Community For Better Health Care

Vol XI, No 3, June 12, 2012


In This Issue:

1.                  Featured Article: Strong American Women vs. Julia

2.                  In the News: It is not whether government is good or evil, but what government does.

3.                  International Medicine: Foreign-Trained Doctors

4.                  Medicare: How does Medicare’s payment system hinder innovation in health care?

5.                  Medical Gluttony:  Hospital Consolidation Increases healthcare costs

6.                  Medical Myths: Decreasing Deductibles and Co-Payments Lowers the cost of Healthcare

7.                  Overheard in the Medical Staff Lounge: Tax & Spend & Mortgage our Children’s Future

8.                  Voices of Medicine: The Snake and I by Michael Sergeant, MD, Sonoma Medicine

9.                  The Bookshelf: PRICELESS . . . The Female Brain . . .

10.              Hippocrates & His Kin: Today, Tomorrow and Next Week in History

11.              Related Organizations: Restoring Accountability in Medical Practice and Society

12.              Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

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A Memorial Day message from President Reagan

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1.      Featured Article: Strong American Women vs. Julia                                                                

Strong American Women versus Julia the start of Obama’s political campaign

By Elizabeth Lee Vliet, MD

GOD’s Blessings to All MOTHERS
(Mother’s Day was May 13, 2012)

The mothers, grandmothers, and great-grandmothers that Americans remember each May are strikingly different from “Julia,” the star of Obama’s political campaign.

We cannot see helpless Julia as Molly Pitcher, stepping up to fire a cannon in the Revolutionary War in place of her fallen husband. We can’t picture Julia taking risks to free slaves in the War Between the States, or doing demanding work nursing dying soldiers in battles, or being willing to endure walking alongside a wagon train to settle the West. Read more . . .

Julia does not work from dawn to dusk to build shelter, plant crops, harvest food to eat, sew clothes, haul water, or clean up waste as our ancestors did. Julia does not stand side by side with her parents, brothers, sisters, and husband to build a community and fight to defend it.

Julia does not seem to have any of those natural relationships most women have—she only has the parasitic “relationship” with the “government” with her from cradle to grave.

Julia doesn’t need the skills our foremothers had…or even the skills of women today who work in fields previously only available to men. Everything is done for Julia through government benefits! But remember, those benefits come from taxing someone else’s work.

Poor hapless Julia can’t even “focus” on her web design work without free contraceptives provided by the government to “ease her worries” about getting pregnant. When Julia does "decide" to have a child, she then sends the child off on a bus to be raised at a government school.

Our foremothers showed strength, independence, and courage. They had no guarantee of the basics of life, even water, food, or shelter, and endured unbelievable hardship. They persevered through hard times, held their families together, and passed along their culture, their traditions, their standards, and dreams of liberty to the next generation.

American women have helped build the strongest and most prosperous nation in the history of the world. Through their own hard work, women reached the pinnacle of success in many fields: business, medicine, law, the military, engineering, space exploration, mining, construction, science, and government. They achieve through their effort and initiative and development of skills, a process we call earned success.

Julia, on the other hand, exemplifies learned helplessness and dependency. Her life shows the stark contrast between the vision of our Founders and the vision of modern “progressives.” Instead of having the freedom to choose her own path and to succeed based on one’s work, one’s intellect, one’s right to keep property, and one’s personal values, Julia’s life is subservient to Big Daddy government for protection to help her day to day. Although Julia doesn’t realize it, she could lose her favored “protection” at any time her protectors lose an election.

Government will take care of Julia—after it decides she is one of the chosen. Julia will be allowed to live as long as she is perceived to be an asset to the state. Once she becomes too old, or too sick, she will be “comforted” and “assisted” in dying when the government decides it is her time to go so that “society’s” resources can be spent on someone younger or more politically valuable.

It is a cruel irony that the very progressives who are reducing our women to this pathetic state are accusing others of making “war on women.” This government nanny kills the soul and the creative spirit of strong women, and creates passive, helpless shells of women living a shadow life. . .

The true spirit of America is embodied in The Lady Liberty, a strong woman who values the law, stands proudly holding her torch high as a beacon to victims of tyranny and oppression throughout the world.

The spirit of women we celebrate each Mother’s Day is embodied in the millions of women who dared to dream, who dared to take risks, who dared to explore the unknown and work alongside men to build a great nation.

