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20 March 2010

Livin' La Vida Veggie

Ok, so it's been about four months, and I am still living the Raw Food lifestyle.  Well, let's say about 80% of the time.  I do occasionally have an egg, and I can't give up cheese.  Although, I have found a source for raw milk cheese.   A lot of my friends and colleagues are amazed and say, "you're still doing that thing?"  Well, yes. 

Why you might ask:
 - About 2 weeks ago I grabbed the wrong black pants to take with me while I was in Boston.  Most women will understand when I say we have our clothes separated into "what I can wear" and "what I used to wear but may get back into so I can't get rid of it."  These pants were definitely the latter.  I pulled them out of the suitcase planning to wear pants to dinner with friends.  When I saw them I thought, "no way."  Then I pulled them on and buttoned them right up.  Oh, yeah.
 - I sleep better.  I have always been a morning person.  I have always had the ability to sleep about five hours and then be able to wake up and get on with my day.  What I have noticed, though, is that my sleep is deeper.  I wake up rested and seem to function better during the day.
 - I think I'm getting younger.  For some reason I haven't had to color the grays away (there don't seem to be as many) and my skin feels smoother (I think drinking all the water has something to do with that).  My joints don't seem to ache as much as before.  I feel like I can just keep going on the treadmill, and I seem to recover faster during a work-out.
 - Things move better.... I'll just leave it at that.

What I have learned so far:
 - there's no such thing as Fast Food:  it takes a lot of preparation.  My fastest meal is a bowl of muesli with almond milk and sliced bananas.  A fruit smoothie means cutting fresh fruit and blending everything together.  Even a salad takes at least 10 minutes just slicing the mix of herbs and vegetables.  Fifteen if I have to make a vinaigrette.
 - I shop more frequently.  I used to go to the grocery store about once a month and then slowly work my way through the cans and boxes and pre-packaged meals.  Now my meal planning consists of which vegetables I want to combine in my salads, what fruits are available, what fruits do I need to augment my dehydrated supplies, etc.
 - really, you can eat that?  One of the 20% of items I actually cook is quinoa (kween-wah).  Slightly toasted, cooked and then tossed with olive oil, pine nuts, and garlic it's very yummy.  It's also a good source of protein.  Even my DH asks for it from time to time, and he's not "choosey."  We also stand and stare at the exotic foods' section of the grocery store and try to find something new to try.  We've made some good finds.  Like golden beets.  Chopped raw on a salad.  Mmhmm.

Also, if you've noticed I've made it to the 50% done with this year.  Woohoo!  We are so looking forward to moving to the land of plenty... Farmer's Markets, a vegetarian's paradise, and some of the best wines anywhere.

17 March 2010

Ship of Fools...

Tomorrow is Match Day.  It's the day that 16,000 US medical school graduates will find out where they will be completing their medical training in residency programs across the country.  Tomorrow is also Doomsday for the health care industry... or so some say.

Let's think about what's underlying all the hype;  everyone should have health care coverage.  I agree, everyone should be able to afford health care insurance.  If you're under the socialist model, if you work you have health insurance.  You go to a state-sponsored clinic, show your worker's card, and get your basic medical care.  As for those 16,000 graduates, they would all be working at those clinics in return for having had free medical tuition.  They complete their mandatory one to two years of service then go off to specialize in their desired fields.  They don't have to worry about an average $150,000 in medical school debt.

But, our 16,000 new graduates do.  They have to face a health care system that is paying less and less for state-sponsored medical plans.  So much so, that many physicians won't see those patients.  I've been told we get paid $19 for a Medicare patient.  That's for an E.D. visit.  My insurance co-pay (so I found out one day due to an allergic reaction) is $50.  A family medicine physician gets about $9 for a Medicare patient.  Our insurance co-pay for an office visit is $20.

Now, before everyone gets all huffy about those "poor rich doctors who just want to make a bunch of money" let's take into account the price of practicing medicine.  I have no qualms saying my medical school debt is over $200,000, and I don't have undergraduate loans like many of my colleagues do.  If I went into primary care I would have to join a group, that rents an office, pays utilities, rents their medical equipment, buys office and medical supplies for their office, has to pay a billing specialist, a medical assistance, several nurses, and not to mention their own salaries.  Most practices are also adding physician-extenders like nurse practioners and physician's assistants to handle the work-load.  The more patients you see, the more money you make.  And, several of the larger  hospital-based groups have set R-something-U (Reimbursement something Units) that they have to meet.

