Few obesity suggestions

As obesity continues to increase in our society, we need to remind people of some simple things that can help.

Statistics show that if kids are obese by the age of 10, they will likely battle a weight problem for a lifetime. Teaching good habits and training kids in better choices will go a long way to helping with this problem.

As Americans, we commonly eat to the point of being stuffed rather than to the point of comfort. If children and adults would take reasonable portions on their first servings at the dinner table, they should then be encouraged to skip the seconds. Even though they may not feel full at that exact moment, it is likely they will within the next 10 minutes as the brain receives the chemical signals indicating satiety.

Other important aspects for kids and adults are to eliminate sodas and fast foods. These are probably the most commonly abused foods in people who are overweight.

Schools need to eliminate the unhealthy snack and soda machines and need to return to a true physical fitness class that actually burns some calories.

Although very simplified, there are two basic principles to remember:

• We are what we eat
  
• 
  
• If Calories in are greater than calories out, weight gain will occur.
  

Medicaid Oversight Committee

I had the opportunity to present testimony to the Select Joint Commission on Medicaid Oversight on Tuesday at the statehouse in Indianapolis.

Overall the meeting was very good and I believe very informative to the Senators and Representatives serving on the committee.

There were about a dozen other physicians and office representatives who also presented testimony from the entire state of Indiana. It was noted that Indiana is ranked about 47th in the nation for Medicaid reimbursement and the rates have not increased since 1989.

Everyone is having similar problems and very concerned about the proposed changes that they are wanting by January 2007.

Below is the address that I gave to the committee.

Chairman Brown and committee members,

I, along with my colleagues appreciate the opportunity to address the committee.

Primary Care Physicians and especially Pediatricians are facing the worst year of their professional careers and patients are facing increased difficulty accessing care.

Physicians understand the financial difficulties the State faces in meeting budgetary requirements while continuing to provide medical services to the Medicaid population. We also know all too well how continued declines in reimbursements have impacted our own practices and our ability to provide care to this population of patients. For some of us, Medicaid represents 30-50 percent of our patient base while utilizing 50-70 percent of our time and resources. Your committee understands that this group of patients are high utilizers and many with little understanding of how to manage their problems.

Some of us here have already dropped the managed care Medicaid program and if the proposed changes take effect in January, more physicians will be forced to drop out of the program. It boils down to simple accounting. We have to maintain more income coming in then expenses going out. Just yesterday a colleague gave me a copy of a notice Medicaid sent him regarding charging for missed appts and medical records. The wording stated they felt like it was part of the overall cost of doing business and the Medicaid rate already covers the cost of doing business. We strongly disagree with this statement and overall assumption since Medicaid rates have not increased since 1989.

The Medicaid program is broke. Any changes that further cuts reimbursements to physicians or any changes that increase the already overburdened red tape with the program will create further access problems for patients, force more physicians to drop out of the program and will lead to even more inappropriate use of Emergency Rooms and UCC’s. This is short-sighted thinking that will cost the State more money.

Medicaid has always been the lowest payor and their rates have neither increased nor kept up with inflation. Medicaid has created a huge burden on our practices because of the paperwork and other administrative hassles. The MCO’s that took over 2 years ago created even more burdens and it has taken us this long just to figure out a working relationship in order to survive.

Some of the problems we have already faced include:
• Patients are switched from provider and plans sometimes without knowledge and sometimes without reason. This causes problems especially with OB physicians because changing plans causes payments to be withheld, delayed or just denied because each plan states the other should be paying.

• Some MCO’s have dropped (kicked out) physicians who have high utilizing patients forcing them to accept one of the other MCO’s. This allowed the MCO to get rid of these high utilizing patients because the patients would follow the Doctor and therefore change to the other plan.

• All the MCO’s have been characterized by consistently holding, delaying or simply denying payments. If you want to complain, the Office of Medicaid oversight is very complicated. Physicians feel there is rarely a successful resolution using this agency. Filing a complaint with the Office of Medicaid oversight about the MCO requires filing every claim that is not paid individually meaning the physician would have to literally send hundreds of individual complaint forms for the same problem related to the same MCO. This burden is overwhelming when you are just trying to recoup what is owed from the lowest paying third party. It actually ends up costing you money when staff time is factored in.

