THE DOCTOR BLOGGER

Doctor Blogger--Why My Absence

DrRima Bishara — Sat, 22 Nov 2008 17:24:00 GMT

There are some months that seem to bring challenge after challenge to a doctor's office.
Last month was one of those. We began with one of the doctors getting sick on a Monday
with nausea, vomiting, and diarrhea. We were certain that it was related to some food.
It was awful, of course. Everyone nursed him along to get through the week. Everyone
was glad to get to the end of the week.

On Monday, the second doctor came to work and felt somewhat tired but OK to work. On
the first appointment of the day, she began feeling hot, flushed, and faint. In the middle of
the first patient visit, she had to sit down quickly to keep from actually fainting. This scared
both the patient and the nurse. After finishing the visit, the doctor went to the restroom to
find that overwhelming nausea and vomiting had pretty much neutralized her effectiveness.

One of the nurses had gone home early on Friday for an event with her daughter and noted
that she had spent most of the weekend sick with nausea, vomiting, and diarrhea. She was
convinced it was from food she had eaten on Thursday until now--didn't sound like anything
caused by food at this point.

Mid morning, an front office staff member announced she was feeling nauseous and faint.
She left at lunch for home.

A Second staff member announced she was not nauseated but was feeling bloated and
over full. She made it through the day only to find herself nauseated, vomiting and having
diarrhea over night.

By the end of Tuesday, everyone in the office, doctors, office staff, nurses, had been affected by
"the bug". Needless to say, it was a rough week for the office and our patients in addition.

We did our best, washed hands more diligently than even daily hand washing, and kept
ourselves hydrated as well as we could.

The week was nearly a total loss other than needed medical care. Chart work piled up,
paperwork went un-done. Patients got cared for and nearly everything else got put off.

From my heart to yours: if this hits you, assume it is a "bug" before you assume it is
from food. One is contagious, one is not. Do everything you can to prevent transmission
including hand washing, alcohol surfaces, bleach appropriate areas, and eat healthy.

If anyone out there thinks that doctors don't get sick or that doctor's offices are somehow
immune to contagion, think again. It took the office a couple of weeks to dig out of the
work that piled up during that pitiful week.

Doctor Blogger--Carbon Monoxide in the Cold

DrRima Bishara — Tue, 18 Nov 2008 17:18:00 GMT

Poison Control Centers Warn of Cold Weather Dangers from Carbon Monoxide

(Alexandria, VA): The onset of cold weather greatly increases the chances for exposure
to poisonous carbon monoxide (CO) gas as consumers increase their use of appliances
such as space heaters and portable generators, warns the American Association of Poison
Control Centers (AAPCC). Every year, hundreds of deaths and many thousands of illnesses
result from exposure to CO.

Among the numerous potential sources of CO are furnaces, water heaters, stoves, ovens,
space heaters, wood and gas fireplaces, wood-burning stoves, portable generators and
automobile engines.

"All fuel powered engines produce CO gas," explains AAPCC Board Member Edward P.
Krenzelok, PharmD, director of the Pittsburgh Poison Center. "Although such devices are
safe if used correctly, a malfunction or improper ventilation can make these common
household appliances deadly."

Carbon monoxide gas is lethal, even though it is colorless, odorless, and tasteless. It
may kill quickly or slowly, and the warning signs specific to carbon monoxide are also
common to the flu and food poisoning. Even when it is not fatal, carbon monoxide can
cause permanent damage to the brain and other parts of the nervous system. Symptoms
include aches, dizziness, headache, confusion, and other symptoms also found with flu
and typical cold-weather viruses.

AAPCC suggest taking some simple steps to prevent carbon monoxide poisoning:

·   Have all of your combustion appliances and especially your furnace inspected and
adjusted before every heating season.

·   Have your chimney, fireplace, and wood stoves, and flues inspected before every
heating season.

·   Have chimneys and flues repaired as needed.

·   Do not use charcoal grills indoors for cooking or heating.

·   Do not use your oven for heating your home.

·   Do not leave your car’s engine running in an enclosed or attached garage, even if
the door is open.

·   Install a carbon monoxide alarm outside of every sleeping area in your home.

Poison control centers around the country are prepared to respond with information and
treatment advice about CO poisoning. To reach a local poison center call 1-800-222-1222.
More information about CO poisoning may be found on the AAPCC’s Website at
http://www.aapcc.org.

Doctor Blogger--Believe While Others....

DrRima Bishara — Sun, 16 Nov 2008 17:07:00 GMT

Believe while others ..
By William Arthur Ward

Believe while others are doubting.

Plan while others are playing.

Study while others are sleeping.

Decide while others are delaying.

Prepare while others are daydreaming.

Begin while others are procrastinating.

Work while others are wishing.

Save while others are wasting.

Listen while others are talking.

Smile while others are frowning.

Commend while others are criticizing.

Persist while others are quitting.

Doctor Blogger--What They Are Saying About Chronic Disease

DrRima Bishara — Sun, 05 Oct 2008 22:40:00 GMT

Partnership to Fight Chronic Disease ( www.fightchronicdisease.org
sponsored a conference call Tuesday and below is the response from
The LA Times.

Healthcare System: the next financial meltdown?

http://latimesblogs.latimes.com/booster_shots/2008/09/health-care-sys.html

When Tommy Thompson scans the horizon, here's what he sees.
"The next catastrophe." Thompson is former secretary of Health and Human
Services under President George W. Bush, former governor of Wisconsin, and
former Republican presidential candidate. He held a conference call with
Kenneth Thorpe, former deputy assistant secretary of policy at HHS under
President Bill Clinton and now executive director of the Partnership to Fight Chronic Disease. "Healthcare has the potential of being the next calamity,"
Thompson said.

They're looking for bipartisan solutions to the healthcare mess, the main
solution being to prevent chronic diseases such as diabetes, heart disease
and obesity in a U.S. population that is seeing epidemics in all three.

Those conditions stay with a person for a long time -- or until death -- once
they hit, and chronic diseases eat up 75% of all healthcare costs. That's
three-quarters of the total $2.2 trillion spent on healthcare in the United
States. That comes to $1.65 trillion, if my online calculator serves me correctly.

That's more than two Wall Street bailouts.

America can't wait for another segment of the economy to collapse before
doing something about it, they said. "There's some concern that given the
current state of the economy, taking on healthcare might be too much,
too big," said Thorpe. "I would argue the opposite. Failure to act on the issue
of making healthcare more affordable is a recipe for disaster. This issue is too
important to ignore. As wages slow down and the deficits rise, we've got to
find places in the public budgets and in the private sector to make healthcare
affordable for families and businesses."

They suggest some major redesigns of the system, including the efficiency
of electronic medical records (which Thompson says should be government
funded to speed up their implementation) and a team approach, using nurses,
nurse practitioners and physician assistants, to prevent and control chronic
illnesses.

It's too big an issue, they said, to be anything but bipartisan.

