and oh-so-sinfully-full-of-calorie-treats...that Planters has stopped making them. They may have stopped making them as long as 2 years ago (you can tell how long it's been since I had them). Now there's a small, empty hole left on my tongue---full of tastebuds which were specially attuned to the savory flavor of these crunchy delights. There are few things in the world with as much cheesey (spelling?) goodness as found in these. What are they going to do next? Stop making pasteurized cheese in a can? I can't bear the thought!Friday, November 21, 2008
Oh the Humanity!
I just found out today, after having a weird craving for these oh-so-greasy 
and oh-so-sinfully-full-of-calorie-treats...that Planters has stopped making them. They may have stopped making them as long as 2 years ago (you can tell how long it's been since I had them). Now there's a small, empty hole left on my tongue---full of tastebuds which were specially attuned to the savory flavor of these crunchy delights. There are few things in the world with as much cheesey (spelling?) goodness as found in these. What are they going to do next? Stop making pasteurized cheese in a can? I can't bear the thought!
and oh-so-sinfully-full-of-calorie-treats...that Planters has stopped making them. They may have stopped making them as long as 2 years ago (you can tell how long it's been since I had them). Now there's a small, empty hole left on my tongue---full of tastebuds which were specially attuned to the savory flavor of these crunchy delights. There are few things in the world with as much cheesey (spelling?) goodness as found in these. What are they going to do next? Stop making pasteurized cheese in a can? I can't bear the thought!
Tuesday, November 18, 2008
Ugh...
How does one not become jaded and discouraged before even beginning practicing? This article has me posing this question. All the time you hear the bleakness of the medical picture, how primary care is undervalued and not compensated, and how things may get worse or won't get fixed.
Sunday, November 16, 2008
Legislating the Doctor-Patient Relationship
I read an article recently in the AMA News about some new legislation in California. Read here:
http://www.ama-assn.org/amednews/2008/11/10/prsc1110.htm
They have made it a law (the Terminal Patients' Right to Know End-of-Life Options Act) that doctors are required to talk to patients "at the patient's request" about end-of-life care, specifically hospice, but they do not have to talk about those "grey areas" (ie, withholding nutrition and water, palliative sedation) that may hasten death.
Now, anybody who knows me might think that I'd be excited about this legislation, given that I have an interest in Advance Directives and informing patients about options near the end of life, the limitations and uncertainties of the medical system, as well as just opening up communication lines regarding death and dying.
My first response though was to scoff at the idea. I realize that this is all in patients' interests--to be informed and to have understanding, and I don't want anything to get in the way of that. BUT SERIOUSLY? Making it a law? These discussions should be happening anyhow--they're part of a responsible doctor's job to make sure that patients are as well-prepared as possible for what may lie ahead.
What good does it do to say that doctors are required to provide this information "at the patient's request"? This is still putting the responsibility upon the patient.
And honestly, those doctors who aren't talking to their patients with a terminal condition about end-of-life care.... does anybody think that having it written down as a law somewhere will make them any more apt to talk about it with their patients? This isn't a conversation that you have because you're "required" to do it--it's a conversation you have because it's a privilege and it's what's right to do for your patients.
Another thing.... nothing in the article mentions what the "penalty" under law is--so it would seem just another worthless piece of paper that tax dollars were spent buying....a distraction to the lawmakers so that they might be able to say that they are "contributing to the health care system" all the while the other problems are sitting around, stewing, because, well, who knows.... "Pay no attention to that man behind the curtain."
Lesson Learned: You can't legislate the doctor-patient relationship.... it would seem legislators are a bit clueless in this realm.
What it's Worth: It's worth being able to keep a true sense of what the doctor-patient relationship is built upon.
http://www.ama-assn.org/amednews/2008/11/10/prsc1110.htm
They have made it a law (the Terminal Patients' Right to Know End-of-Life Options Act) that doctors are required to talk to patients "at the patient's request" about end-of-life care, specifically hospice, but they do not have to talk about those "grey areas" (ie, withholding nutrition and water, palliative sedation) that may hasten death.
Now, anybody who knows me might think that I'd be excited about this legislation, given that I have an interest in Advance Directives and informing patients about options near the end of life, the limitations and uncertainties of the medical system, as well as just opening up communication lines regarding death and dying.
