Home Forums Discussions Problems DEEP THOUGHHTS by Walter Handy

Good catch Gene. I added an extra in case I needed another one later, lol.

What the h?

Further evidence of the relative slowness of the board lately....

I like the slowness of the board. I can lift the ban and allow Andrechuk back in.

I can picture in my mind a world without war, a world without hate.
And I can picture us attacking that world, because they'd never expect it.

Walter asked for a new name to his blog. I thought this was pretty good.

Sandeep,
That is one impressive computer set up.
How do you do those floating screens?

Something I have thought about often but have wondered what others think--does pure randomness and fate necessarily have to be mutually exclusive???

I love the one with extra h even more.

I am trying to escape my reality... , live long and prosper is also my goal.

Even my job is one of the best, deep thinking can rejuvenate a simple mindset. Your guess that I am that cheap by all those whining about expenses this and that, definitely Walter is obsessed with the big M... wrong, my financial is .. somewhat secured.

I told you I have enough social security benefits, 2500 bucks a month forever from our big uncle if something happened not including a large term body and soul warranty lump sump.

Nine dollars an hour from my part time teaching job, .. Walter lying, of course I did tell you that people lying lot more when they text. At public university system, 35.00 an hour for adjuncts, much different then full time teaching, 70 K to 150 K a year, much less than med doc salary unless you are a Nobel candidate. Should have studied harder to go to med school...

Need to spend 4 hours to get that 35.00 an hour. One hour teaching, one hour grading, reading much deeper thought papers and wondering why those kids much smarter than their teacher, one hour answering email explaining why a F but not an A, one hour travel, so 35 divided by 4 . I love to give out Cs instead. An old story, was that FedEx founder, correct me if I am wrong, he got a C from his Hub based idea of delivering packages while in college. Oh another historic figure got a C too. The more Cs I give, the more chance one of my students becomes rich and famous. Then my name would be mentioned.

Was it long time ago? I joined the board to seek help for my doc who needs more life, then our Hockeyref suggested professional help for someone that mental working thru the night... I completely concurred to his ideas.

But sink visits might cost more than what she is able to charge for an exhaustive, difficult level 4 care. For our vacation, we did ask friends to cover, and the visiting honorary fees is not that low. Whining again, solo doc world is tough since you have to pay to take your vacation, doc is to blame herself by not having practice partner. Talk to Gene or David how they do it for long. We need more locums also. Do you know that on the latest med journal, 23 percents or something now working part time compared to 15 percent couple years back. So only solution for work life balance is working less and have more fun.

Don't bother to look at those David's Bugatti, too expensive, even the 2012 Jag for sale soon.Yesteday, I received Jag invitation to attend a private professional instructed driving session. Beautiful car, 5 liter engine, 0 to 60 in a little over 4 secs. I tempted to throw that to the trash but then put it on my kitchen counter. My high end car paid off but boring looking now.... means I am not that rich yet because billionaires driving cheap cars, only millionaires driving fancy cars....

With double Hs, we have to think deep, is that H intentionally added or mistyped? Think hard before post as Bert might ban you. On my first pages, not blogging then, my admire for Bert was that no one could do what he does, to look after our little love ones full time and responses to all asking for help, he is that amazingly capable... so that H must be deep....

At least someone loves me. Does a Lexus 2013 GS 350 count. Hey, it parallel parks by itself.

Thanks. Ergotron LX Arms. They can move almost anywhere.

Our trusted 'office manager' who left us abruptly to work on her new business leaving behind mos of data not entered or misplaced . Medicare/Medicaid/Ins1/Ins2/Copay/NotPay.... is not something we could depend on newer employees. A long term relationship no longer working causes pain and suffering.... Need a good humanware backup.

Walter,

Not making light of your situation and trying to find a positive spin on your situation, but from your description --if your office manager left abruptly (i am assuming no 2 week notice) and also had months of data misplaced or not entered may have given you an opportunity to fill her position with someone more responsible. Also no need to pay for unemployment.
When this situation has occurred, in my 18 years of practice, at first seems formidable often times in retrospect has been an opportunity for a change for the better.

