. Or better yet how do we define ourselves. Do we define ourselves based on how others define us or how we think others are defining us. Is a person defined by his/her wealth, by the car they drive or by the house they live in. Do we define ourselves based on the clothes we wear or other external manifestations of materialism.

Or do we define ourselves based on our relationships with others. How we relate to our spouses and children. How we relate to our friends and coworkers. Some defined themselves by their relationship with god. Does one define themselves by the amount of money they have or by how good they are as a son/daughter or mother/father. I suspect that most of us get caught up in the rat race and the pursuit of more and more stuff but the truth is that like the old man it is the relationships we build that has a greater impact on us than the stuff we accumulate. And at the end of the day if we were to all lose our stuff it wouldn't matter nearly as much as losing the relationships we build with others. For some reason it is difficult to live our lives with this knowledge as we concern ourselves with accumulating more and more.

All of us are imperfect and have flaws but we should always try to find the positive attributes of those around us and acknowledge their impact on our lives. It is especially appropriate on this father's day weekend to appreciate the sacrifices our parents have made for us. This day gives us an opportunity to give gratitude to our fathers and we should all tell our fathers thank you.
So Dad thanks a lot for all you have done for me and I hope my kids appreciate what I do for them. Okay Mom?

Sunday, June 14, 2009

Upside Down World

I once asked a friend of mine who is Korean how many Jews he thought existed in this world. I prefaced my question by telling him there were 1.3 billion Chinese and 1.2 billion Muslims. I don't remember the exact number he guessed but it was much higher than the actual number which is approximately 12 million. He was astonished by that fact, and I am astonished by the impact this minuscule percentage of mankind has had, is having, and likely will have on human events. If you look at where Judaism ranks in terms of population, it is behind Juche (19 million), Spiritism (15 million), and Sikhism (23 million). When was the last time you saw these religions and there adherents referenced in the media?
The disproportionate impact of the Jews is demonstrated by the countless contributions made in so many areas. Not the least of which is the basis of all monotheistic religions ie. the belief in a single god. There is a hardly a field in the arts, sciences or any other human endeavor that hasn't been advanced by contributions from Jews. They have improved the lives of so many Jews and non-Jews alike, but this advancement has come at a great cost. It has engendered tremendous hatred and suffering towards the Jews throughout history and continues today. The world is truly upside down when you contrast the positive contributions of the Jews to the entire world versus the suffering inflicted upon them and the hatred and blame directed at them by the same world.
Just look at three examples that are occurring currently, the holocaust museum shooting, the Wright statements, and the Iranian situation. The shooter was an old man who probably never even met a Jew who blamed his shortcomings and the country's ills on the Jews. Wright blames the Jews/Zionists for controlling what the president does and who he talks to. Ahmadinejad consistently blames the Jews and Israel and would like nothing more than their destruction. The common theme that underlies all three is that the Jews are responsible for all the ills of society. It is the age old scapegoating against the Jews, when things go bad blame the Jews.
It seems that this is as bad as it has been in a long while. Any positive feeling that the Jews had garnered from the holocaust, which was actually just pity for what they experienced, has ended. It is now back in fashion to openly express one's hatred towards the Jews. The hatred was never gone, it just became politically incorrect, but now that veil has been lifted and the truth revealed. That this tiny percentage of the world population, the Jews, is the recipient of so much hatred amongst so many people and disparate cultures ( Middle America, Black Americans, Muslims) is a stain on humanity.
What have these 12 million people (0.2% of the world population) done to generate such hatred? Discovered medical treatments to prolong and enhance people's lives? Won more than 130 nobel prizes (out of approx 720 awarded)? Advocated for the persecuted, the poor, and the discriminated? All they want is to live peacefully, to practice their religion, to contribute to society, and to live in their ancestral homeland. It is precisely their disproportionately positive impact that has created such jealousy amongst the nations. For only a truly chosen people could accomplish what they have accomplished and this is too much for some non-Jews to bear.
We really live in an upside down world and we should all fear how it is trending.