doctor doctor

A patient identified himself as a doctor to me, the front desk, the appointment manager, etc. Everybody knew he was a "doctor" before he even set foot in the office. Today when I asked him what kind of doctor, he said he's a biochemist with a PhD. Now that may be true, but it's irrelevant and a ploy to pull rank. I find that MD's never identify themselves as such. The ones who try to pull rank are the ones without rank.

Disenfranchised

I was recently urged to join the AMA because it's the only organization that represents and battles for doctors' issues. Wrong-o. And that they've helped in getting certain things into PPACA. Wrong-o again. I have learned that the AMA secured many under-the-table promises that were denied later or flat out ignored. If you make a bargain with the Devil don't be shocked when he fails to keep his end. I just cannot relate to wanting to be part of a huge neo-fascist organization that revels in its bureaucracy and dogma. I'd rather go for a walk.

Why was I receiving nearly weekly letters in the mail to buy auto insurance through the AMA? Or more billing/coding manuals? Or phone calls from their sales dept. pushing the latest book---I got fed up long ago. Now I just view that organization the same way I view the cast of "Jersey Shore"--with benign amusement tempered by the taste of bile rising in my throat.

The recent sinking of that Italian cruiser reminded me that oftentimes, forced enjoyment may bring forced pain. I would rather read a quiet book on my recliner with my polarfleece throw and a cup of Earl Grey than be on a cruise ship anywhere in January. When asked where I go on vacation, I often say, where the people aren't. I love New York, Rome, Madrid, etc. but when I need to relax and recharge I go to the places where nobody ever goes or writes about. Of course I wouldn't divulge my secrets because then they wouldn't be secret anymore, right :-)???

Get measured for a bra

There is something I keep seeing over and over in women of all ages. They continue to wear the same bras from years past, and while that doesn't sound like such a crime, it is when considering the inexorable effects of gravity, weight gain or loss, posture changes with osteoporosis, etc. Brassieres are made to hold up that which nature hath giveth....and nylon, cotton, spandex, polyester, etc. cannot  go against Newton's postulates after the fibers have been frayed from washing machines and dryers. The problem comes when such ill-fitting bras lead to digging and tugging at the skin, which tends to accumulate sweat in the folds, and then yeast infections, generic redness/irritation, "intertrigo" (latin for "wheat in between"--yuck) and all sorts of nasties arise. No matter what drugs/powders/lotions/potions are prescribed, the problem recurs. The root of the problem is an ill fitting bra.

Getting fitted periodically for a bra is a good idea. Cup and band measurements fluctuate throughout a woman's lifetime. Most women just continually buy the same bra size they had at age 19. A properly fitting bra will not only be more comfortable, it will also relieve skin chafing and lead to happiness all around. I know Nordstrom's and Dillard's always has a bra specialist in their Lingerie departments, and Soma makes a big point of offering to measure you whenever you even walk in. So there you have it. Shop!!

Tuesday's child

The disease keeps ramping up, and the patients' stress level keeps increasing. So much is uncertain and the populace is scared, nervous, uptight. I really do empathize with my patients, for whatever tumor/rash/abscess they happen to be suffering from. A lady came in today with a retained suture from last month. It happens, I've had it happen personally. The epidermis grows a little too fast and the suture gets trapped beneath it.

ANd oh, 10 days into the new year, Medicare has gotten the notice that it's 2012 and finally posted the new fee schedule. I cannot imagine how thousands of billing offices are automatically 10 days behind on the new year if they've had patients on new years day, the federal holiday, etc. For me it's just a about 3 dozen codes. For multiple doc practices it's hundreds. What a giant hemorrhoid to deal with.

In some uplifting news, the falcons and herons are moving through to their winter hunting and breeding grounds and it's a treat to see.

http://www.allaboutbirds.org/guide/Peregrine_Falcon/id/ac

My new favorite artist is Questlove (?uestlove) not sure how he spells it but I love his vibe.

Goodbye 2011, hello gorgeous 2012!