-- Susan Brink

Doctor Blog--Fighting Chronic Illness--The Key to Health Costs

DrRima Bishara — Fri, 03 Oct 2008 22:05:00 GMT

Former Secretary for US Department of Health and Human Services, Tommy Thompson,
published this article as an editorial in the Milwaukee Journal Sentinel.
http://www.jsonline.com/story/index.aspx?id=799679
There is a lot to agree with and think about.

Fighting chronic illness is key to health costs

By TOMMY THOMPSON

Posted: Sept. 27, 2008

These days, trouble on Wall Street and the housing crisis have Congress and the
presidential candidates scrambling for answers to fix our faltering economy.
However, there is one unexpected long-term option that can help our stalling
economy — reforming our health care system through enhanced prevention and
wellness.

Time has shown us the impact that health care costs have on our nation's economy.
Our health care bill has grown faster than inflation and wages. Last year, we spent
more than $2.1 trillion on health care —16% of our gross domestic product and the
highest proportion in U.S. history. At the same time, the disease burden also has grown.
We are sicker than ever. Chronic illnesses, such as diabetes, cancer and heart disease
and related conditions, such as obesity, affect more than 130 million Americans
(more than voted in the 2004 presidential election).

This disease burden costs us in increased absences and lost productivity at work.
However, even during these belt-tightening times, health care is not something we
can do without — and so, we need to explore new ways to stem the rising costs.
We've heard many ideas on how to do this, from universal coverage to price regulation
and supply-side limits on capacity to demand-side proposals, such as health savings
accounts. The problem is that none of these enjoys broad political support nor
effectively limits costs in the long term. Rather, they simply shift costs from one
payer to another.

The main reason health care costs are so high in this country is our chronic disease
burden is high and rising, yet we pay our doctors and hospitals based on individual
incidences of illness. Our payment system is misaligned. We are focused on sickness
and illness when we need to be focused on wellness and prevention.

Our first step must be to arrest the unchecked growth in poorly prevented and mis-
managed chronic illness, which will reduce costs, improve productivity and improve
our health. Chronic diseases and obesity are at the heart of our health care problems,
but they also show the greatest potential for savings. For example, a Trust for
America's Health report found that spending $10 a year per person on chronic disease
prevention programs would save the United States more than $16 billion annually
within five years.

Wellness programs run by employers across the country have shown that prevention
can make a significant impact on the bottom line. Here are some examples from
companies whose investment in prevention is paying off:

• Utilizing health and wellness programs, IBM has driven more than $175 million in
savings to the company, resulting in health care premiums that are 6% to 15% lower
than industry averages, with employees paying 26% to 60% less than industry average.

• In the city of Ashville, N.C., health care costs were reduced by thousands of dollars
per year per employee through an employee education program.

• With a long commitment to the wellness of its employees, the Pitney Bowes Health
Care University program has led to a 5% decrease in costs for participants over three
years vs. a 2% increase for non-participants over the same time period.

This is the direction we need to move; this is our compass. We need to continue and
increase our education of the American people about not only the health benefits
but also the economic benefits of eating healthy, exercising and not smoking. We pay
too little attention to the lifestyle choices we make, and the consequences are
catching up to us. But we can't tell Americans to "get healthy" when healthy food
and fitness options are unavailable, unaffordable or not readily accessible. As a nation,
we need to make sure that we have policies and practices in place that encourage
Americans to make better decisions for their health.

In my roles as governor of Wisconsin and secretary for Health and Human Services,
I have been at the center of a number of important health care debates. In each instance,
while faced with a great challenge, politicians from both sides of the aisle came together
to do what was right.

Instead of retreating in the face of adversity, my experience tells me that we have an
opportunity to advance and help both our economy and our health. By making changes
to how we deliver health care, we can lower costs and improve quality for all while also
improving job productivity and, ultimately, helping our economy.

Tommy Thompson is former Wisconsin governor and former U.S. secretary for Health and
Human Services. He is co-chairman of the Wisconsin chapter of the Partnership to Fight
Chronic Disease ( www.fightchronicdisease.org).

Doctor Blogger--Change of Shift if Up

DrRima Bishara — Thu, 02 Oct 2008 22:45:00 GMT

Change of Shift is up at NurseLinkUp, hosted by Keith of Digital Doorway.

http://www.nurselinkup.com/content/view/337/69/

Doctor Blog--Final Results for The 3G Project

DrRima Bishara — Wed, 01 Oct 2008 22:01:00 GMT

I wanted to let you know that The 3G Project made it to the Top 25
of Members Project but was eliminated in the last round of voting
for the Top 5.

In working on this project over the past 3 months, I have met many
of those I have emailed and spoken with dozens of people who helped
spread the word about 3G.

What I have learned is that I know hundreds of people who are caring
and vivacious individuals and who want to make the world a better
place. Some I have known for years, some I recently met, some, I
have yet to meet in person. One thing I do know, I am honored to
know you and proud to be counted among your acquaintances.

Thank you from the bottom of my heart for your vote and for your
comments and suggestions. I could not have done it without each of
you.

For the future, I will look for other avenues to fund 3G because I
continue to feel this is what I am supposed to do--the venue will
simply be a different one.

Keep in touch and drop a note to let me know about your efforts for
community service.

It appears that there are many challenges available in the world--it
is simply for us to decide when to stand up and answer those
challenges with as much intelligence and energy as we possess.

As Alexander Hamilton said: Those who stand for nothing fall for anything.

The 3G Project--Voting For The Top 5 Spots!

DrRima Bishara — Wed, 24 Sep 2008 14:16:00 GMT

VOTE UNTIL SEPTEMBER 29, 2008.

For those of you who are following Members Project by American Express,
The 3G Project needs your vote to become one of the Top 5 funded projects.

Please help this very worthwhile and tested project get into the Top 5.

3G has been paired with United Way as the fulfilling organization and
we look forward to implementing it nationwide together!

To vote, go to http://www.membersproject.com/project/view/L889PY .

Only American Express card holders can vote in this phase.

And, for those of you who have already voted for us, a BIG thank you.

Doctor Blog--More On Becoming a Female Doctor

DrRima Bishara — Mon, 22 Sep 2008 22:25:00 GMT

Here's a conversation with another reader who is questioning their
interest in becoming a doctor and wondering how to decide.

Hi , I came acroos your blog recently via google and I was wondering if you
could help me with something.

I am 27 years old, South African female , and I am married and have 3 kids.
I am an IT systems analyst. I am relocating to Dubai early next year and am
considering going to medical school there.

Would you advise this ? or am I too late?

Please answer.

Thank You
Ir

Ir,

I'd be happy to address this question but I need more information.

How old are your kids? Who would help you take care of them? What is
the educational process of medical school in Dubai? In the US, we go to
college (4 years), medical school (4 years), then internship (1 year) and
residency (3-5 years depending on the field). Is medical school education
state funded or would you be paying tuition?

