BO vs. Fox

The White House is making some serious blunders as it tries to vilify Fox News Channel. Perhaps they are trying to use Chicago style tactics against those that do not line up behind their agenda. In reality, all they are doing is demonstrating their lack of confidence in their own ideas and their own staff. It appears that they cannot defend their agenda or appointments but instead must resort to political ploys to quiet their opponents.

What better way to demonstrate the benefits of your agenda than to debate them with others of differing opinions? Why not have a representative from the White House go on Fox to debate and defend their proposal? They should go on O’Reilly, Beck, and Hannity which gives them the perfect audience. Those that do not agree will perhaps be convinced to support their proposals. This should be desirable for the administration unless they feel that their agenda does not hold up to debate.

More and more I see the administration hiding from their own proposals. It seems the less they let the public know about the details the better for them. In fact, it is exactly their strategy to minimize the dissemination of the details of their plans for us. We are supposed to be like sheep lining up and not asking any questions. The problem with Fox is that they are asking the questions and this threatens BO. They are unveiling the details to the public and this frustrates the White House. As the specifics come out BO’s popularity declines.

What’s worse for BO is that Fox is attracting record number of viewers, thanks to him. As he tries to silence his opposition he is in fact doing the exact opposite. People wonder what they are saying on Fox that has BO so riled up so they tune in to find out. BO would have done much better never singling out Fox but now that he has, he must face them directly. He has to confront the opposition or his popularity will continue to fade as people lose their confidence in him. People will assume he has something to hide.

The truth is BO and Rahm cannot defend their positions. Upon close scrutiny their ideas will be unpopular and will not pass. Their only chance is to keep us in the dark. Thank heavens for Fox which shines a bright light on their schemes.

I Just Don't Get It

I went into this hotel last week and got into the elevator along with several others. The door shut and the elevator started rising. Suddenly the lights went off and the elevator continued to rise. All you could see was the digital display of the floor you were up to and the people in the elevator became very nervous. People were screaming. It reached the top floor and all of a sudden something snapped and the elevator went into free fall. The weird thing is I waited one hour to get on the elevator and I even paid to get on knowing what was going to happen. Naturally, I was at Disneyworld at the Tower of Terror.

Can someone please explain to me the attraction of this ride? I just do not get it. And while you are at it you can also explain why people get enjoyment from riding on a roller coaster that makes you feel like you are in free fall. I experience total fear and the sensation that my private parts are transplanted into my throat. I assume I am not unusual with these feelings but the fact that some enjoy them escapes me.

Putting that experience aside, Disney does a terrific job with their customers. Their staff is wonderful, including the greeters at the airport, the drivers of the buses, the hotel staff and the employees at the theme parks. They interact with thousands of people yet are kind and patient and are wonderful with the children. Any company that wants to learn about customer service should send their employees to Disneyworld. As I also deal with the public on a daily basis I know how difficult it can be. I certainly learned from my experience at Disney and will try to be more patient with my clients.

There were many foreigners at the parks which is a testament to the global attraction that is Disney. It is a great asset to this country and generates many jobs, tax revenue, and infrastructure to that region of Florida. Walt was a remarkable man with great foresight.

My four days at Disney with my seven year old son were unforgettable. Watching his smiles as we went through the parks is something I will always remember. I thank Disney for giving me the opportunity.

Next time we go to an amusement park, though, I’ll be watching him from sidelines.

The On Call Nightmare

This week I have the distinct honor of being on call. Let me explain to you what that entails. For one, my patients and the patients of other doctors I am covering for can call me for any problems they may have during hours when the office is closed. I think the public watches too much Grey’s Anatomy because people honestly believe that I live in the hospital and my entire life is exclusively geared towards their every desire. People are surprised to hear that I actually have a life outside of medicine. Because of this, people have no problem calling me at any of hour of the night with their non-emergent issues. It is not unusual to get the call at 3 am from the patient with ear pain that has been going on for a week. The chutzpah of some people who call me in the middle of the night is not to be believed.

As bad as that part is, it is not the worst part of being on call. The worst part is the requirement to take emergency room call. As part of my privileges at the hospital I belong to, I am required to share in taking care of people that show up in the emergency room with problems within my specialty. Now this may sound like a reasonable system but the truth is the system is broken. Many times the people who show up in the ER have no medical insurance. I am required to travel to the ER, take care of the patient, travel back home, all for free (yes, I can bill the patient but I never get paid). And worse, this patient can sue me if things, for whatever reason, go wrong. A high percentage of lawsuits are generated by emergency room visits. I essentially have legal exposure and must pay exorbitant malpractice premiums without the possibility of generating compensation. Now you tell me what other profession is enslaved like this.

