Voices Of Medicine

Current Issue

A Call from the San Mateo County Medical Association.

We need your help to protect MICRA

Dear Physician Colleagues,

We need your help in protecting California’s Medical Injury Compensation Reform Act (MICRA). On November 4, 2014, voters will go to the ballot to vote on Prop 46. The importance of MICRA to physicians in the state of California is significant. We're not asking you to assemble and march on Sacramento as more than 800 physicians, nurses, lab technicians and hospital personnel did in a grass root effort lead by the California Medical Association on May 13, 1975. 

Trial lawyers have sponsored Prop 46. If Prop 46 passes, the current MICRA cap will quadruple from $250,000 to $1.2 million on non-economic damages in medical malpractice lawsuits. If Prop 46 passes, it will result in higher health care cost for everyone and threaten patient’s access to care with his or her providers. If Prop 46 passes, California will be flooded with new lawsuits and big payouts to trial lawyers.

The California Medical Association and county medical associations across the state have been working tirelessly to defeat this measure, but we still need your help. The next two weeks are crucial if we are to defeat Prop 46.

Please make a voluntary contribution ($25, $50, $100, $500) to help us preserve MICRA.

Please click here to donate by debit card or credit card (Visa, MasterCard, or Discover).

You can also mail your check to:SMCMA – Prop 46, 777 Mariners Island Blvd., #100, San Mateo, CA 94404

When November 4 arrives, we hope we will be able to celebrate the defeat of Prop 46 and return to the practice of medicine without increasing threats of malpractice "pain and suffering" awards to increase to $1.2 million blue sky in addition to all the medical injury without limit.

Read the entire report . . .

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Voices Of Medicine

Previous Issue

The Dhar Diet, or D-Diet

Sonoma Medicine
The magazine of the Sonoma County Medical Association

COMMENTARY: The D-Diet

By Sanjay Dhar, MD

There are several hundred different types of diets out there, so I figured why not add one more to the list, the Dhar Diet, or D-Diet. How difficult can it be to come up with a diet? All I need to do is read a few books, adopt some basic ideas, tweak the concept and present it with a new “designer” name.

Diets range from A (Atkins) to Z (Zone), and there is no shortage of advice regarding the different diet plans. You may decide to choose one and stick with it or seamlessly switch from one diet to another. However, with all the diets out there and the endless advice offered, why then are Americans getting heavier at a faster pace than ever before? It seems that it’s a never-ending battle between the food industry pushing processed products that make us gain weight, and the diet industry, which has convinced us that we can never be satisfied with the way we are.

Is the truth somewhere in between? We do know that both these sectors are reaping billions of dollars in profits. Let us also not forget the consumer, who is the most important member in this complex relationship. Ultimately we have to be responsible for our actions, even though we know that we live in a free country where we can eat and drink whatever we want.

As a cardiologist, I have been giving dietary advice to my patients over the last 25 years. Diets come in various shapes and forms, with each having a tailored approach or a certain niche. My focus has been on preventing and hopefully reversing heart disease. I try to evaluate dietary habits rather than just giving a blanket order to “lose weight.”

Patients often have difficulty following guidelines because of poor food labeling. The label on a jar of peanuts may report 200 calories, for example, but you have to read the fine print to realize that the calorie amount mentioned is per serving, and that there are several servings per package. Unless patients take the time to read the label in detail, they often consume many more calories in a single sitting than they think. (A cup of peanuts actually contains 830 calories). The same concept is also true for salt and corn syrup content in processed foods. Unfortunately, we don’t have a fuel-gauge sensor in our body that tells us to stop eating when we have reached sustenance levels in calorie intake.

Why do people diet? Most do so to lose weight, to jumpstart the summer season, or to keep up with their new year’s resolution. Some are forced to lose a lot of weight because they have become morbidly obese and it’s affecting their health. Some diet to help their medical conditions, such as diabetes, hypertension, heart disease, arthritis of lower extremity joints, swelling of legs, reduced aerobic and functional capacity, exertional shortness of breath, easy fatigability, sleep apnea and abnormal cholesterol panels, to name a few. Some people have to change their diet because they have developed food intolerances, whether it’s gluten, dairy, nuts or other food ingredients. Then there are some disease states that demand special attention to food choices, such as chronic kidney disease, gout or other metabolic conditions.

For my patients, I recommend a drawn-up plan, any plan that has a chance of being successful. Ultimately losing weight is simple mathematics: calories in vs. calories out … or is it? We know that under extreme starvation, everyone will lose weight. However, since starvation is not practical or sustainable, weight loss should occur without extreme effort or significant time consumption. A good diet plan should be effortless and simple and yet not boring. . .

Providers and corporations have a financial incentive to treat obesity, and they market this concept everywhere. There are billboards (10 days and 10 pounds or your money back) and TV programs (The Biggest Loser), along with ads of all kinds for gyms, diet plans, weight-loss centers, fat farms and so on. Some of them do present compelling messages, but some sound too good to be true. How can you lose weight by eating more? When all else fails, there is always bariatric surgery. Although complications are rare, mortality is not 0%, and some patients do end up having lifelong morbidities.

In a nutshell, it is for us as physicians to decide what is appropriate, how far to promote weight-loss strategies, and what reasonable goals are. It also is up to patients to find a mandate of their own choice and not be driven by outward pressure to look a certain way.

