Friday, November 22, 2019

Medicine Is Free

I woke up with a vision of a dragon eating an apple. The Dragon was green but otherwise this direction, and size--tail to the left. The apple was in its mouth, but it was a big apple, even bigger than his head.

It is a sign.

Let us amuse you with some of the photos we came across trying to find the 'dragon eating an apple one'...

Here is a dragon you can eat, made of rice, gooseberries, blueberries, kiwi and apple.

There is is from another perspective.

If you look closely at this one, there is a gecko on the apple! Funny right?

Now let us share something that has resonated with Carla very strongly, and if you are one of our readers, you would understand why it would resonate with her:

Even yesterday was ruined because of the politics. The scheduler wanted a day off, and asked Carla to take his very low paying assignment. Carla has a little money pressure, so she said 'yes'. She was to come in at one.  Well, a colleague texted and called her, because he wanted a break from 11 to 1. To go see his doctor, he said. She said she could make it at eleven thirty. She started his case. He would take hers at one. Well, he didn't show up. Her boss came in the room asking for him. She said what she knew. But after the long case, when it was time to go home, another partner who thinks she doesn't like to work because she takes so much time off due to Anthony's needs (illness, sports), said he had a sore throat. Would she please do one more case?  Ross had counseled her to say yes, to appear as a 'team player' to all of the three requests. But he also counseled her next time to say no. And next week there is much, much-wanted, time off. Everything runs on favors...and it is important to keep the peace.

We will provide the comments Carla selected as proof that this woman author who claims medicine is abusive resonates resoundingly strongly with other physicians. As Fair Use we are going to put it at the end.

As always there are lessons, optional ones, which are hard to digest and we never expect anyone to make themselves sick over it, but for those who are curious, and want to understand the what is going on with the world around them, here are options for you to increase your knowledge:

  1. The toppling of Medicine is no accident. It has been planned centuries ago. The only way to take down a society is to both weaken the people, demoralize them, and to take down their elite (well-educated leaders). It happens time and time again. Only this time, it is the 'outside forces' that the doctors are starting to feel, and decide to 'stay or go'--but in truth, it is all going to 'go' anyways and workers will be robotic (humans who are total and completely controlled by the system with no questioning it). 
  2. Child prostitution is making children work. There are laws in just about every nation across the globe against child labor.  Legally, even though child prostitution is a crime, there's a lot of contention about it because the people who do it to blackmail other famous people want to keep doing it. But NO ONE is going to be able to argue against illegal child labor. No one. It is indefensible now in two dimensions--morally and philosophically, and now legally in two different axis of bad.
  3. The wanting to know secrets is the human version of 'curiosity killed the cat'--here we see a video of a female May-Sonnn-Ick chapter, actually two who won't talk to each other in the past but acknowledge one another, and an optometrist who goes up a rank. That feeling of being 'in' and 'accepted' and 'earning' is highly seductive. Remember Rank 33 equals human sacrifice. And as I look at it, I see in my own view, another form of the church of Say-Tan all dressed up. Even stealing the letter G from Divine Creator. Someone has a chip on their shoulder in a big way, Say-Tan. These grandmothers say over and over, 'we are just like everybody else' and 'we are no worse than anyone else'. Right. If you are creative, just imagine similar rituals going back to the times of Egypt--where they wore similar costumes--and Babylon---and Atlantis before that. Possibly even off planet's the fifteen minute video:  

It's going to be okay.

And here is another sign, a video I saw, which yesterday I saw with new eyes.

Watch it and observe the influence of an Archangel incarnate on the masses. Even on you. You will have tears in your eyes to watch it.  And Chamuel (IZ) wasn't even aware who or what he was, and had so many challenges!  And Chamuel's energy is pure, pure angelic power and just melts everything and gets right to the heart. So don't worry about all the creepy grandmas who are part of the Gnu Wurlt Ordah. LOL.  

Our future is set and more and more Archangels and Angels are going to be consciously spreading their light like this:  

Clap! clap!