Taking it a step further, if I am up in the middle of the night taking care of the nonpaying patient I may have a full day the next day with multiple surgical cases and a full schedule of office visits. So here I am operating and consulting on my insured patients with little or no sleep. There is no way anyone can be at their best having been deprived of sleep. The emergency room effects the care of those who are not even there, but just unfortunate enough to have picked their appointment on the day after a bad night for the doctor.

One will ask why then would I maintain privileges in the hospital and I would answer that I really do not want to. But, I am forced to have privileges by whom else but the insurance company. To be on their panels you must maintain privileges in a hospital.

There is no doubt that the system of emergency care is completely broken. More and more doctors are electing not to take emergency call unless they are compensated for it. This will affect care for people who truly require emergent care. Ultimately, it is always the public that suffers.

Well I’ll end it there. I just heard my beeper going off.

9.8% and Counting

Week after week we see more and more jobs being lost. At least 200k jobs almost every week for months. We are up to 9.8% unemployment and that figure probably understates the actual number. The harsh reality is that these many of these jobs are not just temporarily lost but are gone forever. This trend is neither BO’s fault nor GW Bush’s as some analysts would have you believe.

Many of the lost jobs were in industries that were based on bad business models such as the auto industry where a high school graduate could get a job on the assembly line for 60 dollars per hour with unheard of benefits. This is obviously unsustainable and ultimately makes the business noncompetitive in the world market. These jobs are not returning.

Many of the jobs were in industries that were being overinflated due to bubbles. This includes the real estate business with jobs ranging from construction workers to real estate brokers to mortgage companies. Many jobs were lost here after the bubble popped and are certainly not coming back.

Many jobs were lost in the financial industry which was both a flawed business model as well as a business overinflated by the creation of debt instruments. Nothing was actually created by these companies, just the repackaging of debt and selling to the next guy. Then that guy would sell it to another guy. A huge pyramid scheme. These jobs are not coming back.

So where does that leave us? More jobs will be lost as these industries consolidate. That is why we are seeing improvement in earnings as company’s expenses are being reduced due to lower personnel cost, not by greater sales (top line growth). The economy is stabilizing but will only expand once top line growth improves which will only happen when employment improves.

A no-brainer would be to immediately encourage the production and usage of our own sources of energy. This creates new business and enlarges existing businesses in that industry. Instead of shipping billions of dollars to import energy/oil, that money could be staying here creating good paying jobs. The plan to convert all 18 wheelers to natural gas should start immediately. We have lots of natural gas and reduces our funding of despotic regimes.

The key to job growth is in new industries and small business which is being ignored by the current administration. In fact, they are being targeted for more regulation and tax increases. Small business is the generator of jobs in this country and everything should be done to facilitate and encourage their development. It is the only way to create prosperity for all of us. Energy jobs are the way to go, NOW.

College Selection Process

This past week I went with my daughter to visit a college campus that she is interested in applying to. She is a senior in high school and is going through he process of college selection. I think the competition to get into the top universities is much more intense than when I applied almost 30 years ago. I do not envy her as she goes through this process. If you look at the numbers, there are so many kids with perfect SAT scores, top grades and excellent extra-curriculars it seems a very daunting task to go through this process. So many kids go through intense tutoring and spending their summers in educational pursuits that the bar has been risen to unobtainable heights. These kids are prepped to the exclusion of having a "normal" teenage lives just to be able to get into a particular college. Many of these kids lack adequate and critical social skills which are so important in almost all professions and businesses.

I keep telling her that it is not the most important thing where she goes to school and that she will be happy wherever she attends. I encourage her not to fall in love with a particular school that she can attain her goals regardless of the school she attends. I tell her that ultimately it is the qualities that she possesses, not the university from which she graduates that will dictate her success. Nevertheless, her desire to excel generates pressure on herself to go to a top school and I fear her disappointment if this doesn't occur.

After listening to the admissions officer discuss what the school looks for when making their selections, I think that they get it. They do not only look at the numbers but at the entire package. I don't know how they do it and I think it is a very difficult task to weed through thousands of applications and make intelligent selections. Somehow they are able to determine from an application who is the best fit for their university. They understand that the goal is a well rounded child who can excel in their schoolwork yet can also be a good communicator, a leader not just a human computer with perfect numbers.

Say what you want about the average high school graduate in this country, but the upper echelon of graduates that are generated are extraordinary. There always seem to be a group of kids that excel and will be able to successfully compete with piers from anywhere in the world. This is created by their own innate ambition and their desire to excel, not by an external force. I very much hope my daughter gets into the college of her choice but I have no doubt she and other graduates ultimately achieve based on their own assets and liabilities not by the words on their diplomas.