What we do know is that if you consume fresh fruits and vegetables (Mediterranean diet) and reduce intake of highly processed foods, deep-fried foods, artificial sweeteners, foods high in corn syrup, sodas, and saturated fats, you will most likely reduce the probability of becoming obese and/or developing chronic disease conditions linked to heart disease, diabetes and cancer.

So what is the D-Diet? It is simply an ideal diet (heart healthy), made fresh every day from local ingredients. It’s not a liquid diet and it doesn’t come in small containers, cans or cardboard boxes. It’s effortless to follow, quick and easy to make, and is loaded with all kinds of flavors, colors and textures to take you on a pleasing gastronomic cruise. It doesn’t affect your bodily systems in any way, and there are new food choices every day. There are no worries about how much to eat and when to eat. It doesn’t cost a whole paycheck. And by the way, I am still working on it.

http://www.nbcms.org/AboutUs/SonomaCountyMedicalAssociation/Magazine/tabid/747/language/en-US/pageid/685/spring-2014-medical-controversies-feature-articles-commentarybrthe-d-diet.aspx +

Dr. Dhar is a Santa Rosa cardiologist.        Email: santarosadoc@aol.com

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Voices Of Medicine

Previous Issue

A Review of Local and Regional Medical Journals and Articles

Sonoma Medicine
The magazine of the Sonoma County Medical Association

EDITORIAL: Pain and Suffering

Allan Bernstein, MD

Pain is an essential part of our survival mechanism. It warns us that we stepped on a nail or that the coffee is too hot. It triggers autonomic responses that adjust our blood pressure, heart rate, pupillary reactions, blood sugar and blood cortisol levels. It is a warning to get our hand away from the flame and that our shoe is too tight. Pain is something we learn from. We’d like to avoid it, but we need it.

Pain typically indicates injury or potential injury, starting with tissue damage, releasing cytokines, stimulating peripheral nerves, and progressing proximally through nerve roots, spinal cord and into the brain. Spinal reflexes to pain allow us to pull our hand away from a painful stimulus before it even registers in our brain. A series of on/off switches along the way, particularly in the spinal cord and brainstem, allow us to modulate the pain and interpret the meaning. The endpoint, after multiple connections, is the frontal cortex, where we can localize the pain and decide how significant it is.

There are learned behaviors in our reaction to pain and genetic differences as to how we rate pain. “Big boys don’t cry” and “crybaby” are terms used in some cultures but not others. When I was studying painful neuropathy, using a 100-point pain scale, some subjects rated their pain at 80 while others claimed 20 for what appeared (to me) to be similar pain. After treatment, the 80s went to 70 and the 20s went to 17, a statistically identical percentage of reduction. Did one group feel more pain, or were they culturally sensitive when describing pain?

Anticipating pain will activate pain receptors and the appropriate autonomic responses. In contrast, anticipating pain relief will reduce pain signals, at least transiently. Nocebo responses (expecting something bad to happen) and placebo responses (expecting and getting benefit no matter what the treatment) may confound our research studies, but they can be turned into powerful clinical tools. The 45% placebo response in pain research tells us how much anticipation of relief affects our perception of pain.

The brain can create pain that isn’t there, such as phantom limb pain, and override significant pain when circumstances are appropriate, such as war injuries. Chronic pain--pain that persists in spite of no new tissue damage--represents a failure of the normal system that modulates pain.

Suffering is an individual’s emotional response to pain. It is not related to the intensity of the pain, but rather to fear, frustration and lack of understanding as to the meaning of the pain. If the etiology of the pain is well understood, one can rationalize severe pain as due to a specific injury, with an anticipated endpoint. Comprehension may not reduce pain, but it can moderate suffering for many people. The language we use to describe unpleasant situations often hints at a lack of control. We “suffer in silence,” “suffer the consequences” and “suffer the loss of a loved one.” These situations do not describe physiologic pain, but the emotional part of the pain--suffering--is the prominent feature that appears out of our control.

Both pain and suffering are difficult to measure. Pain fibers can be monitored in experimental animals. We assume pain is present when autonomic features appear in correspondence to the level of electrical impulses along pain pathways. We can measure endorphins and serotonin in spinal fluid. While both increase in response to acute pain, they both go down in chronic pain. As we gradually lose our ability to modulate pain, our suffering rises. Raising the level of endorphins and serotonin--through medications, spinal stimulators, exercise, cognitive therapy and diets--may improve pain control and relieve suffering. Therapies such as music, dance, painting and other pleasurable activities also reduce pain and suffering. Dopamine stimulation appears to be the physiologic pathway . . .

Read the entire article at Sonoma Medicine . . .

Dr. Bernstein, a Sebastopol neurologist, serves on the SCMA Editorial Board.

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Voices Of Medicine

Past Issue

A Review of Local and Regional Medical Journals: Sonoma Medicine

The magazine of the Sonoma County Medical Association

INTEGRATIVE MEDICINE - Weaning GERD Patients off PPIs

Sarah Murphy, MD, and Hana Grobel, MD

Mary (not her real name) is a 45-year-old woman who originally presented with mild gastroesophageal reflux disease (GERD) and was started on a proton pump inhibitor. When we first saw her three years later, she was still on PPIs.

As family physicians, we see many patients like Mary who are initially prescribed PPIs for mild GERD, continue their medication for a long time, and subsequently suffer various side effects associated with PPIs. The question that arises is how to safely wean these patients off PPIs. One possible answer is to use an integrative medicine approach.

