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Monday, December 31, 2007

Reaching out to the New Year

I have trouble talking to friends who are going through rough times. It’s a cowardice I’m ashamed of, as I pride myself for being the rock my they can rely on. I don’t waver under crisis. I’ve weathered many events. I have perspective. This is the faith they have put in me. It is who I am. But even though I offer this sturdy character, on the inside I’m weak. Like the rest of us. So when my friends are suffering through their own trials, it’s understood that I am there for them, but really, that’s not the truth. That’s just what we want to believe. I am half man half idea. It is better this way. Or that’s what we want it to be.

Really though, I should write my friend who is in jail, and call my other friend who is alone in Miami, suffering a loss. I should be doing this. But I don’t have the will. I can’t muster up the bravery. What would I say? Who would I be? The rock, the calm, the idea? Or the weakling, the coward, the man?

Should I understand, should I nod my head and sigh along with them? Surely, this would make them feel less lonely, but maybe it would also further realize their situation, and plunge them deeper into despair. I don’t want to inspire more dread. But I feel that’s all my presence would do. I can’t help but acknowledge the circumstance and involve myself with it. I can’t help but understand how hopeless things can be. There is something very special about sharing misery with a friend, something intimate and joyous, as ironic as that may sound. But in the end, it’s not too healthy. Ultimately we have to go at it alone, and when that time comes, that false comfort in misery grows nasty and harder to bear.

So should I be naïve, and pretend that the world’s complexities can easy be untangled? Should I groan in disbelief at the petty burdens life deals us? Something can be said about facing a conquering presence when lost is ones own fragility. It gives us confidence, inspiration. It provides us with an example of courage, one we can hold on to when it seems there is nothing left inside of us to grasp. I can be humorous and aloof. Filled with a spirit bigger than their worries, unconcerned with the daily routine of battle and only considering the victory of war. This approach is usually welcome, not everyone needs to be reminded of their sorrows. But no one wants to feel their friends don’t really care.

This is the fine line I straddle. And the anxiety of it prevents me from reaching out when I probably should. I suppose it is just how I am and I should just resign myself to this conflict. We all suffer for it, but this is what we do.

All this was a tangent, what I really wanted to post was HAPPY NEW YEAR!!

I'm not DJing this year, which I choose not to do. I’m sick of working on New Year. Fuck that shit. So me and the lady might hit up a pretty cool cocktail party, then head to a friends loft party in Williamsburg [which I might DJ at but there is no pressure] then possibly a warehouse party, and/or the bar for their lil' new years soirée. I hope you guys ring it in right. What are your plans?

Monday, December 24, 2007

My Ghost Haunts the Walrmarts in Florida

I got my identity stolen. It happened sometime last Sunday. Or at least that’s when I think it did. I don’t know for sure. I found out when I checked my bank balance online. I’d just deposited some cash I got for this DJ gig. The day before I’d written a check to the gas company (they sent a man in a blue jacket and a tool belt to personally tell me to write it. my back was against the wall, there was no way I could ditch this caller. So I scribbled out a check for some money I didn’t have and hoped he’d take his time cashing it). I wanted to see if it had gone through.

The check hadn’t gone through yet, but the balance wasn’t as high as it should have been, and there was a strange charge I didn’t recognize. It appeared I’d made a purchase for $400 at a Wal-Mart store. And this Wal-Mart store was in Florida. This is weird, I thought, I don’t think I live in Florida. And I can’t even remember the last time I was in a WalMart. Huh, I mused, curious.

So I called the bank and told them there had been some sort of mix up. I told them I lived in Brooklyn, not Florida. And I shop at Target, not WalMart. There had been a blunder somewhere along the line and I was mistakenly charged $400 for it. It is no problem, I said reassuringly, I know it wasn’t your fault. Some fat cat in a white shirt with a fancy tie and a kick ass parking space is probably the fuck up here. You’re ok buddy. No worries. I just want my money back.

He checked my account (after asking a few probing security questions) and calmly told me my identity had been stolen. This has been happening a lot, he explained, they make a fake card with your info on it, and then buy gift cards from WalMart until the card gets declined. Usually they get thousands of dollars before the card is no longer good. With yours, he went on, they only got one gift card, then they went to a gas station and the card was rejected.

They picked the wrong identity to steal. Mine is practically worthless. oh well. I get my money in early January. Like a little new year’s gift, bittersweet as it may be.

In the meantime I’ve been working and finishing up with school. I handed in my final Final on Friday. The shackles of academia have been broken. I am finally fucking free. Well, at least for a month. I start back the end of January. So it goes.

While walking to a store my main man called. He said he was feeling better; he’d been pretty low for a while. I said I know. He told me his wife might be taking him back. That they spent the night together and he had pleaded his case and she’d resigned in the end. The next morning though, she got cold feet and said she had to think about it. But he was fine with it, he said, he felt good about it now.

I didn’t say much for a while. I just let him tell me, breathlessly, that he was not sad anymore. Then I sat quiet for a moment. I thought about how he worried me. How close and intimate of friends we were and how I knew he was just a shattered man, weak and boneless. I knew he felt he’d lost the inside of him and was now a brittle shell. Just a man with a voice that spoke words that meant nothing. I knew how he felt, but I didn’t know what he wanted to hear, and I didn’t know what I wanted to say, so I just made a joke about him finally getting some poontang and we laughed the whole thing off.

Then next day he called me at the bar. He said it was over, once and for all. He said he just wanted to call and tell me that. I asked why the sudden change and he said she hadn’t stopped seeing this other guy. I sighed. He reminded me he was ok with it. That he felt good. I sighed again. Lies. They’re all lies. He told me he was driving from Miami to pick up his mother’s mother who he doesn’t really know and they are going to celebrate the holiday at his crazy aunt’s house. Its balmy there, they might barbecue by the pool.

I know he still smarts from the break up and I know it stings that she’s given herself to another man. That’s an ugly scar and a wound that takes forever to heal. But I don't know what I could say to change it. Best I can do is answer the phone. This is going to be a painful Christmas. They don’t make hallmark cards for this kinda shit.

Wednesday, December 05, 2007

something if not nothing

holy shit its been a lifetime since i last posted. the world has spun a thousand times and a thousand times again. ive smoked hundreds of cigarettes, polished off a million bottles of beer. ive gained weight and age and its not just from all the lager and bali shag, though thats part of it. here are a few of the things that have been on my mind:

- my laptop died. or maybe i should say, my laptop was murdered by me. i spilled a glass of orange juice on its keyboard. i tell everybody that my cat did it because im sort of embarrassed at how dumb it is. death was quick. the glass tipped over and then the keyboard was orange. i hurriedly dried it off but when i pressed the power button it refused to come on. the screen stayed black. i tool it to get fixed last monday, they said they would call me in a week. a week and a day later my phone still hasnt rung. i remain patient.

in the mean time i installed a wireless card into my old pc computer, a feat i cant be proud enough of. ive never been very technologically inclined, so this was something of an accomplishment for me. i brag about it to all my friends. i figured out how to log into the administrator of the pc (something i still dont understand but an obstacle i eventually hurdled) and installed some wireless card software. then i opened up my computer and inserted a wireless card into an empty PCI slot (i think), then, after putting my computer back together and turning it on, i reconfigured it to receive a wireless connection. after all that, viola! a new post on my tiny little online journal. [bows]

thing is, i need my computer. bad. i dont need just A computer, i need MY computer. when i tool it to the store to get fixed, they said they would clean it for $250, but if it needed parts, it could come out to $1100-$1400 on top of that. thats a brand new laptop. and even if i got all my information from it, i would still no longer have a laptop.

all my music is on there. and i have been leaning increasingly on my mp3's for djing at gigs. sure, i could murder a party if all i had to play was house. i got deep vinyl catalog for those occasions. but the gigs i have coming up involve pop and R&B, all the current hip hop and some hipster drum heavy rock and clever mash ups. one important gig, my next gig, calls for christmas carols. i aint gonna go out and by a bunch of christmas carol records, so obviously i need my laptop for the many digital christmas carol tracks there are waiting for my greedy fingers to snatch them up from the internet. plus, this gig pays a good amount of change. enough for a new laptop.

but i cant do the gig if i dont have the laptop, but i cant get the laptop unless i do the gig.

- my back has begun hurting again. its a bad hurt. a familiar hurt. ive gotten out of shape. my girlfriend says my belly's been sticking out. its true. ive noticed it too. i woke up this morning and did some pilates. i promised myself id do them every day from today forward. i break promises to myself all the time. i hope i dont break this one. surgery was brutal. it totally ruined my high.

- the yeasayer album is my new murder.

- There are two movies that will carve a deep niche into american film making this year, those two movies are No Country For Old Men and There Will Be Blood. or at least thats what all the critics are saying. i havent seen either. i was excited about No Country For Old Men from the minute i heard about it. one of my favorite authors meets up with one of my favorite directors (or in this case, directing duos). their distinct narrative styles complemented each other. it seemed a perfect match. everyone is saying its cinematic perfection. the word 'masterpiece' is being thrown around loosely and confidently.

but recently the reviews for There Will Be Blood have started coming in and the critics seem absolutely stunned by it. they have eschewed typical praise almost as if they are afraid it isnt strong enough. they can only comment about how utterly original and profoundly moving it was. they lean on the powerful performances and strangely perfect score (by Radioheads Johnny Greenwood) when describing its good points, and try to find detraction in how remarkably ambitious everything is, from the spare, minimal sets to the almost unheard of early century american cadences the actors use. in the end almost every reviewer has said they dont know if they have seen anything as good in the past 50 years, and that they will have to watch it a few more times to determine this. all i know is i gotta see it. i gotta see both of them.