I have spent a career in Medicine focused on empowering women, not creating dependency. Let it not be said that freedom to choose one’s path in life died on our watch while we made passive, parasitic “Julias” out of our young women.

Elizabeth Lee Vliet, M.D. is a preventive and climacteric medicine specialist with medical practices in Tucson AZ and Dallas TX that take an integrated approach to evaluation and treatment of women and men with complex medical and hormonal problems. Dr. Vliet is also President of International Health Strategies, Ltd., whose mission is twofold: liberty and privacy in treatment options and preservation of the Oath of Hippocrates focus on the individual patient.

Dr. Vliet is the 2007 recipient of the Voice of Women award from the Arizona Foundation for Women for her pioneering advocacy for the overlooked hormone connections in women’s health. Dr. Vliet received her M.D. degree and internship in Internal Medicine at Eastern Virginia Medical School, then completed specialty training at Johns Hopkins Hospital. Dr. Vliet is a Director of the Association of American Physicians and Surgeons.

Dr. Vliet has appeared on FOX NEWS, Cavuto, Stuart Varney Show, Fox and Friends and syndicated radio shows across the country addressing the economic and medical impact of the new healthcare bill.

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2.      In the News: It is not whether government is inherently good or evil, but what government does.

David Brooks: Hamilton rolling over in his grave over role of government,
Sac Bee, May 30, 2012

From the dawn of the republic, the federal government has played a vital role in American economic life. Government promoted industrial development in the 18th century, transportation in the 19th, communications in the 20th and biotechnology today.

But the federal role has historically been sharply limited. The man who initiated that role, Alexander Hamilton, was a nationalist. His primary goal was to enhance national power and eminence, not to make individuals rich or equal. Read more . . .

This version of economic nationalism meant that he and the people who followed in his path – the Whigs, the early Republicans and the early progressives – focused on long-term structural development, not on providing jobs right now. They had their sights on the horizon, building the infrastructure, education and research facilities required for future greatness. This nationalism also led generations of leaders to assume that there is a rough harmony of interests between capital and labor. People in this tradition reject efforts to divide the country between haves and have-nots.

Finally, this nationalism meant that policy emphasized dynamism, and opportunity more than security, equality and comfort. While European governments in the 19th and early 20th centuries focused on protecting producers and workers, the U.S. government focused more on innovation and education.

Because of these priorities, and these restrictions on the federal role, the government could be energetic without ever becoming gigantic. Through the 19th century, the federal government consumed about 4 percent of the national gross domestic product in peacetime. Even through the New Deal, it consumed less than 10 percent.

Meanwhile, America prospered.

But this Hamiltonian approach has been largely abandoned. The abandonment came in three phases.

First, the progressive era. The progressives were right to increase regulations to protect workers and consumers. But the late progressives had excessive faith in the power of government planners to rationalize national life. This was antithetical to the Hamiltonian tradition, which was much more skeptical about how much we can know and much more respectful toward the complexity of the world.

Second, the New Deal. Franklin Roosevelt was right to energetically respond to the Depression. But the New Deal's dictum – that people don't eat in the long run; they eat every day – was eventually corrosive. Politicians since have paid less attention to long-term structures and more to how many jobs they "create" in a specific month. Americans have been corrupted by the allure of debt, sacrificing future development for the sake of present spending and tax cuts.

Third, the Great Society. Lyndon Johnson was right to use government to do more to protect Americans from the vicissitudes of capitalism. But he made a series of open-ended promises, especially on health care. He tried to bind voters to the Democratic Party with a web of middle-class subsidies.

In each case, a good impulse was taken to excess. A government that was energetic and limited was turned into one that is omnidirectional and fiscally unsustainable. A government that was trusted and oriented around long-term visions is now distrusted because it tries to pander to the voters' every momentary desire.

I've taken this tour through history because we are having a big debate about what government's role should be, so, of course, we are having a debate about what government's role has been. Two of the country's most provocative writers have taken stabs at describing that history – imperfectly in my view – in order to point a way forward.

In his illuminating new book, "Land of Promise," the political historian Michael Lind celebrates the Hamiltonian tradition, but, in his telling, Hamiltonianism segues into something that looks like modern liberalism. But the Hamiltonian tradition differs from liberalism in fundamental ways.