But first, let’s back up and consider the function of the entire gastrointestinal tract and the processes that are involved in maintaining the health of our guts. Taken as a whole, the GI tract is one of the largest organs in our body, and its surface area can expand to the size of a tennis court. In our lifetime, we take in 30-40 tons of food that we break down, process, sort, and then use or eliminate . . . 

In addition to the cells of the GI tract, the gut contains 100 trillion bacteria (400 different species), which is 10 times more than the amount of cells we have in our entire body. These bacteria break down food to make nutrients more available, inhibit pathogenic bacteria, and form a layer on the gut mucosa, which protects the intestinal lining and communicates with the enteric immune system.[1,2]

From the perspective of integrative medicine, when we ingest substances that harm this delicate ecosystem, the gut barrier can break down (known as increased intestinal permeability), the microbial ecology can become imbalanced (called dysbiosis), and we can ultimately get sick.[1] Disease not only shows up in the form of GI disorders (e.g., GERD, IBD, IBS, gastroenteritis), but can also present as systemic problems.[3] When the gut mucosa is disrupted, it can become inflamed. Through the more permeable intestinal walls, improperly digested food substances can cross the GI mucosa and trigger further inflammation.[1]

How do we keep our guts healthy and our immune systems intact? One integrative approach is to use the 5Rs of Functional Medicine, where the goal is to support optimal GI health and address the underlying mechanism of disease. The 5Rs stand for remove, replace, repopulate, repair and rebalance. These methods can be applied to many GI conditions, including GERD.

The problem with GERD is not that there is too much acid, but that the acid is in the esophagus rather than the stomach. PPIs block the secretion of acid, thus eliminating symptoms, but they do not address the underlying problem of regurgitation of the gastric lumen contents into the esophagus. In other words, PPIs don’t cure GERD; they only treat the symptoms.

Over time, the body upregulates acid production to compensate for the lack of acid secretion, so stopping PPIs becomes difficult because of rebound symptoms.[4] Some studies have found that long-term PPI use is associated with hyperplasia from increasing gastrin production, as well as increased gastric atrophy.[5,6] Although long-term PPI use has been associated with an increased incidence of gastric cancer, no direct link has been established.

PPIs are valuable in the short-term treatment of GERD, but long-term use may lead to serious complications, including increased risk for pneumonia and Clostridium difficile, and decreased absorption of vitamin B12, calcium, magnesium and iron.[7-12] In fact, our patient Mary was found to be Vitamin B12 deficient.

Despite these potential complications, PPIs are recommended in many circumstances, such as preventing gastrointestinal bleeding in elderly patients on NSAIDs. As with other medications, physicians need to balance the risks and benefits of PPIs, depending on the condition. They should also bear in mind that many patients are on PPIs with no good indication.

The long-term side effects of PPIs make sense based on the multiple roles of acid in the stomach. Acid functions to kill bacteria in the stomach, and it helps break down food to make nutrients more available. In the duodenum, acid helps stimulate release of pancreatic enzymes, which further aid digestion. Higher acidity in the stomach also increases the tone of the lower esophageal sphincter. Thus, acid production plays an important role in tightening LES tone, getting rid of unwanted bacteria, and providing us with properly digested nutrients.

Our goal with Mary was to wean her off PPIs and help her regain the normal function of her GI system. We used an integrative approach based on the 5Rs, as outlined below. Such an approach should begin at least one week before starting to wean patients off PPIs.

Remove. To stop symptoms and prevent their return, it is important to remove the triggers. Certain foods can be aggravating, including caffeine, spicy foods, alcohol, chocolate, fatty foods, dairy, and acidic foods, such as orange juice and tomatoes.[13,14] To identify triggers, patients can use a food diary to document food intake and symptoms. Alternatively, patients can try an elimination diet where specific foods are eliminated from the diet for 2-4 weeks, and re-introduced one at a time to see if symptoms return.[15] Other triggers may include tobacco use, increased weight, prone position, stomach distention and stress.[14] For some patients, addressing lifestyle factors may be enough to stop their GERD symptoms. Don’t underestimate the power of tobacco cessation, weight loss, propping the head of the bed 4-6 inches, eating meals several hours before lying down, eating smaller meals and stress management.

Replace. Once the main triggers are removed, non-aggravating nutritious foods can take their place. Patients may also benefit from replacing vitamin B12, calcium, magnesium or iron, if low.[10] In addition, one small study found that, instead of suppressing acid, some patients may benefit from supplementing with acid to increase LES tone, break down food and stimulate digestion.[16]

Repopulate. Patients who suffer from small bowel bacterial overgrowth after long-term suppression of stomach acid may benefit from probiotics. We recommend at least 10-14 billion units daily, preferably with several different species present. Some symptoms of bacterial overgrowth include bloating, gas, diarrhea and abdominal cramps.[17]

Repair. Various herbs and supplements may help protect and repair the lining of the gut.[3] Many of them act as demulcents and create mucoprotection of the esophageal mucosa, but they can also decrease absorption of other medications, so medication doses must be monitored.[3] One week prior to weaning off PPIs, patients can start taking one or more of the following herbs:

·     Marshmallow (althea officinalis): can be ingested as tea, up to 5-6 grams daily, or as a tincture, 5 mL after meals.