RBishara

Hi Dr Rima,

I sincerely am grateful to you for your prompt reply. I have 3 kids - 2 boys and a girl.
My eldest son is 9, the other son 5 and the youngest, a little girl aged 2. My husband
is self employed and we are thinking of getting a full time nanny in Dubai. I visited
a website www.dmcg.edu for a medical school in Dubai - it is 5 years including
internship.

I have worked in IT for about seven years so I have saved enough for me to go
and study without the hassle of worrying about expenses, although I can try to
generate a bit of income there in my spare time.

What are the pros and cons of being a female doctor?

Once again, thank you for you assistance

I look forward to hearing from you

Regards

Ir

Ir,

It sounds like you have the basics taken care of. A stable income from your
husband, some savings, a plan to care for the children (because you will need
someone at your beck and call at any time of the day or night), and a plan for
getting into medical school.

When the time comes, you will need to decide the setting in which you would
like to practice. This can make a big difference in lifestyle for both yourself
and your family. The post about medical school should help give you some
things to think about.

The short answer is, you are not too late. At 27, if the training is 5 years, you
would be finishing at 32 y/o. That's not too far beyond when most US trained
doctors finish their training. You could work for 30 - 40 years before retiring.

If you have a passion for medicine and taking care of the sick, then you are
not too late. If you are just toying with the idea because it is intriguing and
you think you might have an interest, then look elsewhere for a career.

Medicine is rigorous in any situation. That is what attracts some people to
it and what puts other people off. You will have to decide in which group you
belong and if this is something that fits you and your family.

RBishara, MD

Doctor Blog--EyeWitness Hurricane Ike Aftermath

DrRima Bishara — Sat, 20 Sep 2008 17:17:00 GMT

On Corpus Christi's North Padre Island area, I have gotten reports from
eye witnesses of a five foot storm surge before Hurricane Ike came
ashore 300 miles north.

Now, nearly one week later, it appears that one of the well maintained
public beaches there has basically been wiped clean by that storm surge.
The parking lot has disappeared (presumably washed out to sea), the park
benches and shade covers are gone (presumably washed out to sea),
and the peer, which was substantial, is significantly damaged. The area
where the peer met the beach has been wiped clean of rock tile and that
tile is piled up at the entrance to the beach several yards away.

The sand dunes (the natural barrier for the island) held up well and there
was insubstantial damage to structures on the island.

Additionally, and I find this fascinating, storm debris is showing up on
the beach on North Padre FROM HOUSTON. How do they know? Try
finding a piece of furniture with a Houston address on it. A roof floated
by the beach this morning..............

If anyone has any doubt that they should evacuate with a hurricane
threatening their area, you need to pay attention to what's happening
now, after the storm. Just an inkling of what it must have been like
during the storm.

Doctor Blog--Change of Shift Has Posted

DrRima Bishara — Fri, 19 Sep 2008 17:15:00 GMT

Ahoy Mateys!

Miss Emily has posted the latest "Talk Like A Pirate" edition of Change of Shift
and aye, it was worth waiting for! You can be checking it out at:

http://crzegrl.net/?p=1357

If you be inclined to link, there be grog for ye all!

Kim
www.emergiblog.com

Doctor Blog--Hurricane Ike "Fog"

DrRima Bishara — Wed, 17 Sep 2008 14:56:00 GMT

The daily grind after Hurricane Ike is here to stay with us for some time.

Here's a summary of information from yesterday:

http://www.msnbc.msn.com/id/26695458 news services 9/16/08.

Many service stations have no gasoline.

Some major highways remain under water.

More than 30,000 evacuees are still living in nearly 300 public shelters.

Roughly 2 million people in Texas alone are without power.

Ike's survivors have already walked for miles and waited for hours at supply
distribution centers.

1 million bottles of water, 1 million meals and 600,000 pounds of ice in just the
first 36 hours after the storm passed.

"That process will continue 24 hours a day," said Federal Emergency Management
Agency spokesman Marty Bahamonde. "We'll never be empty of trucks at the
staging area and the goal is to never be empty at the points of distribution."

The relief roll-out appeared to defuse tensions that had flared between FEMA
and local officials after Houston Mayor Bill White vowed to hold FEMA accountable
for delivering on its commitments.

At Texas Southern University, lines of cars stretched two hours or longer
for bottled water and bags of ice.

Doctor Blog--The Days After Hurricane Ike

DrRima Bishara — Mon, 15 Sep 2008 00:17:00 GMT

Well, now the hurricane is gone and we are left with a large city with no electricity,
lots of debris in the roads, lots of people calling for help/rescue who chose to stay.

Personal reports received of families who decided to ride out the hurricane and are
now in dire circumstances. They can't get out because of blocked roadways or
they didn't plan for enough food/water after. Some report they will hunker down
with canned food, bottled water and no electricity ("like camping").

Red Cross volunteers are getting a much needed break today from 24 hour mass
care. There is still plenty to do but, less frantic and slower pace.

New shelters are going up around Houston for "post hurricane mass care". The
real disaster begins.............

Resources are very low and if you can donate even a few dollars to help with
basics such as food and water, it will help the American Red Cross provide the material
that the volunteers can distribute to those in need.

Please help.

Thanx.

Doctor Blog--Hurricane Ike's Aftermath

DrRima Bishara — Sun, 14 Sep 2008 01:38:00 GMT

Watched Hurricane Ike coverage until late last night. Finally went to bed
still not sure how significant the hit would be.

Red Cross is running 4 shelters in our area alone and thousands of evacuees from
the Texas coast are being fed and cared for here.

On call for medical issues. One volunteer injured--in the hospital.

"Hurricane command center" is a room filled with phones and paper/pens and people
making and receiving calls, arranging for meals, emergency care, receiving and
distributing needed items and volunteer time and skill. Not as chaotic as Hurricane
Katrina or Rita's aftermath but hectic enough.

Upbeat mood--the really hard work was done earlier in the week. Now time to
settle into the daily/nightly chores of mass care.

Waiting to hear how long the evacuees need housing and care--Houston/Galveston
utilities are in the toilet and could be down for days to weeks.

Friday, friends living on North Padre and Corpus Christi reported early storm surge
and the beach disappeared under water. Not much structural damage but, wow,
300 miles south of Ike's eye, enough trouble to cause problems on the streets.

Already getting calls for medication refills from people who left in a hurry--running
out of insulin--the pharmacy was closed and couldn't pick up the refill that was
waiting.

Know three families whose Houston based relatives decided to ride out the
hurricane. Haven't heard about them. Hope they're OK.

Doctor Blog--Hurricane Ike

DrRima Bishara — Sat, 13 Sep 2008 04:03:00 GMT

As many of my readers know, I work with the Red Cross. I have spent the last
several days receiving and sending messages to and from our dedicated staff
and volunteers as we prepare for the challenge that Ike brings.

Shelters have been set up, there will likely be some medical triage and care to do
this weekend, food and water is being dispatched, and being "on call" for disaster.