Aloha and Mahalos,

Ross and Carla
The Couple who are family with you


Comments to first article

Allergy & Immunology · edited · Jan 20
I very much appreciate the heart wrenching stories here and I realize that medicine today does not even closely resemble what we were taught and practiced all of our lives. But, the main point is that these discouraged physicians really do CARE! If they didn't, they would just quit, walk away and NOT WRITE ANYTHING! I see and hear a lot of compassion here and yearning for 'a better pathway' for patients and providers. I urge those of you who are frustrated with the current state of affairs in medicine (corporate medicine..) DO NOT leave. Rather let's creatively work towards a venue that will restore the dignity to physicians and patients. Realize that we as physicians are too busy to nurture and sustain any 'program' we agree upon for change. But, we too can hire the brightest and the best to help us with our objective.
A parting thought... No one.. not even a motivated physician can sustain long hours of work, isolation, degradation, sleep, food, and psychological deprivation and still be the bright-eyed Polly Anna top of their game optimist. You have to have something else that 'juices your jets' so you can go back to the "War". If you don't have a hobby or interest outside of medicine,(I know you will say, but I don't have time...)You MUST make the time to do something else for your sanity.

Do this simple exercise:
On a blank sheet of paper, draw a line down the middle.
On the left, list all the things that make you happy ie Stuff you love. BUT YOU CAN'T LIST ANYTHING TO DO WITH MEDICINE.
On the right, list all the things you really dislike ie stuff you hate. Again you can't list anything to do with medicine.
Your sheet would look something like this:

My dogs PIcking up dog poop
Listening to music Whiners
A good read Cleaning the garage
Cooking/ good food Long distance driving
Traveling with my dogs Cold weather

If you can't write down more than 1 or 2 items in the left hand column... you are burning out.. or maybe you are there and need to rethink your life.

Take some 'time out' and study these items. Even if only 5 minutes per day (but set a daily 'sacred' time for yourself) to do at least one thing daily that you LOVE.

Look at how much of the right hand column is dominating your life. Think about what you can do to decrease the amount of 'stuff you hate' in your life. Maybe I should hire a high school student (who loves dogs) to pick up the outdoor dog poop in the kennel a couple of times a week etc.

I think we as health care providers look out for everyone EXCEPT our selves. If we don't nurture our psyche, then we get depressed.
These are only thoughts... But I can tell you this.

MY DOGS (and I didn't grow up with a dog) are the reason I can go back to work in corporate medicine. Also, the GREAT people I have met in the dog world have opened my eyes to new cultures. I write for the Dog Journals (I used to write medical papers... ) I have learned photography because I have to submit photos with the Dog Articles. Now, I nurture others writers to write for the Dog Journals (two of those have been nominated for writing awards and one MD author won a big award for his poetry on the 1st try!)

Finally, physicians are very competitive people. We were trained to be that way. But now we are forced to 'fit the mold' of corporate culture. We no longer have any input into the system. There is even a document out there in 'suit land' that systematic outlines how to mold physician behaviour so that the physicians psyche becomes dependent upon the institution.

We need to nurture each other. Not telling someone else how to 'fix' their life but just listening... that's a trait very few physicians ever learn to do. Listening to someone who is frustrated is cathartic for them and improves your understanding of the 'problem'.

Know that the system puts you under a lot of pressure. You are trying to deliver the best care you can... under difficult restraints... You can't change everything overnight... but you CAN and DO still deliver the best patient care than any one else on the team.

These are just thoughts from one physician... GOOD LUCK!
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James Lilja, MD 
Obstetrics & Gynecology · 12/24/18

Not to beat a dead horse, but the biggest thing is the payment system. Your work on a patient is done first, for either zero money or a “copay” that costs less than a haircut, then you are forced to beg for payment to a multi billion dollar insurer or the government. You have to pay 5-12% of that to employ an army of people to try to extract your payment over months, dealing with uneducated “customer service” idiots on the other end all controlled by ex-nurses and MDs who are incentivized yo deny and delay payment. All of this is under the legal auspices of “claims adjustment” which means you have no rights at all to be compensated. Oh yeah, if you talk to your colleagues about what one of the abusive “private” (read quasi-government) corporations are doing you are breaking anti trust laws.
It’s no wonder most physicians have chosen slavery under a hospital corporation... and we can all see how that will go at the Company Store.

The forces against existing as an MD of the classic type are insurmountable.

The system exists now where patients HAVE to pay massive premiums as a protection money — otherwise financial ruin results if you suffer hospital admission.

Now that everyone is trained to pay a massive monthly fee big pharma, hospitals, EMR companies, insurers, can all feed at the trough.

Politicians don’t care: they can keep promising all is “free”for the old (CMS tax $ only covers 1/3 of cost) and shift burden to “private” patient premiums to cover hospital charges. The insurer can just raise premiums without a vote! They can even boost profits beyond that into the stratosphere!

Just blame the doctor for it all!

