Sunday, December 31, 2017

Whistleblower 2018 Predictions

Here are some predictions that I pray will come true!

  • Nancy Pelosi, James Clyburn and Steny Hoyer will step down in order to pass power to younger Democrats.
  • Donald Trump will be invited to speak at a Planned Parenthood Convention.
  • Mitch McConnell will recommend that Merrick Garland be placed at the top of the list if a U.S. Supreme Court justice vacancy develops.
  • Kim Jong Un decides to denuclearize his country.
  • Debbie Wasserman Schultz declines to run again in 2018 when facing poll numbers that predict she will be thumped.
  • Putin gives back Crimea to Ukraine stating, ‘My bad!’
  • Chuck Schumer responds to a GOP legislative proposal stating, “Wow, that’s a great idea!  Why didn’t we think of that?”
  • The NRA demands that congress close loopholes on background checks before all firearm purchases.
  • Amazon decides to close down to allow for the resurgence and thriving of small shops and businesses. 
  • Millennials will put aside their smart phones and recreate the lost art of conversation and handwritten letters.
  • Folks will state out loud that they have always hated kale. 
  • Due process and proportionality will return to bring back fairness in the public sqaure.
  • Medical studies will announce that fried foods lengthen life.  

Have I missed any?  Please add your own.

Wishing all a serene 2018.

Sunday, December 24, 2017

Merry Christmas in the Hospital Wards

Tomorrow on Christmas I will be working.  I’ve worked on December 25th for as long as I remember.  Our offices are closed but the hospitals are open.  I have chosen a profession that must be available to serve at all times.  If I want a day off, then I am obligated to make sure that there is a doctor in my place.

Many professions share this reality.  Nurses, law enforcement, military personnel, hospital workers, firefighters have all worked on holidays when most families were relaxing together.  We accept this responsibility.  But, at times I do suffer a tincture of envy thinking of folks who never have to wonder if they are working on Thanksgiving since they are off on every holiday. 

I remind myself during my Yuletide rounds that the last place that these patients – at least most of them - want to be is in the hospital.  Yes, I will be spend some hours treating them, but I will return home and not face surgery, medical testing and the various indignities of hospital life.  The nursing staff, the most compassionate profession I know, does their best to bring some measure of holiday of cheer to their charges.

Chanukah and Christmas are celebrated and festooned with light.  Don’t we all need some more light?

Wishing everyone the blessings of peace, health and contentment. 

Sunday, December 17, 2017

Whistleblower Holiday Cheer 2017!

Dashing through the swamp
Through caves of muck and mire
Where folks are much afeard
That someone wears a wire.

Repeal, replace went down
Mitch played a losing hand
Which traitor killed the bill?
Susan, John or Rand?

Now, onto tax reform,
With just a minor glitch,
It crushes us with debt
Excepting all the rich!

Does Rexie have to go,
For someone with more steel,
Who believes with heart and soul.
In Art of the Deal?

The Dems kicked Franken out
Of this they were so sure,
They needed to stampede
To prep for Judge Roy Moore.

The Dems and GOP
Whose mantra is ‘Attack’!
Sometimes face to face,
Or sometimes in the back!

Soon this year will end,
Will next year be duller?
I doubt this will occur
Once we hear from Mueller!

Some want Trump to go.
But does this move make sense?
Would they really want
President Mike Pence?

Joy and Peace!


Sunday, December 10, 2017

Reducing the Federal Deficit - A Monumental Approach

This past week President Trump reversed protection for millions of acres in two national monuments in Utah.  Bears Ears National Monument and Grand Staircase Escalante will be halved as a result of the major surgery just performed by the Chief Executive.  These moves will likely result in job security for scores of environmental lawyers.

Teddy Roosevelt is growling in his grave.

As expected, there were howls from the left, most of whom have probably never visited the sites.  How many people are against opening up the Arctic National Wildlife Refuge for drilling who have never been to Alaska?  Keep in mind that the folks who actually live in Utah, and the legislators who represent them, argue that they should have control over their own lands.  Shouldn’t they have the right to determine the fate of their own state and to resist federal encroachment?   Should the feds compensate states for the economic losses that they suffer when lands are deemed to be federal monuments? When do the feds have the right to ‘trump’ states’ rights?