Hotels are full in towns all across Texas as those who had the opportunity to leave,
evacuated their homes. I hope Houston did not make a grave error in judgement
in deciding to evacuate only certain areas of their city. And, there are a few people
who stayed on Galveston Island to "ride out the storm". It appears those souls may
end up with houses that are house boats before it is said and done.

I know a number of families who are either housing evacuees or expect to house
family or friends on their way out earlier in the day.

I'll try to keep you posted on what the weekend brings.

This feels like Hurricane Katrina/Rita (as our Red Cross personnel named the two
back to back hurricanes when they hit so close together) which means we'll all go
without sleep over the next few days.

My stethoscope and running shoes............yup, they're ready.

Doctor Blog--Parenting with Divorce

DrRima Bishara — Fri, 12 Sep 2008 15:10:00 GMT

Below is a comment from a reader after reading the posts on Divorce and
its impact on children:

I was glad to read your post. As a divorced parent and a step parent I totally
agree that the courts seem to be more worried about making the parents feel
good about themselves, than it worries about what is best emotionally for
the child/children. My step children are in the custody of my husband but had
"liberal" visitation with their mother.

They were evaluated by a psychiatrist a couple of years ago for learning
disabilities and he was appalled by the amount of instability in their lives due
to the visitation schedule.(not to mention that mom does not have them follow
any of the rules from home) I think parents in general want to feel like -if they
don't have custody then they are still a good parent, and if they do have
custody - they want to be seen as being cooperative with the noncustodial
parent. In my opinion, very few people, court included, think about what the
children actually need (not neccessarily what they want).

Doctor Blog--Update on 3G!

DrRima Bishara — Tue, 09 Sep 2008 03:02:00 GMT

I was just notified by American Express that The 3G Project was chosen to be
one of the Top 25 Finalists (of 1190 submitted projects) in Members Project.

Those of us who have worked so hard on this project want to express how
honored we are to have been chosen. We also want to thank all those who
took their time to 1) vote and 2) spread the word about the project.

We could not have done it without each and every one of our voters and
fans.

Now, we go into a second round of voting. Only those who have (or get)
an American Express card will be allowed to vote during this round.

So, please go to the Members Project site and vote one more time for
The 3G Project. We are one more round of votes away from funding.

With the funds, we would develop the digital web-based programming
that can be used any where in the world to teach parents, grandparents,
and children how to live healthier lives.

Thank you SO much for your confidence.

R. Bishara, MD

Doctor Blog--Planning Ahead

DrRima Bishara — Tue, 02 Sep 2008 21:45:00 GMT

The majority of men meet with failure because of their lack
of persistence in creating new plans to take the place of those,
which fail.

Napoleon Hill

Doctor Blog--The 3G Project (Three Generations)

DrRima Bishara — Sat, 30 Aug 2008 12:32:00 GMT

For those of you who are following Members Project by American Express,
The 3G Project still needs as many nominations as we can get.
September 1, 2008 is the last day to nominate.

Please help this very worthwhile and tested project get into the top 25.

To nominate, go to http://www.membersproject.com/project/view/L889PY .

And, for those of you who have already voted for us, a BIG thank you.

Doctor Blog--Smoking Debate

DrRima Bishara — Thu, 28 Aug 2008 21:25:00 GMT

Below is information from a survey on smoking. Where do you fall on this debate?

In a country where health-and-safety regulations butt heads with civil rights and privacy laws,
smoking is a hot topic. More than 7,000 internet users responded to the first AOL
Health/Health.com survey which asked six provocative questions at the heart of the
smoking debate to find out how smoking is affecting the population.

Below please find the link and survey results. Please feel free to use the results but if you
do, please credit AOL Health and Health.com.

http://www.aolhealth.com/condition-center/smoking-cessation/smoking-poll-results

Smoking and children: 47% say that smoking in a home or car around children

should be illegal

Public smoking: 41% want to see smoking banned in all public places

Health insurance and smokers: 44% think that smokers should pay more for

health insurance

Cigarette taxes: 28% believe that taxes should be raised to make cigarettes $10

or even $20 a pack

Smoking in movies: Only 27% wish that all smoking scenes would be banned

from movies

Cigarette advertising: 44% think that all smoking billboards and magazine ads

should be outlawed

The poll was hosted on AOL Health from August 5 through August 22, 2008 and the
results are posted on both AOL Health (http://aolhealth.com) and Health.com.

Doctor Blog--3G Project Update

DrRima Bishara — Wed, 20 Aug 2008 18:27:00 GMT

The 3G Project has reached over 430 nominations so far and counting.
That puts us at about spot #27 of 1189 projects submitted.

Thank you for all those who have voted to date.

We need lots more votes to go and have until August 31 to do it.

Please nominate this innovative project that could have a global impact.

Also, see the video that describes the project.

Doctor Blog--Believe in Yourself

DrRima Bishara — Tue, 19 Aug 2008 18:25:00 GMT

Believe in yourself and there will come a day when others will have
no choice but to believe with you.

Cynthia Kersey

Doctor Blog--The Good Samaritan

DrRima Bishara — Mon, 11 Aug 2008 17:16:00 GMT

No one would remember the Good Samaritan if he'd only had good
intentions - he had money, too.

Margaret Thatcher

Doctor Blog--Become a Fan of The 3G Project

DrRima Bishara — Thu, 07 Aug 2008 18:12:00 GMT

You can also become a fan of The 3G Project on Facebook and help spread
the word about this unique health ed program by asking your network of
friends to vote. Search "3G Project" or click on the following link:
http://www.new.facebook.com/pages/The-3G-Project-Tots-Teach/23288271870?ref=nf

Thank you!

Doctor Blog--Members Project Nominations

DrRima Bishara — Wed, 06 Aug 2008 11:42:00 GMT

At last check, The 3G Project is the top nominated in Texas. We still
need lots of nominations to make the top 25.  Please, keep nominating
this worthwhile and innovative project.

And, to those of you who have already nominated us, Thank You!



I'd like to tell you about a proposal submitted to Members Project. It's called
"The 3G Project" and with your support it could get funding from American
Express. To nominate this project for funding, please go to
http://www.membersproject.com/project/view/L889PY

Members Project is an exciting initiative that brings people together to make
a difference in the world. It's simple. People go online to share ideas for
projects - and ultimately vote on which projects get $2.5 million in funding
from American Express.

In 2007, Members Project provided clean drinking water to children all
across Africa. What will Members Project do this year? The decision is yours.

Please nominate this project.

The first step is to get into the Top 25 Projects nominated. Then, the top 5
projects, which will receive funding, are to be chosen in September.
Show Your Support By Going Online And Nominating "The 3G Project"
by August 30, 2008.

Go To http://membersproject.com/project/view/L889PY

Children are our future and The 3G Project can help hundreds of families
improve their health.