·     Licorice (glycyrrhiza glabra): best taken as deglycyrrhizinated licorice (DGL) 380 mg tablets, 2-4 tablets taken before meals. Glycyrrhizin acts as a mineralocorticoid and can cause hypertension, hypokalemia and edema with prolonged use, so deglycyrrhizinated licorice is recommended.

·     Slippery elm (ulmus fulva) root bark powder: one to two tablespoons of the powder mixed with water and taken after meals and before bed. To increase palatability, mixture can be sweetened with honey.

·     Chamomile (matricaria recutita): used for inflammation and spasmodic effects. 1-3 grams steeped as tea, 3-4 times a day.

·     Throat Coat tea (Traditional Medicinals): contains all the above herbs (licorice root, slippery elm, marshmallow root), but in smaller amounts. Can be taken with meals.

Rebalance. The enteric nervous system houses more neurotransmitters than the brain and makes up 70% of the entire immune system, so stress can affect gut symptoms.[1,18] Many modalities can be used to help decrease stress and prevent the return of symptoms. Stress-reduction modalities include biofeedback, relaxation techniques, meditation, self-hypnosis and journaling. Some studies have found that acupuncture may be helpful for treating GERD symptoms.[19,20] Regular aerobic exercise is also recommended when tapering off PPIs, but symptoms can be exacerbated if exercise occurs right after meals.[13] High-intensity activities like running or cycling may aggravate symptoms.

When using the 5R approach above, it’s important to taper off the PPI slowly. The higher the dose, the longer the taper; counsel your patient to expect rebound symptoms. Begin by decreasing the current PPI dose by 50% each week until the patient is on the lowest dose once daily. After two weeks on this dosage, change to an H2 blocker. If the patient cannot tolerate going straight to an H2 blocker, you can alternate an H2 blocker every other day with omeprazole. After 2-4 weeks on the H2 blocker, taper or stop altogether. After 2 weeks off the H2 blocker, try tapering off supplements. Your patient will benefit from continued lifestyle modifications. .  .

Read the entire article including the details of the 5Rs, lifestyle modification and references in Sonoma Medicine . . .

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Voices Of Medicine

Past Issue

A Review of Local and Regional Medical Journals

Sonoma Medicine MEDICAL ARTS

The magazine of the Sonoma County Medical Association

Roll on, Bob

By Rick Flinders, MD

I first saw Willie Mays in 1958, when I was 12 years old. I watched him play for 14 years as a San Francisco Giant, through the prime of his career, the greatest baseball player I ever saw. Maybe Roberto Clemente had a better arm. Maybe Barry Bonds was a better hitter. But no one has ever played the game of baseball better than Willie Mays. He was magnificent.

In 1972, Willie was traded to the New York Mets. I watched him flail at the plate, no longer able to catch up with major league fastballs. In center field he was no longer graceful, even once dropping a ball while attempting his signature basket catch. It was painful to watch. He retired in 1973. 

I first saw Bob Dylan in 1965, when I was 19 years old. I’d been struck between the eyes with songs like “Masters of War,” “Chimes of Freedom,” and “With God on Our Side.” On stage at the Berkeley Community Theater in December 1965, he stood alone with only an acoustic guitar and harmonica, and he mesmerized us. After intermission, he returned with an electric Stratocaster and four musician friends he called “The Band.” He concluded the show with a song he’d just released, “Like a Rolling Stone.” He was magnificent.

In the past half-century, few artists have had more impact on our language and culture than Dylan. He changed popular music the way Einstein changed modern physics: he changed everything that followed. Dylan took the lyrics of popular music away from the hacks of Tin Pan Alley and placed them in the hands of poets. As Bruce Springsteen said of the influence of Dylan’s music on his generation: “Elvis freed our bodies. Dylan freed our minds.” A recent concordance of legal decisions in U.S courtrooms showed Dylan’s words the most frequently cited lyrics in judicial opinions, from local magistrates to the Supreme Court.

In the years since that first show in Berkeley, I’ve seen Dylan in concert 15 times, each performance as unpredictable as the performer himself, but always worth seeing.

Until now.

This October, at the Greek Theater in Berkeley, it was hard to watch Dylan on stage. Listening was even more painful. His band, still composed of world-class musicians, was only loud and lifeless. His voice, over-amplified to compensate for 50 years of vocal cord injury, echoed only harsh syllables from his former eloquence.

His most recent album had promised more. Called Tempest, the same title as Shakespeare’s final play, it was rumored to be perhaps his final work. Two songs in particular provided proof that Dylan can still bring the poetry. The title track is a poetic vision of the night the Titanic sank, with lyrics sufficiently vivid to bring you to tears. Another song, “Roll on, John,” is a touching tribute to his old friend John Lennon:

Shine your light, move it on

You burned so bright, roll on, John

Though the poet still lives, the voice is gone.

Bob Dylan has earned the right to sing forever. It’s what he does. But, for the first and only time in 50 years, I walked out early from a Dylan concert, the last one I’ll ever attend. How does it feel? Like watching Willie Mays about to drop a routine fly ball from a basket catch. And while it breaks my heart to say it, Bob, I say this with nothing but love and with gratitude for all you’ve given us. May you live long and continue to know and speak the truth as few others have. May your heart always be joyful and your song always be sung. But from that stage where you burned so bright and delivered a lifetime of magnificent lines and transcendent songs, it is time to roll on.