I was shocked to learn that the vast majority of Utah land is controlled by the feds. 

Imagine the reaction if the location that Amazon chooses for its 2nd headquarters were suddenly designated as national monument.  Do you think that state would welcome this federal intrusion?  More likely, would be rioters with pitchforks in the street.

Let's cash in from Old Faithful at Yellowstone Nat'l Park!

Now I admit, I am uncomfortable opening up monuments to development and energy exploration.  Parks and monuments are finite and I fear inexorable mission creep if we have a permissive stance in reducing their size.  But I admit, that my misgivings do not constitute a legal argument.  Keep in mind that Utah is not forced to develop these newly released lands.  If they wish to keep them unmolested, they are free to do so.

Perhaps, we should be looking to generate revenue from governmental protected sites?  This could amass cash that could be used for social programs, conservation efforts or even to provide Americans with tax relief.

As a pilot program, I suggest that the Bright Angel and South Kaibab Trails that descend to the base of the Grand Canyon be monetized.   At each mile marker, hungry and thirsty hikers would encounter Starbucks, Five Guys, a Home Depot Annex, Verizon Customer Service, a Lemonade and Smoothie Stand, Sushi Bar, an Army Recruiting Station, FedEx and Whole Foods.   Of course, these goods and services would not in any way detract from the hiking adventure.  If a visitor does not wish to engage in a commercial transaction, then he can simply walk on by.   But, should we deprive a hiker who wants to satisfy an urge for a Frappacino?

This strategy truly gets airborne when it is applied to all of our national parks and monuments.  If Teddy Roosevelt knew of this plan, would he call out ‘Bully!’ or just ‘Bull’!?

Sunday, December 3, 2017

Does Patient Autonomy Improve Health?

It used to be that doctors knew best.  We told you what to do and you obediently complied.  The world has changed and the paternalistic system of yore has given way to the shared decision model where patient autonomy is respected.  

The Old Way:  “Well, I’ll be setting you up for surgery soon.”

The New & Improved Way: “Let’s discuss all of the reasonable options with their respective advantages and drawbacks.  Then, you make the call.”

To paraphrase the mantra of Fox News:  Doctors Report – You decide!

Has our current fidelity to patient autonomy improved medical outcomes?  I have no idea.  It has certainly changed patient’s (and our) experience, but I do not know if it has improved patients’ health.   I wonder if doctors and patients who have experienced both systems believe that the current system have improved medical outcomes.

Has anyone measured if the new system is better?

Not every patient wants this level of authority.  I cannot count how often patients have asked me over the years to make the medical decision for them – which I do.  There is an argument that the professional is better equipped to make the right medical choice; but the question is who has the right to make that choice. 

My point is not for us to return to our prior paternalistic pattern, but only to pause and consider if patients have benefited under current norms as much as many believe.

I am certain that attorneys and various consultants can relate to this issue very well.  Lawyers today, for example, generally don’t dictate an edict, but present clients with a range of options depending upon cost, risk and tolerance of legal exposure and the facts.

Why not extrapolate to the next level?   Let the patient make any medical choice he desires despite our medical misgivings.  If a patient, for example, wants a colonoscopy, antibiotics, a heart catheterization or removal of the gallbladder – and they are fully informed of the risks and benefits – why should medical professionals obstruct them?  Doesn’t the patient come first?   

Isn't this how the marketplace works?  Customers buy what they want, not necessarily what they need.   Should I be prevented from buying a premium vacuum cleaner if my current one is adequate?  If I want a contractor to do some remodeling which makes no aesthetic or functional sense, should he turn the job down?  

Yes, you might argue that medical care is different than buying an appliance.   But, if we doctors can refuse an informed patient's request, then aren't we returning to the Era of Paternalism that we claim to have abandoned?