In his engrossing new book "Our Divided Political Heart," E.J. Dionne, my NPR pundit partner, argues that the Hamiltonian and Jacksonian traditions formed part of a balanced consensus, which has been destroyed by the radical individualists of today's Republican Party. But that balanced governing philosophy was destroyed gradually over the 20th century, before the tea party was even in utero.

As government excessively overreached, Republicans became excessively antigovernment.

We're not going back to the 19th-century governing philosophy of Hamilton, Clay and Lincoln. But that tradition offers guidance. The question is not whether government is inherently good or evil, but what government does.

Does government encourage long-term innovation or leave behind long-term debt for short-term expenditure? Does government nurture an enterprising citizenry, or a secure but less energetic one? If the United States doesn't modernize its governing institutions, the nation will stagnate. The ghost of Hamilton will be displeased.

By David Brooks

Read more here:

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3.      International Medicine: Foreign-Trained Doctors

Inside Medicine: Pros and cons of foreign-trained doctors

By Dr. Michael Wilkes, UCD

Somewhere around 25 percent of doctors practicing in this country have been trained at medical schools outside the United States (a good percentage are from India, the Philippines, Mexico, Pakistan and the Dominican Republic). Read more . . .

Some of these foreign-trained doctors grew up in foreign countries. Others are American citizens who were not able to find a spot in a U.S. medical school and decided to go abroad for medical training.

Collectively, these foreign-trained doctors are far more likely to practice in less desirable specialties like internal medicine, psychiatry and family medicine, and they are far more likely to practice in physician-short areas like the inner city or rural America. . .

As patients, Americans expect their doctors to listen to them and explain their condition so that they as consumers can participate in making medical decisions. Americans expect doctors to be honest with them and tell them the truth even when the news is bad news. In many countries, such approaches to medical care are not routine and are not taught. But foreign-trained doctors are smart men and women, and they learn Americanisms quickly.

The issue of whether we should make it easier for foreign-trained doctors to get visas so they can come to the United States and take the American medical qualifying exams and get licensed is controversial.

But it's not because there is debate about whether we should allow them to practice here. Remember, without foreign-trained doctors, we can't make our health care system work. The controversy is whether it is fair to their home countries to allow these smart men and women to sit through medical school and then take all that knowledge and move to the United States when they are so badly needed back home.

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4.      Medicare: How does Medicare’s payment system hinder innovation in health care?

Medicare's Payment System Harms Medical Innovation

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Guest Post by Neil Minkoff, MD.*

Government is harmful to medical innovation by setting so much of the reimbursement process. By being, by far, the largest payer of healthcare claims in America, the Medicare fee schedule drives the market for all other private payers. In essence, this sets a floor for clinical reimbursement. Hospitals then set budgets based on expected revenue, not based on the cost of providing specific services. Read more . . .

Patient experience, convenience and quality of care do not effect, or at least significantly effect, clinical reimbursement in the standard, traditional fee-for-service Medicare program. There is therefore no incentive to find ways to create new value in the system. By law, a physician or hospital cannot charge premium pricing for a Medicare-reimbursed service or procedure. I first notice this while treating patient maybe 15 years ago. A first- or second-year physician, I was treating a patient with a serious lung impairment caused by a blood clot in his pulmonary artery. I was transferring this patient from a poorly run suburban hospital, soon to close, to arguably the world’s expert on these types of clots at the Brigham and Women’s, which is consistently rated as one of the nation’s ten finest facilities. Medicare was paying both physicians the same fee and both hospitals the same fee.

This is wrong. This encourages a sense in the market of care that is “good enough.” Nowhere do Medicare providers have any incentive, outside of their integrity and drive, to develop, improve and excel. Only recently has Medicare paid any attention to outpatient quality of care through the Physician Quality Reporting System and, even then, caps payment of a quality bonus to 0.5% of the previous year’s Medicare payments to the provider. This means it costs more to collect the data to report to Medicare than one can earn for collecting it.

Furthermore, the setting of the Medicare fee schedule exempts most of medicine from basic rules of supply-and-demand. Here is an example: over the past five years, Medicare reimbursement for cataract surgery rose from around $900 to about $1,050, a 17% increase, despite a growing volume of procedures as the population ages and what would otherwise be an incentive to lower prices to attract this new volume.