• Each of the MCO’s has their own formularies and many drugs aren’t covered. If a patient has been stable on a drug for years but it isn’t on the formulary, you have to fill out additional paperwork, make phone calls and faxes to maybe get it approved. Otherwise, you have to change the medication and risk complications causing more visits and increased costs. Some of the MCO’s won’t cover certain generic drugs. I have had drugs denied and after talking to the MCO, they said if I referred the patient to a specialist and if they ordered it, they would approve it. This adds an additional cost and delays treatment.

• One Physician was owed money and the MCO asked if they would take a settlement for what they owed. Why should a physician reduce the amount they owe because of the MCO’s inefficiencies? Physicians already agreed to their fee schedule which is lower than any other. Settling for an even lesser amount was ridiculous. The MCO should be paying interest on the money they owe.

• The last issue concerns the ER. Trying to use primary care doctors as gatekeepers will not work because even if a primary care doctor tells the ER registration that we won’t authorize the visit because it doesn’t seem to be an emergency, the ER physicians are required through federal guidelines to see the patient. This means the primary care doctor is denying payment to the ER physician. The ER physician has no choice but to evaluate them. State and Federal rules need to be reconciled so this doesn’t occur.

• The States have to begin requiring personal responsibility to all of the Medicaid recipients. This can no longer be a free ride to them.

I represent southern Indiana where more than 90 percent of the patients belong to Molina or Harmony, neither of which were awarded the contract for 2007.

We know that in order to switch MCO’s this late in the year will be virtually impossible. It normally takes 3 months to become credentialed with a new organization and that is if everything is perfect. It has not happened with any Medicaid program. Physicians will not sign up with all 3 MCO’s because of the added burden, red tape and need to learn new formularies. This will mean that patients will want to see which MCO their doctor takes before they decide. Trying to get every patient and every physician in the program by January is neither practical nor wise. Patients will be left out in the cold not knowing where to go or who to see. They will end up in the ER and UCC.

The last issue is financial. We currently receive about 130% of the Medicaid fee schedule with Harmony and Molina. The best that the new ones offer is 105%. So we will automatically be taking a 25% reduction in pay all while trying to learn how to get through the red tape of the new MCO. Cash flow will be disrupted as always occurs with a new third party payor and some offices will not be able to meet their payrolls.

We implore this committee to re-think the current proposed changes and take some more time to implement processes to eliminate the known problems.

If more than one MCO is being used, the State needs to require a common formulary, along with common rules for payments. There needs to be an easy way to file a complaint and get a resolution. Patients have to bear some financial responsibility for keeping appointments and overutilizing the system. Most physicians will not accept all the programs and therefore having patients choose the MCO will create more problems.

We strongly believe the current proposed changes will create more problems and become more costly for the State. Please don’t make a bad situation worse.

Choices for not having a doctor

Most of us believe individuals don't have physicians for regular care because of financial constraints. We hear this repeatedly from the media.

But according to a recent survey, financial reasons only account for 10 percent. The vast majority of these patients haven't established a doctor-patient relationship because they believe they don't need them.

The study, published in the July/August issue of the Annals of Family Medicine, is based on a representative sample of more than 9,000 adults. Depending on the study design, it cerainly may have underlying biases that make an accurate assessment possible.

It certainly shows that a vast majority of people make a conscious choice to not have a regular physician. We can only encourage these individuals, but we still need to help the 10 percent that truly cannot afford healthcare.

Primary Care

In another recent Medical Economics article, they discuss the issue of primary care shortages over the next several years.
[Where's primary care headed? - It's at a crossroads, and its future may depend on forces beyond physicians' control. - Medical Economics]

Some of the important points mentioned in the article are as follows:

• 
  Nearly 30 percent of current primary care physicians are 55 and older and will retire in 5-10 years
• 
  More women are likely to go into primary care, but tend to work shorter hours and retire earlier
• 
  More than half of US medical school graduates now plan to do something other than practice medicine
• 
  The Council on Graduate Medical Education recently forecast that the US would require 85,000 more physicians by 2020. Another government report projected a need for 33 percent more doctors—and 28 percent more generalists—in 2020 than in 2000
• 
  The output of general internists dropped 35 percent from 2000 to 2003, and there's every indication that that decline is continuing.

These are trends that if not addressed now will ultimately cause even more disparity in health care for the poor and uninsured down the road.

