Family Physicians Against ABFM Maintenance of Certification Coercion

I'm a family physician, and have been "board certified" since I finished residency in 2001. I just recertified again in 2015, with ABFM.  I work full time as a hospitalist, after doing 11 years of clinic crade-grave, with OB, clinic house calls (hospice pts) and nursing home prior to becoming a hospitalist after I got tired of feeding the clinic money and forms machine.  And I'm more and more bothered by the travesty of Maintenance of Certification which seems to be a scheme to feed a reputed $62 million a year to the American Board of Family Medicine, including their chairman who I've read is making $745,000 a year to find new ways to harass us more instead of less.  Anybody know any other family docs who make that kind of money?

And now, MOC is not only boards, it is BLS and ACLS.  As soon as you finish testing on the stupid dummy, you have to take it again in 3 months, or at my hospital, you lose your job, no appeals, no excuses.  I don't know about anyone else, but I have not seen our save-rate go up.  The way it's going, pretty soon you'll have to do a hand-washing class every month just to show you know how.

Personally, I've already gotten board certified by the National Board of Physicians and Surgeons (NBPAS) but that doesn't yet help much, other than getting a few concessions from the ABFM and ABIM MOC rackets.  Malpractice insurers drive too much of the industry, (and perhaps are far too much in bed with the ABFM and other boards anyways) and require some kind of re-testing mechanism to "make sure" that practicing physicians know how to practice well.  And NBPAS does not have a testing mechanism, so probably won't cut it for insurers.


In my opinion, we need to either:

1.  Revamp ABFM as a certifier of REASONABLE (not just profitable) different methods of testing that the individual physician could choose from, kind of like ACLS for instance. Then the market could drive making the test palatable and drive prices down with competition. ABFM could still do tests if they wanted to, but they would be just one source, similar to on-line ACLS courses.

OR

2.  Replace ABFM and/or augment NBPAS to do the above if ABFM and the other racketeering monopoly-test boards don't want to.

And while we are at it, maybe lobby the Congress and the President to repeal and replace the MOC monopolies that the Boards engineered into ObamaCare!

If you are a family physician who wants to organize and do something about it, let's start a dialogue.  And if ABFM wants to retaliate, then I have an answer: class-action lawsuit.   I know we are all busy, but sometime we need to stand up for ourselves against the nonsense and the greed!

Leave comments here, and I'll figure out more on how to contact and organize as we go if anyone else wants to get involved.

- David Jarvis, MD
   Baraboo, WI

Sideline Injury Report Form for Team Doctors or Trainers

My contribution to volunteer team doctors.  Use and modify as you like.  I think you should just be able to copy and paste into your favorite word processor. I use OpenOffice.org and it formats nicely in it to just 1 side of a 8.5"x11" page by picking Optimum under the graphics text wrapping options.   You will probably have to massage the graphics a bit with text wrapping and resizing.  Graphics were obtained off the internet. Do not charge to use these unless you pay the graphics owners, if any!  (and if you charge for sidelines care, or get paid in any way, then you better have malpractice insurance!)

=========================================================

SIDELINE INJURY REPORT FORM

Date: _______________ INJURY TIME: ______________

PLAYER/Official: ________________________________________

INJURY: ________________________________________________________________________

COMPLAINTS: __________________________________________________________

INJURY DESCRIPTION:

approp vitals:

INITIAL RED FLAGS?

Loss Of Consc: YES NO “Near LOC”

Head Pain: YES NO

Neck Pain: YES NO

C/M/S intact YES NO

Immed Swelling YES NO

Able to bear wt YES NO

Relevant Med Hx:

TREATMENT:

____________________________________________

____________________________________________

ASSESSMENT:________________________________________________

PLAN: _______________________________________________________

RETURN TO PLAY: YES NO

SIDELINE HOLD: YES NO

SENT TO ER: YES NO Ambulance called: _____________

FOLLOW-UP ADVISED :

WITH USUAL MD: YES IF STILL PROBLEMS IN ________ DAYS

WITH SPECIALIST: YES IF STILL PROBLEMS IN ________ DAYS

REPORT TO PARENT YES COPY E-MAILED TO COACH: YES COPY SAVED FOR ME: YES

signed: ___________________________________

                   (YOUR NAME HERE)

Disclaimer:

Evaluation and Treatment provided during games and practice is totally voluntary and without reimbursement. Any care provided is not done on behalf of, or for my usual employers, and in no way represents them. Parents or adults should follow-up any concerns with their own physician or hospital ER. 