Conversely, elective visual corrective surgery dropped over a similar time span from $2,100 per eye to $1,700, a 20% decrease. The pressure of the market forced providers to innovate better, more cost-effective ways to do the procedure while maintaining a positive, safe patient experience. These providers have tremendous incentive to measure, report and improve quality-of-care, patient experience and cost.

Payment not based on individual experience may account for another example. Since laparoscopic gallbladder removal became the standard of care, the risk of tearing the bile duct which was the most common serious complication, has plummeted. However, the risk of a common, minor complication, a dropped stone lost in the abdominal cavity, has remained unchanged for over 15 years. There is not enough incentive under current reimbursement to improve a mild issue. In no other industry where service providers compete on price and quality would this lack of innovation be tolerated.

An irrational, one-size-fits-all fee schedule that does not reward quality, patient experience and clinical expertise traps the American public in a medical system where one is rewarded only for doing things… but not for doing them well.

*On May 3, 2012, Avik Roy & Dr. Minkoff participated in a Benjamin Rush Society debate at Harvard Medical School addressing the resolution that government is harmful to medical innovation. This is a summary of his remarks.

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 Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5.      Medical Gluttony: Hospital Consolidation Increases healthcare costs

Hospital Monopoly

The hospital sector has seen huge waves of consolidation and acquisition in recent years:

The implementation of the Affordable Care Act (ACA) will further expand hospitals’ monopolistic power and exacerbate the problem.

Source: Barak Rickman, AEI study.

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Medical Gluttony thrives in Government and Health Insurance Programs.

Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.

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6.      Medical Myths: Decreasing Deductibles and Co-Payments Lowers the cost of Healthcare

The prevailing opinion is the portion of health care that has no or little deductibles or co-payments lowers the cost of health care. The insurance carriers use this as a marketing tool.

Patients love this since they get free healthcare. Since many of them don’t pay the health insurance premiums, it truly is free at this time. However, the huge overutilization will increase the insurance costs the next premium year. So the next premium year the costs will go up for whoever pays the premium, whether it is the state, employer, or some other third party. But some day, it will be you and there will be an unpleasant awakening. Read more . . .

What will happen then?

The entitlement mentality, as with all entitlements, of the here and now will prevail. It’s unfortunate that such a childish response becomes the grown up’s cry: I want what I want when I want it. Isn’t it too bad that the adults’ response is more childish than the little girl’s response:  You’ll get what I got when I get it.

Even the little girl knew there would be many moral restrictions on it before he got it. Why can’t we apply ethics to entitlements? Isn’t stealing from others, (even though governments can make any sin legal), reprehensible?

Fact: Increasing the deductibles and the co-payments decrease the overall health care costs

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Medical Myths Originate When Someone Else Pays The Medical Bills.

Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.

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7.      Overheard in the Medical Staff Lounge: Tax & Spend & Mortgage our Children’s Future

Dr. Rosen:      Aren’t the headlines we see every day frightening? Parks closing. Children forced to play in the streets.

Dr. Dave:        The people are awakening that there is no money left over in the government till?

Dr. Milton:      Why can’t the people see that the lack of restraints on government spending is causing this to occur?

Dr. Paul:         We just have to bite the bullet and raise the taxes. Read more . . .

Dr. Edwards:  These are local concerns and they are covered by property taxes. Who can afford them?

Dr. Paul:         Our property taxes are only one percent since proposition 13 went into effect. Surely we can afford more?

Dr. Milton:      People were losing their homes before proposition 13 went into effect. This not only hurt the people on fixed incomes, it even hurt some of the rest of us. I know a physician who bought his home in Pasadena for about $40,000 fifty years ago. It was then appraised at $800,000. He’s retired, but do you think that even a doctor could afford to go from $400 in property taxes to $8000 in taxes on the same house. In today’s recession, it probably dropped to $400,000, but the current value and the value three years ago bears no relationship to his ability to pay.

Dr. Edwards:  Removing Proposition 13 limits, would bankrupt many of our seniors. As their property escalated in value, sometimes two three times their initial investment and their property taxes were $1000 a year, how could a person living on social security at $700 a month, find an extra $2,000 when their taxes went to $3,000 a year?

Dr. Milton:      Wouldn’t that be rather cruel and inhumane to our seniors, Paul?

Dr. Paul:         Their social security cost of living adjustments would probably keep up with the increase taxes.