Phase II is to dumb down the doctor so they don’t actually PROVIDE care, but stay on as dumb hospital store window displays. That’s why you must quit. Replace you with a shift-working employee beholden to a corporate boss. Malleable. Helpless. Shut up and do what’s profitable (and now: Avoid Bad Quality Metrics)

Get it?

Melissa Kwak, MD 
Family Medicine · 12/23/18
I hear you. I really do. And I once thought similarly and felt probably similarly to how you feel. Please hear me out. There is another way to approach this that may serve us all and the healthcare system better.

I was hating my job and feeling like a victim to EMR and the "system" a few years ago. I was trying to pretend I was fine and everything was fine, but I was not. I was surviving, not thriving. I knew there had to be more, this couldn't be IT. And I realized I didn't want to wait around for the "system" to change for me to thrive in my life and FEEL better in my life. Who knows how long that could take?

I'm now in the exact same job, content, feeling fulfilled again, while also proactively and purposefully putting steps in place such that I can help improve the healthcare system, be a mover and shaker within it. Yes, measly me, one small person.  

I am so fortunate to have stumbled across some mind management and life skills through an amazing life coach.  

I love now taking full responsibility for how I'm thinking/feeling/acting and what results I'm getting in my life.  

Thinking day in and day out that the healthcare system is broken and I'm a slave to the EMR and insurnace and admin was not serving me well. As true as those stories sound, they were keeping me a prisoner to the healthcare system and EMR.  

I'm not arguing for trueness/falseness, rightness/wrongness of thoughts. I'm arguing for, are you sure you want to keep telling yourself the story you currently are about your circumstances? Those stories are what are holding you victim.  

How many people in other countries would LOVE our healthcare system. How many docs and patients in this country currently think our system is just fine? Or just don't give it a 2nd thought? There is no consensus on what a right or best system is. There is just is a system that is constantly evolving, just like we humans are, and the system, and our human brains will just keep evolving on autopilot unless we purposefully steer them.

Again, I get it. I've been there. But listen. So far, us docs calling ourselves victims, telling ourselves our mastery shouldn't be questioned...where's it getting us? Into discontentment, disillusionment, discord, distaste...a whole lot of unnecessary misery. All the while handing all our power over our minds, our feelings, our lives, to....what? A nebulous "system" that is just doing what it's been trained to do? A CEO who's just doing what they're trained to do? A patient who doesn't know any better?

Is this really serving us well?

"There is no question in my mind that physicians are victims of a healthcare system gone horribly wrong. "

How do you feel when you think this? I imagine enraged, or helpless, or anxious, or some combination of such.

How do you show up in the world feeling that way? Do you show up as your most effective self?

If you do, great. Please move on and forget you ever read this. The point isn't to tell you or anyone they shouldn't be thinking or feeling a certain way, especially if it's getting you the life results you want.

But is it?

What if it were just fine to have your mastery and life choices questioned...on facebook, by an administrator, by insurance, by anyone...because it doesn't mean anything about you or take anything away from what you want and where you want to go. It's all good. 

What if the system isn't broken? What if it's been evolving all along the only way it "knows" how, and we get to help steer it how we'd like next if we so desire?

What if we were able to stop resisting and fighting reality, and feel content and fulfilled right where we are now? Not because we don't have dreams of something bigger or better. Not because we want to be complacent. But because in order to achieve bigger and better we have to make room in our brains to dream and think and create and develop and grow, and it is nearly impossible to do that from a place of claiming victimhood, from a place of helplessness, enragement, disillusionment.

We are not victims. Claiming such is not helping us or the "system". This isn't about "blaming and shaming the victim" because there is no victim, unless you choose to be one. There is no shame in deciding the healthcare system is not abusing you and you can stop feeling abused right now. There is only power in such. Take your power back. 
Lisa Adams, MD 
Internal Medicine · 12/23/18
No amount of mindfulness is going to make me enjoy being a data entry clerk and secretary instead of a physician.

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Glenn Freed, DO 
Gastroenterology · 12/23/18
Right ON!!! I’m a “dinosaur” these days. A solo Gastroenterologist who still uses a paper chart, takes a history from the patient, actually examines the patient and spends time explaining my plan and then answering their questions. 
Then I spend hours, days and sometimes WEEKS fighting to get the meds, lab tests, x-rays and procedures APPROVED. 
Of course, unlike an attorney, that time is on me. 
And people can’t understand why I’m so angry. 
Wake up people 

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Stephanie Taylor, MD 
Obstetrics & Gynecology · 12/24/18
Our hospital paid us for 24 hours of ED call-$100/24 hours. That is about $4/hour. It makes a surgeon feel just great when they know they are the lowest paid person in the OR-and that includes housekeeping staff.