Hospitalist Peer Letter of Reference

I made this to help my colleagues, because we all get these requests.  Please feel free to use it at your discretion....

===================================================================

Letter of Reference by Peer(ers)

To Whom It Mayeth Concerneth

I would like to (recommend) (dump off on you)  (kill) my most (esteemed) (idiotic) colleague, the (un)forgettable  ____________________ .

In the practice of Hospital Medicine, (He)  (She) (It) is (a god walking among us) (pretty darn good, what I would hope for in a colleague) (barely manages to survive, and so do his patients) (doesn’t kill too many people) (makes Attila the Hun seem like Mother Teresa).

In day-to-day practice, he – she – it (blazes like lightning in the sky from patient to patient to ER and back again, and is finished with rounds at 930am sharp)  (works hard and spends about the right amount of time with each patient during rounds) (floats through rounds like a dandelion spore on LSD, but everyone is just so happeee when finally done at 9:30pm!  Wheee!)  (careens from room to room like a drunk mountain goat, cowing  and sometimes curing patients unlucky enough to escape his wrath, orders, and procedures-by-machete).

His -  her – the lazy slob’s -  documentation and orders are (marvels of succinct completeness.  Textbooks and talk shows are done on how to recreate these masterpieces yourself!)  (are complete, not too wordy, and nurses like their clarity) (notes and orders are f-ing longer than Tolstoy and about as useful) (what documentation?  Doesn’t believe in it!  Can’t sue what isn’t documented!  Orders?  All verbal!  What are those lazy nurses for anyway?!). 

As for procedures, he- she – the cowboy – (is the best I have ever seen.  Fast, clean, no complications or failed attempts, ever.  Other lecturers line up to watch The Master At Work)  (is pretty average, does more of some things, less of others, as most hospitalists do) (What shall we do with the drunken sailor early in the morning?!).

Regarding patient satisfaction metrics, he-she-that #$%) (is the rock of patient satisfaction that we all flock to for inspiration and meaning in our practice of medicine) (is a pretty nice, pretty clear doctor that patients like to have take care of them) (well, you see, it’s like this, you have a perambulatory disambiguation occurrence with an n of thus and incidence likewise, so therefore it follows exsanguinously that one might expect a reduction in the aftermath of the etiologic indices, you see?) (patients hide under their bed in fear, and so do the nurses). ( We are all getting pay cuts and looking for new jobs because of this jerk).

As far as personal reliability and teamwork go,  He-She- who are you talking about again? Is (a wonderful colleague.  In fact we will pay you to STOP trying to hire them, PLEASE, because our lives are not complete when they so much as leave town) (is a good colleague, and will be a fine reliable member of any team they work on) (doesn’t know what a clock is, but always shows up sometime that morning or evening as expected, and pitches in to cover colleagues) (is a hung-over dirtbag who can’t be bothered to work after payday, and the only evidence of a clock in their life is their ability to call-in 5 minutes before their shift with yet another sh*tscuse to not work) (I don’t even remember what they look like they are gone so much.  Please take them and get them out of our schedule!) (Such an antisocial jerk that I will just shoot myself now instead of hoping you are stupid enough to hire them).

So in Summary, I would like to say, that Dr. ______________  (is a phenomenal Hospitalist, so much so that I can never hope to do more than humbly walk in their shadow and hope some of their goodness rubs off on me) (is an excellent hospitalist, and would be a great addition anywhere, as they are here) (is a well-meaning, even competent, but ultimately failed physician who will never be able to match my peerless abilities.  Why don’t you hire me instead?)  (is a bumbling idiot very nice physician whom we would love to get rid of would recommend to any hospital outside of our own system) (should be in jail, or at best on an ankle bracelet program picking up trash along the roadside while being defecated on by ducks with Giardia).

Sincerely (Good Riddance)

___________________________

Esteemed collegious colleague

Settings for Cyberlink Power Director 

and the Canon Vixia HF M50 camcorder

This is for me to remember, and for anyone else who bought this nice little camcorder and is using Cyberlink software to burn disks to watch.   It took me quite a bit of experimenting over the last week to arrive at these conclusions.

Camcorder Settings: Canon Vixia HF M50

First, if you are videoing mostly stillish stuff without much movement, then Standard settings on the camcorder (AVCHD at 7mbps, 1440x1080 at 30p or the MP4/7mbps/1280x720/30 P) will probably be fine.  If none of that makes sense, you will need to read the PDF for the camcorder, and read up on video formats on the web!