Major changes in our current system need to be made to ensure adequate primary care physicians

Trip to Boston

My wife and I had the opportunity to visit Boston last weekend for a wonderful Focus on the Family Conference. This was our first time to Boston and I have to say it is a fabulous city.



There is a tremendous amount of history and sites to visit. We took the bus tour and walked part of the Freedom trail and visited many of the sites listed in the picture.




The city itself is very friendly to walkers and we probably walked 10 miles or more in our 2 days. There are great restaurants, pubs, and outdoor dining venues. The diversity in language and nationalities was tremendous and the college atmosphere with all the youth was exciting.




It would certainly be a place I would like to visit when I had more time to actually study some of the historical sites.




One thing that could not be denied with all of the historic churches and history is that this nation was founded with Judeo-Christian beliefs at the forefront. Anyone denying this either has not been to Boston or is choosing to deny the obvious because of their personal beliefs and/or bias.

New treatment for rodents

Colorado has recently made it legal to blow up prairie dogs. In the past, landowners have been allowed to shoot at, poison, drown, and even vacuum up prairie dogs in an attempt to keep the pests from ruining crops, but now with clearance the official sanction of the Colorado Wildlife Commission, angry farmers can go all out on the burrowing rodents.

Innovative businessmen have developed systems like the Rodenator Pro costing $1,900. It uses the ignition of gases to collapse prairie dog tunnels. One farmer said "I'm tickled pink; I've got prairie dogs so thick I can't see straight. . . . Ever see that Star Trek episode, 'The Trouble with Tribbles'? It's like that. They are born pregnant."

I am sure we will be hearing from PETA very soon!

Our Society of Wimps

Society has always recognized and accepted the fact that there are underprivileged kids, but we are just beginning to accept the fact that the bigger problem in the 21st century may very well be the over-privileged kids.

These kids are easily recognized because they have been shielded and flattered by their families. They are typically anxiety-ridden or passive-aggressive, depressed, and fearful.

It begins early with playgrounds now being fully padded and parents actually on the playground making sure little “Johnny” isn’t hurt, teased, or taken advantage of. These are the kids whose parents send them to school with sanitizing gels because the bathrooms are no longer safe. These are the kids whose parents have doctors give them diagnoses like difficulty with Gestalt Thinking in order to have them take the SAT test untimed. Parents may call or send letters to teachers complaining about the “C” they received in a certain class. Parents structure their activities and never allow them to fail. If they do fail, someone other than “Johnny” is responsible. There are rarely neighborhood ballgames because every athletic event is carefully controlled and coordinated. Regular playtime is eliminated in kid’s lives. More than 40,000 schools no longer have recess.

We learn through experiences. All experiences aren’t good and protecting children from every bad experience basically sanitizes our children and leads to a failure to cope. Schools are no longer geared for child development but now are purely geared towards academic achievement. Parents will therefore go to excessive means to make sure little “Johnny” is at the top; even if this means making excuses, getting special accommodations, or challenging grades. Grade inflation has become one of the most disastrous policies in grade schools, high schools and colleges. Protecting students from getting what they earn is counterproductive.

If we continue to remove all the discomfort, disappointment and play out of development while increasing the demands for success, we will have kids who are unable to build their creative adaptations to life’s struggles. They become fragile, anxious, depressed and risk-averse.

When these same kids get to college, statistics show they are much more prone to binge-drinking, self-mutilation, eating disorders and other defeating behaviors because they want to fit in or do not know how to handle making decisions for themselves. Studies show that up until 1996 the most common problems from college students were relationship issues. But since then, it is anxiety. These kids have been controlled for so long that they just go crazy.

Kids are losing leadership skills. Believing that only intellectual activities sharpen the brain is inaccurate and wrong. Playing and social engagement with others is more important to improving intellectual skills, fostering decision making, improving memory and thinking, speeding up mental processing and learning the most important skill of conflict resolution vs. conflict avoidance.

Other societal activities that hamper our kids from growing up are cell phones. They have been labeled the “eternal umbilicus” because kids are never too far from mom or dad and being able to have them solve a problem. Calling parents or friends and telling them needless information or making plans to meet in 5 minutes takes away the art of having to actually plan your time and stick with a schedule.