- i need to sleep more.
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Dr. D.Y. Patil Vidyapeeth, Pune
Established under Section 3 of the UGC Act, 1956, vide NotificationNo. F.9-39/2001-U.3 dated 11th January 2003 of Government of India
Re-accredited by NAAC with a CGPA of 3.62 on a four point scale at 'A' Grade
An ISO 9001 : 2008 Certified University

Collaboration with national / international Institutes / Industries:

The Vidyapeeth has given emphasis to collaborative research with national and international institution and industries. National and International institutes and bodies provide financial and expert assistance while the Vidyapeeth provides expertise human resource and infrastructure to facilitate collaborative research. Meetings between faculty of different institutes of the university and representatives of industries are encouraged. Financial assistance from the university is provided as per the MoUs.

a) List of Institute Collaborations:

  • International:
    • Johns Hopkins University, Maryland, Baltimore, USA
    • Hong Kong University, Hon Kong, China
    • Thammasat University, Bangkok, Thailand
    • University of Iberoamerica (UNIBE), San Jose, Costa Rica
    • University of Edinburgh Napier University, Scotland
    • Dongseon University, Busan, Korea
    • London School of Training, London
    • Malaysian Allied Health Sciences Academy, Kaula Lumpur, Malaysia
    • International Team for Implantology, Switzerland
    • University of Skövde, Sweden
    • Middle Tennessee State University, US
    • University of Miami, Florida, US
    • L’Ecole Nationale d’ingenieurs de Sfax, Tunisia
    • Goldman School of Dental Medicine, Boston
    • Virginia Commonwealth University School Business, Richmond, Virginia, USA
    • Cornell Medical school, New York
  • National:
    • Agharkar Research Institute, Pune
    • Chest Research Foundation, Pune
    • National AIDS Research Institute, Pune
    • National Chemical Laboratory, Pune
    • National Institute of Virology, Pune
    • National Research Center for Grapes, Pune
    • Indian Institute of Science Education and Research, Pune
    • National Institute of Immunology, New Delhi
    • National Environmental Engineering Research Institute (NEERI), Nagpur
    • National Institute of Oceanography, Goa

b) List of Industry Collaborations:

  • International:
    • BioHorizon, USA
    • Rocky Mountain, USA
  • National:
    • Colgate- Palmolive, India
    • ICPA, Mumbai
    • Khosla Industry, Bhosari, Pune,
    • Tata Motors, Pimpri, Pune


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Life on Tap.

Home Reviews Your Wish Is Granted

Your Wish Is Granted

Though brewed with pungent Nelson Sauvin and Citra hops, the nose of this double IPA is subtle and refined, with soft Juicy Fruit and apricot fragrances abutting faint notes of onion and white pepper. Sweet orange juice, white grapes and turbinado sugar give the flavor some oomph but are less expressive than we’d like; the brew’s well-constructed and clean, but mellow.

More Reviews in this style

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For the creature ability, see Swarm (monster).

Swarm is a unique shortbow in Dragon Age II.

Acquisition Edit

Looted from the Mature Dragon slain during the Act 1 quest The Bone Pit.

Trivia Edit

  • Shares its physical appearance with other shortbows, including Cracked Bow and Fereldan Shortbow.
  • This shortbow's item ID code indicates that it is an Act 2 bow, however it is acquired during Act 1.

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Saturday, February 4, 2012

hello You

it had been a heck of a year.wasnt it??
fer me- HELL YEAH

bye 2011 (i know like soo yesterday~)
hi 2012 ( babe its like the 2nd month of the year already?)

yeahh i know ~ that is actually to remind me of how i have been missing a lot of things by not blogging!
so im back blogging here?
 i dont know mates...
sometimes i have this feeling to blog and sometimes i dont...and when i do feel like blogging i'll end up closing the tab..leaving a draft
believe me, if you could be checking my draft box, you'll see a hell lot of drafted 'about to be posted but not posted' text.

sighs -being this undetermined and unpredictable is really making me blue like very sad..NOT

anyway- i'll try it this time to keep on blogging like how i always have long time ago :)
ohh i still have this crude grammar and vocab probs-so bear with it because i am trying my hardest to work on it..i am seriously making an effort here dude! what else would i continue blogging..

so thats all fer now! LY tc and thanks fer reading.

p/s: rawrrr

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Dr. John H. Watson (perfectlysteady) wrote in dressing221b,
Dr. John H. Watson

I really need a drink...

"Most people blunder around this city and all they see are streets and shops and cars. When you walk with Sherlock Holmes, you see the battlefield..."

Life seeing the true face of London can be an adventure. Sometimes, however, at the end of the day all one really wants to see is a stiff drink...

Two People Walk Into a Bar
A Glimpse into the Night Life of...

The basic idea of this scenario is that your character has finally finished a long day of deducing, detecting, policing, or organizing criminal affairs as usual. Whatever it is they do, on this particular evening, they have decided to blow off some steam in their favourite spot.

Is this place a bar in a swanky hotel? A nightclub? A corner pub?

That's for you to decide.

Choose your place and your poison and try and relax while you can.

Who knows who you'll run into...

-Post with your character, tell where they are (setting) and what they are doing there
-Prose or RP-format welcome as far as I'm concerned
-Remember the PG-15 rating rule for the overall comm (I don't want to get in trouble), but feel free to explore the effects of drinking moderate or copious amounts of alcohol and what you may or may not say to or do with whomever you bump into...

This idea struck me earlier and I'm just hoping that someone else likes it as much as I do.
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Pamela Geller

Pamela Geller, PhD

Associate Professor, Ob/Gyn and Public Health
Department of Psychology
Office: Stratton 280
Phone: 215.553.7117

Additional Sites: Women's Health Psychology Lab

Curriculum Vitae:

Curriculum Vitae (PDF)

Research Interests:

Clinical and health psychology; Stressful life events and mental and physical health outcomes particularly in the area of women's reproductive health

Pamela A. Geller, PhD, completed a BA in Art and Biology and BS in Psychology at Newcomb College of Tulane University. She earned her MA and PhD in Clinical Psychology from Kent State University and completed a NIH postdoctoral fellowship in Psychiatric Epidemiology at the Joseph L. Mailman School of Public Health at Columbia University. In addition to the Director of the Drexel University Student Counseling Center on the Center City Hahnemann Campus, Professor Geller is a tenured Associate Professor of Psychology in COAS, and Research Associate Professor of Obstetrics and Gynecology in DUCOM. She also holds a faculty appointment in Drexel’s School of Public Health.

Professor Geller’s research interests involve the association between stressful life events and mental and physical health outcomes. Her work has focused largely on women’s health–particularly in the area of reproductive health (e.g., mental health consequences of miscarriage), and has been published in peer-reviewed journals and other venues, as well as presented both nationally and internationally. She is an editor of the Health Psychology volume of Wiley’s Handbook of Psychology (second edition forthcoming), and an editor of the new book, Women’s Health Psychology, also to be published by Wiley. Geller, along with her DUCOM colleagues, created an interactive, web-based curriculum to educate healthcare providers about pregnancy loss (Available from, which received the 2010 APGO Electronic Educational Resource Award from the Association of Professors of Gynecology and Obstetrics.


text:
MS in Applied Behavior Analysis

Delivery Options

The MS in Applied Behavior Analysis is a flexible program, offering full-time and part-time options as well as the choice to participate online or on campus.

Online Program

With over 20 years of experience offering online courses, Drexel University provides valuable, accredited degree programs that can be tailored to suit students’ busy schedules. Online students learn from the same faculty and curriculum as students who participate on campus.

As the winner of the 2010 Sloan-C Award for Excellence in Institution-Wide Online Education, Drexel University is committed to providing quality education opportunities online.

On-Campus Program

On-campus students attend classes at our main campus in Philadelphia and have access to the university’s invaluable resources.

Both our online and on-campus courses have been certified by the Behavior Analyst Certification Board, an international non-profit organization responsible for outlining professional standards in the behavior analysis field.

Concentration in Autism Spectrum Disorders

As education and behavioral health experts gain a better understanding of autism, we have increasingly better opportunities to help students who live with autism spectrum disorders. Experts in this area are in high demand and in a position to have a meaningful impact on both society and individuals.

MS students may opt for a concentration in autism spectrum disorders to prepare for work with people on the autism spectrum. The concentration emphasizes communication, language skills and research-based interventions.

The concentration’s curriculum examines current issues and best practices for supporting students with all levels of autism spectrum disorders (ASD).

Advisement and Support

Students in the MS in Applied Behavior Analysis program are advised by a full-time developmental advisor who serves as an important resource as students progress and manage their educational and career goals. Students receive one-on-one personal advisement to ensure that educational and professional objectives are met within the course of study.

If you would like to speak to the academic advisor for this program, please visit the Academic Advisor Directory.