Dr. Flinders, who serves on the SCMA Editorial Board, is a lifelong fan of Bob Dylan.

Email: flinder@sutterhealth.org

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

 

Voices Of Medicine

Past Issue

A Review of Local and Regional Medical Journals

A Doctor Leaving Solo Practice

by Marsha McKay DO

I am one of the docs who decided that medicine is not fun anymore, and more importantly is no longer tolerable with all the documentation, coding, referrals, prior authorizations, begging insurance companies to “let me” prescribe necessary medications and so forth. I can’t practice medicine anymore as an Authentic Doctor so I closed my private solo rural practice five days ago and will now just work 8 hours a week in small county jails. I am tired of spending my days clicking templates on an EMR so that if I get audited I don’t have to go bankrupt paying back Medicare or being accused of fraud when I just forgot to document that someone has a gun in their house or doesn’t wear their seatbelt. I did the EMR incentive program for a year, got my $14,000 and then realized it was a loser financially and time wise and added nothing to good patient care. Ditched the program the next year. Then it was time to cope with ICD 10, ACO’s, patient centered medical home, an electronic health record at the local hospital which is completely unusable and adds hours to hospital work.

I really loved my patients, my little office and wonderful staff but I am completely exhausted and done with the struggle of trying to be a good doctor when the forces out there seem to be determined to wear me down. So now about 1500 people have to find a new doctor and I will retire from active family practice at the age of 59. Pretty stupid waste of my training and compassion to be done so early. I am also tired of being perceived as the rich greedy doctor who only wants to make money and is the source of all the health care problems in this country. I am anything but that. Life is too short to work so hard, sacrifice being with family and friends and spend all my time servicing the insurance industry.

I’m not tired of being a physician, I’m just done with all the unnecessary garbage that comes along with it. I agree that doctors are wimps and in our defense, we are just too busy most of the time to get organized and do something about this mess. Most of us are just trying to do some good in a complicated world. Now I’m going to take care of myself, my family and have a real life. Yahoo!

Read the original in Authentic Medicine. . .

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

 

Voices Of Medicine

Past Issue

A Physician summarizes Obamacare in just one sentence

Dr. Barbara Bellar

http://www.youtube.com/watch?v=mZbFrAAV3-o&feature=youtu.be

We are gifted with a health care plan we are forced to purchase and fined if we don’t; which purportedly covers at least 10 million more people without adding a single new Doctor; but provides for 16,000 new IRS agents; written by a committee whose chairman says he doesn’t understand it; passed by a Congress that hasn’t read it and signed by a President who smokes; with funding administered by a treasury chief who didn’t pay his taxes; for which we will be taxed for 4 years before any benefits take effect; by a government that has already bankrupted social security and Medicare; all to be overseen by a surgeon general who’s obese; and financed by a country that’s broke.

What on earth could possibly go wrong?

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

 

Voices Of Medicine

Past Issue

A Review of Local and Regional Medical Journals and Articles

Retaliation against a Physician Whistleblower

By Lawrence R. Huntoon, M.D., Ph.D. Editor, JAPS

Dr. Michael W. Fitzgibbons, an infectious diseases specialist and former chief of staff at Western Medical Center in Santa Ana, California, is not a man who simply walks away and gives up, even in the face of grave injustices inflicted upon him and his family. But more than demonstrating his integrity, his story shows how far some hospital administrators will take retaliation against a physician whistle blower. We all have a stake in the integrity of our judicial system. Many would choose another course, but though

paying a high professional and personal price, and uncertain of any level of victory, Dr. Fitzgibbons chose to stay on the battlefield.

The battle was which ended on Feb 8, 2013. The details of what was done to Dr. Fitzgibbons are frightening and shocking. His story was detailed in a series of articles published by the , weekly newspaper for Orange County, California, published in Costa Mesa, which covered the story intensely.

In 2004, the financially struggling Tenet Healthcare Corp sought to sell four hospitals in southern California—Western Medical Center of Anaheim, Chapman Hospital in Orange County, Coastal Community Hospital in Santa Ana, and Western Medical Center of Santa Ana, the hospital where Dr. Fitzgibbons practiced.

Some physicians expressed concerns about the proposed purchaser, Dr. Kali P. Chaudhuri and his company, Integrated Healthcare Holdings, Inc. (IHHI).

According to an article published in , “Four years ago, Chaudhuri’s KPC holding company closed 81 Southern California medical clinics it had purchased just a year before. The closures stranded 300,000 patients without care and, in many cases, without medical records. Insurers and doctors scrambled to pick up the pieces. Asked to account for the chain’s assets, a bankruptcy judge said the money trail was too complicated to follow. The resulting charges of mismanagement, fraud, and diversion of assets led to dozens of lawsuits and thousands of creditor claims against Chaudhuri and KPC, most of them unsatisfied to this day.”

According to another article, “So vehemently do they oppose Chaudhuri’s takeover of the four Tenet hospitals that in October Fitzgibbons and fellow physicians took to the streets with picket signs. More than 70 doctors from the targeted hospitals formed their own acquisition group and offered Tenet a competing bid.”

At the urging of Fitzgibbons and other physicians, state Senator Joe Dunn convened hearings in 2004 that resulted in an agreement to limit the involvement of Dr. Chaudhuri in the takeover of the four hospitals.

