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 11 
 on: Today at 11:07:51 AM 
Started by Crafty_Dog - Last post by Crafty_Dog
 grin

 12 
 on: Today at 11:04:04 AM 
Started by Crafty_Dog - Last post by Crafty_Dog

http://www.thedailybeast.com/articles/2014/04/14/how-being-a-doctor-became-the-most-miserable-profession.html

How Being a Doctor Became the Most Miserable Profession
by Daniela DrakeApr 14, 2014 5:45 am EDT
Nine of 10 doctors discourage others from joining the profession, and 300 physicians commit suicide every year. When did it get this bad?


By the end of this year, it’s estimated that 300 physicians will commit suicide. While depression amongst physicians is not new—a few years back, it was named the second-most suicidal occupation—the level ofsheer unhappiness amongst physicians is on the rise.
 
Simply put, being a doctor has become a miserable and humiliating undertaking. Indeed, many doctors feel that America has declared war on physicians—and both physicians and patients are the losers.

Not surprisingly, many doctors want out. Medical students opt for high-paying specialties so they can retireas quickly as possible. Physician MBA programs—that promise doctors a way into management—areflourishing. The website known as the Drop-Out-Club—which hooks doctors up with jobs at hedge funds and venture capital firms—has a solid following. In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession.

It’s hard for anyone outside the profession to understand just how rotten the job has become—and what bad news that is for America’s health care system. Perhaps that’s why author Malcolm Gladwell recently implied that to fix the healthcare crisis, the public needs to understand what it’s like to be a physician.

Imagine, for things to get better for patients, they need to empathize with physicians—that’s a tall order in our noxious and decidedly un-empathetic times.

After all, the public sees ophthalmologists and radiologists making out like bandits and wonder why they should feel anything but scorn for such doctors—especially when Americans haven’t gotten a raise in decades. But being a primary care physician is not like being, say, a plastic surgeon—a profession that garners both respect and retirement savings. Given that primary care doctors do the work that no one else is willing to do, being a primary care physician is more like being a janitor—but without the social status or union protections.

Unfortunately, things are only getting worse for most doctors, especially those who still accept health insurance. Just processing the insurance forms costs $58 for every patient encounter, according to Dr. Stephen Schimpff, an internist and former CEO of University of Maryland Medical Center who is writing a book about the crisis in primary care. To make ends meet, physicians have had to increase the number of patients they see. The end result is that the average face-to-face clinic visit lasts about 12 minutes.

Neither patients nor doctors are happy about that. What worries many doctors, however, is that the Affordable Care Act has codified this broken system into law. While forcing everyone to buy health insurance, ACA might have mandated a uniform or streamlined claims procedure that would have gone a long way to improving access to care. As Malcolm Gladwell noted, “You don’t train someone for all of those years in [medicine]… and then have them run a claims processing operation for insurance companies.”

In fact, difficulty dealing with insurers has caused many physicians to close their practices and become employees. But for patients, seeing an employed doctor doesn’t give them more time with the doctor—since employed physicians also have high patient loads. “A panel size of 2,000 to 2,500 patients is too many,” says Dr. Schimpff. That’s the number of patients primary care doctors typically are forced to carry—and that means seeing 24 or more patients a day, and often these patients have 10 or more medical problems. As any seasoned physician knows, this is do-able, but it’s certainly not optimal.

Most patients have experienced the rushed clinic visit—and that’s where the breakdown in good medical care starts. “Doctors who are in a rush, don’t have the time to listen,” says Dr. Schimpff. “Often, patients get referred to specialists when the problem can be solved in the office visit.” It’s true that specialist referrals areon the rise, but the time crunch also causes doctors to rely on guidelines instead of personally tailoring medical care. Unfortunately, mindlessly following guidelines can result in bad outcomes.

Yet physicians have to go along, constantly trying to improve their “productivity” and patient satisfaction scores—or risk losing their jobs. Industry leaders are fixated on patient satisfaction, despite the fact that high scores are correlated with worse outcomes and higher costs. Indeed, trying to please whatever patient comes along destroys the integrity of our work. It’s a fact that doctors acquiesce to patient demands—for narcotics, X-rays, doctor’s notes—despite what survey advocates claim. And now that Medicare payments will be tied to patient satisfaction—this problem will get worse. Doctors need to have the ability to say no. If not, when patients go to see the doctor, they won’t actually have a physician—they’ll have a hostage.

But the primary care doctor doesn’t have the political power to say no to anything—so the “to-do” list continues to lengthen. A stunning and unmanageable number of forms—often illegible—show up daily on a physician’s desk needing to be signed. Reams of lab results, refill requests, emails, and callbacks pop up continually on the computer screen. Calls to plead with insurance companies are peppered throughout the day. Every decision carries with it an implied threat of malpractice litigation. Failing to attend to these things brings prompt disciplining or patient complaint. And mercilessly, all of these tasks have to be done on the exhausted doctor’s personal time.