Doctor Blog--More on Genetic Profiling

DrRima Bishara — Tue, 05 Aug 2008 20:37:00 GMT

The New England Journal of Medicine, July 24 issue had another
article on genetic profiling. This time the article details a bill that was
signed into law by the President forbidding insurance companies from
excluding individuals from their health plan when they have a known
risk factor for a particular disease--that is, a family history or positive
genetic markers for a disease. Protection is left out of this legislation for
individuals who have been diagnosed with a disease already.

Interestingly, those who have been difinitively diagnosed are those
that are getting medical care and have a better chance than most
at early detection and prevention of advanced or catastrophic disease.

The real question is, how serious are medical insurance companies about finding
disease early and eliminating the possibility of disastrous illness. Otherwise,
there will continue to be a fear of disease detection by the US population
and the "bottom line" attitude.

It is the opinion of many of my patients (based on their experience with
insurance) that providing access to medical care has not only become
secondary but, that limiting and preventing access to medical care is the
primary goal. And, ironically, although medical insurance companies are
supposed to be in the business of providing access to medical care, many
patients feel that because many companies are publicly traded, the
primary goal seems to really mostly be profit making.

Doctor Blog--Members Project from American Express

DrRima Bishara — Sat, 02 Aug 2008 17:16:00 GMT

I'd like to tell you about a proposal submitted to Members Project. It's called
"The 3G Project" and with your support it could get funding from American
Express. To nominate this project for funding, please go to
http://www.membersproject.com/project/view/L889PY

Members Project is an exciting initiative that brings people together to make
a difference in the world. It's simple. People go online to share ideas for
projects - and ultimately vote on which projects get $2.5 million in funding
from American Express.

In 2007, Members Project provided clean drinking water to children all
across Africa. What will Members Project do this year? The decision is yours.

Please nominate this project.

The first step is to get into the Top 25 Projects nominated. Then, the top 5
projects, which will receive funding, are to be chosen in September.
Show Your Support By Going Online And Nominating "The 3G Project"
by August 30, 2008.

Go To http://membersproject.com/project/view/L889PY

Children are our future and The 3G Project can help hundreds of families
improve their health.

Doctor Blog-Medical School: Is it for me?

DrRima Bishara — Wed, 30 Jul 2008 23:13:00 GMT

This reader has several questions about medical school, medicine, and a life
taking care of people.

Thank you AS for asking the questions and giving me the opportunity
to provide some of the answers.

AS writes:

Hello,

I know that you must be busy but I saw this as a great opportunity to get some
much needed information. I am a freshman in college and thus about to decide
where I would like my life to go. I am looking to go into Pre-med, but there are
some questions I was wondering about concerning being a doctor.

One concern I have is that I am very torn between the artistic side of me and the
part that loves science and medicine. I feel that if I choose one, I am giving up
the other and I want to make the right decision. I am very interested in the field,
in the science aspect and also because doctors have been such a help to me when
I seriously ill, but sometimes I am not sure that I could hold up to the rigorous
demands and schedule of medical school and medicine itself.

I am a very good student and can memorize well, but the prospect of someone's life
resting in my ability to remember information is frightening.

What is the typical schedule a doctor has ( length if shifts, typical hours)? I noticed,
through reading your blog, that you have children. This is encouraging to me
because in the future, I know I may want to have a family but I was very concerned
that becoming a doctor would not leave me any time to be at home. Is it ever
difficult to find free time or family time?

Another question I was curious about is if you had a hard time when you first had
to work the ER. This seems like it would be a very difficult thing to face, not only
because of the sometimes gruesome nature of the situation, but also because of
the need to be able to come up with snap diagnoses.

A final question I have is if you ever had doubts about your profession during the
hard intern/resident stage or, even now, when things get rough.

Thank you for your time and also for your blog. It is very interesting and a great
way to get a look at a doctors perspective

                                                                           sincerely

                                                                                             A.S.

ANSWERS

1. With regard to your artistic side, many physicians are artistic. Many of them
play musical instruments, sing or paint. That is entirely consistent with what
you will find among other physicians. Those who are physicians have decided
to make being a doctor their vocation and their artistic side their hobby. Being
artistic can really help you be a "human" doctor and relate to patients better.
It can also help with the creative side of medicine that requires a doctor to make
decisions with pieces of information that may not look like much to other people.

2. Yes, training is very rigorous although, in the US, accreditation agencies have
demanded less hours for residents overall. You will still face many long hours of
work. I always found that the best policy was to get regular exercise and a good
diet to help keep up my energy. It really is amazing that if you are dedicated to
what you are doing, you will find the energy. It is mind over matter. You will be
fatigued and sometimes sleepy but, most residents have learned how to master
their fatigue and have learned to focus their minds on the task at hand.

Keep in mind that there is training (internship, residency, chief residency, fellowship)
and then there is being in practice. These two things are different and the
schedules are different. Read on.

3. There are no "typical hours" for doctors. The great thing is that there are many
settings you can pick from when you start your career today. And, as far as
having children, make them a priority and you will find the time. But, make sure
you have a partner who can understand your committment to medicine and
who is willing to share daily tasks (cooking, cleaning, picking up the kids, shopping,
etc. etc.).

Residencies are tough--period. It is necessary training and you deal with it.

As for real life practice hours, it really depends on the field you choose.
It also depends on the setting in which you decide to practice. For example, if you
decide to go into Obestetrics and Gynecology(Babies and Women), your
schedule will depend on when the baby decides to be born. Most doctors
have partners to share "on call" hours so that they do get a break periodically.
If you are in private practice, you are it if you are on call. If you work in a large
teaching hospital or large clinic, doctors will usually work "regular days" (that
might start as early as 5-6am and may last until 8-9pm) for 3 to 4 days in a row and
then be "on call"--meaning they are the person to call if a patient has problems
in the overnight hours.

The more rigorous specialties tend to be surgical (General Surgery, Neurosurgery,
Orthopedics, etc.) because people hurt themselves and can require surgery at
any time of the day or night.

Less rigorous specialties (as far as schedules) might include Dermatology and
Ophthalmology, again, depending on the practice setting.

These days, there is even beginning to be a differentiation of doctors
by whether they practice in hospitals (hospitalists) or in clinics (outpatient care).
Doctors who work in outpatient clinics see patients only in clinics. If a
patient needs to be admitted into the hospital, they will arrange for the
hospitalist to care for the patient while they are in the hospital.

Primary Care (includes Family Practice, Internal Medicine, Pediatrics) is primarily
practiced in clinics now with support from hospital based doctors in most locations.
These specialties usually have fairly predictable hours in this type of setting with
work being mostly 8am-5pm and paperwork time after.

4. Working in the Emergency Room is only one mandatory rotation during Medical
School. All residents have to learn to negotiate the ER during Internship and
Residency because that is where many patients come into a hospital.
Your concern of having someone's life in your hands and having to make rapid
decisions is "Hollywoodized". You would not be allowed to hold that much power
until you have learned to make many decisions on your own.  Also, not everyone
wants to work in the ER unless they want to specialize in Emergency Medicine
(a very stressful field with one of the highest rates of burn out in the medical
profession). So, don't stress about working in the ER. It is one experience out
of hundreds that you will have along the way.