However, if you are a crazy hockey parent like us, you want to get fast moving kids and pucks without horrible zebra and double-image artifact on your final output!  The Canon M50, like every other digital camera I have ever seen, comes with a plethora of junk modes to make it look like you can videotape into the next millenium on the built-in 8GB memory, much less a SD card.  Just don't expect to be able to watch any movement in the resultant video without getting sea-sick at all the zebra-striping and shadow-imaging that results from less-than-best modes!

In a nutshell, if you are videotaping sports, etc, only videotape at the highest-quality settings for AVCHD which is MXP (1920x1080/60i at 24mbps), or for MP4, which is 30P (1280x720/30p).  Then you can get milky smooth movement on your final output video - if you choose the right settings in your video output program.

Video Output Settings: Cyberlink Power Director and Power Producer

First, I can't see any particular reason to use the included software that came with the camcorder.
Cyberlink PowerDirector and Power Producer offer much more customization.  But that is to be expected, as the software that comes with most cameras is usually... pretty cheap.  I installed the VideoBrowser software that came with the camera, to see what it would do, which is basically copying the SD card contents to a cryptically named directory (Import Mgr Data) in the My Documents folder instead of in the My Videos folder on my Windows7-64 computer.  Then, you have to keep drilling down through layers of junk names to find your files, which I promptly moved to a dated folder in my server Videos directory. I got Cyberlink programs with my LG USB3 Blu-Ray drive, upgraded to the newest versions for 64bit and AMD GPU support, and am pretty satisfied with them. Makes disks and DVD iso's; Also Blu-Ray folders for more copies of Blu-Ray disks, which I haven't tried yet.

Instead, I would recommend just putting the SD card in your computer, looking for the relevant directory ("Private" for AVCHD files, and DCIM for MP4 files) and moving them where you want them so they are not lost forever when you uninstall the goofy apps Canon has you install.

Then decide what you want from your video.  If all you want is a basic dump to DVD or Blu-Ray, then Power Producer will do just fine, and is easy and reliable, and does add a nice cover screen menu with one option (PLAY) to click on.

If you want to do more editing, then try Video Editor, which has timeline, etc. Both programs allow background music track to be added.

Absolutely key, is the output choices. If you are videoing sports, you will get the best output from 60p AVCHD choices, and next best from 30p.  The interlaced and 24p options stink, making you think you are watching zebras slide across the screen, often in duplicate. But if your output is he same as the original in frame size for MP4, or 60p for AVCHD, (using progressive frame encoding), then you get gorgeous video that looks the same as when you shot it, which is the best I have seen on a consumer camcorder, bar none. I have made Blu-Ray and AVCHD DVD's that look gorgeous from last weekend's games.

What I haven't Tried and Don't Need (Probably): 

WI-FI features of the Canon M50 have been pretty poorly reviewed everywhere I have seen them, and to me, seem like a waste of my phone data allowance and my time, when copying the SD card to computer is much faster by just plugging it into the computer.  Also, copying the internal 8GB by wireless would be an exercise in patience that I don't have, and hoping no errors from dropped signal, etc.  And that is if I would be patient enough to do the wireless setup everytime my router gets turned on and off, which isn't likely.

To me, until the newer post-N wireless is incorporated into cameras, wireless is just too slow for either my DSLR or for video files, both of which eat up memory like me at a burger joint...

Auto-upload to You-Tube, etc via wireless or built-in software
Yeah, I've uploaded videos of my kids without any title screen etc.  Painful to watch.  In general, not a great idea except of your kids, for adoring family to watch!

CONCLUSIONS:

I'll get a video up to YouTube when I have the time.

At first trial, using the camera in Standard Mode was a little disappointing, and similarly Cyberlink defaults, with seasickness-inducing videos coming out on my TV from hockey video that looked great on HDMI from the camcorder.

But if you choose highest quality video to start with, and highest quality output, then the digital video output is phenomenal!  I am very happy with the results of the combination of camera and software.

Let me know if any comments...

Star Wars The Old Republic: 

Worst Customer Service and On-line Financial Transactions, EVER

WARNING FOR ALL ASPIRING JEDI, SITH, AND MANDALORIANS:

SWTOR ( http://www.swtor.com ) is a MMPORG game with fantastic detail and depth in the Star Wars universe.  It is also, without a doubt, the worst experience I have ever had with an on-line billing system for a game, and with hours on hold waiting to talk with Customer Service.

