Archive for the ‘personal’ Category

Memorial Day

Sunday, May 29th, 2016

MIkeMedals

I don’t remember much of the Second World War although I was alive for all of it. I can remember being taught some of the WWII songs, like “Don’t Fence Me In” and “Mairzy Doats.”

Most of the friends and relatives of military age went in and most returned after it was over. Not all did and the man in Bud Kerrison’s squadron who sent me the medals in the photo, was shot down and killed before I received them.

theSalute

Here, I am saluting Bud Kerrison before he went overseas. He had completed bombardier training. He served in the North African Theater and flew 50 missions, from June 1943 to January, 1944. He served in The 301st Bomb Group, 352nd Squadron.

His B 17 was named by the pilot, “Spirit of Phyllis” after his girlfriend or wife and also after an earlier plane that had crash landed in England, named “Phyllis.”

Bud's plane

There is “Phyllis” after the crash landing in England.

When the war ended, the guys all came hime and my parents had parties for them.

Saloon

That is one of the parties in 1946. My father is behind the bar and Bud Kerrison is also behind the bar with Pat Neary who would later marry a friend of Bud’s named Frank Flanagan. Frank stayed in Chicago after that although his father had been Chief of Detectives in Philadelphia. Pat’s father was an Inspector in the Chicago PD so they were a police family. I have previously recounted the story of Frank.

Well, we all get old. Bud did too and is gone now.

BudKerrison

There he is with his kids who are now all grown. I would love to have been able to take him up in a B 17 as I did my son for a birthday present a few years ago.

B 17 nose and Joe

There’s Joe in what had been Bud’s “office” as Dana Andrews described in in the pivotal scene of “The Best Years of Our Lives. “

Planning another vacation.

Sunday, April 24th, 2016

After our bad experience last year with Europe, we have decided to stay in north America this summer. In June, we plan a trip to Chicago, partly to review family history.

In September, I am planning a bit more adventure in Denali National Park.

I have been there before and we had a family trip 20 years ago with all my kids. We rented a motorhome.

kids alaska copy

This worked well and we spent almost two weeks with time in Denali Park and in the towns of Seward and Valdez.

Kids in Alaska

My youngest was 13 and the other three were all adults. My older daughter had just taken her bar exams in Washington State.

We drove from Anchorage to Palmer where there was a nice RV park with water and power at each site. There we parked for a couple of days and did a couple of local tours.

Camper dinner

The dinners were prepared in the motorhome and we would often be having dinner at 10 PM or later because the sun did not set until 1 AM at that time of year. It was easy to forget how late it was but we weren’t getting up early anyway.

Claire Alaska

The kids got to walk on glaciers. My younger daughter, Claire, is wearing my wool shirt for the glacier jaunt. She had to sleep in the folded down dinette and her brother got her up early every morning so everyone could have breakfast.

Bears

The kids got to see few bears and the rest stops had big warning signs to never take food with you out of the bus.

This year we are going to do something different.

denali-backcountry-lodge

We are going to fly to Anchorage and take a Princess tour that includes a bus to Denali Park and a three day stay at the Backcountry Lodge in the park. It is 50 miles into the park and surrounded by wilderness. The lodge is not roughing it.

BN-DBL-River-View

It is located on a creek that flows past and there is a lake nearby. There are day tours for those more energetic.

Anyway, I have made reservations for early September which is after most of the tourist season. I’m looking forward to it. I tried to interest our English friends in coming over to go with us but they have other things to do.

Denali_Backcountry_Lodge4

I can’t think of a much better way to spend a week. After the lodge, we will go back to Anchorage and then to one of my favorite places, Homer Spit.

homer spit

It doesn’t get much better then this although the hotels are a bit basic. Some of the kids who work on fishing boats just camp on the beach. They got out for days at a time and no one bothers their stuff.

tents

Life is good. Some of these kids can make $50,000 in a summer with no expenses.

Why Importing Foreign Doctors may not fix the shortage.

Sunday, April 17th, 2016

MoS2 Template Master

The coming doctor shortage that I have previously written about might be dealt with as Canada did with theirs some years ago, by importing foreign medical graduates. Britain has adopted a similar plan as thousands of younger doctors plan to leave Britain.

How is the plan to import foreign doctors working out ?

Not very well.

Nearly three-quarters of doctors struck off the medical register in Britain are foreign, according to shocking figures uncovered in a Mail on Sunday investigation.
Medics who trained overseas have been banned from practising for a series of shocking blunders and misdemeanours.
Cases include an Indian GP who ran an immigration scam from his surgery, a Ghanaian neurosurgeon who pretended he had removed a patient’s brain tumour, and a Malaysian doctor who used 007-style watches to secretly film intimate examinations with his female patients.