Race Relations under BO

This week I was on call and was called into the hospital in the middle of the night to consult on a patient who was having an emergent problem breathing. He bit his tongue and the entire tongue swelled to the point where it was blocking his ability to breath. When I arrived at the bedside in the intensive care unit there was a Filipino nurse an Indian hospitalist, an Arabic respiratory therapist, an African American anesthesiologist and me, a white Jewish guy. This is truly a remarkable collection of disparate ethnicities that were brought together that night. Almost every corner of the globe was represented that night, assembled to save the life of this man. The truth is nobody in that room cared about the sex, color, religion, or age of the other people. Especially the patient didn't care, he just wanted us to do our best to help him.

When I arrived there I saw the anesthesiologist who was trying to help this man. I have known him for several years and is one of the best anesthesiologists I have ever worked with. I was incredibly relieved knowing that he, in particular, was there as we worked together to save this man. His skin color never was or is a factor in our working relationship. We respect each others ability to do our jobs as we aim to help our patients. We look at each other and we look past the superficial. When I look at him I do not see a black anesthesiologist, I see an extremely competent professional, an excellent anesthesiologist. This patient was very lucky to have had this anesthesiologist on call that night. The two of us live in a post-racial world where we judge each other not by color but by our abilities.

This episode stands in contrast to what I am reading in the newspaper and seeing on the television. The comments by Jimmy Carter that opposition to BO's health care is racially motivated. The questions of Barbara Boxer to Harry Alford about his taking a position not in line with the black caucus. The recent discovery that BO's czar Van Jones believed white people were intentionally polluting black communities. All these are making race relations worse. BO was supposed to be healing racial tensions but I believe instead things are getting worse. Certain people in both parties cannot get past the color thing. One might expect more from the dems as they are the party that supposedly represents most African Americans. But every time they bring up the race card they show they are just as fixated by color and cannot see past peoples skin.

We will never live in a post racial world as long as every time someone opposes a position by BO they are called racists. How are we supposed to have a democratic system if your motives are questioned whenever you disagree with a position held by someone of the opposite sex, different color, or another religion. Fortunately for that patient the other night, many of us do live in a post racial world and see each other as colleagues and partners. We work together as equals to perform for our patients. We see past the amount of melanin in our skin. We in the real world have made great progress in this regard while the government and politicians cannot and may in fact be contributing to undermining this progress.

We all thought that having an African American president would be great for the country. Even if we didn't believe in his policies it would demonstrate that we are past the whole race thing that we could elect a black president. Unfortunately, I believe the legacy will be that race relations will worsen under his administration. There are just too many people white AND black that just cannot see past skin color.

Perspective

As much as I rant about the issues related to health care I must say that the practice of medicine is a very sobering one. This past week I had the unfortunate opportunity to diagnose two women in their twenties with cancer. They both came with masses in their necks and after biopsy were both positive for lymphoma. They were living completely normal lives until one day they felt something abnormal in their bodies. It is unimaginable that in the course of days we can go from our normal routine to our lives being turned completely upside down with our lives in jeopardy. I am left with something very important and that is perspective as my "problems" seem very small after having to tell these women their diagnoses.

I think we tend to lose our perspective as we focus on the details of our lives. This is likely our natural tendencies to concentrate on our own sheltered lives until we are exposed to another's tragedy or perhaps one of our own which then give us perspective. It is unfortunate that it takes a shock to regain our sense of what is truly important. On the other hand, is it preferable to go through life with the attitude that things can always be worse, that every problem that arises is negligible compared to what these women are faced with. This approach tends to minimize any conflict that is not tragic which can also be problematic.

Clearly, the balance lies somewhere in between where we deal with our problems but always keep them in perspective. This is easy to say but difficult to live. We tend to drift back into our own worlds as it is too difficult and painful to live our lives thinking that tomorrow or the next day we will feel a lump somewhere in our bodies that shouldn't be there. I think as doctors we are faced with people's tragedies and are reminded often about perspective which tends to minimize other problems that may arise. This doesn't necessarily work well if our spouses do not share our perspective and feel that we too easily dismiss what they consider problematic. I suppose this is an occupational hazard.

These next few weeks are the period in the Jewish calendar where we are judged and our fates are determined for the coming year. Who will live and who will die. Whether one believes that his/her future is determined in the next couple of weeks is a personal issue but it certainly demands that one put their life into perspective. We never know whether we will wake up one day with a lump somewhere and our lives will forever be turned upside down.