My son plays this game, and I watch him do it, and of course provide the funding.  Unfortunately, their system to buy "Cartel Coins" is probably the worst ever, having been broken for over a month now.  Furthermore, their promised game cards, which could get around their worthless credit card heist system, have yet to show up at Game Spot stores, as has also been promised on their website.

As far as their credit card heist system, BUYER BEWARE.  If your account gets stray electrons that mess up a single byte of information, then trying to add different payment options fails (such as adding your Pay Pal, different credit card, etc).  The only way to see if it works is to try making a purchase, which I did with the CS rep several times, and on my own while on hold for roughly the length of the Star Wars movies (combined) it felt like.

You call Customer Service, thinking that they can fix it... and listen to 30-60 minutes of the same boring Star Wars music and stupid messages about being in a que, and laughable messages about how they are improving their Customer Lack-of-Service (haven't yet, from a user perspective!).  Finally a polite guy took my credit card info, and entered it, so that it works, and purchase finally went through. Lack-of-Customer-Service rep tells me the account is automatically locked out for 24 hours after a purchase, to prevent re-purchases.  Hmmm - that is wierd.  Why would that be necessary?

But the account is finally functional, a purchase was made. Yaay - problem solved, right?

WRONG.  Over the next day, all of the failed transactions were submitted to my Mastercard account.  Instead of a single $39.99 charge, I have around $300 of charges.  Pretty good money-making scheme.

So then I call Customer Service. Hours on hold, to get told that you have to call during Central Standard Time business hours and talk to an business office account billing droid-person-something.  Here's the kicker:  YOU CAN'T CALL THEM DIRECTLY, YOU HAVE TO GO THROUGH THE CONSTIPATED CUSTOMER SERVICE QUES!

 Well, since I actually work for a living, it isn't easy to sit on the phone all day right away.  Nevertheless I called today about 4pm.  About 40 minutes of waiting into it, I got a human-sounding guy who told me the same as the last guy - talk to billing during business hours, put me back in the same interminable waiting. Now it is 5:23pm, and the business office is undoubtedly closed, and I am still on hold.

This game is technically well done, but the implementation of their credit-card heist system is criminally negligent, and reflects badly on Lucas Arts, Lucas Films, George Lucas, Electronic Arts, and Disney now, which is a real shame.  I don't much care what their excuses are; if your billing system is stealing from people, then it should be shut down until it works, and just let people play for free other than their monthly fees.  How hard can that be?

For now, all I can say is BEWARE SWTOR ( Star Wars The Old Republic ) unless you want your credit card ripped off.  For me, I am calling Mastercard to dispute the charges and have them removed.  And I removed the credit card from SWTOR, of course.

I hope others aren't ripped off like this or worse.  In 2012, it is a shame that a neat game is compromised by a cheap billing system.

RV Park Review - Standrock Campground, Wisconsin Dells, WI

I've camped here now 2 Springs in a row for a week or so at a time, for the yearly shakedown, and to get out after a long winter. Gives me the chance to work and camp at same time.  Peaceful, pretty, spotless, close to Dells, good store, camp in back, not front to be away from freeway. http://www.standrock.com/

It's a little close to the I-90 freeway, so you won't want to camp in the front rows by the clubhouse if you don't want to be in sight of the freeway.  However, the back rows of campsites are really nice!  (I was in 19).  Easy to back into and full hookups in many (not all, check first).  Good tall shade trees, but enough sun to enjoy sitting out.  The campground is pretty with nice hiking trails (not very well maintained - wear jeans and shoes!) that highlight the midwest pine and oak forest in the rocky Dells. Excellent playground for kids, and farther over is a basket ball court and 6 horse-shoe throwing course thingy's and plenty of room for throwing a Frisbee or playing ball, etc, well away from campers.

The camp store has all the basic camping and RV supplies and soft-serve ice cream.  And, being Wisconsin, they have their own tavern, too!  (Good low key family-friendly Wisconsin-style tavern, with fresh free coffee in the morning for campers).  The pool is nice looking but I haven't tried it as it opens on Memorial Day, and I have camped before then.

Internet connection is probably OK at the camp store, but unusable at sites.  Use your Verizon phone/data plan and you will do well, with 5 bars most of the time, and only occasionally dropped connection during work and surfing use this year.

The campground is kept up spotlessly and excellent restrooms, spotless, too.

Overall, very nice place for peaceful camping yet close to Wisconsin Dells.  Far better than the next place north of here that shall remain nameless due to it's noisy carousing teens and drunks on golf carts near the river...

