A Few Days Later
It was a bad week. I know a lot of other people who felt the same. I happen to be fortunate enough to live in an area where the vast majority of the population shared my dismay, but it was still difficult. Not much sleep. No appetite. Hard to concentrate. Anhedonia.
Calls for “healing” and “moving on” didn’t help. I feel assaulted, and it’s just too soon to try forgiving my attackers.
I had to keep going, though, so this morning I went downtown to work at one of my side gigs. Actually, I was there last week, but someone called out so they asked me to fill in this week as well. So I went....
Source: Musings of a Dinosaur - November 13, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Politics Source Type: blogs
The Day After
I feel like a cell in a body. A tiny little cell that’s part of something far bigger and more complex than myself.
It’s a body that has cancer. Not a terrible cancer. Something curable with appropriate treatment. The treatment wouldn’t be pleasant, but it wouldn’t be crippling. But it has to happen, because without it, the body really would die.
But the body has somehow inexplicably rejected conventional treatment, and decided to go with alternative medicine. Woo. Nonsense. Fantasy-based care.
“That chemo is poison!”
“The drug companies are all in cahoots, trying to keep me sick ...
Source: Musings of a Dinosaur - November 9, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Politics Source Type: blogs
I am a Terrible Doctor; and I ’ m Proud of it
It’s that time again. As the year draws to a close, various insurance plans try to finish collecting data to calculate bonus payments as “incentives” for “Quality” care. The only problem is that, as I’ve written before, all of their “Quality” measures are in fact nothing but proxies for cost, most of which I have no control over.
Back in the 1990s at the beginning of the Managed Care era, the model of the primary physician was that of gatekeeper. Twenty years later, the last vestiges of this model is the wretched “Referral,” a word which used to mean something but...
Source: Musings of a Dinosaur - October 4, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Inventing a Recipe
Happy Jewish New Year!
One of the staples of the holiday is round challah, a rich egg bread in a round shape. Yesterday I experimented with creating a recipe for it on my own.
Well, not entirely all on my own. I had a ration to work with: 5:3. Five parts flour (by weight) to three parts liquid. That, plus the fact that I already know how to make bread (i.e. techniques for mixing ingredients, kneading, etc.) and away I went.
I also took pictures:
First I measured out 40 oz of flour:
That meant I needed 24 oz of liquids. I had 5 eggs left in the box, so I took one of them, separated it, and saved the white to brush over the...
Source: Musings of a Dinosaur - October 4, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Food Source Type: blogs
Twenty-Seven Years
Twenty-seven years. More than a quarter of a century. Maybe not much in terms of a tree, but rather a long time.
Time for a babe in arms to reach adulthood, complete with a condo, live-in girlfriend, three cats, and a PhD within spitting distance.
Time for a medical practice to begin, grow, expand, and contract again until it is just the right size for a solo dinosaur.
Twenty-seven years ago today I hung out my shingle in front of a tiny basement office. I saw three patients that first day but only three more the rest of the week. I’ve had my ups and downs; overall, more of the former than the latter. Paper charts ha...
Source: Musings of a Dinosaur - October 2, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Family/Personal Medical Source Type: blogs
Alternate History
In an alternative line of history, I’d most likely be going down to Washington DC this weekend for a party. In this alternate history, today would have been my parents’ 60th anniversary. Falling on a Friday, dollars to donuts says we would have partied on Saturday. And what a party it would have been. 60 years is quite a long time; worth celebrating.
But my mother died thirty years ago, when she was younger than I am now. She never saw my kids or any of her other grandchildren. She never made it to the 21st century; never used an iPad or a smart phone. How she would have loved the Internet, early adopter that s...
Source: Musings of a Dinosaur - September 16, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Family/Personal Source Type: blogs
New Writing Gig
Although it looks like I’ve gone nearly silent here (I haven’t; promise) I’ve been doing some other gigs lately.
Check out my new article:
Toilet Talk; What Does Your Waste Say About You?
I know you’ve always suspected, but now it’s all too obvious: I really do have a potty mouth.
(Source: Musings of a Dinosaur)
Source: Musings of a Dinosaur - September 13, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Writing Source Type: blogs
Veggies
For a much longer time than I’d like to admit, my dietary advice to patients was squarely in the “Do as I say, not as I do” department.
I’ve never liked fruits or vegetables. Oh, I’d eat salads, but not with tomatoes. I can’t stand tomatoes. I love cucumbers, but not the seeds. Once I discovered the seedless ones, though, I couldn’t get enough. Potatoes, of course. Onions were okay, but only cooked. That was about it.
