Archive for the ‘personal’ Category

Why Doctors Quit.

Friday, May 29th, 2015

Today, Charles Krauthammer has an excellent column on the electronic medical record. He has not been in practice for many years but he is obviously talking to other physicians. It is a subject much discussed in medical circles these days.

It’s one thing to say we need to improve quality. But what does that really mean? Defining healthcare quality can be a challenging task, but there are frameworks out there that help us better understand the concept of healthcare quality. One of these was put forth by the Institute of Medicine in their landmark report, Crossing the Quality Chasm. The report describes six domains that encompass quality. According to them, high-quality care is:

1) Safe: Avoids injuries to patients from care intended to help them
2) Equitable: Doesn’t vary because of personal characteristics
3) Patient-centered: Is respectful of and responsive to individual patient preferences, needs and values
4) Timely: Reduces waits and potentially harmful delays
5) Efficient: Avoids waste of equipment, supplies, ideas and energy
6) Effective: Services are based on scientific knowledge to all who could benefit, and it accomplishes what it sets out to accomplish

In 1994, I moved to New Hampshire and obtained a Master’s Degree in “Evaluative Clinical Sciences” to learn how to measure, and hopefully improve, medical quality. I had been working around this for years, serving on the Medicare Peer Review Organization for California and serving in several positions in organized medicine.

I spent a few years trying to work with the system, with a medical school for example, and finally gave up. A friend of mine had set up a medical group for managed care called CAPPCare, which was to be a Preferred Provider Organization when California set up “managed care.” It is now a meaningless hospital adjunct. In 1995, he told me, “Mike you are two years too early. Nobody cares about quality.” Two years later, we had lunch again and he laughed and said “You are still too years too early.”

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Memorial Day

Sunday, May 24th, 2015

Another Memorial Day is coming upon us and we are sinking slowly into the morass that Barack Obama has created. I am frankly surprised that a community organizer can do this much harm.

Anyway, memories of better times beckon.

theSalute

That was 1944 and I was welcoming home my cousin Arthur G Kerrison who was home on leave. He was a bombardier with the 301st Bomb Group, 352nd Squadron in North Africa.

Here is another photo of him.

Bud, Marion and MIke

This one is with his sister, Marion, and yours truly about 1943 or early 1944 since it seems to be in front of the house we moved from in November 1944. “Bud” as he was known in the family, completed his training at Roswell, NM and went over seas to join the 15th Air Force in North Africa. His first mission was in June of 1943 over Leghorn Italy. His 50th was in January 1944. He must have been home after he completed his missions.

My own service was at home in California with the 146th Air Transport Command and I saw no combat. The worst danger was the drive to Van Nuys Airport.

I did try to teach the girls about the history of war and its cost in France in 2006.

Utah

There they are at Utah Beach.

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And at Omaha Beach

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And in the US military cemetery above Omaha Beach.

MIkeMedals

This is me wearing the medals that were sent to me by a member of Bud’s squadron who was shot down before I received them.

Please remember them. We owe them our freedom.

Growing up in Chicago in the 40s.

Monday, May 4th, 2015

I grew up in a Chicago neighborhood called South Shore. At that time, 1943 to 1956, it was one of the nicest parts of the city. Now, now, it is a cesspool of crime.

When my father moved us to the house at 7344 Paxton Avenue, I was 6 years old. The area was quiet and peaceful. Not far away was South Shore Country Club, a beautiful club that offered golf, skeet shooting and a horseback riding to members.

ssold1

It was a elegant place and I visited a few times but we were not eligible for membership because my father was in the business of owning and repairing juke boxes. That was not a respectable enough occupation. Prosperity was not the criterion. Los Angeles County Club has barred people from the entertainment business for the same reasons.

Our home had been built in 1912 and still had gas lighting fittings in the bathroom and living room, as electrical lighting was still a bit suspect.

Paxton

This is the house many years after we were gone. It has had the front porch enclosed in brick. Otherwise, it looks much the same. The owner saw me taking a photo and came out to ask me who I was. He insisted on showing me through the house which has had some interior remodeling. He asked if I could send him photos of what it looked like when we lived there but most of my old pictures are home movies.

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A Preview of Coming Attractions.

Sunday, April 5th, 2015

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A significant number of Somali immigrants’ children have traveled to the middle east as jihadis.

ISIS has been luring thousands of Westerners to the battlefields of Syria and Iraq. The number of Americans who have traveled to Syria is still relatively small — in the neighborhood of 150 people — and a thin slice of that group, perhaps as many as two dozen Americans, are thought to have joined ISIS.