Camping Passages

I used to camp with only what I could carry on my back.  Then came the Navy, a couple back surgeries, and a couple wonderful kids...  Now I can't sleep on anything hard, and my RV has a microwave and surround sound stereo!  But it is still great to get out and listen to birds and bugs without the distractions of home, and to walk somewhere without overhead speakers calling, where each step is new.  To live simpler again.  To be able to stop where I want and lay out my camp there.

Yeah, it's different, but it's still camping.  I hope you can, too!

Want to donate to support my WebOS development if you like my apps?

If you do, here's the link to my CME/Development page that has a PayPal link.

http://home.centurytel.net/BBooDoc/

Vicodin can be a Godsend - occasionally

Treating chronic pain is interesting, to say the least, when you have it yourself.  

There are not many days my back doesn't bother me.  I am 20% disabled according tothe VA, from old Navy injuries.  It hurts worse if I am in bed too long, and generally wakes me up by 6 hours.   So sleeping in is not usually an option.  Pain meds aren't often an option either, as thinking must be sharp to catch babies, and feeling like a zombie is no fun.  Most of the time it is just meloxicam.stretching, walking, and thinking about something else.

So this weekend it was a real treat to be able to take a Vicodin, sleep for 2 more hours, and be able to get right out of bed without hurting.  Pity it isn't real and doesn't last!  At this rate I'll finish my 30 tablets from 2007 ... Sometime next year.  I already have 6 more I can pick up, which were prescribed when I couldn't find the 2007 bottle.  My doctor asked me if she should be concerned when I asked for the refill. 

And, that is what I think about when people want hundreds of pain pills each month for nebulous "pain" conditions.  Pain may come from this or that part, but it is RESPONDED to between the ears.

Bishop Score for HP / Palm WebOS

As announced previously, the most basic Bishop Score calculator for WebOS devices (HP / Palm Pre and Touchpad and similar devices) is now out.  It is an app for physicians and nurses and midwives to use with pregnant moms.  I will add more info to it over time.  Please leave me feedback here.

update 3/19/11 - I just uploaded to the HP WebOS App Catalog tonight.  Previously, it had been in the HP WebOS Web Distribution Channel, which is not as easily available to WebOS users. It may take a few days to show up in the App Catalog, while it awaits review.

WebOS Developer here

I am now an "official" developer, having posted an app to the HP Palm Application Catalog (Web Distribution feed).  It is just a simple Bishop Score calculator that I am using to teach myself how to make apps for HP WebOS devices (currently Palm Pre, Pixi phones.  TouchPad tablet and more phones and even desktops coming).

 I am doing this because I am a obsessive-compulsive technophile family doctor.  I like good tools - whether it is in my pocket in Labor and Delivery, on the ranch fixing fences, on my camper, or on my computer.  The old PalmOS PDAs and phones had great medical tools for obstetrics.  However, WebOS doesn't yet have the depth of medical apps. 

Fortunately, Dr. Alan Teh in Singapore has stepped forward and made a whole suite of medical apps. His site is here: http://palmdoc.net/ .  Also, in response to some ideas back and forth on PreCentral.net, SiratoXero started OB Tracker, an app to keep an OB list on WebOS devices.  Sirato got busy though, so he handed the code off to me to finish.

Since I know (knew) nothing about coding other than some high-school programming courses on TRS-80's in the 80's(!), I am starting by programming a Bishop Score calculator to learn how to do this.  Dr. Teh graciously got me started with instructions and a code framework to flesh out.  It is a free app, available here: http://developer.palm.com/appredirect/?packageid=com.monkonapps.bishopscore . 

When this app is satisfactory and I have learned more (a long ways to go!), I will start working on the OB Tracker app.  The goal of the OB Tracker app will be an encrypted HIPAA-compliant  list of pregnant moms that can be sync'd to a laptop without every putting any information on the cloud".  With it, a doctor or midwife will be able to keep their pregnant mom list of EDD's, blood types, Group B Strep status, G's and P's, and a free-text note field, too.

Why is this important?  So we can plan when to be out of town!  (That and the rather more important ability to instantly look up critical information on moms during obstetric emergencies or while discussing with consultants or checking out to partners, etc).

HP requires developers to have a web site.... so this is it.  Leave me comments/questions, and I will try to check this enough to be helpful.

A huge "thanks" to the moms who let us be part of their miracles, and to Dr. Alan Teh of Singapore, and SiratoXero, without whom I would still be trying to figure out what JSON is important for!