We have become a society of instant gratification. We have instant access to cash, fast food, 24 hour stores, and we therefore expect instant friendships and instant intimate relationships. All of this leads to impatience, frustration, and unwillingness to work out problems and broken relationships.

Harvard psychologist Jerome Kagan found to his surprise that the development of anxiety in children was rarely inevitable despite apparent genetic programming. At age 2, none of the “over-excitable” infants in the study wound up fearful if their parents backed off from hovering and allowed the children to find some comfortable level of accommodation to the world on their own. Those parents who overprotected their children—directly observed by conducting interviews in the home—brought out the worst in them.

We are now giving a label to those 20-30 year olds who still haven’t “grown up”. We now call this time period early adulthood. In 1960, 65 percent of males reached adulthood by this age as defined by living on their own, married, or basically self-sufficient. In 2000, this number had dropped to 31 percent. In women, it went from 77 percent to 46 percent.

Bending rules, making excuses and over-protecting our kids is morally corrosive. The same parents who feel that their kids cannot handle these routine disappointments in life are usually the same ones that believe their kids can handle the separation or divorce of the parents and complete disruption of the family unit.

Children’s sole purpose is not to make his parents look good. A child's calling is to grow up and be productive members of society. Our current culture fails to appreciate this important aspect and therefore will continually be burdened with childish adults that are unable to cope with the stresses of life.

The France Stance

France is at it again. Chirac is upholding the same philosophy that so many previous French leaders have done. Chirac said yesterday that he is "never in favor of sanctions"

"I don't believe in a solution without dialogue," Chirac said in an interview with Europe-1 radio. "I am not pessimistic. I think that Iran is a great nation, an old culture, an old civilization, and that we can find solutions through dialogue."

Diplomacy certainly has its place, but sooner or later, you have to have action. The consequences of a nuclear Iran will eventually be ongoing terror threats or worse.

France continues to maintain the perception of being passivists and has been joked about by various people as seen here.

"I would rather have a German division in front of me than a French one behind me."General George S. Patton

"We can stand here like the French, or we can do something about it."Marge Simpson

"As far as I'm concerned, war always means failure"
Jacques Chirac, President of France
“As far as France is concerned, you're right."
Rush Limbaugh

"The only time France wants us to go to war is when the German Army is sitting in Paris sipping coffee."Regis Philbin.

"You know, the French remind me a little bit of an aging actress of the 1940s who was still trying to dine out on her looks but doesn't have the face for it."John McCain, U.S. Senator from Arizona.

"I don't know why people are surprised that France won't help us get Saddam out of Iraq. After all, France wouldn't help us get Hitler out of France either"Jay Leno

"The last time the French asked for 'more proof' it came marching into Paris under a German flag."David Letterman

War without France would be like ... uh ... World War II.
The favorite bumper sticker in Washington now is one that says 'First Iraq, then France.'"Tom Brokaw

"What do you expect from a culture and a nation that exerted more of its national will fighting against DisneyWorld and Big Macs than the Nazis?"Dennis Miller

"It is important to remember that the French have always been there when they needed us."Alan Kent

"They've taken their own precautions against al-Qa'ida. To prepare for an attack, each Frenchman is urged to keep duct tape, a white flag, and a three-day supply of mistresses in the house."Argus Hamilton

"Somebody was telling me about the French Army rifle that was being advertised on eBay the other day -- the description was, 'Never shot.
Dropped once.'"Rep. Roy Blunt (MO)

The "Doughnut Hole"

Many people have asked me to explain the Medicare Doughnut Hole. With the Medicare Part D drug plan every patient has a $250 deductible. This means that the patient has to pay the first $250 for their drugs.

The next $2000 dollars of drugs, Medicare will pay 75 percent of the cost. This means the government will pay $1500 of the $2000 worth of drugs and the patient will be responsible for the other 500 dollars.

So out of the initial $2250 dollars worth of drugs, the patient pays $750 and the government pays 1500 dollars.

At this point, the government benefit plan will not pay another penny until the patient has actually spent $3600 in total drug expenses out of their own pocket. At the point that the total drug cost hits $5100 ($3600 patient has paid plus $1500 Medicare paid) the government will now pay up to 95% of any further expenses.

The doughnut hole is that portion between $2250 and $5100 that the patient is totally responsible for.