Dr. Rosen:      Paul, you obviously belong to the “tax & spend & mortgage our children’s future” party.

Dr. Paul:         Rosen, you are the eternal pessimist.

Dr. Rosen:      No, I’m the eternal realist. I think that everyone in the “Responsibility and Freedom” party is. Debt means you’re not living within your means. If you can’t live within your means today, what makes you think you can live within your means as recession caused by the “Tax & Spend” party reduces your income or even brings it down to zero if you lose your job.

Dr. Edwards:  The members of the “tax and spend” party make government their god and the source of all good things. They can’t conceive of government having any limits.

Dr. Rosen:      The major problem is that the T & S people will bring the rest of us down to their cesspool.

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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8.      Voices of Medicine:  The Snake and I by Michael Sergeant, MD, Sonoma Medicine

I was just after a few rocks. That’s all. I wanted to make a beautiful arrangement for my wife, Diane, who was returning in the morning from taking care of her mom in a hospital in Atlanta.

I had the roses: delicately beautiful, magenta, magic. I had the lovely vase from Portugal. What I needed was a few desert rocks to complete the picture in my head and the feeling in my heart. It didn’t quite work out that way.

The magic was different: I got to dance with the power of nature. Read more . . .

I was singly focused as I walked out the front door with a dishpan to gather those few desert rocks from our front garden in Tucson, Arizona. My vision was tunneled toward the creative endeavor.

I think the snake (or maybe snakes) would actually have been quite satisfied to be left alone. I expect it was not the least bit pleased to have the still of the evening disturbed by a human tromping around and picking up the rocks near which it lay. It is also possible that there was an even more egregious infraction: snake coitus interruptus. Whatever the case, indicting said snake or snakes for the subsequent events would be inappropriate.

So there I was, contentedly in my own front yard, dressed in my desert best (shorts, T-shirt, flip flops), in the pale glow of the front porch light, gathering a few rocks I thought would lend beauty to my arrangement. Beneath the nearby garden wall, the ground was in shadow. I was oblivious. The night was quiet.

I was bending over to pick up the last couple rocks when my peaceful world exploded in pain. My left foot had been crushed, it seemed, by an acid-coated sledgehammer wielded by none less than John Henry himself. Shock first. Then a knowing. And then, only after the truth had already permeated my consciousness, the slight and ever so ominous rattle. What I would not know until the next day is that I had actually, in that life-changing split second, been bitten twice.

The brief moments following the shock resulted in only a little disruption of the quiet desert night as a few choice words erupted from me; not so much as a yell, more as a series of almost disbelieving profane whispers. My mind, once convinced of the reality of being snakebitten, switched almost immediately to a kind of analytic stillness. As I hobbled into the house, I told myself that 20-30% of rattler bites are not poisonous, and though the ongoing pain was telling me otherwise, I was briefly hopeful that would be the case for me. By the time I reached the bathroom, my hopes were dashed when I saw that my foot had ballooned to half again its normal size.

In the bathroom I found the top of my foot bloody. I had a syringe right there and actually attempted to aspirate some of the venom from the wounds. This was not one of my more brilliant moments, but the illusion that this would be effective fortunately lasted only a few seconds, ending with my recognition of the foolishness of the endeavor and an understanding of my need for immediate medical care. I needed antivenom, and I needed it as quickly as possible.

Back to clear thinking. I considered calling 911 for an ambulance and medics but reasoned that by the time they got to me, got me loaded and then again left, much more time would be eaten up than if I just took off for a hospital. So, with increasing discomfort (euphemism for pain), I got out to the garage, grabbed a tourniquet from the crash bag I keep in the car, and opened the garage door. There was a brief moment of internal debate as I considered the tourniquet: current evidence recommends against the use of them in snakebite as the amount of local damage is increased and there is a risk of bad things happening when the tourniquet is removed and a bunch of toxin is quickly released into the general circulation. Despite this knowledge, I decided to apply the tourniquet lightly, hoping to diminish systemic effects of the venom while driving to the hospital.