Program Outcomes

The Master of Science in Applied Behavior Analysis is designed to produce graduates who are proficient in the assessment and analysis of behavior and social skills. The program increases the effectiveness and marketability of clinical and educational leaders.

Students will be fully equipped to pursue opportunities in school settings, ABA therapy for families with autistic children, residential facilities for persons with disabilities and other environments that encourage supervised behavior adaptation.

Career Opportunities

Students of the MS in Applied Behavior Analysis will gain knowledge and skills that will support them in careers as special education teachers, school psychologists, social workers, case managers, and experts in other education and behavioral health disciplines. Graduates of this program are also in demand as behavior analytic consultants, program coordinators, senior clinical directors and interventionists.

This program builds a strong foundation for students who wish to enter PhD programs in applied behavior analysis, school and clinical psychology, or experimental psychology.


text:
Monday, October 26, 2015

Sunday Morning Comin' Down: Fundraiser Day One

It's my birthday this week.

Also too, thanks to Governor Hedgefund's draconian budget cuts, I no longer have the part-time gig I had (and enjoyed and at which I was very good) a few months ago.

So it seemed like a really good time for my traditional birthday week fundraiser :-)  The link to my tip jar is at the bottom of the post.  Now, on with the show...

"Beware The Space Senility!" Edition
Bova walked off the series the week after Trumbull left, because of scientific illiteracies he’d warned them against, such as “radiation virus” (which is an impossibility...radiation is a matter of atoms, viruses are biological entities, even as you and I and Kline and Davidson, I presume), “space senility” (which, I guess means old, feeble, blathering vacuum), and “solar star” (which is a terrific illiterate redundancy like saying “I live in a big house home”).

-- Harlan Ellison, Stalking The Nightmare
Having covered the Mouse Circus/Sunday Gasbag Cavalcade for over 10 years now, I can say that "old, feeble, blathering vacuum" is probably the most accidentally wonderful description of the awful political kabuki which our Village elders put on each week to prop up their own self-regard and investment portfolios.

The same old players shambled from set to set, declaiming the same Beltway common wisdom within the frame of the same 2-3 "stories" which the networks have decided will constitute "news" this week.  As a source of informed analysis you can use to add to your stock of knowledge about how our country works, the Gasbag Cavalcade is entirely useless;  as a topographic map of the Beltway's own political agenda, the Gasbag Cavalcade is unerringly accurate.

This week, for example,according the Beltway the major political "stories" were not....
  1. Look!  At the hyped-by-the-Right-like-a-The-Force-Awakens Pillory Clinton Committee!  It's the Party of Lincoln throwing acid in its own face and dying of Rovine spongiform encephalopathy ™  on live teevee.

  2. Holy Jebus Hephaestus Christ,  god of salvation and anvils, if that lonely strand of brittle Barbie hair which tethers Ben Carson to our reality ever breaks, he really will just float away to wingnut Neverland.

  3. On Left, substantive, respectful debates over issues.  On the Right, a knife fight at Arkham Asylum.
Instead we learned that...

The Republican Establishment (the zillionaires who own the GOP clown car and who never show up on-camera) are genuinely freaking over the fact that Donald Trump and Ben Carson are not merely strap-hangers on their clown car, but have tossed the driver out the window and are fighting over the steering wheel.  Meanwhile their thoroughbred -- Jebulon! -- it turning out to be less of a plucky mudder who will come from behind to save them, and more of a rotting mackerel with a sell-by date of January, 2002.

And so the Republican Establishment has been burning up the phone lines to turn the "Donald Trump and Ben Carson" story into (take it away Jake Tapper and every other talking head)...
Marco Rubio, dumb as a loaf of toast and running third or worse everywhere.  Some say he's the man to beat!  We'll talk with him next.
Ross Cardinal Douthat in the NYT:
Marco Rubio, the Unusual Front-Runner
Even Trump (on the Jake Tapper show) knows enough to stop bouncing the Jeb! rubble around and start spreading his fire everywhere...
Trump:  SuperPACS are a scam.  A big fat scam.  They're raising all this money.  Nobody knows who they are.  I hear that Ben Carson's SuperPACs are basically running his campaign in Iowa.  Same with Jeb, who is now hiding used his bed while Mommy and Daddy huddle with the rest of the Bush Family consiglieres tot try and figure out how to same his doomed ass.

I'm calling on all candidates to disavow their SuperPACs.

Low energy people can't stop the people who are beheading people in Syria and other places!

Rubio wanted to give the country away.  He was part of the Gang of Eight who wanted to give the country away.  Then he got in trouble and ran away from it.
We also learned that the "GOP Is Nuts/Democrats Are Not" story remains 100% terrifying to the Both Siderist teacup poodles who staff the Gasbag Cavalcade.  And so, instead of reporting that Bernie Sanders and Hillary Clinton simply are not taking out after each other in the same way that Republicans routinely slash and slander each other.  Beltway goofs are so desperate for a slap-fight between Hillary Clinton and Bernie Sanders they are combing the litter box for anything they can gin up into a story that does not involve public policy -- which is boring and which they are, frankly, too stupid to understand -- or the Hindenberg-ing of the GOP :
Jake Tapper:  Senator Sanders, some appreciate your high tone in this campaign, but Hillary thinks you're a sexist.

(Plays clip which in no way says that at all)

So, do you wanna fight her over it?  Huh?  Do ya do ya do ya?  Huh old man?  Are are you gonna let an old lady push you around?
Bernie declined the bait.

Over on "Meet the Press", Shuck Todd brings all of his his of experience to bear on the problem of not laughing in Ben Carson's face, tossing his notes in the air, and walking out of the studio with a loud "Oh, just fuck this."
Todd:  What's with the Nazi references all the time?

Carson:  A lot of rabbis love me.  They say I'm spot on.  And really, this is caused mostly by people in your business who try to cause a ruckus and stir things up.

Todd:  Should nutty people be able to have surface-to-air missile?

Carson:  We have laws against owning surface-to-air missiles.

Todd:  But doesn't the whole Republican gun-fetish point that any restriction on any weapon is just a hop-skip-and-goosestep away from the Holocaust?

Carson:  Speaking of Nazis, ideally, mothers should not think of their babies as their enemy.  We have allowed Liberals to convince women that babies are like, oh, let's say Nazis.  Also too. termination any unwanted  is just like slavery!  I know it's not politically correct, but I'm gonna tell you, Roe v. Wade will end under my reign and all abortions will illegal.

Todd:  Any exceptions at all.

Carson:  I'm a reasonable person.  If a Nazi liberal fascist can come up with a good reason to murder a baby, I'll listen.

Todd:  Any exception for rape?

Carson:  Rape babies are beautiful and women were put on Earth as brood mares for men.

Todd:  And you want to get rid of Obamacare?

Carson:   Yes.  People should have health savings accounts.  Also Medicaid should be de-Nazified and turned into money for people who get very sick.  It'll all work out.  Unless you're in favor of slavery!

Todd:  You would never hire a doctor who had no medical experience.  Why would anyone hire a president with no political experience?

Carson:   Political experience is stupid.  Solomon was never a senator or a Nazi, but hired a lot of good people.  I'll be like Solomon!  I will go through Angie's List and find the best roofers and plumbers and diplomats.  I will be a magician and an exorcist. I will have 700 wives and 300 concubines.  David will name me as his successor and I will kill all the generals.  Also many amulets and medallion will bear my name.
This man is leading by double-digits in Iowa.  In case you were wonder why this man in

CNN's Inside Politics lets you in on a little secret (h/t Blue Gal! -- emphasis added):
BERMAN: What does Ben Carson do about this all of a sudden now that he's winning somewhere?

PACE: Well, that's going to be a fascinating question because Ben Carson actually hasn't been campaigning very often. We haven't seen him on the campaign trail very much.

TALEV: He's on a book tour.

PACE: He's on a book tour. And a lot of his support is grassroots built up from people who have followed him throughout his career. Now there's going to be a lot of focus on him when he's in the debate next week. He's going to be getting more time, more questions on policy which has not been a strength of his. But again, this is a cycle where some of these standard things that we expect candidates to rise and fall on have just not mattered....
From Brother Charlie Pierce:
I will grant you that the question, "I'm sorry, sir, but have you wandered into my studio from the Chronic ward?" might be considered impolite in such circumstances, but, honest to blog, isn't that the only possible follow-up to a guy who is running a heretofore successful campaign for the Republican presidential nomination on the basis of not holding back on undistilled political Jesus juice? (By the way, later in the show, the entire panel agreed that nasty old Donald Trump was out of bounds in taking a shot at Carson's Seventh Day Adventist beliefs. Considering that Carson is running almost primarily on the theory that Jesus wrote the Constitution, this seems to me to be a legitimate issue.) And isn't there something to be asked that concerns why this codswallop sells to the voters of one of the only two political parties our system allows itself to have? Doesn't the current mental state of the Republican Party make it a danger to itself and others? Is there any point in even asking these questions anymore?
Finally, it was absolutely critical to the Beltway Both Siderist narrative that the Pillory Clinton Committee not be read as an indictment of the absolute hollowness, madness and jaw-dropping perfidy of the Republican Party, but merely as a political story in which Hillary Clinton used superior sitting-and-gesturing tactics to win the news cycle.   Which was why Shuck Todd interviewed Gowdy Doody in the gentlest manner possible --
Todd:  Chairman Gowdy, let me show you a clip of you stepping on your own dick.