Michael W. Fitzgibbons, M.D., vs. Integrated Healthcare Holdings, Inc., et al., OCWeekly

Conclusion

While the last chapter in this saga has yet to be written, physicians can learn from it the tremendous power of hospital cartels, and the ruthlessness they may display in retaliating against a physician who opposes them or exposes their wrongdoing.

Lawrence R. Huntoon, M.D., Ph.D. is a practicing neurologist and editor-in-chief

of the Journal of American Physicians and Surgeons. Contact: editor@jpands.org.

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

 

Voices Of Medicine

Past Issue

Whistleblowers attempt to change the culture of federal agencies

Advocates Applaud Senate Passage of S. 743

November 14, 2012 by
Filed under CampaignCongress & Courts

November 14, 2012

FOR IMMEDIATE RELEASE

Advocates Applaud Senate Passage of S. 743
After Decade Long Campaign, Federal Whistleblower Bill Sent to President’s Desk

After a decade long campaign by the Make It Safe Coalition to restore federal whistleblower protections, we applaud yesterday’s Senate passage of the Whistleblower Protection Enhancement Act, S. 743 (WPEA), by unanimous consent. The House of Representatives approved this measure in September, also by unanimous consent. Congress’ sweeping endorsement of S. 743 demonstrates the strong bipartisan support for this government accountability legislation to expand protections for federal employees who disclose wrongdoing and protect the public trust.  Longtime whistleblower champion and retiring Senator Daniel Akaka (D-HI) was joined by his cosponsors Susan Collins (R-Maine), Joe Lieberman (I-CT), Senators Charles Grassley (R-Iowa) and Claire McCaskill (D-MO) in advocating for passage of this crucially needed reform legislation. A full list of Senate cosponsors can be viewed here. We cannot thank these champions and their staff enough for their marathon commitment to the WPEA.

Whistleblower advocates from across the ideological spectrum celebrated this government accountability and taxpayer protection measure: 

AFGE is proud to join a bipartisan group of lawmakers and a coalition of worker, good government, and civic advocates in applauding passage of S. 743, the Whistleblower Protection Enhancement Act by the Senate. For far too long managers in the federal workplace have faced little or no accountability when they retaliate against federal workers who blow the whistle on fraud, waste and wrongdoing on the job,” said Beth Moten, Legislative Director for American Federation of Government Employees. “The Whistleblower Protection Enhancement Act marks the beginning of a new day of free speech and due process rights for federal workers such as Transportation Security Officers who protect our nation’s airports, food safety inspectors, government scientists, and others when they speak up on behalf of the public.”

“After a 13 year roller coaster campaign, Congress unanimously has given whistleblowers who defend the public a fighting chance to defend themselves. This is a major victory for taxpayers and public servants, but a major defeat for special interests and bureaucrats. Free speech rights for government employees never have been stronger,” said Tom Devine, Legal Director for the Government Accountability Project. “It would be dishonest to say our work is done, however, or to deny that government whistleblower rights are still second class compared to those in the private sector. House Republicans blocked two cornerstones of the legislation: jury trials to enforce newly-enacted protections, and extension of free speech rights to national security workers making disclosures within agency channels.” 

“A transpartisan impulse expressed through bi-partisan consensus. Good to see the U.S. House and Senate finally do something right for the American people,” said Michael Ostrolenk, National Director of the Liberty Coalition. ”The passage of the Whistleblower Protection Enhancement Act is an important first step in protecting citizens against Federal waste, fraud and abuse of power.”

Congress has just made a major bipartisan stride to stand behind conscientious federal employees who stand up for taxpayers,” said National Taxpayers Union Executive Vice President Pete Sepp.“Whistleblowers are true trailblazers on the path to fiscal responsibility in Washington, and passage of S. 743 is a hopeful sign that more progress and more protections lie straight ahead.”

National President Colleen M. Kelley of the National Treasury Employees Union commented: “This is a vital piece of legislation that expands protections for federal employees who disclose fraud, waste, abuse or illegal activity on behalf of taxpayers and in the best interests of our nation. Notably, it includes specific protection for the scientists who work for our nation, are committed to valid research and who should not be swayed or penalized for their work. NTEU is very pleased to see its passage before the end of this current session of Congress.”

“This opening salvo to the lame duck shows that Congress can put aside partisan posturing and deliver more government accountability to the American public. These hard-fought reforms will substantially improve the status quo for federal whistleblowers and taxpayers,” said Angela Canterbury, Director of Public Policy for Project On Government Oversight. “It has been a long time coming, but the federal workers now will have a better chance at real justice when they suffer from retaliation for exposing waste, corruption, and abuse. These courageous workers deserve no less for their service to us and our country.”

“Reforms such as these create a vehicle for workers to safely call out potential hazards in the workplace without retaliation from the employer,” said Keith Wrightson, worker safety and health advocate for Public Citizen’s Congress Watch division. “By giving federal workers more opportunity and resources to identify hazardous workplace situations, the government will become more efficient.”

“Whistleblowers are critical in making the government more efficient and accountable. This legislation finally gives Whistleblowers the respect and protection they deserve,” said David Williams, President of Taxpayers Protection Alliance. “Congress has shown the American people that they are willing to work together and put partisan differences aside to do the right thing by passing the Whistleblower Protection Enhancement Act.”