Once in the car, I realized I was unsure which hospital to head for as I was right between at least two. So I finally called 911 while driving to ask if there was a regional snakebite center. There wasn’t. I found that the 911 dispatcher was not pleased that I didn’t want to wait for an ambulance. When I said jokingly that I knew I was fine because I knew it was October 1947, her angst amplified significantly, and I had to convince her repeatedly that I was joking and that I was OK to drive. That said, it was a very surreal journey as I drove to a large private hospital, pointedly avoiding the regional trauma center on an urban Saturday night.

When I arrived outside the ER, the venom effects were getting markedly stronger. I was unable to bear any weight on my left foot and was feeling progressively more ill. I left the car in front of the ER and hopped in. Once I announced the nature of my problem, I was quickly wheeled back to the triage area, where two IVs were started and blood was drawn.

From that point on, events settled into a strange kind of slow motion. I was moved into a treatment area, where I was first seen by an ER nurse, then by an intern and a resident who really knew nothing about snakebite. I treated my own anxieties by talking to them about the pathophysiology involved. The attending physician finally showed up and ordered the antivenom. Herein lay the next problem: antivenom takes about an hour just to reconstitute. Tack onto that the time required to transcribe the order, send it to pharmacy and for pharmacy to get to work on it … there was an eternity yet to wait. By that time I had removed the tourniquet and had slipped briefly into a bit of denial imagining that I might somehow get a few vials of antivenom and then dance on home as if nothing had happened. . .

Suddenly I felt poorly and said, “I feel really bad here y’all.” I was immediately surrounded, my gurney was tipped head down, and someone said my pulse was in the thirties and my blood pressure was in the fifties. These aren’t good numbers. I don’t remember how they knew my blood pressure so fast, but I do remember feeling a way I’ve never felt before. It was something like the feeling one gets just before vomiting or perhaps before fainting. It was like being both here and there and not knowing which was what.

Someone said, “Get the pacer pads,” and a nurse put them on me. Then another moment of brilliance. I, the trained physician, said, “Don’t do that, it will hurt.” I laugh now as they did then. After all, what are some little shocks compared to the pain that was now climbing my swollen leg? Further, if I did need to be paced, that pacing would keep me alive. . .

The next couple days were spent in the hospital with very good nursing care. My blood pressure came up, making pain medicine finally available. This time is a bit of a blur. I became quite anemic from the effects of the venom. On the last day, I tried to move around a bit, but the pain was searing any time my foot wasn’t elevated. I was pretty weak. Just maneuvering to the bedside commode was both immodest and excruciating. Still, healing had commenced.

There were moments of frustration and of laughter. On day 3, I was discharged from the hospital with a final touch of humor. My nurse on that last day looked to be about 11. She was asking me her nurse questions, and when she got to “What is your work?” I answered that I was a doctor. She was shocked. Why would I say that? I can only quote her: “Uhn uh, a physician? Shuuut uuup!” I found this hilarious but also a reminder of the mythology that doctors are somehow made of something different from “regular” folks. Lying in that bed, unable to take care of myself, I was reminded of just how regular I am.

I’ve now been home for a few weeks. I am just beginning to bear a bit of weight, and the swelling is now limited to the foot and ankle. My platelets fell last week, and I had a little bleeding under the skin, but that has now resolved. I know I will be rehabilitating for some weeks to come. I am on the mend, but somehow I am not the same.

Above I mentioned gifts. That is what I have taken from this experience more than anything else. I have been given a much deeper understanding of who I am, stripped of my titles, and even of the physical abilities by which I define myself. Under all that I am just a man.

I have worked at my job a few days and found it remarkably difficult physically, yet the support and care of those with whom I work has filled my heart. I have come to an even more powerful experience of love: that of my wife, my family and my community. A couple rattlesnake bites that landed me in the ICU and waved my mortality before me have not left me traumatized nearly so much as thankful. Not to suggest that I would be interested in a repeat performance; no, once is enough. Yet, I would not wish for this not to have happened. The many costs of this event are repaid with interest by what I was given on a Tucson Desert night.

Dr. Sergeant, a graduate of the Santa Rosa Family Medicine Residency, directs hospital medicine at the Gila Regional Medical Center in Silver City, New Mexico.


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

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9.      Books Received Awaiting Review

PRICELESS – Curing the Healthcare Crises, by John C. Goodman, Father of HSAs

HEALING THE HEART OF DEMOCRACY – the Courage to Create Politics Worthy of the Human Spirit, by Parker J. Palmer

THE FEMALE BRAIN – What makes us Women, by Louann Brizendine, MD, Psychoanalysis at Langley Porter, UCSF

WELCOME TO ENTREPRENEUR COUNTRY – Julie Meyer, CEO, Ariadne Capital, London

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The Book Review Section Is an Insider’s View of What Doctors are Reading about.