Walter,

I don't want to kick you when you're down, but Adam and I have an extremely good Practice Consultant. By that, I mean she manages seven practices. She knows all the medical laws and everything else. But, she mainly knows billing. This is not a lie: If my biller went two days without a deposit, she would be mailing her, emailing her, texting her and talking to her. There is no way we would be months behind. You have to meet payroll, and you have to have cash flow.

Thanks Jimmie, Bert for your uplifting kicks

My doc not cut out to work solo, my latest assessment! She is worry about almost everything... Male mentality is different. I think 50% of the time I speak for her instead. An old psyche paper saying that opposites attract is just a myth, people do pick their partners with similar interests, might not be applied to us. We are indeed vastly different...

Even last year when I was complaining about high 6% billing outsource, we haven't done anything about it then. The fee tickets uploaded regularly to our biiling company, so our cash flow is fine. Only AC accounting data lacking, also missing EOBs.

She graduated more than 20 years ago but mostly a worker doc, flying solo less than 4 years, currently passed her prime. Natural process is not something to celebrate about, feeling so tired after a single sleepless night or need to write down a list...

Automated medical technology are ready, only things to hold it back are job security and alien forces. Look at the old Harrision internal med book not too long ago, not much data in there at all. Most medical software are smaller sizes too.

Educate me if I am wrong, I feel that only 4 needed steps for docs to give a proper diagnose: vital signs, overall assessments, abnormal symptoms, body fluids/tissues compositions. A medical booth could do all of those with the need for remote support of all specialty docs. 10 docs employed by a medical center working in a med call center responsible for 20 medical booths, working 30 hours a week. Much less support staff compared to a typical drone support of 180, CNN?. Much better than the current solo doc environment, 60 to 80 hours work week and day and night stress. Same high salary without the defensive treatment worry. Computer brains doing all preliminary diagnoses, docs just looking at the result output and click ok.

I kept nagging her, a happy life is more important. She should consider join a 'nice' group to work less instead of flying solo. They said less than 100K would bring about the most happiness... Haha at one time, she worked for a nice doc, might be not as cheap as Bert former employer who made his employees to write a three character word instead of four to save on toner, a person that frugal exists? Occasionally she has seen more than 30 patients in the morning... that doc is still doing papers...

Walter,

Happiness is reading the Roald Dahl novel Matilda with your nine year old daughter--life for an instant is magical.

Walter,

That is a tough and stressful spot. I've been there, and lived to tell the tale.

Let me encourage you to not lose sight of why your spouse/doctor is doing what she does. Her practice goal is not to "maximize throughput"; it is to be the best physician she can be as she sees it. She is a physician, not an investment banker or an accountant, and there is a lifetime of training and honor guiding her every decision. jimmie, or Leslie, or I might visit your practice and say " why are you doing this part this way? You could make your life easier, if only..." But, for her that would not be true. For example after what seemed a lifetime of dealing with emergencies and ICU patients in addition to an outpatient practice, my spouse/partner and I decided about several years ago that we were either going to retire or find a way out of hospital work, night and weekend call. The answer was to support a group who became hospitalists. We gave up ER and inpatient care without a second thought. But there are some local physicians for whom inpatient care is so much a part of their image as a doctor that they could never do that. They had to find their own way, or eventually change their view or retire.

We survived medical training because we saw it gave us something unique and precious. It is also very fragile. I do not think it survives well when forced to be "efficient".

I know of no other field where you will practically sell your soul to get in. One would do ANYTHING to get into medical school. Read Flowers Manuals 30 times. Take out thousands of dollars worth of loans. It was about the happiest day of my life when I got in. It was one of the saddest days when I realized what life would be like as an attending.

I still remember the day when the Dean personally called and asked if I would like to attend medical school. Like you Bert, one of the happiest days of my life too.
I agree with you David too, this profession is very fragile, and even 18 years into my career I still have to pinch myself when people not only listen to me but keep coming back to see me.
Maybe its because there is a nationwide shortage of primary care docs, and my patients are stuck with me, but I still feel enormously grateful to have been given this opportunity.
When I was engaged to be married, my sister gave me a book called the 5 love languages--one of the languages of expressing love is acts of service, and I suspect Walter this may be what drives your wife to the point of exhaustion, by showing her appreciation to her patients and obviously by your writings they recompense her by coming back for more.
Walter, one other thing you need, in my opinion, to diagnose, is good old fashioned horse sense, to tie the 4 steps you mentioned together. But being face to face with a patient and picking up on body language, nonverbal cues, sound, and actually examining and touching someone really aid in the ability to diagnose and trying to do diagnose via a medical booth over a computer screen would vastly impair one's horse sense.