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Roy Sheinbaum, MD 
Anesthesiology · 12/16/18
I left full time practice in 2017 at age 60, because I felt I had been abused enough and had a lifetime of traumatic experiences, on many levels, behind me. I have continued to practice part time and have refused to sign any contract with any health care companies even in my part time work. I recently am having to give up a pretty good job to do so, because I was lied to by my employer that they needed someone just like me who doesn't even want to work full time. Six weeks in, while being complementary about my work, I was told that they had changed their mind and needed someone full time. I declined to sign anything so I guess I'm working there full time until they find someone willing to sign on the dotted line. Meanwhile I gave up another situation to take this and now six weeks in am being treated this way. I am glad they want me to be full time, but the discussions I had with them are that I don't wish to be full time and they agreed to that. This is only the most benign example of how I have been treated my entire career as an anesthesiologist. I have had many worse experiences with corporate medical entities. I'm glad I'm old enough and have planned my own financial security, so that I am not held hostage to any corporation again. Ever.
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Robert Percell, MD 
Cardiology · 12/16/18
Excellent synopsis! As physicians, we have a hazardous occupation. Not only are we exposed to communicable diseases on a daily basis, we are expected to walk on water and accept abuse and less pay. As an EP doc, I'm exposed to cancer causing radiation on the daily. Additionally, one catheter that I use for a routine ablation can cost more than what the entire staff (myself) makes in a day. 


Marc Yland, MD 
Anesthesiology · 12/15/18
The public looks for "care" on their "smartphone" , we are just an obstacle to get prescriptions, authorizations, timely appointments, and copays.
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Marc Yland, MD 
Anesthesiology · 12/15/18
According to WHO only two countries have seen a decline in the overall quality of health care since 1995.
The first one shouldn't surprise you.
The other one is South Africa.
At the end of segregation in 1995 many doctors left.

We are the only country that allows advertising for medical products (1995 Supreme Court decision).

We are almost the only country that uses litigation instead of peer review.

We are almost the only society in which non physicians are called Doctors.

We are one of a few countries with extensive use of NP's PA's etc.
Physicians in US are underpaid compared to many of their
European counterparts, taking into account cost of education, insurance, and pension.
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Christine Melgar, MD 
Obstetrics & Gynecology · 12/10/18
I am not sure of the average age of the responders below but I suspect it is around 60yo. I am an OB/Gyn and my husband practices Internal Medicine. We are around 60 yo, trained in the late 1980'-90's. We saw physicians our age at that time, taking less call, financially well off, well respected and working because they wanted to and still enjoyed it. We got a taste of the tail end of the "good" years before HMO's, etc hit in the late 1990's. Right now, I am working harder, the nights are brutal at my age, we are bringing home less money than we made in 1995. The career is certainly less satisfying. I am more fortunate as I know so I don't like to complain but both my husband and I worked hard to get here, sacrificed our 20's, raised 3 amazing children (2 of which are in medical school, by their choice) and we are still working just as hard. Sometimes, at 2 a.m. en route to the hospital for another delivery, I break down in tears, saying why am I still doing this? Patients just expect us to always be there not realizing how physically hard and emotionally stressful being a physician is. I don't have time to address that and come home broken and collapse. I am ready to "cut back", give up night call, and work only 40 hrs a week instead of 60-75hrs per week. But I am struggling giving up Ob and it would be a hardship for my partners until we hire a new physician. But I enjoy teaching the residents and hate to give up Obstetrics totally. I know that there is a change in the next generation of physicians who will go into a career in medicine with a different mind-set. Our graduating residents are looking for a 40hr per week job, with a punch the clock job, as it is a "job". They don't want to work like us. For our generation, it is much more than a "job". For us a career in medicine is part of who we are, and infused in our souls.