“We hope that this law will begin a process to change the culture of federal agencies when it comes to whistleblowers,” said Celia Wexler, Senior Washington Representative, Union of Concerned Scientists Center for Science and Democracy. “People who protect the public from unsafe drugs, tainted food, defective products, and environmental hazards should not fear for their jobs when they speak up for safety and scientific integrity.” 

The WPEA includes critically important upgrades to the broken system for federal whistleblowing to better serve taxpayers. Though it does not include every reform that we have sought and will continue to seek, the bill will restore and modernize government whistleblower rights by ensuring that legitimate disclosures of wrongdoing will be protected, increasing government accountability to taxpayers, and saving billions of taxpayer dollars by helping expose fraud, waste and abuse. Overall, the WPEA’s provisions will restore free speech rights closed through arbitrary loopholes and create new protections for federal scientists and Transportation Security Administration officers. The bill also will strengthen due process rights, such as a two-year experiment in normal access to appeals courts (effectively breaking the Federal Circuit’s monopoly on appellate review); provide compensatory damages; create whistleblower ombudsmen at Inspectors General offices; and strengthen authority by the U.S. Office of Special Counsel to help whistleblowers through disciplinary actions against those who retaliate, and to file briefs in court supportive of whistleblower rights.

The Senate cosponsors and their dedicated staff worked closely with their House colleagues, Oversight and Government Reform Chairman Darrell Issa (R-CA), Ranking Member Elijah Cummings (D-MD), retiring Representative Todd Platts (R-PA), Chris Van Hollen (D-MD),  Paul Gosar (R-AZ), Steve Pearce (R-NM), and their committed staff, to reach a bipartisan compromise that could pass this usually contentious Congress. After a hard-fought campaign, Congress has finally enacted this important reform.

A menu of key reforms can be viewed here: http://bit.ly/PwafFC

The bill can be viewed here: http://bit.ly/UDaepU

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Voices Of Medicine

Past Issue

Authentic Medicine - Douglas Farrago MD, Editor, Creator & Founder

SPEAKING HONESTLY AND OPENLY ABOUT OUR BROKEN HEALTHCARE SYSTEM SINCE 2002

The mission of Authentic Medicine is to rediscover how much the art of medicine means and allow us to reconnect to our roots once again. It is about fighting back against those things that are taking us away from the direct care of patients while still pointing out the lunacy and hypocrisy of this job. Be part of the movement that will take back the healthcare system from the idiots who are ruining it.

Douglas Farrago MD is a full-time practicing family doc in Auburn, Maine.  He is board certified in the specialty of Family Practice.  He is also the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver, and its knock-offs, are worn by many major league baseball catchers.

From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years.  He was featured in the Washington Post, US News and World Report, the AP, and the NY Times.

Authentic Medicine was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. Only when physicians regain control and connect back to the roots of this profession will we ever have AUTHENTIC MEDICINE again. 

about this site

Authentic Medicine is about connecting us back to the roots of medicine.  This online “magazine” will constantly be updated with informative and challenging opinions and ideas.   The goal is to fight back against those things that are taking us away from the direct care of patients while still pointing out the lunacy and hypocrisy of this job.  It is the evolution of what I was really trying to accomplish by the end with the Placebo Journal.

Physicians and patients need to join together to form the “Authentic Medicine Movement”.  This is not about being Republican or Democrat. It is about opening up a dialogue and keeping that conversation going.  You may hate some of the things I say.  I may hate some of your comments.  It doesn’t matter.  

The wrong people (politicians, businessmen, and administrators) are running and ruining this healthcare system.   We need to speak up and be part of the NEVER ENDING DEBATE.

Issues that I am concerned about:

  • Why we are moving to an era of Industrialized Medicine
  • The Quality Movement and why it is a scam
  • The ever expanding Medical Axis of Evil
  • Medical Dogma and the Alphabet Soup (JC, HIPAA, etc.)
  • Bureaucratic Drag and the distractions from treating patients
  • Burnout and depression amongst healthcare professionals
  • Humor in caring for the patient and the caretaker

I would be honored if you can check out the site and tell me what you like or dislike so far.  Come back regularly as new items are added daily (at least).

Email Dr. Farrago – doug@authenticmedicine.com 

Subscribe at http://authenticmedicine.com/

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

 

Voices Of Medicine

Past Issue

Dr. Sam Vaknin, Israelis Psychiatrist, says Obama has a Mental Disorder

By Michael A. Haberman, MD, An Israeli M.D.

The Voice of a physician in another part of the world

A Reflection Of What Is Happening To The USA—In The Eyes Of Others!

Israeli doctor says Obama has a mental disorder—
Labels him a pathological narcissist.
No greater insanity than electing one says Dr. Sam Vaknin an Israeli psychologist.
Another view on our president.

Dr. Vaknin states "I must confess I was impressed by Obama from the first time I saw him. At first I was excited to see a black candidate. He looked youthful, spoke well, appeared to be confident, a wholesome presidential package. I was put off soon, not just because of his shallowness but also because there was an air of haughtiness in his demeanor that was unsettling. His posture and his body language were louder than his empty words. Obama's speeches are unlike any political speech we have heard in American history. Never a politician in this land had such quasi "religious" impact on so many people.

The fact that Obama is a total incognito with Zero accomplishment, makes this inexplicable infatuation alarming.  Obama is not an ordinary man. He is not a genius. In fact he is quite ignorant on most important subjects."