I really wish I could experience this nationwide shortage. I believe there is a shortage in FP, but there seems to be none in pediatrics.

Jimmie country man at heart and his love for animals still with him...most caring and sentimental doc of the month.

David been preaching ...go rural where people still depend on each others and patients love you more, a basket full of veggies and eggs would be ok in exchange for copay.

'Kill my day' patients more frequent visits in our clinic. ... Docs could make same kind of money with lesser stress practicing rural but to many we could not stand such simplicity lifestyles. I just saw Imax 3D Avengers and going to see Battleships probably tomorrow. Sneaking out of office for couple hours might seem a good young fun. ....Working solo has its advantages.. ever try to block out half a day to enjoy playing golf alone... my doc would never do that, patients to care for priority one or to improve practice revenues, saving college funds ...

My visual of medicine practice using med booths to accommodate newer rules based practice plus lacking of courteous attitude. People changes for the worse so the passion of care should become the techno of body fixing, programming medicine might be more effective in treating difficult patients and create lesser stress on docs. Detachment is key to survive emotionally. Doc could refer ready to let go patients to medical booth and practice best medicine on his others. Patient could also do same. Same as ATM services. Quick and efficient.

Everyone has their reasons for how and where they practice - being solo has some great things, but unfortunately many of us who do this sacrifice many things to do that - missing family outings, working late at night, going to costco to pick up paper towels on their day off. Everyone has to learn to prioritize and stuff as much things in days off as possible - on my restful 3 days off I went with my kids to a buffet dinner out of town (seafood), went to the Tacoma Zoo, went to a minor league Tacoma Rainiers game (they won), went to our Pacific Science Center followed by Avengers Imax 3d and tomorrow will find something to do on the way home so on Tuesday I can hit the ground running.....Although our town rolls up the sidewalks at 9 you can still find ways to be entertained. Good luck and enjoy Battleship - although I was thinking Men In Black 3......

Not to be side track here but BERT, who is this: "Andrechuk"????

Is he just some big hockey fan from either Buffalo or Florida or do we simply have someone in the group with the same very unique name???? Or has Dave Andrechuk entered the practice of medicine post Professional Hockey at the Stanley Cup Championship level???? Or does he have and support a spouse like person like some of us here like yours truly over here???

I gotta say I really did like all the "Chuks" that were on the same team at once back in those days up here in Buffalo... Nancy used to call them "The Buffalo Chuks" there were so many guys with the same ending in their names it was pretty funny.... Dave Andrechuk, Clint Malarchuk, Howerchuk (spelling not sure of) I beleive even Eddie Olchuk might have been a part of that version of the team. I swear there was a 4th "Chuk" on that team back then....

But yes Medicine is a calling, and an art and no two artists are alike and it is more than "thru put" as it is a human relationship kind of art as well... Don't you talk to your hair stylist person and other people who you have a relationship with who work with yours and your family members bodies, minds souls???? So much sucks about this business and the most important part is to remember that the AMA and CMS have been in bed together via the RUC for at least 20 years colluding against primary care and other Office Visit, Cognitive Specialties in support of the weath and unfair advantage and gains of the Procedure based specialties.... What we need is Serious Increases with no extra crap tied to it, in Fee Structures in support of Primary Care so docs can slow down and do the great job that they are capable of doing if only given half the chance and the time and support with which to do it....

Gotta run but I have a new and interesting twist on this I want to throw out here, perhaps on this or another thread... Let me get my kids now....

Paul

http://amazingcharts.com/ub/ubbthreads.php/topics/44167/Ban#Post44167

Paul- where have you been???????

Gene

I believe the "shortage" is only as real as the dollars that drive it.
This whole house of cards is about to get blown over, and we will soon see how many neurosurgeons and gastroenterologists and cardiologists we really need.