Gowdy:  Jesus, does my head really look like that?

Todd:  I'm afraid so.  The most charitable description we have heard was "bevel-headed hill person" and "malformed coal cold chisel".  The second one was by the American Council of Coal Cold Chisel Manufacturers.

Gowdy:  I would like to share an exciting word with your viewers.  "Traunch".  As in "traunch traunch traunch".  Hillary said many things, but I don't know how we're going to be prepared for the next Benghazi if Hillary Clinton refuses to admit that the night of the attack, instead of doing her job, she was having lesbian scissor-sex with Huma Abedin while Sidney Blumenthal live-texted the whole thing.  And as soon as we find the email that proves it...

Todd:  Here's a word-cloud of you stepping on your own dick.

Gowdy:   But Sidney Blumenthal really did email Hillary Clinton.  Many times.  And as soon as we figure out how email works we'll nail that lesbian scissor-sexing monster.

Todd:  You seemed freakishly obsessed with Blumanthal.

Gowdy:  But the piles, Chuck.  Didn't you see the piles?

Todd: Some people have said that your hearing made chimps having a poo fight look like the Algonquin Round Table.

Gowdy:  Trust me, we're awesome when you can't see us.  We always do better when we can do things behind closed doors and then leak misleading fragments to the public.
-- Shuck Todd went on to feign bafflement as to why Elijah Cummings declined to join in the Hillary Clinton tar-and-feather party and instead turned his attention to breaking up the mob carrying the tar and feathers.
Todd:   Why didn't you ask Hillary Clinton a shitpile of stupid, vicious questions like the Republicans did?

Cummings:  Because it was a fucking sham, Chuck.  We promised the families of the victims not to let this be turned into another wingnut inquisition and believe me, Chuck, that's a god damned full time job.

Todd:  But what about...the video.

Cummings (bangs head on desk):  What about it, Chuck.  In the first, chaotic hours and days people were trying to sort this out.  We decided to stay on the committee because can you imagine what kind of Kafkaesque nightmare if no one was there to call "bullshit" on the bullshitters?
Or, to quote Mark Twain,  ",,,no mob has any sand in the presence of a man known to be splendidly brave."

Later, gentle butterfly Doris Kearns Goodwin expressed concern that mean words may hurt the process.  Because Adlai Stevenson.

And why on this planet of Earth is Jennifer Rubin on "Meet the Press"?

Sorry, rhetorical question.   Not a week goes by that one cannot ask the "WTF?" question of more than half the guests and panelists on every Sunday show at the Gasbag Cavalcade.

But seriously,  why on this planet of Earth is Jennifer Rubin on "Meet the Press"?

Old, feeble, blathering vacuum indeed.

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Michael Wells said...

Not to nit pick but it is "cold chisel" not "coal chisel." My cold chisels are far more useful that cone-head Trey Gowdy but can't help the HRC campaign the way he did.

bowtiejack said...

I wonder if this observation from Jung explains Dr. Carson ("OMG, he's a doctor and a brain surgeon!"):

An inflated consciousness is always egocentric and conscious of nothing but its own existence. It is incapable of learning from the past, incapable of understanding contemporary events, and incapable of drawing right conclusions about the future. It is hypnotized by itself and therefore cannot be argued with. It inevitably dooms itself to calamities that must strike it dead.

Carl Jung

Robt said...

There are times when this Goebbels- de- Goop (NAZI Carsonisms)
cases symptomatic thoughts of

*America should consider having a foreign policy too deal with (red) states of America.

*Consider placing economic sanctions on the GOP and the beltway media.

The thing is, it is not bringing them to the "table" It is their lack of manners to barf at the dinner table routinely.

dinthebeast said...

Do you think they got the piles from David Brooks? I heard that he has some very good piles...
And does Jennifer Rubin still hold Princess Sparkle Pony's title for the worst sentence ever published in WAPO, or did Richard Cohen win it back?

-Doug in Oakland

Frank Stone said...

Just to be all pedantic, the title of the specific Harlan Ellison essay you excerpted from Stalking the Nightmare is "Somehow, I Don't Think We're in Kansas, Toto" (which, for those who may not know, is Mr. Ellison's recounting of the horrendous experience he had creating and working on the SF TV series The Starlost).

And yes, "old, feeble, blathering vacuum" is all too appropriate.

Kathleen O'Neill said...

H/T to The Bard: "It appears no other thing to me than a foul and pestilent congregation of vapours."


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c l i c k _ i m a g e s _ t o _ e n l a r g e

Moving out of Harlem

I've decided to hit the road. Blogspot, you have been a huge part of a lot that has happened for me in the past years. I thank you.

But I am not done just yet.

I'm off to Tumblr, a place where a GIF can really live. I took all the old pieces from here and updated them to a new look I've been tinkering with. I have also since stopped using the #7f7f7f gray and switched to #3D3D3D. Please take a look and see how much a little change can get.

Thank you for all the support from everyone here. Keep in touch and in tuned for an even bigger project in the future. I hope to see you in the new crib. But if this is where we part, I leave you with my last Drop Me Off In Harlem:

who is

My photo
mrkprtll.com / mrkprtll@gmail.com


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Diagnosing and Treating Celiac Disease

The Connecticut Post ran an interesting article called Support group for children with food allergies.

In Food Allergies For Dummies, we touch briefly on celiac disease, pointing out that it’s not actually a bona fide, IgE-mediated food allergy, but it still falls in a category of illnesses that often involved the expertise of allergists.

Following is an excerpt from our book:

Celiac disease, also known as gluten sensitive enteropathy, is a form of food sensitivity in which people can’t tolerate any form of gluten–a protein found in wheat, rye, and barley. Symptoms typically include abdominal pain, vomiting, diarrhea, and weight loss (or poor growth in young children).

“Symptoms can be quite severe and appear very early in life or remain low-grade, flying well below your doctor’s radar until adulthood. Although celiac disease is not IgE-mediated, your doctor can perform other blood tests to make an accurate diagnosis. In all cases strict avoidance of all gluten is essential and typically requires you to abstain from these foods for the rest of your life.”

If you’re interested in learning more about celiac disease, check out Danna Korn’s Living Gluten Free for Dummies at


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Tuesday, October 26, 2010

Family Medicine: Learning in Chocolate Town, USA- Hershey, PA

The Dr. Synonymous Show October 26, 2010
Family Medicine:  Learning in Chocolate town, USA- Hershey, PA
Patient Blog
Chat room favorite patient blogs, please post
Physician blog: Healthcare, etc.: Paternalism of Science  AFP Community Blog:  CAM
My blog
Book Suggestions

            How Doctors Think by Jerome Groopman, MD

            The Politics of Meaning by Michael Lerner

            A Cry Unheard by James J. Lynch

Hershey, PA:  Chocolate Town USA
            Site of my FM Residency Training: Health teams, Physician Extenders, Quest for Physicianship
Site of the FMEC, Inc NE Regional Meeting
                My three presentations
                                Pain Management the Family Medicine Way
                                Social Media for Geeks and Geezers
                                Consumer Oriented Human Centered Health Home
Thanks to the chat room and listeners
Next week we'll have a report on the FMEC, Inc meeting in Hershey, PA
November 9th, we'll interview Ken Bertka, MD, AAFP Past Board Member and OAFP Past President
I’m Dr Synonymous, Good Night

Dr Synonymous Show: Family Medicine: Building the Dream with Patients, Family Physicians and Social Media

Dr Synonymous Show October 19, 2010
Building the Dream with Patients, Family Physicians and Social Media
Salute to Patients
Overview of Show

Patient Blog “I Am Sick of Being as Big as a House”

Physician social media example: http://afpjournal.blogspot.com/2010/10/putting-depression-guidelines-into.html

Dr Synonymous blog (FM: Ohio AFP Recharges the Dream) and tweets (Howard Dean interview on Radio Rounds)

Medical Information
            What’s in Placebos?

            Mexican Beer Lime Rash

            Social Media CDC

            Ohio Medicine Social Media Tool Kit

Communication with Dr Sarah Sams, President OAFP

            Let’s hear about the AAFP mtg in Denver last month

                        What happened?
                        Any interesting resolutions?
                        Advances for the specialty?

            How about Ohio AFP?  What’s happening at the state level?

            What’s surprising about being president?

            What else would you like to say to our listeners?

            Pipeline of family medicine workforce- status?

Sunday, October 24, 2010

Family Medicine: Using Social Media to Connect, Learn and Teach

It just sort of started.  Facebook, MySpace, YouTube suddenly showed up in conversation and then on my monitor. I don't remember the moment or the person who inspired me to take the plunge, but here I am using social media all over the place and there's still more. I added Twitter in late 2009 a few months after LinkedIn, which I actually signed into in 2008 when a nephew emailed me to connect with him on LinkedIn.  It's tough to find my user ID and password sometimes because there are so many sites. Worse if I haven't used one in a while like MySpace where my cousin, Sara has some great songs recorded.