Dr. Sam Vaknin, the author of the Malignant Self Love believes "Barack Obama appears to be a narcissist." Vaknin is a world authority on narcissism. He understands narcissism and describes the inner mind of a narcissist like no other person. When he talks about narcissism everyone listens. Vaknin says that Obama's language, posture and demeanor, and the testimonies of his closest, dearest friends suggest that the man is either a narcissist or he may have narcissistic personality disorder (NPD).

Narcissists project a grandiose but false image of themselves. Jim Jones, the charismatic leader of People's  Temple, the man who led over 900 of his followers to cheerfully commit mass suicide and even murder their own children was also a narcissist. David Koresh, Charles Manson, Joseph Koni, Shoko Asahara, Stalin, Saddam, Mao, Kim Jong Ill and Adolph Hitler are a few examples of narcissists of our time. All these men had a tremendous influence over their fanciers. They created a personality cult around themselves and with their blazing speeches elevated their admirers, filled their hearts with enthusiasm and instilled in their minds a new zest for life.  They gave them hope! They promised them the moon, but alas, invariably they brought them to their doom.

When you are a victim of a cult of personality, you don't know it until it is too late. One determining factor in the development of NPD is childhood abuse "Obama's early life was decidedly chaotic and replete with traumatic and mentally bruising dislocations, "says Vaknin. "Mixed-race marriages were even less common then. His parents went through a divorce when he was an infant two years old. Obama saw his father only once again, before he died in a car accident. Then his mother re-married and Obama had to relocate to Indonesia , a foreign land with a radically foreign culture, to be raised by a step-father. At the age of ten, he was whisked off to live with his maternal (white) grandparents.  He saw his mother only intermittently in the following few years and then she vanished from his life in 1979. "She died of cancer in 1995."

One must never underestimate the manipulative genius of pathological narcissists. They project such an imposing personality that it overwhelms those around them.   Charmed by the charisma of the narcissist, people become like clay in his hands. They cheerfully do his bidding and delight to be at his service. 

The narcissist shapes the world around himself and reduces others in his own inverted image. He creates a cult of personality. His admirers become his co-dependents. Narcissists have no interest in things that do not help them to reach their personal objective. They are  focused on one thing alone and that is power. All other issues are meaningless to them and they do not want to waste their precious time on trivialities. Anything that does not help them is beneath them and does not deserve their attention.

If an issue raised in the Senate does not help Obama in one way or another, he has no interest in it. The "present" vote is a safe vote. No one can criticize him if things go wrong. Those issues are unworthy by their very nature because they are not about him.

Obama's election as the first black president of the Harvard Law Review led to a contract and advance to write a book about race relations. The University of Chicago Law School provided him a lot longer than expected and at the end it evolved into, guess what? His own autobiography! Instead of writing a scholarly paper focusing on race relations, for which he had been paid, Obama could not resist writing about his most sublime self. He entitled the book Dreams from My Father.

Not surprisingly, Adolph Hitler also wrote his own autobiography when he was still a nobody. So did Stalin. For a narcissist no subject is as important as his own self. Why would he waste his precious time and genius writing about insignificant things when he can write about such an august being as himself?

Narcissists are often callous and even ruthless. As the norm, they lack conscience. This is evident from Obama's lack of interest in his own brother who lives on only one dollar per month. A man who lives in luxury, who takes a private jet to vacation in Hawaii, and who raised nearly half a billion dollars for his campaign (something unprecedented in history) has no interest in the plight of his own brother. Why?  Because, his brother cannot be used for his ascent to power. A narcissist cares for no one but himself.

This election was like no other in the history of America. The issues were insignificant compared to what is at stake. What can be more dangerous than having a man bereft of conscience, a serial liar, and one who cannot distinguish his fantasies from reality as the leader of the free world?

I hate to sound alarmist, but one is a fool if one is not alarmed. Many politicians are narcissists. They pose no threat to others. They are simply self-serving and selfish. Obama evidences symptoms of pathological narcissism, which is different from the run-of-the-mill narcissism of a Richard Nixon or a Bill Clinton for example. To him reality and fantasy are intertwined.

This is a mental health issue, not just a character flaw.  Pathological narcissists are dangerous because they look normal and even intelligent. It is this disguise that makes them treacherous. Today the Democrats have placed all their hopes in Obama. But this man could put an end to their party. The great majority of blacks voted for Obama. Only a fool does not know that their support for him is racially driven. This is racism, pure and simple.

The downside of this is that if Obama turns out to be the disaster I predict, he will cause widespread resentment among the whites. The blacks are unlikely to give up their support of their man. Cultic mentality is pernicious and unrelenting. They will dig their heads deeper in the sand and blame Obama's detractors of racism. This will cause a backlash among the whites. The white supremacists will take advantage of the discontent and they will receive widespread support. I predict that in less than four years, racial tensions will increase to levels never seen since the turbulent 1960's.

Obama will set the clock back decades.  America is the bastion of freedom. The peace of the world depends on the strength of America, and its weakness translates into the triumph of terrorism and victory of rogue nations. It is no wonder that Ahmadinejad, Hugo Chavez, the Castroists, the Hezbollah, the Hamas, the lawyers of the Guantanamo terrorists, and virtually all sworn enemies of America are so thrilled by the prospect of their man in the White House.

America is on the verge of destruction. There is no insanity greater than electing a pathological narcissist as president.

Michael A. Haberman, MD, An Israeli M.D.

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