Well, I've just been exhausted by this year. Seriously bone crunching exhaustion. Medicine is hard work. Whoever thinks it's all glamour and gliding doesn't know shit. It is backbreaking and long hours on your feet, long hours being smooth and suave, and doubly difficult if you're having a bad day and faking it. Arthritis is developing and I have a new found respect for the elderly. Ice packs, anti-inflammatories and stretching through yoga are my new saviors.

I really hope the old garbage from 2011--the uncertainties, the corruption, the inconsistencies---go away. I'm ready for a positive uplift. I want goodness and gladness and seriousness. It's a good time, like the Roman Janus of old--half looking back, half looking ahead--to examine where you've been and where you want to go.

Here's to an abundance of health and prosperity for all  in 2012!! Cin-Cin!!

Groundhog Day every end of year

http://www.moneynews.com/Economy/Payroll-Tax-Medicare-Cuts/2011/12/22/id/421833


Well, once again, they hung the guillotine over our necks and they averted a nearly 30% pay cut for those of us in the trenches doing the work.
This charade happens every year. I am completely sick and tired of this annual ritual. CMS halts the processing of Medicare payments for the first 14 days of every January to give Congress "time to find ways to avoid the pay cut". CMS knows there would be a massive walk-out/revolt by doctors if the cuts came through. We still don't know what the fee schedule for 2012 will be, nor what the deductible will be. They'll figure it out well into 2012, with all of us scrambling to program billing software with the new fee schedules well into the new year. Their (Congress')  incompetence, contempt for the citizen, lack of knowledge of what it's like to be working in America today....(grumble grumble) GGGRRRRRRRRRR.

In a bizarre way, I actually want the cuts to happen. It would force their hand to restructure a bankrupt government entitlement with ever increasing Medusa-like growth.

Seasonal Nostalgia

Like many people this time of year, I find myself a little sad thinking of my childhood Christmases. The dreaming of Santa Claus arriving in the night--Ma, how he does he get into our apartment if we have no chimney? The family gatherings, and missing those who aren't with us any longer. The snow and the dark days ( I grew up in NJ). Now that I'm in a warmer climate and have real world, adult pressures, the season can be fraught with have-to-dos and responsibilities. I still look for Santa and believe he's around. It's easy to feel that you're missing that "magic" in all the sappy commercials this time of year.

I was reminded of a simple gesture by a patient's daughter. My patient passed away a few weeks ago, and his devoted daughter always came with him to his appointments. She came to bring me a thank-you card in the midst of her grief, thanking me for the support and the help I had given her father, and how he absolutely trusted what I thought. It brought a knot to my chest and I had to keep it cool in the middle of a busy clinic morning. Her gratitude reminded me what's most important for us to remember at all times--being kind, mindful of the golden rule, and just aiming for your best everyday, despite the headwinds!!!

In an earlier post I talked about bikram yoga, how deadly hot it was and how it wasn't for me. I truly love yoga and I persisted, I found a studio that offers "power yoga" in a room heated to 85 degrees, so you sweat but don't die. The studio is clean, smells good, has big windows facing a garden courtyard with lots of open space around it. I really feel that your surroundings impact your practice, your work, your life.
I was sold. I've been attending "power vinyasa" classes, a faster paced sequence of challenging poses in a heated room for 60-90 minutes, and it's wonderful. I really like how we begin and end each class with a long powerful "OM". There is a wisdom to this ancient practice of fitness, and I am much more flexible, limber, stronger after a few weeks. I can already do a partial tripod headstand! OK so my legs aren't straight and I can only hold it for 5 seconds, but it's a victory at age 43. Physical fitness is so important, it sets the pace for everything. Growing old, obese, weak, winded, and full of elevated lipids and diabetes and high blood pressure, NOT for me. I wish my peers and patients would listen to me when I suggest this. They are sooo behind the times, they think I'm crazy when I push for exercise, yoga, biking, swimming, etc.

Have yourselves a Merry Christmas and a healthful new Year!!!