Several companies do offer additional insurance that will cover this gap, but it comes with additional monthly premiums.

Which plan a patient chooses should be individualized based on their needs, finances, current drug costs and risks they want to take.

Physician-Board Meeting

Well, for all the critics out there who have questioned whether physicians actually inform the board of our ongoing issues, we did meet with three Board members last week. The concerns that were officially addressed with these Board members and CEO were as follows:

• Diversion problem and the plan for the winter season. We have already been on diversion more this summer than any previous summer we remember. It is very concerning to physicians as there has been no official statement on what plans were being made to help alleviate the situation.
o At the suggestion of physicians, they are agreeable to form a multidisciplinary group with physicians, hospital personnel from nursing, ICU, registration, bed control, discharge planning, EMS etc. to discuss possible solutions to help alleviate the problem.
• ER issues including satisfaction and why the fast-track and the observation unit are not yet up and running as we were told last year.
• Length of stays that seem to be increasing
• Staffing issues on the floors and other departments
• OB issues regarding the facility and the staffing
• The Board was updated them on Medicaid concern
• We discussed the rumor about the hospital’s Bond Rating
• Two of the Board Members were questioned on their decision to add a VP position when all other departments were asked to cut their budgets. The only additional comment that was offered was that they didn’t want to lose good people to other places. So, does this set a precedent that any director needs to just threaten to quit and then receive a VP position? We will continue to disagree on the poor timing of this decision.

(corrected paragraph)But it is to be noted that the vote was 4:3. The three Board members voting not to add the VP position at this time were Von Marshall, Kay Garry, and Darrell Mills. Board members who voted in favor were David Atkins, Mame Garner, Keith Megraw, and the Chairman Bob Kleehammer cast the deciding vote.

So, as you can see, important issues were once again brought to the attention of the Board and again to the CEO.

Nurse Avenger

Here is an innovative approach to relieve healthcare frustrations. A California-based consumer advocacy group has launched an online game called "Nurse Avenger," in which players win points for wasting greedy insurance executives in the name of universal healthcare.

It is a spin-off of many popular shoot-em-up video games. You basically take on the role of the caped nurse crusader and blast the mobster HMO bosses who are trying to kill the patient and deny their healthcare. There are many weapons and levels to master and you can eventually obliterate Blue Cross and WellPoint.

The game was unveiled a couple of weeks ago by an advocate with the Foundation for Taxpayer and Consumer Rights. It was in response to show support for the Senate Bill 840 in California which narrowly passed the California Assembly.

The game can be played at the following site and it is quite entertaining:

[CALHEALTHPLAN.ORG]

SETI and ID

The Oak Ridge Observatory telescope sits in Harvard, Mass scanning the skies as part of the Search for Extraterrestrial Intelligence (SETI) project. In addition to the Oak Ridge Observatory telescope, the Allen Telescope Array is scheduled to begin operation later this year to continue an in-depth survey of the skies, listening for radio signals from a million different stars in a search that will take until at least 2025.

The search for extraterrestrial intelligence is reportedly a legitimate scientific enterprise. It began in 1960 with Frank Drake, an astronomer at the National Radio Astronomy Observatory in Green Bank, W. Va.

Carl Sagan said "It is difficult to think of another enterprise within our capability and at relatively modest cost which holds as much promise for the future of humanity".

The majority of the SETI work has involved listening for radio signals at the frequency of 1.420 gigahertz, which is the frequency emitted by hydrogen. Scientists are looking for some sort of basic mathematical information like a list of the first dozen or so prime numbers, repeated again and again. But almost any non-random pattern would be likely to catch our attention. The point is that if an intelligent agent wishes to communicate, it can use natural materials to convey a message and humans can discriminate these attempts from the natural processes. It would be like smoke signals or SOS calls.

The University of California at Berkeley runs the SERENDIP (Search for Extraterrestrial Radio Emissions from Nearby Developed Intelligent Populations) project, which piggybacks observations off of the Arecibo Observatory in Puerto Rico. Millions are spent on these “scientific projects” and about 5 million homes tap in as well to help analyze and sort through some of the raw data.

So the researchers involved in SETI use scientific equipment, collaborate with scientists, attend scientific conferences, publish scientific articles, and generally look and smell like scientists.

Here’s the question:

If these scientists ever do detect a signal, what will they conclude?