First of all, foreign medical schools are often limited in real experience and students often graduate with nothing beyond classroom lectures.

This was the case with Mexican medical schools, like that in Guadalajara where many American students attended. A program was devised to provide them with a year of clinical training before they could be licensed.

The revelations come just a week after it emerged health bosses want to lure 400 trainee GPs here from India, to help ease short-staffing in the NHS.
Last night Julie Manning, chief executive of think-tank 2020 Health, said: ‘The NHS has thrived on many international doctors coming to work in the UK – but the public needs reassuring they are all truly fit to practise in the first place.’

Of course, the foreign doctors have their defenders.

Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin, admitted ‘there is a problem’ with the high strike-off rate among foreign doctors. But he claimed racism played a part.

We have a similar problem with affirmative action medical graduates but the figures are not available about their rates of license revocation. For example, the The Alan Bakke case went to the US Supreme Court, which eventually ruled in his favor. By the time the court ruled, years had gone by and Bakke eventually did gradate from medical school and has practiced quietly ever since.

However, a black student admitted by the program that denied Bakke a place was subsequently prosecuted for gross negligence and his license removed. Affirmative Action has been vigorously defended.

An admissions process that allows for ethnicity and other special characteristics to be used heavily in admission decisions yields powerful effects on the diversity of the student population and shows no evidence of diluting the quality of the graduates.

However, the conclusion does not match the findings in the study.

Regular admission students had higher scores on Parts I and II of the National Board of Medical Examiners examination, and special consideration students were more likely to repeat the examination to receive a passing grade.

The article goes on to explain that There was no difference in completion of residency training or evaluation of performance by residency directors.

A friend of mine was the Chairman of the Department of Surgery at a UC medical school who decided to fire a black female resident for incompetence. He was advised by the UC system and the other department heads that he would lose a lawsuit if she filed one. She did, in fact, file such a lawsuit alleging racial prejudice (of course). The department chair was able to successfully defend his decision but the fact that no one else was willing to try explains the finding that There was no difference in completion of residency training or evaluation of performance by residency directors.

I have had the experience of being a Surgery Department Chair in a community hospital confronted with the application of a known incompetent surgeon. The same factors apply to those known to be dishonest. A request for a letter of reference from the department in which the applicant trained usually results in a response that states, “The applicant completed the residency from X date to Y date.” No other information is provided and a further request is usually answered by “The matter is in litigation,” or words to that effect. This applies to all such applicants but affirmative action individuals are almost impossible to find negative information on even if the “grapevine” has provided warnings.

The general concern can be found, but details are thin on the ground.

A quick scan of the documents reveals that white students applying to medical school with a GPA in the 3.40-3.59 range and with an MCAT score in the 21-23 range (a below-average score on a test with a maximal score of 45) had an 11.5% acceptance rate (total of 1,500 applicants meeting these criteria). Meanwhile, a review of minority students (black, Latino, and Native American) with the same GPA and MCAT range had a 42.6% acceptance rate (total of 745 applicants meeting these criteria). Thus, as a minority student with a GPA and MCAT in the aforementioned ranges, you are more than 30% more likely to gain acceptance to a medical school.

There are other sources of the facts, but they don’t appear in mainstream publications. Social Justice keeps most of these concerns underground.

A friend of mine, who is Cuban born and an immigrant as a child, applied to UC, San Francisco medical school. This was in the 1970s. Affirmative Action was well underway. He waited several weeks, then months, to hear if he had been accepted. Finally, he drove to San Francisco and asked someone in the Admissions Office what had happened to his application. He was told that it was in the “Hispanic Applicant Committee.” Having no idea what criteria such a committee might be using to determine who should be admitted, he asked if his application could just be considered as a “white” applicant. This was done and he received a letter approving his admission a few days later.

The pressure is now on medical education to provide the hundreds of thousands of new doctors this society believes it needs. Productivity of the present graduates is well below that of my generation. Some of that is the disappearance of fee-for-service practice which motivates work ethic. Some of it is a result of the 60% female medical school classes.

The female doctor population is acknowledged to work less.

Today, however, increasing numbers of doctors — mostly women — decide to work part time or leave the profession. Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time.

This was the reason why medical school admissions committees “discriminated” against female applicants in the 1960s when I was a medical student. They were concerned, even then, about a doctor shortage and assumed women would stop working to have children or practice part-time.

They were absolutely correct.