Almost comically, the response of medical leadership—their solution— is to call for more physician testing. In fact, the American Board of Internal Medicine (ABIM)—in its own act of hostage-taking—has decided that in addition to being tested every ten years, doctors must comply with new, costly, "two year milestones." For many physicians, if they don't comply be the end of this month, the ABIM will advertise the doctor's "lack of compliance" on their website.

In an era when nurse practitioners and physician assistants have shown that they can provide excellent primary care, it’s nonsensical to raise the barriers for physicians to participate. In an era when you can call up guidelines on your smartphone, demanding more physician testing is a ludicrous and self-serving response.

It is tone deaf. It is punitive. It is wrong. And practicing doctors can’t do a damn thing about it. No wonder doctors are suicidal. No wonder young doctors want nothing to do with primary care.

But what is a bit of a wonder is how things got this bad.

Certainly, the relentlessly negative press coverage of physicians sets the tone. “There’s a media narrative that blames physicians for things the doctor has no control over,” says Kevin Pho, MD, an internist with apopular blog where physicians often vent their frustrations. Indeed, in the popular press recently doctors have been held responsible for everything from the wheelchair-unfriendly furniture to lab fees for pap smears.

The meme is that doctors are getting away with something and need constant training, watching and regulating. With this in mind, it’s almost a reflex for policy makers to pile on the regulations. Regulating the physician is an easy sell because it is a fantasy—a Freudian fever dream—the wish to diminish, punish and control a disappointing parent, give him a report card, and tell him to wash his hands.

To be sure many people with good intentions are working toward solving the healthcare crisis. But the answers they’ve come up with are driving up costs and driving out doctors.  Maybe it’s too much to ask for empathy, and maybe physician lives don’t matter to most people.

But for America’s health to be safeguarded, the wellbeing of America’s caretakers is going to have to start mattering to someone. 


 13 
 on: Today at 11:03:47 AM 
Started by Crafty_Dog - Last post by DougMacG
To all my good friends of that break-away faction of Judaism known as Christianity my warmest good wishes and prayers on this Good Friday-Easter weekend.

Your kind words are well-received from the break-away faction and the wishes go both ways!  I get to celebrate with family and pray in the Christian church this weekend.  During the past week enjoyed Passover leftovers with friends.  With all of that I feel doubly blessed - and then some.   smiley

 14 
 on: Today at 10:54:01 AM 
Started by Crafty_Dog - Last post by Crafty_Dog


http://www.washingtontimes.com/news/2014/apr/19/scalias-students-high-taxes-certain-point-perhaps-/

 15 
 on: Today at 10:51:46 AM 
Started by Crafty_Dog - Last post by Crafty_Dog


http://www.nationalreview.com/article/375620/roots-cairs-intimidation-campaign-andrew-c-mccarthy

 16 
 on: Today at 10:43:29 AM 
Started by Crafty_Dog - Last post by Crafty_Dog

http://www.nationalreview.com/corner/375924/bundy-and-rule-law-andrew-c-mccarthy
 Bundy and the Rule of Law
By Andrew C. McCarthy
April 16, 2014 5:04 PM



I agree with David and Rich that John Hinderaker’s Bundy post is very strong. As a matter of law, Cliven Bundy is in the wrong. He is nevertheless a sympathetic figure, and the concerns raised by the standoff in Nevada transcend the illegality of his conduct.

Rich’s recollection of Lincoln’s exhortation that reverence for the law become “the political religion of the nation” triggered my recollection of a seemingly inconsistent speech Lincoln delivered as president nearly a quarter-century later. As the Civil War raged, the president very controversially suspended the writ of habeas corpus and imposed martial law in states where Confederate operatives and sympathizers were taking seditious action. Addressing Congress on July 4, 1861, Lincoln defended his suspension of the writ:

    Of course some consideration was given to the questions of power and propriety before this matter was acted upon. The whole of the laws which were required to be faithfully executed were being resisted and failing of execution in nearly one-third of the States. Must they be allowed to finally fail of execution, even had it been perfectly clear that by the use of the means necessary to their execution some single law, made in such extreme tenderness of the citizen’s liberty that practically it relieves more of the guilty than of the innocent, should to a very limited extent be violated? To state the question more directly, are all the laws but one to go unexecuted and the Government itself go to pieces lest that one be violated?