5. As far as doubts, read about my moment of doubt in Medical School.
The bottom line is, if you feel it is your calling to be a doctor, you will find solutions
along the way for many of your concerns. If you are having really grave doubts
about committing, you might consider some other degree in the health
professions that would allow you to care for patients without the extended
and difficult training program of an MD.

Examples might include Physician's Assistant, Nurse Practitioner (for nurses),
Nursing, or one of the "Therapies" such as Physical Therapy or Occupational
Therapy. All these fields provide patient care but are less rigorous in training
in terms of time spent in school and time spent in residency training.

Good luck A.S. Let us know what you decide.

Doctor Blog-Medicare Reform

DrRima Bishara — Sun, 27 Jul 2008 18:18:00 GMT

Below is a press release about a working group formed to tackle
Medicare reform. It is self explanatory.

for immediate release

CENTURY FOUNDATION ANNOUNCES NEW WORKING
GROUP
ON MEDICARE REFORM

Group Featuring Nationally Prominent Physicians
and Public
Health Experts Will Explore Ways to Improve Care
While
Reducing Waste

July 22, 2008, New York, N.Y.—The Century Foundation (TCF) today announced
the formation of a new Working Group on Medicare Reform. TCF, a nonpartisan
public policy research foundation, has assembled a group of prominent physicians
and health care experts from around the country to assess the current state of
Medicare and make recommendations to reform and strengthen one of the nation’s
most effective and enduring public programs.

The Working Group will be directed by Maggie Mahar, a fellow at the Century
Foundation, author/editor of the highly respected blog Healthbeatblog.org
(www.healthbeatblog.org), and author of the widely acclaimed book Money Driven
Medicine: The Real Reason Health Care Cost So Much (Harper/Collins, 2006). She
notes that a unique aspect of this panel is its composition. “This Working Group
is composed primarily of physicians and public health officials, because they know
better than anyone what’s wrong with the system and what’s needed to fix it,”
she said. “They also were chosen for this panel because they each have a reputation
for being professionals who put patients first.”

Working Group members include:

Christine Cassel, MD

President and CEO of the American Board of Internal Medicine

      and ABIM Foundation

Peter Eisenberg, MD

Medical Director, California Cancer Care

Ezekiel J. Emanuel, MD, PhD

Chair, Department of Bioethics

            National Institutes of Health



Elliott S. Fisher, MD, MPH

Director, Center for Health Policy Research
The Dartmouth Institute for Health Policy and Clinical Practice
Professor of Medicine and Community and Family Medicine, Dartmouth
Medical School
Senior Associate, VA Outcomes Group, White River Junction

Diane Meier, MD, FACP

          Director, Hertzberg Palliative Care Institute

            Professor, Geriatrics and Internal Medicine,

Mount Sinai School of Medicine, New York

James E. Sabin, MD
Director, Ethics Program, Harvard Pilgrim Health Care
Clinical Professor, Departments of Ambulatory Care/Prevention and Psychiatry,

Harvard Medical School


Steve Shortell, Ph.D., M.P.

Dean, School of Public Health,

      University of California, Berkeley

Robert M. Wachter, MD

Professor and Chief of the Division of Hospital Medicine
University of California, San Francisco
Chief of the Medical Service, UCSF Medical Center
Editor, AHRQ WebM&M (http://webmm.ahrq.gov) and Patient Safety
Network (http://psnet.ahrq.gov)

The Working Group will create a blueprint for reform based on recommendations
in the Medicare Payment Advisory Commission’s 2007 and 2008 reports. They
will analyze the recommendations with the goal of refining, explaining, revising, or
adding to them in ways that would strengthen the system. Among the issues they
will consider will be:

revising Medicare’s physician fee schedule to pay more for primary care,

palliative care, and co-ordination and management of chronic diseases;

rethinking Medicare’s fee-for-service system to reward doctors for quality,

not volume;

creating an independent Comparative Effectiveness Institute that reviews

head-to-head testing of drugs, devices, and procedures to ensure that they

are effective; and

identifying and rewarding hospitals that provide better outcomes and higher

patient satisfaction at a lower cost while helping other hospitals meet benchmarks.

Mahar believes that strong successful Medicare reform could be used as a demonstration
project for national health reform. “As I see it, the larger goal of Medicare reform would
be to show that lower cost and higher quality do indeed go hand in hand,” she said.

The Working Group plans to report its recommendations later this year.

For more information about the Working Group or for media interviews with Maggie
Mahar, contact Christy Hicks at hicks@tcf.org or 212-452-7723. Read Mahar’s
blog at www.healthbeatblog.org. Learn more about Century Foundation work
in Medicare and Healthcare reform at www.tcf.org or www.healthpolicywatch.org.

The Century Foundation conducts public policy research and analyses of economic, social, and foreign policy issues, including inequality, retirement security, election reform, media studies, homeland security, and international affairs. The foundation produces books, reports, and other publications, convenes task forces and working groups, and operates seven informational Web sites. With offices in New York City and Washington, D.C., The Century Foundation is nonprofit and nonpartisan and was founded in 1919 by Edward A. Filene.

Doctor Blog-Real Strength

DrRima Bishara — Fri, 25 Jul 2008 18:01:00 GMT

Strength is the ability to break a chocolate bar into four pieces with
your bare hands - and then eat just one of those pieces.

Judith Viorst

Doctor Blog-How Much Alcohol Is In Your Drink?

DrRima Bishara — Tue, 22 Jul 2008 17:55:00 GMT

To follow is a press release addressing alcohol use and container labeling to help consumers decide how much they alcohol they are getting in the drinks they are choosing.

NCL Challenges Myth that Some Alcoholic
Beverages Are
“Safer” and “Less Potent”

New Initiative Underscores Need for New Alcohol Label

Washington, DC; July 16, 2008 – For the many Americans confused about the
potency of different alcoholic beverages, one of the most respected national
consumer organizations has this important message: it is a myth that beer and
wine are not as strong as the typical cocktail. Standard serving sizes of all
alcohol beverages -- beer, wine, and distilled spirits -- are equal in alcohol
strength and their effect on the body.

Because even the most basic information about alcohol content is not clearly
and consistently listed on the labels of beer, wine and distilled spirits products,
the National Consumers League is going public with Alcohol: How It All Adds Up,
a new initiative challenging the myth that some alcoholic beverages are “safer”
and less “potent” than others. According to the League, this belief is pervasive
and linked with the overconsumption of alcohol and the permissive attitudes of
some parents about underage drinking. In an opinion poll commissioned by the
Center for Government Reform, 88% of parents mistakenly concluded that beer
is safer than liquor.