People can't afford medical care any more, the employers are increasingly unable to pay for the "insurance" (Mafioso protection racket is more like it) and the government is apparently so broke they can't even afford printing presses to make more money!

Gene,
Obviously (I think anyway...) I've been busy with life especially, kids, coaching hockey, our practice (uugghhh!!!) and mostly my own self in terms of attempting to get my "Me" back. Life got especially rough, with similar over exposure to different "traumatising" things, no other way to put it but pretty much a triple exposure, one super bad daily like for 3/4's of a year, and two others concurrent on and off for a year or two.... two I speak of publically with little hesitation while the other is deeply personal and only a select few folks know some or much of the details.... Nothing physical I wasn't jumped or attacked nor was I in a war zone thank goodness, but none the less it really is basically PTSD and it has kicked the [censored] out of me like almost nothing else could have....

And is this gift that keeps giving too in many ways both in my not doing what I need to for my life, our lives business wise and family wise at times, as well as I have developed at least one all too real physical aliment that was not present only 3 years ago. Yes it may be genetic to some extent but I seriously doubt it would have been "Triggered" had it not been for the horrible experiences and the constant emotional termoil.... I now have UC, Ulcerative Colitis that at first was more than a bit treatment resistant but is finally coming around quite nicely with access to a better, Generic in Canada for years, only this year here in the states Medicine.... Endocort EC, Budesinide EC, 3 mgs capsules, times 3 daily.... Properly time released Steroids right in the large intestine right where you need it with only 9-21% absorbtion into the main bloodstream, so very little if any steroid side effects like the predisone I am finally weening down from very slowly.... Really Bad Headaches and respritory side effects in allergy season like mad.... Symbacort for the lungs and Spray up the Schnoz... But my gut feels great most days now and no bleeding at all for like 8 months or more too....

I strongly recommend this Med to all of you who treat folks with UC as it puts the steroid RIGHT where it is needed, at the Illium and ready to head downstream to coat the inside of the entire large intestine... And all without having them do what has happened to me and my body the last 10 months or so because the salizides and I don't agree with one another.... It is a blessing. Our fairly new Crestor Rep told me about it going generic as we started to gab about other things one day.... She has a Liver Auto Immune problem and she takes the stuff too.... As it gets taken up by the Liver, and right out it goes... So it is the perfectly delivered oral med for UC and Liver problems that would benefit from a steriod treatment it seems.... I have read about many cases that eventually were able to tapper down to one or two pills only once or twice a week, one a week or even completely off of it with long stretches of remission, so fingers crossed here.... And I am taking a good amount of (billions of litte boogers per dose) some of the better shown to help Probiotics too... 30 Billion of the stinkers daily and since bumping up to the 30 from about 10-13 again another level of interesting improvement too... Almost frighteningly normal... I almost am affraid to Jinx myself after the last couple of years I have had.... Like there is light at the end of the tunnel here finally...

So my FP and Nancy both agree that the predisone probably has a good amount to do with my feeling so weird and bad for so long and that weening down ain't no picnic either.... So it is hard to know what is the whole Steroid trip thing, verses what is the former problem being sticky and resistant as well... So my FP and I agree that I need to do the weening down first to see how I feel and am after all of that is over and done with the steroids....

So is that enough garbage for ya???? I'm sorry to spew but it just sort of was there and came on out of my talkative fingers....

Yes but it still doesn't answer was it Dave Andrechuk or not???? That would be too cool regardless of the crap he was throwing around... Or even better still, Great Hockey Gossip ya know....

"Hey guess what Dave Andrecuck is now Dr. Andrechuk and boy what a flippin Piehole he is with his fellow doctors...."

It would be truly weird and amazing.... Ya can't make this stuff up sometimes...

Paul

Walter--thanks for the compliment!! But the organic farmers out there would like to throttle me with my characterization of them in another thread.
Paul--thanks for opening up about your problems and the excellent advice about the treatment of UC--hang in there.
Steven--appreciate your feedback on the perspective on solo practice--we had a few inches of snow here on the weekend so my daughter wanted to make an igloo--we got about 1/2 way done but couldn't quite get a roof on, then I felt for the first time snuff box arthritis in my right thumb the next day--uughgghghh

Jimmie,
You're welcome and thanks for being pleasant and accepting and the like too... But It still Doesn't answer the "Chuk" question for me, us now does it. Anybody out there know this one? Who was this guy? A Sabres, Lightning Fan or the real deal or even another guy with the same interesting family name?