Winter in Wisconsin

Can be a restless time.  People get tired of the same 4 walls around them, the same piles of dirty snow around their driveways, the same old paychecks, etc.  So we go to the capitol and protest!  Power to the people!  Da*n the torpedoes, and full union ahead!

As usual, the best course probably lies somewhere in between our govenor Moammar Walker and "screw you and the state and any chance of competitiveness or keeping businesses open" unions.

And when it gets warm and the snow melts, we'll find better things to do I am sure.  Moammar for one will be off in Cali relaxing with his good ol' buds the Koch brothers.  A lot of teachers may be looking for new jobs if they don't go back to work, soon.

And I will be taking care of patients and camping around our beautiful state on weekends!

Nice Times for a Change

Primary Care medicine is all about production and pt satisfaction these days, 2 goals which are often very opposed to each other. Add into the mix that insurance purposely throws roadblocks in our way for any pt care that is expensive, hoping it will be too burdensome for us to order it.

They are right. Primary Care is dying, choked to death by the system.

So it was nice lately...

(when I got busy and didn't finish the post - sorry!)

Published with Blogger-droid v1.6.6

wpd (.wpd) file problems - Microsoft screws up again

A long time ago, Word Perfect had Word Perfect Documents.  They may still have.  Then Microsoft decided to have Windows Photo Documents.  They were edited with Windows Live Gallery.  Both used the .wpd file extension.  My wife used both, too.  About a week ago, someone figured it out, and MS apparently turned off wpd files, and those DIRECTORIES were no longer accessible.   Nice job Microsoft!

After trying lots of utilities to delete the offending Windows Live WPD picture files, to no avail, I finally hit on using our Windows Home Server to do it.  It doesn't recognize Windows Live anything, and I was able to open the directories and delete the 2 files.  Hours wasted before figuring that out.

Hopefully Google will see wpd here and direct other frustrated users here to the solution: delete the offending modified files with an old computer/OS.  Never use Windows Live Photo Gallery to modify anything again!

Antibiotic Overuse?

I just read another interview with a CDC doc who doesn't actually treat patients, and complains that 50% of antibiotic prescriptions are un-necessary.  I am sure he is right about most of them. 

What he didn't say anywhere, is that the decision not to do anything is going to result in several patients this time of year being admitted with pneumonia a few days after you see them in clinic, and tell them that acute viral bronchitis does not need antibiotics.  He also didn't address that coming back to see the doctor yet again costs real people real money, and oh, by the way, we are in a RECESSION right now.  Missing even more work for working patients, if they do have pneumonia that wasn't treated, will cost them even more.

Our patients expect us to be right every single time, unless we are Dr House (the TV doc).  HMOs expect us to get people in, treat as little as possible while preventing everything expensive, and bill maximally.   We know that is not realistic.  So simplistic "just don't prescribe" sermons by dolts who rarely treat real people just come across as wildly unrealistic.  Contingency-prescribing ("fill this if no better or worse in X days") would be a more realistic approach than the black and white recommendations of the experts from their statistics labs.

In the meantime, I am sure that I will hear more experts complain about primary care over-prescribing antibiotics, and hospitalists complain about why we didn't.  It's easy to call the plays from the nice clean announcer's box when you don't have the defensive line breathing down your neck!

The Blog Bog for me to Ramble In..

Well here I am after 12 years off the internet (other than Flickr http://www.flickr.com/photos/bdwbjarvis ).  Previously I had a web site that started out as part of my medical school research project, and grew to include pictures, poems, stories, articles that I wrote for newspapers, blah blah blah.  Then it died when I graduated from med school.

That was then, this is now.  Everyone is on Facebook or something like it.  Why a blog instead of Facebook you might ask?  Because I am irascible enough to want to say my piece and not have to read everyone else's comments on their life, too!  If I wanted that much human interaction I would have been a doctor.

Wait a minute, I am a doctor!  OK, actually, after a long day interacting superficially if I am being "efficient" (not enough according to my productivity numbers), or more intensely if I am actually trying to care about helping people and their problems (too much of this by the productivity goals), then I need to step back re-charge, and not give a bloody blaze about the world's problems for just a while.  So here I am, free to vent and ramble as long as I want... no Twitter limits, no Facebook invitations to some stupid game, etc.  And, I can be just as cynical as House if I want, because this is all about Me!  If you are reading this, it is because you want to, not because I plastered it all over my Friend's pages... so buyer beware while I ramble!