“Without ready access to information about the amount of alcohol they are
consuming, many Americans believe that beer and wine offer a ‘soft’ option and
can be consumed in greater amounts than so-called ‘hard’ liquor,” said Sally
Greenberg, Executive Director of the League. “We are trying to give consumers
the basics about the alcohol content of different alcoholic beverages, but the
real answer is government action to require standardized and complete labeling
information on beer, wine and distilled spirits products. Consumers should know
how many calories, carbohydrates, and other nutrition information are in a
standard drink. They have it for nonalcoholic beverages, food, and nonprescription
drugs. It is time for this information to be on the labels for alcoholic beverages.”

The Meaning of a “Standard Drink”

While renewing its calls for the Alcohol and Tobacco Tax and Trade Bureau to
make information about the alcohol content per serving a requirement on alcohol
labels, the League is attempting to fill the void with a new guide that tackles one
of the most important concepts for consumers to grasp – what constitutes a
“standard drink.” Research commissioned by the League finds 54% of Americans
don’t know there is such a thing as a “standard drink,” even though a large
majority of state drivers’ license manuals and national and state public health
agencies use the “standard drink” concept to explain responsible drinking.

As the guide explains, the common denominator for a “standard drink” of beverage
alcohol is 0.6 fluid ounces of pure alcohol. Based on this amount of alcohol, a
standard drink consists of a 12-ounce bottle or can of regular beer (5% alcohol),
a 5-ounce glass of regular (dinner) wine (12% alcohol), and a 1.5 ounce drink of
80 proof (40% alcohol) distilled spirits or liquor (either straight or in a mixed drink).

“It shouldn’t take a calculator to know how much alcohol you are consuming,”
Greenberg stated. “Better labeling is badly needed to tell how many ‘standard
drinks’ are in a particular product. If consumers can tell from the label how many
standard drinks they are consuming, they can learn their limits and avoid
exceeding them.”

Misperceptions Contribute to Underage Drinking, Binge Drinking

As part of its initiative, the National Consumers League is also calling on parents
and community leaders to address underage drinking, reporting that parents
often underestimate how early drinking begins, how much alcohol their adolescents
consume, and the risks involved. According to the National Institute on Alcohol
Abuse and Alcoholism (NIAAA), three-fourths of 12th graders, more than two-thirds
of 10th graders, and about two in every five 8th graders have consumed alcohol.
Compounding the problem, research commissioned by The Century Council finds
that 65% of underage youth who drink obtain alcohol from their parents, their
friends’ parents, older friends and older siblings or have easy access to alcohol
on college campuses.

“Parents need to understand that one can of beer or one wine cooler has roughly
the alcohol equivalence of one shot of vodka,” said Greenberg. “Believing
otherwise undermines and runs counter to all we know and all we have done
to prevent underage drinking.”

While underage drinking is associated with motor vehicle crashes, major injuries
and delinquency problems, what is not well understood is its link to binge drinking,
which NIAAA defines as a pattern of drinking alcohol that brings blood alcohol
concentration to 0.08 grams percent or above. For the typical adult, this pattern
corresponds to consuming five or more drinks for men, or four or more drinks
for women, in about 2 hours. Consumption at this pace can also result in alcohol
poisoning, a serious condition that can lead to choking, coma and even death.

“Study after study shows that parents have the most influence over their teen’s
decision to drink,” Greenberg said. “Parents should be a role model for their teen
about responsible drinking, whether they drink or not. This means talking regularly
and often about drinking alcohol, including how to resist the peer pressure that
can lead to underage and binge drinking.”

New Tools for Consumers

To improve Americans’ alcohol awareness, the National Consumers League is
making available a new Alcohol: How It All Adds Up guide and a series of information
sheets about alcohol content, alcohol labels, and binge drinking to consumers,
community leaders and health professionals. These materials are available in
downloadable form on the League’s Web site, www.nclnet.org.

About the National Consumers League

Founded in 1899, the National Consumers League is America’s pioneer consumer
organization. Its mission is to protect and promote social and economic justice
for consumers and workers in the United States and abroad. NCL is a private,
nonprofit membership organization. For more information, visit http://www.nclnet.org/.

Drunk Driving Is Clear In Any Language.

Doctor Blog-More on Diabetes Lifestyle

DrRima Bishara — Thu, 17 Jul 2008 23:03:00 GMT

One of my readers writes the following comment and question:

"In today's fast growing lifestyle, industrial professional like, IT, health, education
or defense, wherever they work, are prone to diseases like Diabetes, heart attack,
etc, i think yog could be play a very significant role in this regard. And meditation is
also a better idea.

What would you suggest, to lead a safer life with Diabetes."

I have posted on Diabetes before including the following entries:

1. Insulin Pumps
2. Ten Things to Know About Diabetes

The bottom line with Diabetes is that a diabetic can either control the disease
or the disease will control their life.

This means some adjustments in lifestyle that mainly have to do with a
committment to living a "budgeted" life and knowing how much and when
to eat and to exercise. Everything else can work around these things.

What I mean by a "budgeted" life is that diabetics have to eat at similar
times of the day, similar amounts and similar kinds of food at meals.
Also, they need to exercise and need to do so at regular times
and for similar amounts of time each time.

So, a sample diabetic day would include breakfast at 7-8am, lunch at 12-1pm,
supper at 5-6pm and possible snacks before bed if necessary to modulate
sugars at night.

Exercise might be walking for 30minutes each evening at 7-8pm after supper.

Relaxation, as my reader suggests, can be helpful in controlling stress which
tends to raise sugars unnecessarily. There are many forms of relaxation
ranging from sitting in a quiet corner and reading a book and to music on
CD's and tapes to listen to in an effort to reach a relaxed brain wave pattern.

Dean Ornish, a physician who now lives and practices in San Francisco, has
pioneered non-surgical treatment of cardiovascular disease. He has proven
that with dramatic lifestyle changes that include diet control, exercise, and
relaxation techniques, that even the most severe disease can be improved
to some degree.

Doctor Blog--Death of a Giant

DrRima Bishara — Tue, 15 Jul 2008 01:24:00 GMT

Dr. Michael Debakey died over the weekend. He probably contributed more
to medicine in the 20th century than any other physician. He was well known
for his work ethic and passion in caring for his patients.

Read the full story and his impact on medicine.

Doctor Blog--Enterprise

DrRima Bishara — Thu, 10 Jul 2008 19:35:00 GMT

Jim Rohn is an amazing life and success coach. He has spoken for years
about opportunity and how to manage life.

The following entry comes courtesy of AsAManThinketh.net which provides
daily inspirational quotes and stories.

Creating Opportunity

By Jim Rohn

An enterprising person is one who comes across a pile of scrap metal and
sees the making of a wonderful sculpture. An enterprising person is one
who drives through an old decrepit part of town and sees a new housing
development. An enterprising person is one who sees opportunity in all
areas of life.

To be enterprising is to keep your eyes open and your mind active. It's
to be skilled enough, confident enough, creative enough and disciplined
enough to seize opportunities that present themselves... regardless of
the economy.

A person with an enterprising attitude says, "Find out what you can
before action is taken." Do your homework. Do the research. Be prepared.
Be resourceful. Do all you can in preparation of what's to come.