BTW, as a not so medical person in this AC Community your mentioned something interesting in passing that I would love an explaination of: What is "Snuff Box" arthritis of the thumb? I ask because at times I wonder if this old guitar player and hockey stick holder might be experiencing something similar now that I too have recently crossed over the great 50 divide, in the game of life... (Mongo just pawn in game of life....) Thanks much...

Paul

Paul,
First (and most important), sorry to hear about your recent IBD diagnosis, but glad that you seem to be making some progress. I am sure many others here can vouch for the potential physical and psychological side effects of steroids. Hopefully budesonide will enable you to avoid many of them.

I can't help much with the "snuff box arthritis" (though I remember a bit about the anatomy of the snuff box; some of the old terms stick with you forever). I will leave the arthritis help to others. But hey, those steroids will probably help with that, too! Do keep in mind that there is sometimes reactive arthritis associated with ulcerative colitis.

As to Andrechuk, I think you will find the news to be disappointing. I believe that the guy who was here is a podiatrist in California, and Andrechuk is a contraction of his first and last name. So he is not the true Andrechuk that you are hoping for. On the other hand, just before his departure, he did reveal himself to be a Flyers fan, so I suspect that his name choice was not entirely accidental.

Yes I saw that Flyers Logo and reply just this evening as a matter of fact. And NOW it all makes sense. To anybody who doubted that he may have been rude, offensive, inappropriate and in need of a Match Penalty, Game Misconduct like penalty, this entire "Flyers Fan" thing speaks louder than a thousand words to any true NHL hockey fan.

You see the Filth-adelphia Flyers have been known since the early to mid 1970's as the dirtest and rudest, most head hunting, intent to injury and cheapshot team in the league, nick named "The Broad Street Bullies"; I kid you not. Google Andre "Moose" Dupont, Dave Schultz, Bobby Clarke, and their coaches from those times too... Philly is the worst rink in the league for an oppenent and not because they are simply loud and supportive, they are the poster child for obnoxious, rude, even prejugdice, literally Collisum like Blood Thirsty fans. And the managment has for years been drafting and imposing a will of not simply strong and hard work hockey but cheap and dirty, Bully and Intimate hockey too.

Any of us other normal hockey fans of almost any other team in the league find it hard to really understand the mindset of the average Philly fan or players. It never cessess to amaze me when time and time again they start trading around for more goons and more knuckle men, which then keeps us east coast teams at a competitive disadvantage because we too always feel a need to have at least one or two halfway skating Defenders and Fighers, Goons ourselves to protect ourselves and go toe to toe with the kind of teams that the Flyers have continued to try and put together for at least 30 years now.... Meanwhile because there is so little East West Play during the regular season, the West Coast teams although the appreciate size and strength in their athletes, they are usually drafting more for speed, fleet footed and creative play makers who can outskate and out create and out think their oppenents. And come playoff time if you don't have a super well stocked team with guys who are some how Both or so good at shutting down the other teams speed and skill, we east coasters are at a disadvantage....

It's not so bad as it used to be pre- "New Standard" (going back to calling the fouls the way the book was truly written and enforced most of its history) but to this day, east coast teams rinks don't have as good ice that bounces more, is slower and harder to skate on, making for more mucking around in the corners and boards, less sharp at speed passing no less against the grain and reverse passes, give and goes and the like.... Watch LA and NJ tomorrow night in NJ and watch how much the puck bounces and how normal or slow the game appears... and then watch the next two games out in LA where I bet their guys are gearing up to have super dry cool air which leads to better faster smoother, stronger ice, and you will finally see the LA Kings Dissect the NJ Devils with their skill and speed no less creativity.... And it's not like the guys on the Devils can't skate and creat themselves either... But LA is just that impressive and unbelieveable at times to watch....