My first response though was to scoff at the idea. I realize that this is all in patients' interests--to be informed and to have understanding, and I don't want anything to get in the way of that. BUT SERIOUSLY? Making it a law? These discussions should be happening anyhow--they're part of a responsible doctor's job to make sure that patients are as well-prepared as possible for what may lie ahead.
What good does it do to say that doctors are required to provide this information "at the patient's request"? This is still putting the responsibility upon the patient.
Legal Rep: "Doctor, why didn't you talk to this patient about dying?"
Doctor: "Well, he didn't know he was dying, and didn't ask me about dying, so I didn't need to bring it up."
Legal Rep: "Oh, ok, then, well, as long as they didn't ask about it...I guess we don't have a beef."
And honestly, those doctors who aren't talking to their patients with a terminal condition about end-of-life care.... does anybody think that having it written down as a law somewhere will make them any more apt to talk about it with their patients? This isn't a conversation that you have because you're "required" to do it--it's a conversation you have because it's a privilege and it's what's right to do for your patients.
Another thing.... nothing in the article mentions what the "penalty" under law is--so it would seem just another worthless piece of paper that tax dollars were spent buying....a distraction to the lawmakers so that they might be able to say that they are "contributing to the health care system" all the while the other problems are sitting around, stewing, because, well, who knows.... "Pay no attention to that man behind the curtain."
Lesson Learned: You can't legislate the doctor-patient relationship.... it would seem legislators are a bit clueless in this realm.
What it's Worth: It's worth being able to keep a true sense of what the doctor-patient relationship is built upon.
Thursday, November 6, 2008
Yo, Adrian!
AMC is creating the bane of my existence currently. They've decided to run the "Rocky" series of movies on multiple nights this week. Although I don't particularly have one TV show I must watch, Rocky, Rocky II, Rocky III, and Rocky IV have been on the TV..........ugh........ I really don't know what else to say. I thought about putting up a picture of Stallone just as a graphic for this post, but I'm too disgusted to see his human growth hormone-loving face one more time, or to have it on my blog.
Monday, October 27, 2008
On Another Planet
I started my outpatient Dermatology rotation today. The details of the "other planet" are dizzying. I'm not talking about me being clueless regarding dermatologic disease, I'm talking about the way that a Derm office runs. I must say, it's pretty obscene.
Firstly, the doctor has appointments scheduled every 10 minutes, some (probably 1/4) are double-booked. AND THEY NEVER RUN BEHIND!!!
The nurse to doctor ratio is 3:1....let me repeat, the doctor has 3 nurses to herself, probably leading to why the first point above exists. Each nurse comes into the room with the doctor and performs the following duties:
Firstly, the doctor has appointments scheduled every 10 minutes, some (probably 1/4) are double-booked. AND THEY NEVER RUN BEHIND!!!
The nurse to doctor ratio is 3:1....let me repeat, the doctor has 3 nurses to herself, probably leading to why the first point above exists. Each nurse comes into the room with the doctor and performs the following duties:
- Getting all of the Chief Complaint, History of Present Illness, and Past Medical History from the patient without the doctor repeating the questions
- Writing prescriptions and if a patient needs refills, the nurse goes ahead and writes it
- Ripping the carbon copy off of the prescription (as in, today, the nurse handed a prescription to the doctor with its carbon copy on the back and the doctor handed it back to the nurse--I think, for the only purpose of the nurse ripping them apart and handing it back to the doctor)
- Numbing areas to biopsy
- Being at the beck and call of the doctor to run and get samples, etc.
- Doing all the teaching regarding wounds and dressing
My mind was boggled at what the doctor DIDN'T have to do...and how she billed for the visits.
One visit she called a "Level 4" (which, for those non-medical out there... pretty complicated but not the highest, Level 5) --the patient was on Accutane, she looked over his dry skin, suggested heavy mosturizer, asked him a few questions about mood, and looked at his lab work...that was it! Geeze, I'm sure in Family Medicine nobody would get away with calling at a Level 4.
And one last thing...all of the patients came in with an understanding that only their skin would be taken care of, that's it. It was so strange to not have them bringing up multiple, unrelated complaints...and very boring.
Lesson Learned: I'd be bored to tears and unable to sleep in peace at night if I did "medicine" this way.
What it's Worth: Seeing how "the other half" lives.
Tuesday, October 21, 2008
Words!