Enterprising people always see the future in the present. Enterprising
people always find a way to take advantage of a situation, not be burdened
by it. And enterprising people aren't lazy. They don't wait for opportunities
to come to them, they go after the opportunities. Enterprise means
always finding a way to keep yourself actively working toward your ambition.

Enterprise is two things. The first is creativity. You need creativity to see
what's out there and to shape it to your advantage. You need creativity
to look at the world a little differently. You need creativity to take a
different approach, to be different.

What goes hand-in-hand with the creativity of enterprise is the second
requirement: the courage to be creative. You need courage to see things
differently, courage to go against the crowd, courage to take a different
approach, courage to stand alone if you have to, courage to choose
activity over inactivity.

And lastly, being enterprising doesn't just relate to the ability to make
money. Being enterprising also means feeling good enough about yourself,
having enough self worth to want to seek advantages and opportunities
that will make a difference in your future. And by doing so you will
increase your confidence, your courage, your creativity and your self-worth,
your enterprising nature.

To Your Success,
Jim Rohn

Doctor Blog--Excellence vs Mediocrity

DrRima Bishara — Tue, 08 Jul 2008 14:35:00 GMT

The price of excellence is discipline.

The cost of mediocrity is disappointment.

William Arthur Ward

Michael Phelps in the 400 IM

Doctor Blog--I Learned........

DrRima Bishara — Mon, 07 Jul 2008 18:16:00 GMT

I learned that the only way you are going to get anywhere in life is to
work hard at it. Whether you're a musician, a writer, an athlete or a
businessman, there is no getting around it. If you do, you'll win. If you
don't you won't.

Bruce Jenner

Doctor Blog--Priorities During Major Disasters--Who and How

DrRima Bishara — Thu, 03 Jul 2008 18:00:00 GMT

This comment comes from one of my readers named Heather. She writes
about Dr. Anna Pou in New Orleans in the days after Hurricane Katrina hit.

She brings up an interesting point which is that our priorities as a nation
are reflected in this case. I would have to agree, unfortunately.

The questions brought up include how to triage in the setting of massive
natural disaster, who is responsible, how to address limited resources,
and how to determine how they are distributed (or who determines
distribution).

It is a discussion worth revisiting. Let me know what you think.

"I think if anyone should have been under attack it should have been the
doctors that left those patients alone to die. I do understand that, given
the circumstances, they were fighting to save themselves, however, it is
the duty of any doctor to put their patients first. If, in this case the doctors
had not left and stood by that duty...the situation never would have
happened. Those nurses, along with Anna, were very courageous for
what they did.

It is disgusting to be a 23 year old and see that, in a
profession I hope to one day be in, this is what happens when you
stand by your obligations.

We could very well point blame to anyone in that situation, including,
FEMA, and the United states government for not responding sooner,
or actually having a stable plan of action in place for a crisis such as this.
It makes me afraid of anything else that could possibly happen and for us
to not be prepared for. Why not prosocute the President of the United States?

It is so ridiculous living in the hypocracy of the United States at times.
We can send soldiers out to kill and be killed, spending trillions of dollars
a day to do it...however, when a doctor, who is willing to sacrifice themself
to save another persons life, does the best she can in given circumstances
and for the comfort of the patient, she is put on trial for murder..remind you..
everyone else decided to run when faced with disaster.

Everything is such a mess, and no one seems to have the right direction/or
priorities at this point. I think the point I am trying to make is that this case
stems far beyond Anna Pou and those 3 nurses that acted in such a heroic
manner. It stems back to what our priorities are as a nation."

Doctor Blog--"Genetic Profiling"

DrRima Bishara — Tue, 01 Jul 2008 02:06:00 GMT

I recently had a conversation with a woman in her mid 30's who has
been diagnosed with breast cancer. She was unaware of any family
history until her diagnosis when a long lost relative revealed that
two aunts had been diagnosed with breast cancer in their 50's in
the past.

The discussion was in a social setting so she was sharing from her
sense of life view at this point in her experience.

The subject of genetic testing came up. She has a very young daughter
who now is at greatly increased risk of contracting breast cancer herself.
The question that is pressing my friend is whether or not she should have
genetic testing herself and whether she should have her daughter tested
as well.

Her concerns are real. What if the little girl has positive genetic markers?
What would an insurance company who is looking at increased revenue
for publicly traded investments going to view her child's positive genetic
marker? Will there be a "pre-existing condition" exclusion whereby the
little girl may be excluded from health or life insurance with such a
marker on her record? What is the price of genetic testing? Does a
doctor have to order the test or can a lay person ask for the test if
they are paying out of pocket?

Well, The New England Journal of Medicine from June 26, 2008 has an
article which addresses "genetic profiling". The article is entitled:
Polygenes, Risk Prediction, and Targeted Prevention of Breast Cancer.

The authors look at the potential use of genetic markers to "profile"
women at risk for breast cancer and thus create a personalized
screening program. The idea is a good one in theory: figure out
who has the gene that increases risk of disease and then be more
aggressive in screening the person at higher risk for the disease--
the earlier the diagnosis the better the chance for cure.

The article is based on the theoretical application in the United Kingdom
which has a National Health Service Program to set guidelines for
disease prevention and treatment that are used for clinical decision
making. The authors acknowledge the chasm between the theory and
the application even in a system like the one in the UK.

The question would be how would something like this apply in the
United States where, at present, there is a for profit health care system
for working Americans? That is, what is the incentive for an insurance
company to provide coverage to a woman who tests positive for a
gene which significantly raises her risk of breast cancer compared to
her peers? What is to prevent insurance companies from using genetic
profiling to deny claims related to markers as "pre-existing conditions"?
For profit, publicly traded health insurance companies appear to have a
primary interest in profits for investors, many times at the expense of the
patient. It seems that genetic testing would make it easier for insurance to
"screen out" of their plans individuals with negative genetic profiles in the
pursuit of profiteering.

In fact, my friend is so fearful of the implications to her daughter's future
healthcare coverage that she does not even want to mention it to her
physician or her daughter's physician for fear that ANY mention in the
record of a discussion about genetic testing would be picked up and used
to "profile" her daughter's health risk.

How sad that a working woman who becomes ill in the United States has
so little confidence in health insurance companies and, in addition to her
illness, has to deal with the fear of medical insurance being withheld from
her daughter as a result of her own illness or genetic link to her child.

Meanwhile, the CEO's of many for-profit medical insurance companies earn
millions in salaries and millions more in stock options or profit sharing.

Let me know what you think of this issue...........

Doctor Blog--Playing the Piano? Impossible!

DrRima Bishara — Sun, 22 Jun 2008 00:03:00 GMT

More on Dr. Ruth Pitts.

For those of you who read the entries on the importance of music
to children and for brain development and who also read the
interview with Dr. Ruth Pitts, watch the video below and you will
see her play a piece by Liszt.

She has a total of 5 (five) fingers on both hands.