I bet the NJ crew might have even intentionally turned down their chillers a bit and perhaps their brand new rinks AC and De-humidifiers to try and slow down the ice a bit to give the more muck and grind home team Devils a bit of an advantage on home ice.... The Kings literally Dissecced their first 3 rounds of opponents, coming into the play-offs in last, 8th place seeding and then destroying and making it look all too easy how they dispacted with the first two, 1st and 2nd places teams in the West and even the Coyotes didn't last too long either as the 3rd place team. As of right now they have a perfect road record this run, 9 games on the road with 9 wins to show for it... Amazing!

In the words of JD, the Rangers retired goalie and long time TV color man before snagging the job as the St Louis Blues GM:

"Oooooooh Baby!!! Now That's Hockey!!!"

Paul,

I am almost to the 50 year mark myself. After spending a decade in the wild and wonderful hills of West Virginia got all too familiar with tobacco products, especially snuff. Now as I recall there are different types of snuff, and the chewing type like Skoal or Copenhagen is different than the fine powdered snuff that the ladies of the 18-19th century would snort into their nasal passages. And thanks to Bert with the anatomy of the snuff box delineates how a nice pocket is formed if one extends the thumb outward by holding the hand palm down. This "snuff box" would hold the finely powdered tobacco as it was poured from the tobacco tin into this anatomic depression and then held to the nose and snorted.
It so happens that the 1st metacarpal bone adjoins to one of the wrist bones in the same location and is one of the most common sites of osteoarthritis of the hands, and thus the term snuff box tenderness or arthritis developed. And I defer to Jon about the reactive arthritis associated with inflammatory bowel disease, which I think is an excellent possibility as well.
I did not know the answer to your question about Andrechuck, I had voiced my opinion on another thread giving Bert my support thinking how I would have handled the situation if I was in his place.
And talking of other threads, the one you wrote about the AC get together and your analysis is nothing short of brilliant--I have to agree with Bert you may have to step it up to another level.

Jimmie,
Thanks for the nice words. BTW, I was wondering if it had something to do with this pocket area that used to be used for sniffing the snuff (snuff said???). And if you have some hand strength or played guitar or drums there is a muscle just above that pocketed area that we used to refer to as "The Drummer's Muscle". Our old friend who used to drum for us a lifetime ago now, used to have two very strong buldges there and even we as a bassist (Nancy) and guitarist (me) used to have some interesting amount of strength there from squeezing and running the neck and either hammering plucking the bass or using my small jazz picks for picking and squeezing in on those too....

Anyway, I have this discomfort, pain sort of on the back but a bit on the side facing the other fingers that seemed to be especially noticable this year in the cold winter and rinks. It's almost not noticable now in the warmer weather unless I expose it to some cold at a rink or with the AC Vents pointed at my face in the warm weather while holding the steering wheel driving for a long while, longer drive....

So I was sort of caught by this term as it sort of would be part of this Snuff Box area created by the thumb, forefinger and that side of the hand, its webbing might we say.... And it does seem to be a bit more when attempting to make the thumb pull in and clamp as opposed to a more straight down wrapping... I figured it was just age and time catching up with me for years of hard work with my hands as a mover, shadetree mechanice, guitar player and hockey stick holder and player since I was a kid on almost all of that.... Pretty Interesting and very accurate name there....

Thanks again and Good Night.

Paul

Well, jimmie, as we welcome Paul back, you will soon see that he is well known for his long and well written posts. Problem is he generally writes them late and long, and we/I never get through them.
I truly think that if the posts were measured by length and not by number, I would be far behind Paul.

And, Paul, you should know that is is also well known that Jimmie is the nicest user on the board. Would definitely be one of my top five I would want to meet at a user conference.

Bert,

Thank you for the compliment. Growing up small and not terribly strong or quick witted, I had to adapt, even though it is against my nature, I had to evolve into becoming nicer in order to survive. My wife and I are planning on going to the user conference, so hopefully can meet you as well. I figure I better drag her along so she can be my interpreter with all the software/hardware lingo.

Paul,

Sounds like the twins Arthur and Itis are plaguing your snuff box.

Paul, welcome back. You've been (and are going through) a very rough time. Glad to hear that some issues are starting to be resolved. Hang in there guy.

To see Buy WOW Gold or Buy RS Gold world in a granda of stand.And a heaven in a wild flower.Hold infinity in the palm your hand and eternity in an hour.

Bert,
Looks like somebody doudou'd on the boards