The blog as Dr Synonymous started in April, 2010, followed by BlogTalk Radio in June.  Now they feed each other.  I blog the show outline and links so people can tell what might be on the podcast of the show before they listen.
The superphone happened in May, connecting me to the Internet and SM everywhere, even at the in-laws farm in Farmersville, OH (which is, to say the least, out in the country).

The people are the amazing part of SM use.  So many and so interesting and so many who share my interests, especially in family medicine and helping others.
Now I have about 175 friends on Facebook representing family, friends, family medicine, and West Point friends.  I look twice daily to peruse how folks are doing. I post my new blog posts and announce my blogtalk radio show on my Facebook page.  I wish relatives happy birthday and comment on posts of close relatives when big events occur. I may prod a grand-niece or grand-nephew about the time of day if they are hanging out on FB late into the nite (midnight to 1 AM).

Twitter is dynamite for bits of information screened per unit of time. I follow less than 100 people and entities, perusing them for info about health care, diseases, health care policy, etc. A weird one is asteroids, showing near misses of objects in space with earth.  I tweet all of my blog posts and my Dr Synonymous blogtalk radio shows so followers can just click on the link and see or hear the particular Dr Synonymous information.

LinkedIn is useful for professional connections with people in groups I joined, including professional organizations like the AMA, AAFP, etc. and past experiences such as Ranger, Airborne, Service Academy Graduates, Ohio State University, etc.  Others are future oriented such as Health 2.0, Innovation, Personalized Medicine, Patient Centered Medical Home, etc. I link my blog and blogtalk radio show into LinkedIn when appropriate for groups that may have an interest in the content.  The Dr Synonymous blog can always be reached from my Home page on LinkedIn.

I peruse lots of potential information daily and open a lot less info for in depth review. The useful info I tweet back for my followers on Twitter and/or email important articles to colleagues as indicated.

The weekly commitment to the Dr Synonymous Show on BlogTalk Radio every Tuesday night from 8-9 PM ET drives the rhythm of my sustained use of Social Media.  Family Medicine is dependent on patients for our existence, so I honor patients on each show, usually by reviewing a patient blog or two.  Their stories are great reminders about how illness and disease impact peoples lives and about how resilient people are.
I also discuss a physician blog or two and some medical information (the new flu shots, what vitamins may be helpful for health, etc.)  then some information sources that may help patients.

An interview with an educator, thought leader, physician leader or family medicine supporter is part of the show every two or three weeks. It takes a couple hours weekly to organize and support the show.  All of the shows are saved as podcasts that can be downloaded or listened to 24/7 by anyone.

Other SM people are very helpful citizens of the SM community.  Friends such as fellow family doctors Doctor Anonymous (the medical wizard of SM who does it all) and Jill of All Trades, patient bloggers such as  WarmSocks, SeaSpray, ThatsWhatSheSaid helped to promote my SM sites.

The wildest SM activity so far is the tweet chat on Sunday nights with #HCSM  (Healthcare Communication and Social Media) which includes forty to 80 of a possible 190 group members tweeting for one hour in response to two or three questions posed by a moderator.  It's like "drinking from a firehose" of tweets and information.

So, I'm an accidental social media citizen, hoping to learn and help others, especially seeking to help the cause of family medicine which serves so many.  As the need to "go viral" to bypass the sludge of the Medical Industrial Complex increases, the SM is a great way to get it done for the good of all.  Hi Tech, Hi Touch.  We need to make more time for the Hi Touch, paradoxically the Hi Tech becomes one way to make it.

Saturday, October 16, 2010

Family Medicine: Ohio AFP is Recharging the Dream

The dream embodied in the letter of application to medical school is about helping people.  Service to others is at the heart of the dream of the physician- to- be.  Early in medical school at Ohio State, I looked for physicians who were living the dream.

The Ohio Academy of Family Physicians reached out to medical students with an opportunity to meet family doctors and serve on committees.  I visited Academy Headquarters on High Street where Florence Landis, the chapter executive director, introduced me to the caring attitude of Ohio Family Medicine.  She discussed available committees and we agreed that I would be on the Education Commission.

At my first meeting of the Education Commission, I listened to discussions about continuing education for family doctors. The comments of these physicians repeatedly came back to  patients and patient care.  Their cheerful demeanor and friendly engagement with each other was punctuated with humor and thoughtfulness.

As we stood up to leave at the end of the meeting, several of the doctors introduced themselves to me.  Dr.'s Jack Verhoff, Doug Longnecker, Jud Reamy, David Barr, Carl Spragg, were welcoming me.  A lasting vision of the meeting for me was a greeting, smile and firm handshake from Tenny Williams, MD.  (Tenny was about to become the chair of the soon to be established Department of Family Medicine at Ohio State.)  At that exact moment, I knew I belonged.

Since that meeting in early 1974, I've met hundreds of family physicians who are committed to patient care.  Their stories are fascinating and their commitments intense.  They are living the dream of helping and serving others.  And so am I.

Thanks and a salute to the early leaders of the Ohio Academy of Family Physicians for their vision about education and connection to medical students.  And thanks for their vision that employed Florence Landis as "The mother of us all" in those formative years.

Today I attended two committee meetings at the OAFP headquarters, noting the energy of those present, the commitment to patient care and the comaradie, peppered with compassion and humor.  I looked at the photos of past presidents on the walls of the conference room, including most of those present at my first meeting.  (And my photo, too).

Sarah Sams, MD, the "quilting doctor" and current president, holds the last spot in the photos.   She is delightful in her commitment to help the academy move into the next era with "good old family medicine" combined with the best technology that enables patients to get more quality time with their family doctor  She teaches young physicians and medical students who quickly note her love of patients and them. She attended the new Social Media Workgroup meeting, enthusiastically supporting the use of communication strategies that will deliver information about family medicine and our members to patients, medical students and societal leaders who will benefit.

Mike Sevilla, MD, social media enthusiast and chair of the workgroup helped Dr. Sams sign up for Twitter and send her first Tweet (that he photographed with his cell phone/camera).  With "high touch and high tech", the Ohio Academy of Family Physicians is "recharging the dream" to inspire more medical students to align with their personal dreams of helping people and serving others.

The Healthcare and Health Care Systems: What are the Rules?

How can we know the rules for the patient-physician engagement?  It's very confusing to patients and even to doctors.  What would the rules be if we get a chance to make them again?

Since that's not the case, I'll list a few thoughts about how the rules look for one family physician in Ohio (Me).

One issue that relates to the rules is about the business model of the patient and their family. What do you spend your money on and what do you expect someone else to buy for you under various contractual relationships?
Another issue is the business model of the third party that is paying someone else's money to the doctor for services rendered to the patient...but limited by several rules (only 4 diagnoses fit on the bill per visit; a physical involves no treatment for illness or disease; an illness or disease mgmt visit is not a physical or prevention but some insurances allow the physician to do both types of services in the same encounter, but both services will be billed ala WarmSocks blog example.  The physician only has a certain amount of bits of service to deliver per day, so one patient can't decide to use it all or no one else gets any service...etc.).

Another issue is the physician's business model, who they work for and what happens to the bills they generate and the money they generate and who pays their overhead, etc. The physician's tasks per unit of time may be mandated by the employer of the physician. They may be pressed to see more and more people per day to generate more revenue for the employer or group.

The physician is selling knowledge and skills to someone. Those who wish the physician to use more knowledge and skills for their health and sickness will be asked to find a way to pay more.  Time is limited and determined by the physician or the entity (e.g., physician's employer) that makes the rules about how money is distributed for services.

Most third parties only pay for one visit to an individual physician per patient per day.  A woman being seen for an annual woman's prevention exam generally needs another appointment or two or three if she has a problem with arthritis, diabetes, depression, needs a mole removed, etc.
The patient rarely knows the definitions listed in their payment contract with an insurance company for different types of services.  The physician also doesn't know what deal an insurance company has with a particular patient.

That's my first post about "the rules" of engagement in the family doctor's office.  It may change daily due to the volatility of "the rules".  The situation begs for the patient to take back their health care from the night.  Partner with your family physician to educate and protect each other from the buzz saw known as the Medical Industrial Complex.

More later on health system issues after a couple posts about The Human Centered Health Home.

Wednesday, October 13, 2010

Dr Synonymous Show: Family Medicine and Family Nurse Practitioners: A Timely Partnership

The Dr. Synonymous Show October 12, 2010
Dr Synonymous on #BlogTalkRadio http://tobtr.com/s/1257444
Happy Ten’s Day plus two (10/10/10 Where were you?)
Patient Blog WarmSocks:   "Doctors and Groceries and Rules"
Physician Blog Dr Rob:  http://bit.ly/csvkmp "What is a Patient"
Do we know the rules yet?