Over the years, though, I can’t tell if I’ve become more adventurous, or just less rigid. I started adding red peppers to my salads. Then I found a magnif...
Source: Musings of a Dinosaur - September 1, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Family/Personal Food Source Type: blogs
It ’ s Happening; Unintended Consequences of “ Quality ”
Once again, I called it!
Some of my previous takes on the fallacies of “Quality”:
9/24/09:
The biggest mistake made by Medicare, private insurers, and other entities seeking to improve medical care by rewarding “quality” is mistaking it for “performance”.
2/18/13:
The real reason doctors have begun “requiring” that patients undergo all manner of screening interventions is to enhance their compliance ratios. After all, the quickest way to get to 100% is to get rid of everyone who falls short.
Now it’s moved to hospitals:
Hospitals are throwing out organs and denying transplants to meet federal ...
Source: Musings of a Dinosaur - August 12, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Vaccines Do Not Cause Autism, and Hillary Clinton is Not a Liar
What on earth do anti-vaxxers and Hillary-haters have in common? I’ll tell you:
They are terminally resistant to actual, verifiable FACTS.
As has been shown over and over by numerous scientific studies, vaccines have absolutely no relationship to the development of autism or autism-spectrum disorder. None. Zilch. Zip. Nada. That association has been debunked, disproved, laid to rest. It is false.
None of that proof stops people from continuing to believe it, though. Anti-vaccine drivel drips from every corner of the Internet. Why? Because certain people want to believe. They don’t trust doctors, or scientists, ...
Source: Musings of a Dinosaur - July 31, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Politics Source Type: blogs
Openings: Part 1
What are the worst Chief Complaints you’ve ever heard?
For the non-medical reader, the Chief Complaint can be thought of as the patient’s opening statement. It’s what shows up on the schedule as the only thing I know about why the patient is there. I’ve compiled a brief and definitely non-exclusive list of the worst chief complaints I’ve ever seen; the ones that make me sigh in advance, knowing that taking the history is going to be like pulling teeth and that the patient is probably not going to be satisfied.
Here goes:
“Nerves”
“Fatigue”
“Depression”
R...
Source: Musings of a Dinosaur - July 11, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Thirty Years
Thirty years is a long time. A helluva long time.
Thirty years after I graduated from college, I wrote about taking my youngest child to begin his career there. Damn good piece, if I do say so.
2012 was a big year in my family. Multiple graduations, weddings, milestone birthdays and anniversaries got me thinking about my mother, who by dying in 1986 had missed out on the entire lives of her grandchildren. I wrote this poem and posted it that year.
I’ve posted other things on this date, my mother’s yahrzeit, in previous years: 2015, 2014, and 2011, in addition to the above link to 2012. But for some reason, tod...
Source: Musings of a Dinosaur - June 16, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Family/Personal Source Type: blogs
Intellectual Suicide
Physician suicide is an enormous problem. We lose approximately 400 doctors and trainees annually to suicide. This is a tragedy, pure and simple. Not limited to the human carnage of the equivalent of an entire medical school class or more, but, to quote Dr. Pamela Wible, “Each year more than one million Americans lose their doctors to suicide.”
What does it mean, then, when physicians who are trained in medicine — defined as the application of scientific principles to the diagnosis and treatment of human ills — turn away from reality to accept the magical thinking of pseudoscience? I submit that it...
Source: Musings of a Dinosaur - June 13, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Dialog: Doubling Down on Dropping Out
Dr. Wible and her young colleague have responded to my previous post: [Cross posting with her comment section, to share the clicky love as we continue the dialogue]
A few corrections to your blog Lucy:
1) I do NOT have a subscription practice. I see all-comers and I take insurance.
2) I have never turned anyone away for lack of money. I don’t believe in a two-tiered health care model.
3) Diet and nutrition is not woo (and is certainly not taught in med school). There are HUGE problems with allopathic medicine which does not prepare us to care for patients in an outpatient setting when it comes to prevention, lifestyle, a...
Source: Musings of a Dinosaur - June 10, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Dropping Out is NOT the Answer
I like Dr. Pamela Wible. I think she’s doing fantastic work bringing attention to the tragedy of physician and medical student suicide. We also have similar practice styles (solo, unhurried visits, total communication) although hers is a subscription practice and I still make do with insurance. Also, she’s monetized it with the title Ideal Micropractice, an organization which costs $250 a year to join. After 26+ years, I’m pretty comfortable with my version, which is ideal for me, and can’t see paying for the privilege of sharing what I’ve learned. (I just offer it for free to anyone who asks....
Source: Musings of a Dinosaur - June 8, 2016 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