In the discussions at the White House this week, one city has focused minds: Minneapolis-St Paul. It had been ground zero for terrorist recruiters in the past, and is fast becoming the center of ISIS’ recruitment effort in the United States.

This is a growing problem with the emergence of “lone wolf” attacks by jihadis.

The young man pictured above is one of many young black men, many recruited in prison, who have committed these actions.

Over the weekend, the FBI announced that it would treat Islamist Alton Nolan’s alleged beheading of Colleen Hufford, 54, as a case of workplace violence. That despite the fact that Nolan’s Facebook page contains a picture of Nolan giving the ISIS salute, multiple pictures of Osama Bin Laden, a screenshot of the 9/11 attack on the World Trade Center, and a quote reading, “I will instill terror into the hearts of the unbelievers: smile ye above their necks and smite all their fingertips off them.”

Then, of course, we have another example of “workplace violence” courtesy of Major Hassan.

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Western Civilization.

Saturday, January 24th, 2015

When I was a college freshman, back when dinosaurs roamed the earth in 1956, we had a class called “Man and Civilization.” That class is no longer taught, of course, just as “World History” is no longer taught in high school.

There is a good post on Ace of Spades today.

The first leg of the three legged stool that supports Western civilization came from the Jews, and it’s monotheism. The idea of one God as opposed to many different gods begats the concept of absolute right and wrong, which is necessary in order to have the concept of morality. Morality is what takes humans away from a world where might makes right.

The second leg came from the Greeks and Romans, and that’s the idea that the world has certain natural laws, that these laws are universal, and that they can be studied and understood and even manipulated. From this comes science, of course, but a better term for this would be reason.

Finally, from the Anglo-Saxons we got the concept of rule of law. Just as there are universal natural laws that govern nature, so too must man’s laws for governing man must be universal. Nobody is above the law, thus everyone is treated equally. Equality is the third leg.

I agree with this and a corollary from Robert Heinlein, the science fiction writer. In fact, it is #1 on my list of favorite quotes.

Throughout history, poverty is the normal condition of man. Advances which permit this norm to be exceeded—here and there, now and then—are the work of an extremely small minority, frequently despised, often condemned, and almost always opposed by all right-thinking people. Whenever this tiny minority is kept from creating, or (as sometimes happens) is driven out of a society, the people then slip back into abject poverty.
This is known as ‘bad luck’.”

– Robert A. Heinlein

Another bit from the Ace post.

Western culture is the only place that all three have gained equal ascendancy, and that brings us back to where we started, because leftist political ideology is dedicated to destroying all three of the legs upon which our society rests.

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More Biology

Saturday, December 20th, 2014

I have been posting some long comments at at Chicagoboyz, and decided to do them as post here. The topic is the future of technology.

I am pessimistic on molecular medicine for several reasons. I have gotten into two nasty debates on evolution at conservative web sites. One was at Ricochet and was nasty enough that I quit going there. There were something like 250 comments, of which about four were friendly. At Althouse, it was a bit better but still very negative, about 4 to 1. I let my membership at Ricochet expire and so can’t find the thread.

Found it with Google.

A sample of comments is here.

No disrespect Mike but I think you are suffering from the same problem that a lot of people suffer from. The inability to factor faith into the intellectual equation. It is possible to understand and embrace the science of evolution and apply the knowledge gleaned from it even if you aren’t 100% sure we have the story right.

I 100% believe the story of creation in the Bible, but I have no problem understand the evolution of the sickle cell trait. In the same way I have no problem believing Jesus brought Lazarus back from the dead or healed the server of a Roman centurion from miles away even though these things seen completely at odds with medical science.

That doesn’t even take into account the anti-GMO lefties who seem to be more accepting of human modification than with plants.

In both cases, I got into it by commenting that I would not write a letter of recommendation for a student applying to medical school who did not believe in evolution. I tried to make the point that I am not the king of medical school admissions but it was no help.

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Reduced blogging.

Wednesday, October 29th, 2014

For a while I have noticed that comments dropped way off and I attributed this to the fact that I had some health issues a couple of years ago and slowed down blogging considerably. I have also been invited to blog at Chicagoboyz and did not always post the same things here. I do often write the first draft here so I can see it, or, if the topic seems more local to my own community or interests like Mission Hospital, I only posted the item here. If anyone is interested in my posts over there, they are Here although most are at both sites.

A couple of commenters seem to be coming back and commenting so I thought an update was in order.

I’m still teaching at Keck (USC) medical school in the same Introduction to Clinical Medicine Program as I have for fourteen years now.

I also spend a day or two examining recruits at the Los Angeles MEPS which allows me more time to visit with young people and I enjoy it.