So, you have to see more patients to bring money into your group to cover your expenses.  You're under pressure to "perform" or risk losing your job.  And, the government is paying less for the patients that are under their programs.  I am sure those 16,000 graduates-to-be would like to live their American Dream having worked toward it for the last 8 years and who are now getting ready to dedicate another 3+ years toward.  Maybe that's why recent articles in the Associated Press, Journal of the American Medical Association, and USA Today show that only 2 - 9% of graduates are going to go into primary care.

Given a generous 10%, that's 1600 graduates to be mostly spread around the lower 48 states.  So, on average each state will get about 33 new primary care doctors.  Of course, the more popular states like California and New York will get a bigger share of those, and less popular states will get the leftovers.  Ever wonder why there are so many foreign-born doctors in some areas...?  They fill the spots left open where there is still need.

Ever wonder why you can't get in to see your doctor?  Wonder why it takes several hours for a 10 minute appointment?  Well, that's part of the reason.  So, I get the overflow in the E.D.  A large percentage of the time when I ask a patient why they didn't go their own doctor it was because of a 2, 3, sometimes 4 week wait for an appointment.  Or, as one patient told me, they did go but after waiting 5 hours they left.

Now, let's pass a bill that's going to make insurance mandatory for everyone.  Let's flood the system with new patients who suddenly have the means to see a doctor.  There's a shortage of primary care physicians because reimbursement is so low.  And, I sincerely doubt that any federal program is going to pay much more than is currently being paid.  So, my business is going to go up.  However, in some parts of Los Angeles there's no E.D. to go to because they're closed due to budget constraints.  Small clinics are going to have to close down.  Everyone will have health care but there will be no where to go.

Also, from the grumblings I've heard, a lot of doctors are looking for alternative careers.  Just amoungst my med school colleagues I've heard of people practicing non-clinical medicine.  Many are saying they are thinking of working less hours to fall just under the $250,000 earnings line... remember that campaign promise that will probably actually be kept?  A friend of mine said, "Who wants to pay their patients to come see them?"  We pay the taxes that fund Medi-whatever State Care that is given to illegals, those on disability (don't even get me started on some of the bogus diagnoses that get a free ride), and many others who don't put a dime back into the system and then come in expecting everything.  As you can imagine that $19 doesn't even cover the cost of a chest x-ray.

So, at the risk of being long-winded, give doctors and teachers and police and firemen what they're worth.  If government is going to get into the business of medicine, make us all federal employees who will be eligible for our lifetime pensions when we turn 54.  You can't sue the federal government so we would no longer have to worry about tort reform.  Pay for our medical education and in return we will care for your huddled masses who came to this country to earn their American Dream.  They didn't expect anything to be handed to them... they expected to make money the Old Fashioned Way - they earned it.

Our 16,000 graduates-to-be have earned it... let's hope we give them a future that's worth it.

Ship of Fools - Grateful Dead
"Though I could not caution all, I still might warn a few:  
Don't lend your hand to raise no flag atop no ship of fools.  
Ship of fools on a cruel sea.  Ship of fools sail away from me."

04 March 2010

I Object!

So, I just spent the last week in Boston.  From July of '04 to June of '05 I was there as a Junior Fellow in Cardiac Surgery.  Basically, I was the Cardiac Surgery ICU scutmonkey.  Well, one of them actually as there were four of us hired that year.  My days and nights were spent taking care of the many, many different types of cardiac surgery patients in the ICU.  I learned a lot during that year.  Many of the events of that year helped mold me into the type of physician that I would want to become.  I think back to that time as an amazing experience.  However, during the last several months I have had to look back at that experience and wonder if I even realized then how a simple series of actions could lead me to spend four days in a courthouse; three of which were on the witness stand. 

Now, I like to think of myself as a pretty honest, thoughtful, considerate physician who lives by the philosophy of "Primum non nocere" - "First do no harm."  I think this governs my actions even more than the Hippocratic Oath.  And, in general, I don't like (not that anyone does) being asked in a public forum to defend my actions, my honesty, my very integrity.  But I had to.

I'm not going to delve into the whole experience which at times left me feeling every emotion from pure anger, to self-doubt, to honest reflection, to sheer relief.  I was lucky to have one of my colleagues from that time there to support and share in the experience.  If anything, we were a sounding board to each other about our thoughts on the day, the lawyers, the plaintiffs.  We also shared memories of the time.  And, revisted a few of our old haunting grounds.

She's continued on in surgery and will graduate this year and start her practice of medicine.  I changed to emergency medicine and will start my own practice later this year.  We're amazed at what we remember from that time and what we've done since then.  In a lot of ways both of us have been changed by this experience.  I feel for the better... however, just don't get me started in an argument about healthcare reform... except for my awesome legal team I'll be quoting Shakespeare, "The first thing we do, let's kill all the lawyers."