Now, it was only advisedly that I described this speech as “seemingly” inconsistent with the one Rich excerpted. For one thing, Lincoln did not believe his suspension of the writ violated the law, and he had a very colorable argument. The Constitution provides for the writ’s suspension in cases of rebellion or invasion; it does not say who may suspend it. The Supreme Court’s eventual conclusion (in the 1866 case of Ex Parte Milligan) that Congress must enact a suspension because the relevant clause is in Article I was sensible, but it was not indisputable. Lincoln was not without reason to believe that he had the necessary authority as long as a rebellion or invasion had occurred. Moreover, Lincoln’s passion for the rule of law was evident even in the act of arguably breaking it: He not only vigorously contended that his suspension was lawful; he also urged Congress to affirm the suspension by passing legislation (which Congress did in 1863).

But all that said, Lincoln’s speech does justify law-breaking in extraordinary circumstances. I’d construe his argument as follows: Even if what I have done is unlawful, it was necessary because it was done for the higher purpose of preserving the system that protects our liberties—under dire circumstances where violating the law was more faithful to the Constitution than obeying it would have been.

Many of us think Lincoln was right—I certainly do, and I even suspect the Supreme Court did (note that the suspension was invalidated only after the war was over). This informs our assessment of the situation in Nevada, and explains why Bundy gets our sympathetic consideration even if we cannot absolve his illegal conduct.

The underlying assumption of our belief in the rule of law is that we are talking about law in the American tradition: provisions that obligate everyone equally and that are enforced dispassionately by a chief executive who takes seriously the constitutional duty to execute the laws faithfully. The rule of law is not the whim of a man who himself serially violates the laws he finds inconvenient and who, under a distortion of the “prosecutorial discretion” doctrine, gives a pass to his favored constituencies while punishing his opposition. The rule of law is the orderly foundation of our free society; when it devolves into a vexatious process by which ideologues wielding power undertake to tame those whose activities they disfavor, it is not the rule of law anymore.

The legitimacy of law and our commitment to uphold it hinge on our sense that the law and its execution are just. As John Hinderaker points out, concerns about the desert tortoise—the predicate for taking lawful action against Nevada ranchers under the Endangered Species Act (ESA)—turn out to be pretextual. The ideologues who run the government only want to enforce the ESA against a disfavored class, the ranchers. If you’re a well-connected Democrat who needs similar land for a solar project, the Obama administration will not only refrain from enforcing the ESA against you; it will transport the tortoises to the ranchers’ location in order to manufacture a better pretext for using the law to harass the ranchers.

When law becomes a politicized weapon rather than a reflection of society’s shared principles, one can no longer expect it to be revered in a manner befitting “political religion.” And when the officials trusted to execute law faithfully violate laws regularly, they lose their presumption of legitimacy. Much of the public is not going to see the Feds versus Bundy as the Law versus the Outlaw; we are more apt to see it as the Bully versus the Small Fry.

 17 
 on: Today at 10:31:54 AM 
Started by Crafty_Dog - Last post by Crafty_Dog
Rubin (Hurricane) Carter, Fearsome Boxer Wrongly Convicted of Murder, Dies at 76
Rubin (Hurricane) Carter, a star prizefighter whose career was cut short by a murder conviction in New Jersey and who became an international cause célèbre while imprisoned for 19 years before the charges against him were dismissed, died on Sunday morning at his home in Toronto, his friend and onetime co-defendant, John Artis, confirmed. He was 76.
The cause of death was prostate cancer, Mr. Artis said. Mr. Carter was being treated in Toronto, where he founded a nonprofit organization, Innocence International, to work to free prisoners it considered wrongly convicted.
READ MORE »
http://www.nytimes.com/2014/04/21/sports/hurricane-carter-fearsome-boxer-wrongly-convicted-of-murder-dies-at-76.html?emc=edit_na_20140420


 18 
 on: Today at 01:11:23 AM 
Started by Crafty_Dog - Last post by Crafty_Dog
HIDDEN LEGAL TRAP WARNING: Even if your state allows you to legally be prescribed medical marijuana, the feds haven't officially changed their position on this and you could be "fried like a chicken gizzard on a hot, sticky Sunday night in the Deep South (Pancho Vilos)" for possessing a firearm and marijuana at the same time or admitting to being a user of marijuana, even for medicinal purposes. Never forget, BATF also stands for Ban All the Fun (also, by Pancho Vilos).

http://www.foxnews.com/politics/2014/04/18/gun-ban-for-medical-pot-users-dropped-from-illinois-proposal/?intcmp=latestnews

 19 
 on: Today at 12:57:52 AM 
Started by Crafty_Dog - Last post by Crafty_Dog


http://www.ft.com/cms/s/2/58cbbbe2-ba70-11e3-aeb0-00144feabdc0.html#axzz2yCpH8pzh

 20 
 on: Today at 12:56:05 AM 
Started by Crafty_Dog - Last post by Crafty_Dog
http://www.cnbc.com/id/101592426

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