Maynard Brandsma

Tuesday, September 2nd, 2014

I was just thinking tonight about an amazing character I knew years ago. In 1972, I moved to Mission Viejo and began a surgical practice at Mission Hospital, now known as Mission Medical Center. When I arrived in December of 1972, I met an internist who had an amazing career and personal history. He was born in Holland and during World War II was supposedly a fighter pilot in the Dutch Air Force in what is now Indonesia. At the time it was the Dutch East Indies. He was also a physician at the time and was chief of staff at the hospital in Indonesia where another physician friend, Sergei Lockareff was born.

Maynard practiced as a physician in Santa Monica and was the personal physician for a number of movie stars, including Humphrey Bogart, Greer Garson and Carole Landis.

Life seemed very good indeed. But Bogie came home one day and told me that he’d run into an old co-star, Greer Garson.
Over lunch, she’d announced that she didn’t like the sound of his cough, and dragged him to see her doctor, Maynard Brandsma, at the Beverly Hills Clinic.

I was so used to Bogie’s cough that I never paid too much attention. He’d been off his food a little, but that wasn’t unusual. I should have realised at once that the mere fact that he’d consented to go with Greer to a doctor was indicative of something serious. Any time I’d ever mentioned a doctor to him, Bogie bristled.

Maynard discovered Bogart’s esophageal cancer and cared for him during that illness. Another physician friend, Burt Meyer, was the surgeon who operated on Bogart and who later said that the cancer was so small that he would never operate on another. If he couldn’t cure that one, there was none he could cure. Burt operated on John Wayne for his lung cancer with better luck.

Maynard was the physician who examined and treated the wife of David Niven for her fatal head injury, suffered when she fell down a flight of stairs in the dark at a Hollywood party.

When I came to Mission, Maynard had been there for several years. He had moved to Mission Viejo after marrying his second wife Mickie. He was active in practice and was kind of intimidating to a new surgeon. By that time, he was 65 years old but still very active. I remember that he tried to get me to join the Coto de Caza gun club, which was abruptly closed by the developer in 1991. At the time that Maynard was a member there was good quail shooting there but I couldn’t afford it.

He was quite the character. One night his telephone did not answer and the hospital asked the sheriffs to go to his house and let him know it was pout of order and they were trying to reach him. They knocked on his door at 3 AM and he came to the door with a .45 automatic held behind his back. Things were far less tense with the police in those days and they thought nothing of it.

The hospital was quite small at the time and Maynard was seeking a second career and life with his new wife. His career at St John’s Hospital in Santa Monica was spectacular in that he had been chief of staff and had a Hollywood practice, as well. One of his patients was John Ford and he made the diagnosis of Ford’s colon cancer that ultimately killed him.

Maynard was a good physician and continued to practice for a number of years after my arrival. Eventually, he and Mickie moved away and they are buried in Montana. He was a very colorful character and I remember him fondly.

Medicine is coming to be a government benefit.

Sunday, August 3rd, 2014

Obamacare is having serious trouble as I have discussed. The success stories, like California, are an example of what I have called Medicaid for All.

“It’s a total contradiction in terms to spend your public time castigating Medicaid as something that never should have been expanded for poor people and as a broken, problem-riddled system, and then turn around and complain about the length of time to enroll people,” said Sara Rosenbaum, a member of the Medicaid and CHIP Payment and Access Commission, which advises Congress.

Most of the new enrollees are Medicaid members and those enrolled in “private insurance” learn that they have severely restricted choice of doctor or hospital.

Now we have a new development.

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New developments at the hospital where I used to practice.

Friday, June 27th, 2014

When I moved to Orange County in 1972, I joined a friend from my surgery residency in practice at a new hospital that had opened a year before. It was called “Mission Community Hospital,” and was owned by a group of doctors with one of the partners an owner of the new development of Mission Viejo. His name was Richard O’Neill and his family had developed Mission Viejo from part of their huge ranch.

The hospital was small with 110 beds total and the staff was made up of young doctors who had recently finished their training like me. The owners were mostly older doctors and practiced in another area of the county. Some of them we would not have allowed on the staff if they had applied. They largely left us alone and over a period of a few years we developed what we thought was the best hospital in Orange County.

Mission Hospital in 1975.

Mission Hospital in 1975.

This is what the hospital looked like in 1975. The swallows used to nest in that entry area. To the right of the entry, there was a doctors’ parking lot and, for a while, the hospital paid a kid to wash our cars. Tom and I always tipped him extra. The food in the doctors’ dining room was free and good and I got a bit pudgy. The hospital went to considerable trouble to make it friendly to doctors and we responded.

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