Canada is finding some productivity issues and even some explanation.

a fee for service model, and its inherent encouragement of increased productivity through increased volume of patients, a significant shift away from this single model is taking hold.

This, of course, will not deter the Social Justice types as more doctors with less productivity is somehow more efficient than paying doctors more to encourage higher work loads. Socialism is the aim, productivity will have to take care of itself.

In the meantime, PHYSICIANS WHO DID not attend medical schools in the United States or Canada, referred to as “international medical graduates (IMGs)”, play an integral role in the U.S. health care system. Such physicians now represent approximately 25 percent of practicing doctors nationwide.

It’s going to increase.

Feminism and Victimhood Culture.

Friday, April 8th, 2016

We are living an age when any reference to women runs the risk of violating the “victimhood” rights of feminist women.

What is “Victimhood?” It was explained by two sociologists in 2014.

We’re beginning a second transition of moral cultures. The first major transition happened in the 18th and 19th centuries when most Western societies moved away from cultures of honor (where people must earn honor and must therefore avenge insults on their own) to cultures of dignity in which people are assumed to have dignity and don’t need to earn it. They foreswear violence, turn to courts or administrative bodies to respond to major transgressions, and for minor transgressions they either ignore them or attempt to resolve them by social means. There’s no more dueling.

The “Honor Culture” requires that one avenge insults to preserve honor. The law and third parties are avoided and this culture is typical of areas where law and authority is mostly absent. A classic example is the American West in the Age of the Frontier. As law and authority became available, the culture gradually changed to one of The Culture of Dignity in which people are assumed to have dignity and don’t need to earn it. They foreswear violence, turn to courts or administrative bodies to respond to major transgressions, and for minor transgressions they either ignore them or attempt to resolve them by social means. There’s no more dueling. Lawyers have made this culture ubiquitous, even in war.

Now, we have a new phenomenon.

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The Doctor Shortage, discovered once more.

Friday, April 1st, 2016

33 - Lister

I have previously written posts about a coming doctor shortage.

They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

This is all well and good. What happens when a patient comes in with a serious condition ?

The health policy “experts” have been concerned to train “lesser licensed practitioners” and have pretty much ignored primary care MDs except to burden them with clumsy electronic medical record systems that take up time and make life miserable.

I repeatedly ask medical students if they would choose a career in primary care if it would completely erase their student loan debt. A few hands go up, but not many. In fact, for a while now, the federal government has dedicated millions of dollars to repaying loans for students who choose primary care. Yet residency match numbers show that the percentage of students choosing primary care is not increasing. Though loan forgiveness is a step in the right direction, medical students realize that by choosing a more lucrative specialty, they can pay off their loans just fine.

I proposed years ago, a health reform that resembled that of France where medical school is free. It could be arranged that service in primary care, low income clinics would give credit against student loans. Nothing happened. Except physician income has declined. And tuition has increased.

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We were pretty close.

Friday, March 18th, 2016

When we were in Brussels last September, we stayed at a nice hotel near the Grand Place called The Bedford Hotel and Congress Centre.

belgium-brussels-grand-place

I showed some of our photos here.

The Grand Place is about four blocks from our hotel which is quite central. Also fairly central is Molenbeek where the leader of the Paris terrorist attack was captured today.

brussels

To the left is the canal and across it, the Molenbeek neighborhood where the terrorists were holed up. We walked by it during our stay which was a few weeks before the attack. Our hotel was locked down for a week after the Paris attack as they searched for the perpetrators.
We were very close.

Another update on the NHS, Bernie’s favorite health plan.

Friday, February 12th, 2016

NHS

I have mentioned problems with the NHS here before.

That was about emergency care.

Last fall there was a concern about junior doctors emigrating to other countries.

Britain is already suffering from a serious, and unprecedented, shortage of GPs, on a scale that doctors’ leaders say is fast becoming a crisis.

According to figures released last week, a staggering 10.2 per cent of full-time GP positions across the UK are currently vacant, a figure that has quadrupled in the past three years.

Two-thirds of practices are now finding it ‘difficult’ or ‘very difficult’ to find locums — freelance medics — to cover the shortfall.
As our population gets steadily older, and sicker, frontline surgeries are becoming increasingly swamped.
‘We are in dire straits if we do not act to address the GP recruitment crisis immediately,’ the Royal College of GPs warned last week.

In standard government medicine fashion, the British Health Minister imposed a new employment contract that ignored doctors complaints.

The result ?

Junior doctors are threatening a mass exodus to Australia after Jeremy Hunt forced through his controversial new contract yesterday.
There has been a huge surge in the numbers seeking certificates to practise abroad and some have already lined up jobs.
Almost 760 doctors were issued with documents by the General Medical Council in the first four weeks of this year – nearly 200 a week and almost double the usual number. Although they include some older GPs and consultants, the vast majority were disillusioned younger doctors.