The RWJ report for the Institute of Medicine:
The Future of Nursing: Leading Change, Advancing Health - Institute of Medicine:

AAFP Takes Issue With IOM Report Calling for Greater Nursing Role -- AAFP News Now -- American Academy of Family Physicians

Good post from American Journal of Nursing about the IOM report with a nursing perspective at  wp.me/prthD-1wp

AMA - AMA Responds to IOM Report on Future of Nursing http://t.co/MS0P6P0

Books to Ponder: New Rules for the New Economy by Kevin Kelly 1998
How Healthy is Your Family Tree by Carol Krause 1995
The Visionary’s Handbook  (9 paradoxes that will shape the future of your business) by Taylor and Wacker 2000

Interview with Catherine Johnson, FNP PhD
                How are the babies?
How was the trip to NM?  Silver City, NM
Let’s hear about the nurse practice program you are developing for Mt Carmel
What do you think of the future of nursing practice? The IOM report?
Where is the profession now? Physicians are concerned about boundaries, scope of practice, licensure, etc.  How are nurse practitioners with those issues these days?
30 million patients where’s the care?  Who’s the care?
Inter disciplinary communication may be difficult at times.  How is it when communicating professionally with social workers or SW educators?  Physicians? How do we best serve patients?
Any thoughts about what your FNP grads are going to be doing? What practice models?
What’s the Ohio practice market look like for the next ten years?
Thanks for your insights, Dr Johnson, and for joining us on the Dr Synonymous Show
This is Dr Synonymous, Good Night

Listen to a podcast of the show 24/7 at the blogtalk radio link at the top of this blog.

Saturday, October 9, 2010

Dr Synonymous Show October 5, 2010 Connecting Patients and Doctors. Factoids and Reflections

The Dr Synonymous Show October 5, 2010 blogtalkradio.com/drsynonymous
Disclaimer:  We're not practicing medicine on the show.  That's best done with your own family doctor.
Overview of Show
Patient blog:  Dr Fatty Finds Fitness- a Texas family physician/patient in online 100 day weight loss collaboration (http://Drfattyfindsfitness.blogspot.com)
Recognize Chat Room
Medical Student Show “http://RadioRounds.org” episode 408 Dr Synonymous and Steve Deal interviewed about the medical home and the Human Centered Health Home (HCHH)
Physician blogs and tweats: http://theNNT.com a new decision support site for physicians and patients, the American Family Physician Community Blog on Cultural Competence 9/29
                The #hpm daily on Twitter newsletter about hospice and palliative care.
Dr Synonymous Blog 10/2/2010 on Human Centered Health Home: Connecting Patients and Family Physicians.
Flu is here, discussion of 3 flu types in the flu shot which now includes H1N1.  CDC recommends that all get immunized.
Tips from Medical Journals
                Health Policy Graham Center p.601 AFP:  Med students specialty selection swayed by expected salary. $3.5 million difference in lifetime earnings specialists vs. primary care physicians
                Chat room do you agree that med students can be swayed by money?
Books I recommend
                The Mind and the Brain by Schwartz, OCD therapy section is helpful
Web Sites I recommend: http://lef.org Life Extension Foundation Magazine Great Vitamin D3 information, testosterone replacement therapy and estrogen replacement therapy well covered
Vitamins and Supplements that I recommend
                Multivitamin with minerals, recommended in  JAMA Nov 2002
                Omega 3 Fish Oil 2000-3000 mg. daily  from lef.org
                Vitamin D3 2000 IU from lef.org 12/2009
                B Complex 50 lef.org
Gene Wright, MD, Past President of OAFP died in Lima last week.  He had a big heart, always caring, always helpful.  Thanks for your friendship and leadership, Gene.

My Family Doctor through age 22: George Martin, MD Miamisburg, OH. My aunt had worked for him as receptionist.“It won’t hurt” he said, before penicillin shots, "I’ll bet you a nickel".  I always won the nickel.
Chat room: any memorable family doctors in your lives you wish to honor?
Thanks to the chat room
Next week we finish the interview with Dr Catherine Johnson, FNP
Remember the Dr Anonymous Show Thurs nights at 9 PM on Blogtalk Radio
FMEC Mtg in Hershey, PA Halloween Weekend
I’m Dr Synonymous… good night

Saturday, October 2, 2010

The Human Centered Health Home: Connecting Patient and Physician

The Human Centered Health Home (HCHH) as defined by our Center for Innovation in Family and Community Health is best supported by patient-physician processes which include: respecting, protecting, connecting, detecting, correcting, and reflecting.  Previous posts discussed respecting (7/2/2010) and protecting (7/28/2010 and 8/24/2010 ).  This post introduces connecting for both patient and physician, starting with human to human connection in which both humans somehow recognize their equality and common ground.  The dyad of patient and physician are able to accomplish more if they remember and reaffirm their humanity first.

A behavior that helps to separate them from outside distractions should begin the engagement.  Usually this behavior is touch: a handshake with a greeting and appropriate eye contact may be a good start, while a hand on the shoulder or touch of the forearm may fit better for many.  The thought for both is about greeting an important person with unique attributes who is a neighbor with shared community values.  The need for both is to escape from their last activity and the technology that surrounds them.

The touch strategy has to be altered and "framed in disinfectants" if infection is involved.   A person who is coughing should remember to cough into their elbow and make a commitment to prevent the spread of their infection to their physician and office staff.  Hand sanitizer is liberally placed in physician offices so patients can minimize spread of infection to others by following the rules of "Champion Hand Washing" promoted by the award winning program of Henry the Hand (www.henrythehand.com).  Likewise, the family physician, who is frequently exposed to infected individuals, will follow the same guidelines.  Many physicians wash their hands or sanitize them in the patient's presence, sometimes more than once depending on types of contact during each encounter.

The physician also has to recognize their time issues as an element of respect toward the patient that may impact the quality of connection.  If the physician is delayed in their connection to the patient, the physician should speak to the issue, "I'm sorry to hold you up" or "I'm sorry for your wait".  Unfortunately, physicians can't reveal what they were doing that delayed them due to patient confidentiality.  Other comments about physician timeliness are located elsewhere in this series and in some excellent patient and physician blogs.

The human soon to further assume the role of patient gets the most benefit if they are focused and help the physician to focus on this encounter.  A neighborly patient will greet the neighborly physician with eye contact, touch and a connecting comment, such as, "Hi, Dr Smith, how is your new baby doing?" or "You look ready for winter with your bright sweater, Dr. Jones."  The connecting comment should be genuine and help to refresh the physician's humanity (which has just been relating to another person/ patient's humanity and health/ disease  issues possibly followed by, or concurrent with,  interaction with electronic devices) including an intention to separate the physician from distracting technology.

As we get closer to mandatory electronic medical records (EMR) for all patients, they and physicians are vulnerable to more technology driven distractions. We should  remember to start the visit with something that "doesn't compute", i.e. humans.  The basis of the HCHH is the human encounter of the dyad, not the technology and not "the numbers".  It is about two worthy, neighborly humans first and foremost.  The complex work of the dyad is best if it starts with two connected humans.


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Monday, February 28, 2011

Family Medicine: Hippocrates, Hope and Heart

The Hippocratic Oath
(Original Version)
"I SWEAR by Apollo the physician, AEsculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgement, I will keep this Oath and this stipulation.
TO RECHON him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look up his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according the law of medicine, but to none others. ...."

 The Hippocratic Oath
(Modern Version)
"I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient....."

The second paragraph of the oath I took as a graduating medical student in 1976 (the modern version of The Hippocratic Oath) includes a teaching mandate for physicians to teach others.  This may include learners of many levels, including medical students.  Teaching (and learning from) medical students has always been rewarding for me.  They know a lot and they are a member of my "guild".  Patients almost always enjoy their youth, energy, knowledge and promise for the future of medicine.  They also feel a sense of pride, as I do,  in helping the student to become a physician.

Young, smart enthusiastic learners, like all humans, are flawed.  One of the outstanding flaws of almost all medical students is their desire to reassure patients, even if they don't know enough to be able to reassure them.  I have taught medical students since 1977, often using audio and video technology to assist.  Early in the experience almost all medical students falsely reassure a patient or two. "You will be better after the surgery (or chemotherapy)".  "Don't worry about the side effects, you probably won't get any."  "I think this infection won't bother your diabetes."  "You're going to be OK." Etc.

Why are they so compelled to make comments to ill people with disease processes they may not understand? (Some of the students had just completed their first year of med school).  I don't know.  I do tend to tell the students that, if they need to reassure patients, reassure them that the student will review the situation with Dr. S. and we'll be in soon to further examine and clarify the patients situation.

My current best theory about the intense need of the student to reassure is that it fulfills their dream of helping people, at least by giving them hope.  The dream might be so intense that they forgot the part about knowing more medicine before they prematurely reassure.  The students are living part of what I call the "paradox of the medical healer".  Their heart is so committed to be a helper that it's blind to the brain, which is inadequately prepared to be a helper.  The other end of the paradox is that a trained physician may have so much medical brain that the helper in their heart is overwhelmed into silence.

Teaching medical students is one of the ways to balance the "paradox of the medical healer".  Being around the passion in the healing hearts of the students may warm the hearts of their mentors, teachers and patients with hope.  The other part of the paradox is that many patients feel the caring heart of the student and sometimes appreciate the hope it generates more than the medical brain of their personal physician, which they know is going to follow the student part of the ambulatory clinical encounter.

How might the dyad of student-teacher balance out their respective shortcomings?  Somewhere between Malcolm Gladwell (and between Blink and Outliers) and Donald Berwick, MD's speech to Yale U graduating medical students on June 11, 2010 is the potential to imagine the development of physicians from the neophyte who puts on the white coat at The White Coat Ceremony to the master,coat-less, busy family physician.  The white coat is a symbol of separation- from patient to doctor, from all heart to mostly brain, from free spirit to burdened potential healer, from broke-ness to huge debt and potential brokenness, unless heart and brain get to balance, from helpee to helper.  (A full discussion of the white coat is beyond the scope of this post.)