I've decided I love words. Last night as I was trying to go to sleep, I was thinking about how remarkable they are. A series of letters, put together to convey greater meaning, to share thoughts, and to connect the human experience. I was thinking of some of my favorite words--some are my favorites just because of the sounds they make coming off of the tongue, and some are my favorites because they are just perfect for what sentiment, what action, what thought is needed for any situation. So, here they are...in no particular order:
1. Raucous--"disagreeably harsh or strident OR boisterously disorderly"
2. Serreptitious--"done, made, or acquired by stealth OR acting or doing something clandestinely"
3. Recalcitrant-- "obstinately defiant of authority or restraint OR difficult to manage or operate OR not responsive to treatment "
4. Glower--"to look or stare with sullen annoyance or anger"
5. Querulous--"habitually complaining, fretful, or whining"
6. Candid--"free from bias, prejudice, or malice OR marked by honest sincere expression"
Lesson Learned--none really from the statements above, but I will leave it with the following caution from the Bible:
"When words are many, sin is not absent, but he who holds his tongue is wise." Proverbs 10: 19
I'm still working on that one.
(also, many thanks to merriamwebster.com for their formal definitions.)
1. Raucous--"disagreeably harsh or strident OR boisterously disorderly"
2. Serreptitious--"done, made, or acquired by stealth OR acting or doing something clandestinely"
3. Recalcitrant-- "obstinately defiant of authority or restraint OR difficult to manage or operate OR not responsive to treatment "
4. Glower--"to look or stare with sullen annoyance or anger"
5. Querulous--"habitually complaining, fretful, or whining"
6. Candid--"free from bias, prejudice, or malice OR marked by honest sincere expression"
Lesson Learned--none really from the statements above, but I will leave it with the following caution from the Bible:
"When words are many, sin is not absent, but he who holds his tongue is wise." Proverbs 10: 19
I'm still working on that one.
(also, many thanks to merriamwebster.com for their formal definitions.)
Wednesday, October 8, 2008
Personal Responsibility Anyone?
I think I may write a more coherent and collected blog about this later (maybe). I don't know if I'd be able to accomplish this without being, well, legalistic, unforgiving, judgemental, condemning... yadda yadda. If you've not seen the following articles online lately, I suggest you read below.
http://www.foxnews.com/story/0,2933,409262,00.html
and
http://www.cnn.com/2008/US/10/08/nebraska.safe.haven/index.html
and
http://www.foxnews.com/story/0,2933,429106,00.html
Basically, the genius lawmakers in Nebraska have made a law letting people "abandon/drop off/give a safe haven" to "children." They left it open to interpretation (seemingly intentionally) as to children up to 18 can be given over as wards of the state. I think that one of the fatal flaws in their thinking is that those people who actually TAKE THE INITIATIVE to drop off their children probably wouldn't have been horrible parents in the first place, because they care about how their children might turn out. Those who actually are playing an active role in abusing and neglecting their children--I wonder how many of them would use this law?
Now, I'm not implying that any child should be deprived of a safe, nurturing, supportive home. Where is the personal responsibility in all of this? As Americans, we've become devoid of any consequences, ready to have somebody bail us out, give us a quick fix, and take away any little thing that may cause stress. Promises seemingly mean nothing, nobody stops to think ahead.
Out of all the actions we can perform on this Earth... shouldn't the decision to have children be one that gives us the most pause?
http://www.foxnews.com/story/0,2933,409262,00.html
and
http://www.cnn.com/2008/US/10/08/nebraska.safe.haven/index.html
and
http://www.foxnews.com/story/0,2933,429106,00.html
Basically, the genius lawmakers in Nebraska have made a law letting people "abandon/drop off/give a safe haven" to "children." They left it open to interpretation (seemingly intentionally) as to children up to 18 can be given over as wards of the state. I think that one of the fatal flaws in their thinking is that those people who actually TAKE THE INITIATIVE to drop off their children probably wouldn't have been horrible parents in the first place, because they care about how their children might turn out. Those who actually are playing an active role in abusing and neglecting their children--I wonder how many of them would use this law?
Now, I'm not implying that any child should be deprived of a safe, nurturing, supportive home. Where is the personal responsibility in all of this? As Americans, we've become devoid of any consequences, ready to have somebody bail us out, give us a quick fix, and take away any little thing that may cause stress. Promises seemingly mean nothing, nobody stops to think ahead.
Out of all the actions we can perform on this Earth... shouldn't the decision to have children be one that gives us the most pause?
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