Becoming a doctor is a classic middle class occupational choice. Few doctors become rich and almost none do so from actual practice. There was a phase in the 1960s when doctors suddenly became much more prosperous as Medicare was introduced, providing payment for care that had been done for no charge mostly. With time, the US government has reduced compensation and imposed rules designed to reduce costs. With the imposition of Obamacare, many older doctors who do not have heavy student loan balances and whose own children are educated, are choosing to drop all insurance, including Medicare, and practice for cash.

Obamacare has resulted in many hospitals consolidating and buying up medical practices to develop a vertically integrated system of health care delivery that resembles old industrial models. The result for physicians is a trend to salary jobs and dissatisfaction with their careers.

I met a woman geriatrician, the only fellowship trained geriatric specialist in central Iowa. She had quit Medicare. That sounds a bit suicidal if all your patients are Medicare age. What had happened was she was being harassed by Medicare because she was seeing patients too often. Many of them were frail elderly living at home. She dropped out and began charging her patients cash for services. She was making a decent living after a year and was happy with her decision. I don’t know how many realize that geriatrics, as a specialty, is a university subsidized field. There is no private geriatric practice because the doctor can’t survive on what Medicare pays. She tried and had to quit. She is doing it on her own now.

That was about Medicare. The same is happening with Obamacare and the medical conglomerates that have been assembled in anticipation of the “Industrial Model” of medical care. How is that working out in Britain ?

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Will California real estate prices collapse ?

Tuesday, January 26th, 2016

I sold my house in 2010 and moved to Lake Arrowhead where I bought a house on a rare level piece of land that I fenced for my dog.

After, living there for two years, I found that I could not tolerate the altitude, even though it is only 5200 feet. I was short of breath and had trouble sleeping. I had to sell the house and move back to sea level. In doing so, I lost a lot of money and have been renting since 2012, first a small condo and now a three bedroom house in Mission Viejo. I have slowly rebuilt my funds and have started to think about buying another house. I would really like to move to Tucson but my children are in California and I would be alone in Tucson. Jill and I are back together since 2014 and so one reason for staying here is less important. I would not be alone.

The other reason why I am reluctant to buy another house in southern California is the insane level of real estate prices. In moving to Lake Arrowhead, a resort, I found the only real estate market that is NOT increasing in value. Mission Viejo, where I have lived since 1972, is in Orange County and has some very high real estate values. I have been nervous about another collapse in prices and don’t want to buy at the peak of the market.

Recently there have been a few signs that the party may be over.

In the 1980s, there was a surge of buying from Japan as Japanese used the towering real estate prices in Japan to borrow and buy expensive houses in southern California. When Japan entered the present 25 year slump, the prices of southern California homes also dropped and many were sold for a fraction of the previous price. An impressive example, is what happened at the Pebble Beach golf resort. In 1989, a Japanese investor bought the resort for an amazing price. Ten years later, he had to sell for a fraction.

The sale will end nearly a decade of Japanese ownership of Pebble Beach, which became a symbol of the exorbitant prices paid and, subsequently, the massive losses suffered by Japanese investors who flooded into U.S. real estate during the late 1980s and early 1990s.

“We think it’s the best golfing place on the globe,” said Ueberroth, who began negotiations to purchase the property in March. “I’ve been lucky enough to have played there over the last 40 years.”

The purchase of Pebble Beach Co. includes the Pebble Beach Golf Links and three other nearby courses; two luxury hotels, the Lodge at Pebble Beach and the Inn at Spanish Bay; and 17-Mile Drive, a popular tourist destination.

Pebble Beach Co. is owned by a partnership between Taiheiyo Club Inc., a Japanese golf resort company, and Sumitomo Credit Services Co., one of Japan’s largest issuers of Visa cards. The partnership purchased Pebble Beach in 1992 from golf tycoon Minoru Isutani, who bought the company only two years earlier from a group headed by oilman Marvin Davis. However, the debt-ridden Isutani was forced to sell the property at an estimated $350-million loss.

That’s a big loss and an example of what happened. Now, China is is seeing a stock market crash similar to the Japan real estate crash in 1990.

china

China is still going through a difficult transition from socialism to capitalism, meaning its government that once tightly controlled the economy is slowly letting the global market take the wheel. That’s a tough process, particularly for a government that is used to being able to turn the economic knobs as it pleases. It still likes to do so from time to time, as it did on Thursday — a currency move that will get to in a bit.