So how can physicians learn about heart from students and students learn about brain from their mentors and teachers, while learning together how to balance the two?
One aspect comes from the Berwick speech:
“…But, now I will tell you a secret – a mystery. Those who suffer need you to be something more than a doctor; they need you to be a healer. And, to become a healer, you must do something even more difficult than putting your white coat on. You must take your white coat off. You must recover, embrace, and treasure the memory of your shared, frail humanity – of the dignity in each and every soul. When you take off that white coat in the sacred presence of those for whom you will care – in the sacred presence of people just like you – when you take off that white coat, and, tower not over them, but join those you serve, you become a healer in a world of fear and fragmentation, an “aching” world, as your Chaplain put it this morning, that has never needed healing more.”

The (experienced-"Outlier") teaching Family Physician is someone who can help with overcoming the potential for the "paradox of the medical healer".  The experienced, teaching Family Physician knows how to role model for the student by taking off the white coat and leaving it off.  Their humanity is easily shared with the patients humanity.  Even while empathizing with the patients plight, they are helping the patient and the system of care to get better connected.  They are relating the natural history of the disease process to the patients life and family processes while reflecting on the patients illness and suffering.  They know that the patient has an illness that may or may not include a "medical" disease process.  Their human to human connection skills already span the gap between big heart and big brain medical learners.  Teaching medical students is one way to hold onto the "heart" part of health care while sharing the much needed clinical brain that the students desire.

As discussed in The Foundations of Primary Care (by Joachim P Sturmberg, MBBS DRACOG MFamMed FRACGP PhD Radcliffe Publishing 2007), illness is "a loss or disturbance of the unconscious taking for granted of one's body...defined by the disruption of embodiment, rather than necessarily a structural change.  ....illness is intimately related to the patients personality and his life experience and understanding the doctor's role as helping patients to come to terms with, i.e., to find personal meaning in, their illness has a profound impact on the way we organize and deliver health care.  Illness is a whole person problem, not a problem of one part."  This perspective is at the heart of the patient-physician relationship in family medicine.  We're already there, and the students can keep us there.

The intensity of this era unfortunately is driving the family physician from practice and the medical students from selecting it as their specialty.  Both the "hearts" and the "brains" are being crushed by the cash registers of the Medical Industrial Complex.  The "paradox of the medical healer" faces a difficult challenge as we head toward the PCMH and the ACO.  Let's make sure the students go with us.  They can reassure us that everything will be OK.

Wednesday, February 23, 2011

Dr Synonymous Show 2/22/2011: Patient and Doctor Blog and Tweet Review

Dr Synonymous Show on BlogTalk Radio                Listen to this show on   BTR: Dr Synonymous
     Introduction/ Disclaimer

I:  Patient Blogs:

     Seaspray: Its a Wonderful Life

Grief Songs:   Music From a Grieving Heart: Self Help Expressions

II:  Tweets Retweeted by @apjonas (dr synonymous):

Sara Stein MD
by apjonas
Now's your chance to submit your idea to impact childhood via Slate - actually some good ideas!! What's...
June Soyka Cook
by apjonas
Grief Songs: Music for a Grieving Heart. Great list of songs.. -
Dan Munro
by apjonas
30% of docs don't use Anti-virus s/w and 34% don't use a firewall. We need to all practice safe IT ;-)
Susan D'Elia
by apjonas
Shouldn't all this communication between providers and patients be via an online portal and automatically archived as part of an EHR?
Stephen Meyers, MD
by apjonas
T3: One issue, e-mail, like EHR, tends to bring more work (that was previously delegated) upon the provider.
Liza Bernstein
by apjonas
@ re: institutional soc med are mostly just ads. Our dr says this or that./Yes IMO, those who do it r not getting thepoint
P. F. Anderson
by apjonas
SocMed particularly good for health literacy outreach
April Foreman
by apjonas
t2 If both pts. and hc agencies have common goal of good health, then soc med is another way to make that happen. Everyone wins.
III:  Physician Blogs:

The Singing Pen of Dr Jen: The High Stakes of those Conversations About Flu Shots

IV:  Family-Oriented Primary Care by McDaniel, Campbell and Seaburn:  Working with Couples

V:  Next Week, March 1st:  Blog and Tweet Review

VI:  March 8 Show:  Founders Interview with Tennyson Williams, MD Founding Chair of The Ohio State University College of Medicine and Public Health

VII:  This is Dr Synonymous:  Good Night

Saturday, February 19, 2011

Family Medicine: A Flu-less, Star-less week in Little Boxes

I'm thinking this will be the start of the flu week, reinforced by the blog post of Dr Fatty Finds Fitness in Texas who said they're full of flu patients this week.  So two or three folks today were close to flu but not miserable enough.  The flu is associated with lots of pain and lots of mucous (which I refer to as "the state bird of Ohio").  One common finding in my  flu patients over the years:  They are so miserable with pain and mucous that they often say, "for a while I felt like I might die, and it would be OK."  THAT is THE FLU.  No, the flu warriors haven't arrived yet.

The strep mongers showed up, though.  Group A, Beta hemolytic Streptococcal pharyngitis is ruining many President's Day Weekends for the local school kids.  Parents seem to be slightly more likely to choose the Penicillin injection for their child this year than most.  In the "Families Only Practice" model that I adhere to, if we get half of the family with strep throat, we offer treatment to  everyone in the family with an appropriate antibiotic (because an old study showed that 75% of family members will get strep pharyngitis once two people have it).

Notice that the parents or patients are choosing which therapy they wish after I apprise them of the risks/benefits of the various treatments.  Since they are conscious adults, I believe they can make their own choices after we clarify their assessment (diagnosis) and therapeutic options.  The medical literature implies that physicians treat patients exactly as the literature says, like dictators, and holds physicians responsible for patients always following clinical guidelines.  Patients are worthy of more personal consideration than that.  The insurance companies also act as if patients should have no choices but should be forced to follow clinical guidelines (that may not apply to to them).

We get bonuses from many of the managed care plans if the patients follow the medical literature guidelines (for eye exams, prescribing generic medications, liberal use of statins, mammograms, colon cancer screening, etc.).  The patients aren't usually aware that we make more money if they agree to follow the guidelines.  I disagree with anything that removes the patient's freedom to decide.  They make decisions after we give our perspective and recommendations (there are writings about how we physicians should be more forceful with our recommendations).  With infections that have risks of spread to others, I strongly recommend appropriate infection control strategies such as staying home, staying away from others, covering coughs, washing hands, etc.  If they are impaired from their usual decision making abilities, I help more in the decision process.  Obviously, if patients are suicidal or homicidal or endangering children, we have ethical obligations to act against their wishes, but that is pretty rare.

I believe that patients can define their own quality goals with input from their personal physician.  This leaves me out of Anthem "quality" bonuses for last year (although I always write for generic medications except Plavix, Januvia and a couple others that don't have generics) and their data said I only did it 79% of the time which surprised me.  I also just lost two "stars" on my United Health Care web site where they changed their criteria for quality and cost effective physicians.  I felt like both companies pushed us to diminish the importance of patient uniqueness and choice.  So I'm feeling a bit boxed in by artificial quality guidelines.  Now I'm also a starless physician and somewhat proud of it and somewhat annoyed by it.  Patients are too interesting to get jammed into little boxes (ala, the old Pete Seeger song,  Little Boxes).  I guess we're in the Little Boxes together for a while longer, then the PCMH and ACO's will offer bigger boxes.  Onward.  Where are you, Flu?

Monday, February 14, 2011

The Human Centered Health Home: Building Trust by Sharing Patient and Physician Uncertainty

"Years ago, I thought that everything doctors said was totally true.  The treatment for an illness was one hundred percent effective, I would always respond by being cured.  I'll never forget the time my family doctor sat me down to clarify what my oncologist meant by five year survival percentages.  Then I was afraid for a while.....  In a few months, though, I realized how much more trust I had in my family physician than previously.  I realized that he wasn't going to withhold the truth from me when I needed it."

Many patients have expressed thoughts like these about trust and uncertainty to physicians over the years.  This era with more complexity and uncertainty may require patients and doctors both to upgrade their sharing and trusting skills.  As the complexity in the modern health care world increases, patients and physicians both deserve the opportunity to make their best decisions, individually and together.  Trusting each other enough to share uncertainty may enhance the quality and results of their complex decisions.