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10.  Hippocrates & His Kin:  Can we relate government to reality?

Today’s news: California had to close 70 parks because of budget deficits. Children have to play in the streets.

Tomorrow’s news: California had to close 7 hospitals because of budget deficits. Sick people can’t get admitted. Read more . . .

Next week’s news: I had a coronary, but all hospitals were filled and I couldn’t get a room. Moses and St Peter, do you still have space?

Next year’s archives: Why are we having flu, TB and small pox epidemics again?

Our children’s history books: Entitlements, Budget deficits, Taker mentalities caused public health to take a nosedive reversing the progress of the last century.

Or if the guy in the Big White House isn’t doing his job, maybe we should just let him go.

Are Entitlements Corrupting Us?

With a treasure chest of government-supplied benefits readily available, a taker mentality has become part of our way of life, writes Nicholas Eberstadt in the WSJ.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

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11.  Restoring Accountability in Medical Practice, Healthcare, Government and Society:

                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at and register to receive one or more of these reports.

                      Pacific Research Institute, ( Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog.

                      The Mercatus Center at George Mason University ( is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government.

                      To read the rest of this column, please go to

                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to

                      Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. ( Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law. 

                      FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder,, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser’s view on today’s health care problem:  In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “singlepayer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.

                      Michael J. Harris, MD - - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

                      David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at To read his "Lessons from the Past," go to For additional articles, such as the cost of Single Payer, go to; for Health Care Inflation, go to

                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at

                      Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see To see Attorney Sharon Kime's response, as well as the California Medical Board response, see Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to 

                      The Association of American Physicians & Surgeons (, The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

                       The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .

Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"

                      PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.

Our motto, "omnia pro aegroto" means "all for the patient."

12.  Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

Words of Wisdom

I don’t make jokes. I just watch the government and report the facts. –Will Rogers.

Government’s view of the economy could be summed up in a few short phrases:
If it moves, tax it.
If it keeps moving, regulate it
If it stops moving, subsidize it.  –Ronald Reagan (1986)

Some Recent Postings

In The May Issue:

1.                  Featured Article: Unrecoverable accounts receivables more important than Medicare cuts

2.                  In the News: Doctor’s Office Visit for the price of a cup of coffee for 57 years.

3.                  International Medicine: Socialism & Socialized Healthcare have the same END GAME.

4.                  Medicare: Natural Rights Trump Obamacare, or Should

5.                  Medical Gluttony: The Medical Myth of providing improve access to care is gluttonous

6.                  Medical Myths: Putting Medicaid patients into HMOs will improve their access to care.

7.                  Overheard in the Medical Staff Lounge: The next occupant for the White House

8.                  Voices of Medicine: Inside Medicine: Doctors are often in the dark about costs

9.                  The Bookshelf: Why We Get Fat: And What to Do About It, by Gary Taubes

10.              Hippocrates & His Kin: Preventing Free Trade in HealthCare

11.              Related Organizations: Restoring Accountability in HealthCare, Government and Society

12.              Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

In Memoriam

Dietrich Fischer-Dieskau: Imperfect Greatness


The obituaries for Dietrich Fischer-Dieskau, who died last week at the age of 86, praised him without stint—and, for the most part, without qualification. The English tenor Ian Bostridge, who paid tribute to him in the Guardian, spoke for just about everyone when he called the German baritone "a titanic figure and a mirror of his age." You'd never guess from reading these heartfelt paeans that Mr. Fischer-Dieskau was also one of the most controversial artists of his age, or any other. For every vocal connoisseur who praised him to the skies, another dismissed his singing as "mannered" and "croony," and it was not until after he retired in 1993 that the carping ceased and he came to be regarded as above criticism.

Needless to say, no one supposes that Mr. Fischer-Dieskau was anything other than an immensely gifted and consequential musician. Though he was best known as a recitalist, he also appeared frequently in opera, and he is believed to have made more recordings than any other classical performer, including a near-complete set of Schubert's 600 songs. . .