But to show how precarious things are, a relatively small tweak sent investors into a pretty steep nose dive. And when China dives, so does everybody else, as evidenced by the market declines around the world.

So, how much effect will that have on Los Angles real estate ? This much.

Prices for the top 5 percent of U.S. real estate transactions remained flat in 2015 while all other houses gained 4.9 percent, according to data from Redfin Corp., a real estate brokerage and data provider.

In the Los Angeles suburb of Arcadia, where Zhang is struggling to sell the six-bedroom home, dozens of aging ranch houses were demolished to make way for 38 mansions built with Chinese buyers in mind. They have manicured lawns and wok kitchens and are priced as high as $12 million. Many of them sit empty because the prices are out of the range of most domestic buyers, said Re/Max broker Rudy Kusuma, who blames a crackdown by the Chinese on large sums leaving the country.

And now, the Chinese market is crashing. Hmmm. Can southern California real estate be far behind ? I’m waiting. Meanwhile, I still like Tucson where prices are much lower.

For example. We are still thinking about it.

2015 is gone, thank God.

Friday, January 1st, 2016

2015-a-maes-Marty_thumb

I am content to see the year 2015 gone. I can remember as a college student thinking that 1960 would never come. That was a good year. I didn’t graduate from USC as planned but I did get married and I did get accepted to medical school.

Some of the story is here in my short biography. More of it is here in my “stream of consciousness.” The next installment is here as I describe Basic Training.

When I got back from Basic Training in December 1959, I had my first date with Irene Lynch. A year later to the day, we were married and a week later, I got a letter from SC Medical School telling I had been accepted to the class beginning in September 1961. So, 1960 was a pretty good year.

In 2015 I spent what I think will be my last year teaching medical students at what is now named “Keck School of Medicine of USC” and is where I attended from 1962 to 1966. I went back to teaching there in 1998 in a program called Introduction to Clinical Medicine, which seems to be disappearing into the “Family Medicine” Department which is a shame.

I now have a book of memoirs called “War Stories: 50 years in Medicine” and which is a Kindle book only so far. Much of my medical school experience is included along with stories from my years as a surgeon. It started to be “40 years a surgeon” but I decided to include the rest and changed to 50. In June 2016, it will 50 years since I graduated from Medical School and that seemed a appropriate.

I enjoyed my time with students and I am quitting only because of frustrations with the Electronic Medical Record, about which I used to be enthusiastic, and with changes in the County Hospital which used to be a wonderful teaching institution. The Electronic Medical Record, now more often called The Electronic Health Record, probably because much of it is not about medicine, is a big problem.

The EHR, as it is called, has acquired a bad reputation.

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Celestial Navigation

Tuesday, October 13th, 2015

CatalinaLaborDayRace

In 1981, I sailed my 40 foot sailboat to Hawaii in the Transpacific Yacht Race. That year some large yachts had what were called “Sat Nav ” receivers aboard to track a system of satellites that required continuous tracking and took quite a bit of electrical power. It is now called “Transit” or “navSat”

Thousands of warships, freighters and private watercraft used Transit from 1967 until 1991. In the 1970s, the Soviet Union started launching their own satellite navigation system Parus (military) / Tsikada (civilian), that is still in use today besides the next generation GLONASS.[10] Some Soviet warships were equipped with Motorola NavSat receivers.

My small sailboat could not use such a system. It drew about an amp an hour, far too great a drain on my battery. For that reason I used a sextant and sight tables like these, which are published for the latitudes to be sailed.

sight reduction

That volume is published for latitudes 15 degrees to 30 degrees, which are the ones we most sailed. Hawaii is at about 20 degrees north and Los Angeles is 35 degrees north. The sight tables provide a set of observations that can be compared with an annual book called a “Nautical Almanac.” As it happens, the Nautical Almanac for 1981 is used for training and is still in print.

Nautical al

The third component, besides the sextant, of course, is a star finder, like like this one, to aid with navigational stars.

The whole system is called Celestial Navigation.

The first thing one needs is an accurate clock. This is the reason why sailing ships need a chronometer in the 18th century.

Harrison solved the precision problems with his much smaller H4 chronometer design in 1761. H4 looked much like a large five-inch (12 cm) diameter pocket watch. In 1761, Harrison submitted H4 for the £20,000 longitude prize. His design used a fast-beating balance wheel controlled by a temperature-compensated spiral spring. These features remained in use until stable electronic oscillators allowed very accurate portable timepieces to be made at affordable cost. In 1767, the Board of Longitude published a description of his work in The Principles of Mr. Harrison’s time-keeper.

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