How do we know when patient and doctor are relating well enough to be safe and effective with their decisions?  How might each relate their certainty and uncertainty about information that should be and is shared?  How and when do they acknowledge and/ or clarify understandings and misunderstandings?  How might each one know when to withhold disruptive information (usually for later sharing) due to the  temporary or permanent vulnerability/suffering of the other person (which usually would abate, allowing the sharing of the withheld information)?
The uniqueness of the Human Centered Health Home (HCHH) model contributes to better sharing of uncertainty starting with its emphasis on Human Centering of the patient and physician.  Their humanity and commitment to humanity starts the relationship before the roles of patient and physician emerge.  This is followed with the six step process of the HCHH including Respecting, Protecting, Connecting, Detecting, Correcting and Reflecting by patient, physician and the dyad of patient and physician.
Some specific aspects of the six steps that allow sharing of certainty/uncertainty and (therefore) trust building are:
                Respecting:  Patient and Physician respect themselves and each other enough to allow the “truth” to be shared, including uncertainty about important (if not all) aspects of the diagnostic, therapeutic and administrative processes.  The timing of the sharing may vary depending on the communication style of the patient- physician dyad and comfort levels of each during the engagement.  Each learns to respect the roles that they may manifest during the engagement and across the relationship's lifespan.  (Including roles as human, patient, physician, consumer, consumer coach, steward, teacher, learner, friend, neighbor, leader, follower, household member, head of household, etc)
                Protecting:  Both protect the time allotted for this engagement and the time allotted for scheduled engagements before and after this one, including those of other patients, family and friends.  Both members of the dyad and office staff are protected from unreasonable aspects of health care process and the Medical Industrial Complex (MIC).  Both protect each other from unreasonable expectations and their respective family of origin pathologies.  Both protect each other by timely sharing and withholding of information as they realize when and how the other and the dyad is most vulnerable and most powerful.

                Connecting:  The dyad works to connect as humans first, considering and clarifying each persons context. (see posts- 11/22/10, 11/30/10, 12/03/10)  Then they may choose to connect via other roles such as patient and physician, once their shared humanity strengthens their trust and helps to protect them.  They use  three or more of the five senses to connect as they allow trust to develop.

                Detecting:  While detecting patient alignment with goals and dreams, the physician may do likewise to enhance their wholeness and ability to respond effectively to the patient's situation.  Therein they will detect and share the certainty and uncertainty of each person’s insights about current and ongoing problems and situations as they relate to the current and future engagements of the dyad.  They share in detecting supporting information that may clarify a better understanding of probabilities that impact their individual and shared decisions.

                Correcting:  While developing a shared plan for addressing the realignment of patient situation with patient goals and dreams, both will seek to further clarify levels of certainty and uncertainty using available resources.  They will each give their perspective on the important probabilities that impact the current decisions facing the dyad and seek to correct misunderstandings about the probabilities under consideration.  After sharing their perspectives they will merge their understandings as possible and go ahead with the plan for correction.

                Reflecting:  They will reflect on the dyadic interaction and share their perspectives on the trust levels of the dyad.  They will each allow and accept that the interaction and the decision process happened.  Both will reflect on levels of certainty and uncertainty involved in the agreed to decisions and identify if any need exists for later clarification.  Both will reflect on their sense of trust in each other and their process of communication.   They may elect to forgive themselves, the other or the dyad as indicated as they seek to nurture the relationship via the HCHH process.

Saturday, February 5, 2011

Family Medicine: Winter Weather Leads to Full and Fun Fridays

Suddenly, on Monday, most of the patients for the next day call and reschedule their appointments.  "Dr., your schedule is full now and these two want in today.  They said the snow and ice tomorrow is predicted to close everything, so they don't want an appointment then.  Mrs. Smith says the baby has diarrhea and is passing some blood.  Mr. Jones is really anxious since he still has left shoulder pain in spite of the physical therapy."

This type of conversation causes a re-evaluation of the patient schedule for the next few days and some quick decisions about patient care.

After three frozen days, it's Friday and the world is unfreezing.  Most have their electricity back on, or they stayed in a motel or with relatives.  Ohio has looked like a scene from Dr. Zhivago with the cold, all-white outdoors look for over two months.  The ice storm this week knocked out the power supply for over 90,000 people in the Dayton, Ohio area.

Who comes to the doctor in this type winter situation?  People with deteriorating chronic problems who were getting acutely ill for seven to ten days.  Children with fevers.  People just discharged from the hospital with a list of new medications and an incredible story of hospital personnel who withheld some of their chronic opiate medication.    Parents who finally caught the kids' infection after kids and spouse recovered.  Someone who slipped on the steps at the high school three days ago, now getting more pain and shortness of breath.  Check for fracture, bruised kidney, stunned lung, etc.  Kill pain, support breathing, decide on how pain fits with job situation, negotiate ideal strategy for next few days with patient.  He gets the main vote.  I advise him about the medical stuff and the drugs.
Then come the poor, unemployed people who used the fireplace for heat and exacerbated their emphysema.  Their cigarettes comforted them in the cold, dark night while adding to their breathing problem and sputum production.  The boy with intense cough until he vomits has no insurance.  "Just send us the bill.  We're applying for medicaid for the boy, but we knew we had to bring him in after four days of fever and his loss of appetite."  I congratulate the parent on his good judgment about his son.

Someone is in the next exam room who lost nine pounds in January by reading and acting on Healthy for Life by Ray D. Strand, MD (I recommended it) to reverse their insulin resistance.  See my post about, and listen to,  The Dr. Synonymous Show (BlogTalk Radio) on December 7, 2010 for four reference books and a discussion about Insulin Resistance  (Here).  I cheer for them and schedule a follow up lab test and office visit in two months.  The follow up visit in Family Medicine is one of the most important ways to get issues wrapped up.

People often have more confidence in lab tests than their own mirror for feedback about health.  While both can be important, seeing how the patient looks and affirming their success clinically can help with restoration of their confidence in their health.  The lab results can be icing on the cake of success, but the patient is the central player.

A Rapid Strep test in the East Room, a nebulizer treatment with albuterol in the West Room, a Toradol injection in the Blue Room, four brief call-in notes about four patient situations requiring physician action and we're turning the corner toward the end of Friday sigh.  Re-examine the two people who had the albuterol therapy for wheezing to make a treatment decision for home, check the rapid strep result and recommend treatment for a child with fever, cough and sore throat.  Write fast, engage with eye contact, ask if there are any other questions of patient.  Hand them the chart (or parent or caretaker depending on situation) to take to check out counter, "to the people having more fun than they can stand".

Last room, last chart.  Read chart in hall (Chief complaint, vital signs, last visit note, patient written sign in sheet with reason for visit in their handwriting- note difference (s) between that initial patient note and the medical assistant note once patient is in room and responds to question about purpose for the visit).  Deep breath, focus, develop plan for initiating this encounter, knock and enter, make eye contact, greet with name and handshake (unless cough is part of chief complaint in which case I usually don't shake hands since most patients still cough on their hands.  I have to think of public health, contagious diseases and my own potential to spread infection or catch it).  Respect, Protect, Connect, Detect, Correct, Reflect.  Use the whole process every patient, every day to the extent possible.  It's more fun and satisfying that way.

Note time, reflect on entire office, who is the "late person", who needs a physician OK before they can leave.  Look through remaining pile of lab results, imaging studies and patient notes from calls quickly before releasing last MA.  Cringe at the number of tasks per unit of time that I need to deliver before I can feel comfortable leaving.  Place the piles on a work table in front of a large window.  Get twelve ounce glass of water, walk through front office, gather any remaining reports.  Translate illegible writing for staff to finalize codes for diagnoses.  Listen to issues of people or programs from people at the front, especially if there are left over intense feelings about interaction with patients or physicians.

About 18 patient issues are represented in the end of the day pile today.  Eighteen different patients with various documents to review, comments to write, forms to sign, people to contact by MA, front office person or me.  Abnormal thyroid test result -patient has work up scheduled; the Monday baby with blood and diarrhea actually didn't have blood on further clarification, but culture of diaper rash verified it was the infection I theorized and treated that came from a session in the children's hospital.  Pleased that I selected the best antibiotic now verified by the culture report.  Refill two meds for disabled senior citizen.  Put six patient call backs on Saturday MA's work pile for morning disposition, when we'll both be here.  Etc.,etc, etc.

Look at laptop for Facebook, Twitter, Blog, and email. Thirty minutes later, pack it up and leave.  Reflect on how lucky I am to be a Family Physician.

Tuesday, February 1, 2011

The Medical Profession and "Physicianship"

After the events of September 11, 2001, the leaders at the United States Military Academy (USMA) at West Point studied and revised the training and currriculum for the Corps of Cadets.  Increased emphasis was placed on "officership", which expanded the concept of being an Army officer.  It is time for the medical profession to do a similar upgrade of professional development.

In discussing professional development of physicians, the term "physicianship" could be used to refer to the needed upgrade of the profession which faces considerable challenge in the current and coming eras. Physicianship means more than being a doctor and practicing medicine.  In this post I offer for discussion a short list of some roles and attributes that I believe are important for physicianship.  What do you think?

Physicianship is striving to be and becoming:

     A professional who is competent and technically proficient

     A member and citizen of  a respected profession

     A leader of character who inspires, motivates and communicates
     A servant of patients and society

     A warrior for humanity, safety and teamwork


text:
Friday, February 25, 2005

1-minute movie of the antenna movement

This animation has been created using sequential photographs taken on Sunday during the movement of the antenna. The quality has been decreased to make the file smaller.
Move Preparations
South Camera
North Camera

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At 11:12 AM, Blogger Jud said...

Not being familiar with the program, I have a few questions that, I hope, someone can answer:
1. Why did the antenna have to be moved in the first place?
2. How far was it moved?
3. What is the weight of the antenna?
4. What are some of the overall dimensions of the antenna?

You can send the answers to me at

Thanks, Jud

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