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7 months and 11 days

February 18, 2013

Part of the joy of medicine is the intellectual challenges brought about by continuing education in which  doctors discuss changes, medical advances, and discard old  practices that have outlived their usefulness or been replaced in the name of progress.  I’ve done this by going to conferences, reading, and getting together with fellow local doctors to discuss medical articles.  Its been a while since I’ve been able to go to “journal club” but last week we had our informal get together over beer and pizza and discussed some recent articles in some of the leading medical journals interspersed with analyzing the woes of modern medicine and life in general.  I’ve always enjoyed learning new things, analyzing data, and thereby do the best I can for my patients.  We live in an age where many of our core medical beliefs and established practices are being brought into question.  The skeptic in me loves the questioning and dethroning of myths and dogma.

Unfortunately, in the name of cost effectiveness and improvement in medical care, we are witnessing changes across the country and here in Santa Cruz which are a bit unnerving.  Changes are being instituted in medical policy and care without first having good evidence that indeed they will accomplish their goals.  For a drug to get FDA approval, it has to go through several trials to show safety and effectiveness.  Policy changes should do the same.  We call this “demonstration projects”.  This is where we take a population of people or an area and see if an idea works over time.  Recently the federal government has set up metrics that they believe will benefit the public and they’re adding a financial reward if doctors follow the protocol.  For example,  one of the “pay for performance” practices is telling doctors how frequently mammograms for women should be done.  The problem is that there is no consensus.  We don’t really  know the answer to that question.  It might be wise to test the hypothesis out in a group of women or in various cities to see if mortality really does go down.  Many studies have suggested that we’re spending money and not getting the results.  The other thing I don’t like about “pay for performance” is that there is a subtle push for large medical group bureaucrats and doctors to start looking at medicine from a financial reward perspective instead of from a healing arts perspective.  Sort of like in education where teachers are “teaching to the test”.

OK, enough pontificating.  I’ve been fighting a chest cough for a while and a couple of days ago I called Stanford.  It’s impossible to call Stanford or COH and not have them go to defcon 5.  So I had a nasal swab for respiratory viruses like influenza and RSV etc… at the local hospital and the results were negative, that’s good.  It just doesn’t take much to tip me over.  I just have to keep a low profile and be patient.  I’m hoping to have an informal get together in May at some restaurant and visit with anybody who can drop by after the flu season runs its course and I get the OK from COH and Stanford.  We’ll see how things go.  Next week I go to COH for another bone marrow biopsy.


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  1. Holly Bengtson permalink

    You are THE BEST!!! All the medical policy changes stuff makes me feel helpless and simultaneously nauseous. I LOVED the defcon 5 reference when u call Stanford or COH hahaha. A few yrs after my BMT I went to ETC w/a little fever. Had chest X-ray and MD on-call said, “well, I think I’m going to admit u…..”. I had a complete meltdown, “NOOOOOOOOOOOOOOOOOOOOO!” haha. Can’t wait to c u when u come down. Hey! The BMT Reunion is May 10(Fri). You HAVE to come. It’s AWESOME!!!!!! Thanks for post! You are really doing great!!!!!! Holly

  2. Chip Goldeen permalink

    Good luck next week!


  3. Loren permalink

    Hope that you can soon return to journal discussions. One thing I miss in retirement is not receiving journals and reading them before placing them in the physician’s library. Hearing a variety of viewpoints would excite me.

    I’ve been recovering from some mean virus for about 3 weeks of croup. The croup, as you undoubtedly know, is something like a fierce fat lab mama dog signaling you away from her pups from somewhere far within; a cough is more like one of the chattering classes trying not to further disturb Wait Wait Don’t Tell Me.

    Thinking of you, Jim.


  4. Dave Pfaff permalink

    Hi Jim,
    I have been following your messages, and continue to have you in my thoughts and prayers. I would love to visit with you anytime, let me know when.



  5. alexis permalink

    continue to do your best! you are doing incredible with your recovery

    can’t wait to see you in april for sammy’s wedding


  6. Ron and Merrilyn Marker permalink

    I love your “pontificating” and we are always to pleased to hear from you. We think of you often.
    Ron and Merrilyn

  7. marc yellin permalink

    hola amigo….good to hear you are getting out more. I am still waiting to visit with you. Just let me know when it is OK to do so. Stay strong and happy and maybe you too will get that Ferrari!

  8. Linda Bobbitt permalink

    So good to hear that you are doing well. Keep up the good work so you can come back to us as soon as posible. We miss you so much. Just take care of yourself so you don’t get any of these bugs that are going around. We continue to pray for you and will keep doing so until you come back that is if you want to come back after all this time. But you better or we will come find you. All our Love, Dennis and Linda

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