Mr. Fischer-Dieskau didn't much care for America, and so performed here infrequently. As a result, the only time I saw him onstage was at a series of three 1988 recitals at Carnegie Hall that were his last public appearances in this country. He sang songs by Gustav Mahler, Schumann and Wolf, and I confess to recalling nothing specific about the performances themselves. What I do remember—indelibly—was his physical appearance. He seemed at least 8 feet tall, and he strode about the stage with the energy of a very young man, all but thrusting himself at the audience. It was as if he had cast off his inhibitions and plunged into the music like a madman leaping headlong into a volcano.

By then I had been listening attentively to Mr. Fischer-Dieskau's recordings for a decade and a half, and had gone from being a he-can-do-no-wrong fan to a judicious, somewhat skeptical admirer. Seeing him in concert, though, reminded me of the singularly vivid expressivity that first led me to fall in love with his singing, and ever since then I've unhesitatingly ranked him among the greatest of the greats. Perfect? By no means. But perfection has a way of becoming boring. Whatever else he was or wasn't, Dietrich Fischer-Dieskau was always interesting. He never gave a performance that didn't make you think—even when it was wrong.

—Mr. Teachout, is the Journal's drama critic

This Date in History – June 12

June 12, in 1776, was truly a red-letter day in American History. On this date, while the Continental Congress was meeting in Philadelphia, the Virginia Declaration of Rights, largely written by George Mason, was adopted by the Virginia Convention. This was one month before the Declaration of Independence, and influenced not only the Declaration, but also The Constitution and the Bill of Rights.

That all men are by nature equally free and independent and have certain inherent rights. . . the enjoyment of life and liberty . . .and pursuing and obtaining happiness. –That all power is derived from the people. It also included articles on Freedom of the press and freedom of worship. –A remarkable document for its and our times..

On this date in 1987, 25 years ago, President Reagan delivered a speech in Berlin in front of the ceremonial entrance to East Germany, the Brandenburg Gate: “General Secretary Gorbachev, if you seek peace, if you seek prosperity for the Soviet Union and Eastern Europe . . . come here to this gate. Mr Gorbachev, open this gate. Mr Gorbachev, tear down this wall.” Peter Robinson in his column, Four Words That Moved the World:  “Tear Down This Wall,” in the WSJ, wondered if this speech really mattered or was it just some speechwriter’s words. He was able to determine that the Berlin Wall address revealed a lot about President Reagan. The State Department, the National Security Council, the ranking American diplomat in Berlin all objected to it. In all, seven alternate drafts of that speech  omitted the call to “tear down this wall.” The president insisted on delivering the call anyway. In the limousine on the way to the wall, Reagan told his deputy chief of staff, “The boys at State are going to kill me for this, but it’s the right thing to do.” Gorbachev responded last spring, “We really were not impressed. We knew that Mr Reagan’s original profession was actor.”

Mr Robinson’s further research with various dissidents including Yuri Orlov, a physicist in the Soviet Union, “Theater?” Yuri said. “No.” In the 1975 Helsinki Accords, Yuri explained, even the West accepted the division of Europe. “Imagine how hard this made our struggle. We almost had to admit that it was hopeless. Then Reagan says, “Break the wall!” Why break this wall if these borders are valid? To us, it was more than a question of Berlin or even Germany. It was a question of the legitimacy of the Soviet empire. Reagan challenged the empire. To us, that meant everything. After that speech, everything was in play.”

President Ronald Reagan was hardly alone, of course. John Paul II, Margaret Thatcher, Lech Walesa and Vaclav Havel called for an end to the division of Europe. Yet when the president of the United States demanded the destruction of the Berlin Wall . . . he issued a summons of such great power and clarity that many who heard him felt as if they had suddenly regained consciousness. The Berlin Wall address represented a call to awaken.

Who tore down the wall? Nancy Reagan stated that the president felt that it was the people that made it happen. Ronald Reagan, that good and valiant man was happy to have helped them.

After Leonard and Thelma Spinrad

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The 10th Anniversary World Health Care Congress


The 10th Annual Congress is committed to improving global health care by bringing together business, political, and academic health care leaders to actively share information and work together to improve the overall quality and cost of health delivery in the US and throughout the world.

The 10th Annual World Health Care Congress will be held April 8-10, 2013 at the Gaylord Convention Center, Washington DC.
For more information, visit
The future is occurring NOW.

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