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Josephine Daluga, MD 
Emergency Medicine · 12/9/18
I work in Las Vegas. The situation in Nevada is dire because of a physician shortage in this state that is one of the worst in the country. You'd think that would make us more valuable, wouldn't you? But oh no, we're treated like indentured servants. I joined the county hospital system and worked in their Urgent Care clinics for several years. We worked 12 hour shifts, from 8-8. We were expected to see everyone who came in the doors, regardless of the volume, time of day, or presenting illness. 
The doors closed at 7:30, but we were expected to see everyone who'd signed in, no matter how late we stayed. My record was 63 patients in one shift. 63. And it would have been more, except that some patients got tired of waiting and left. My supervisor (also a physician, but one who didn't have to work where I did) chastised me for not being happy peppy with the patients, and refusing them their narcotics or work notes or unnecessary antibiotics. I got fed up with this, and began asking to close the doors early when it became clear that we had enough patients to take us past our eight o'clock shift end. My supervisor called me up, screamed at me over the phone, and told me NEVER to do that again.He said it wasn't my decision, I didn't have the right to do that.
That was when the reality hit me. I was a slave. 
Boris Berejan, MD 
Emergency Medicine · 12/10/18
I had a hospital administrator one day tell me, before every shift to look in the mirror, smile and say " it's show time!" so I could have a big grin on my face. Same idiot brought an ice cream sundae cart to the ER waiting room to hand out ice cream to the patients. Perfect for those vomiting, and waiting to be seen for their abdominal pain. The clueless leading the powerless....

Boris Berejan, MD 
Emergency Medicine · 12/10/18
We see patients right up to closing the doors. Worked a long 12 hour day, patient came to the door at 2 minutes to 8. As we were rushing him back he said with a big grin " well someone isn't going home on time tonight!" And we are supposed to just smile and swallow that ......
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Albert Mercer, MD 
Cardiology · 12/9/18

We might be happier if we understand that being a physician is a job. We are employees. My 40 year experience has been transactional. The patients whom I served were benefitted in length and quality of life. The job allowed me to provide safety to those whom I love.
We ask too much of our work to expect it to define our personal self worth or give us place in society. Being a physician is not identity. 

I do not criticize colleagues for changing geography or using their education and skills, that came at high personal and financial cost, in non clinical pursuits. We deserve flexibility, portability and the right to say enough. Choices made in our early years often based on romanticized, naive half-truths should not be forced into permanence by peer or societal pressure. This outdated sense of responsibility to a “calling” placed on all groups of providers is not reciprocated by the patients, payors or the controlling human component of the provider system: administrators. 
The system component benefiting most from physicians’ misconception of their leadership/ responsibility are the administrators. Their system reputation is built on the goodwill engendered by physicians and other clinical providers .The special role tacitly defaulted to physicians that we unwittingly embrace is responsibility for shortfalls in system performance. 
I suggest MD’s wake up to the facts.
Things can be different / better for providers and patients .That is a topic for rational fact based discussion.. 
Albert Mercer, MD , FACC

Athanasios Bonoris, MD 
Cardiology · 12/8/18
Every word in this article is correct and experienced by MANY. The function of the CEO is to have some MD’s in his payroll to pass his policies and cut-cut-cut so as to have a greater end year bonus. Some nurse doing morning rounds will sternly say to you “pt in 803 is going home today, right”. If you disagree you get a myriad of phone calls. If pt is discharged and something happens you are liable. Not to repeat any of the very honest thoughts I would add you then lose your privileges if you refuse to recertifications for all boards take. In essence you cannot have a normal life—call and phone calls from ER are additional burdens—but we will tell you how much you get, you prescribe certain meds, you explain to every family member what is going on, and we do not care about your experience or technical skill but only that piece of paper that you recertified. Try lawyers that charge by 10 mins, are not nice at all, and to represent a current friend for talking a prosecutor for about 5 mins charged an obscene amt—and they do not lose their jobs due to no recertification. You also try to work a code blue or purple with them. They are calm and move mighty slow for their cases.
Angelo Argento, MD 
Internal Medicine · 12/9/18
And all the while the CEO and lawyer are sleeping soundly in their million dollar mansions looking forward to the weekend on their private yacht
Joe Littlejohn, MD 
Urology · 12/8/18
I am a practicing Urologist with a Startup company which aims to make life better for Providers. Our flagship product decreases clerical burden. Future products will be aimed at other pain points of practicing. Let’s support efforts aimed at improving our current situation.

Tamela Martin, MD 
Ophthalmology · 11/25/18
Great article! Though I'm 51 I'm considering leaving surgery and clinical medicine as well. Patients feel I owe them my time 24/7- my father had a stroke and a patient expected me to leave the ICU to come see them because he was leaving for a European trip that day (& did not want to be inconvenienced?!) I'm tired of giving away the best parts of my life to ungrateful patients. I dont like who I've become in "medicine today" 
Edward Chastka, MD 
Psychiatry · 11/25/18
The new system of medicine makes doctors and patients resent each other. Patients feel entitled to what their insurance company or the government promises them and doctors are left "holding the bag." 
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