Voices Of Medicine

Current 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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Voices Of Medicine

Previous 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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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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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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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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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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