Their belief is that if they find a repeating code then they will conclude there really is an intelligent source creating it (extraterrestrial life).

This line of thought is absolutely no different from what Intelligent Design is doing. They are looking scientifically for evidence of complex design that could only come from a designer.

Why is one funded and taught as science and the other discredited?

Neither SETI nor ID will ever be able to prove their conclusions based on our current knowledge, but both are legitimate scientific endeavors.

ISMA Medicare Memo

Shown here is the urgent message sent to all Indiana Physicians related to the proposed ongoing Medicare cuts.

We need everyone to understand the significant consequences of these continued cuts and how it will not solve the rising medical costs.

In fact, by cutting the fees even further to physicians, access will become an even greater issue and more patients will be seeking their healthcare in more expensive ways. Overutilization will continue to rise in the Emergency Rooms and urgent care centers and patients will wait longer before getting the help they need.

This will cause them to be sicker and require more healthcare dollars and cost the government and we the taxpayors even more money.

This shortsighted philosophy is crushing our health care system!

Ethics talk on Stem Cells

Here is an lecture on Stem Cell research and ethical considerations. It should be thought provoking for all those in attendence. My understanding is that physicians as well as other health care providers could attend.

Adding Insult to Injury

The CEO, once again, has created more discontent by his recent attempt to justify the extremely poor timing in new VP promotion.

He made the following comments in the latest edition of the Microscope publication:
"In today's complex health care environment, I believe it is important to have a Human Resources position at the Administrative and Board Tables to represent the interest of our associates."

He goes on to say:
"Over the last year, we have been actively engaged in the process of succession planning and talent management. Through this assessment, we have worked to identify future key leaders to ensure the continued success of Floyd Memorial in the years to come. While we may be going through some challenging times right now, it is important to recognize and promote individuals like Mike to leadership roles."

The first statement is just lip-service. The HR director was already at the "director" level and attended all of the administrative council meetings. As far as the Board Table, the CEO had the HR director in the meetings when employee issues were being discussed and the HR director gave numerous presentations to the Board over the years. So now, after 16 years of tenure and at a time of financial crisis, he now believes it is important to promote someone to a VP position to continue doing was he is already doing.

This phrasing may sound good to those who have a lack of information, but to the other directors and managers, they know this to be unctuous speech.

The second statement has really caused some at director and manager levels to question their value and future opportunities at Floyd. Are they not identified as key leaders and are they not performing at a level to be considered for advancement? Some have many more years of experience, training and education and feel as if they are being passed over.

But the real key to his comments is the fact that he admits we are going through challenging times yet none of the explanations listed justify why this promotion had to be done now. Finances are bad, departments have been asked to cut their budgets and HR has been represented appropriately for the past 16 plus years.

What is the real underlying motive to making this promotion in light of everything else?

Does this promotion mean that other qualified employees are no longer being considered for advancement? What is the succession plan and what is the timetable? Employees would love to know as would many others.

The basic underlying question remains; what possible benefit does this promotion provide to the hospital now, that could not have waited until the budget was in better shape and the departments were not having to slice their own?

He still cannot defend this decision and continues to add fuel to an already hot fire!

Coffee costs

Did you realize that buying one cup of gormet coffee each work day will cost you nearly $9000.00 over the next 10 years? This assumes a 6% interest rate and that you drink the 25 cent office coffee.

Here is a neat little coffee calculator that you can plug real numbers into and see what you would actually spend and save.
[Break the Starbucks habit and Save big!]

That Folgers is looking better and better and I think it even tastes better!!

Big win for Christian Education

After almost 10-months of waiting, a California Judge finally gave a ruling on the University of California (UC) motion to dismiss the suit by the Association of Christian Schools International (ACSI). The ruling means the religious discrimination suit against the nation's largest state university system will proceed and will likely have national implications.

What is also interesting in this case is that the Judge used the 1981 Indiana Supreme Court ruling in Thomas v. Review Board of Indiana as being most applicable to ACSI's case. The key ruling stated “When the state denies an important benefit—in this case admission to the state university system—because of "conduct mandated by religious belief, thereby putting substantial pressure on an adherent to modify his behavior and to violate his beliefs, a burden upon religion exists."

The Judge felt that the plaintiffs demonstrated that they were forced to choose between taking equally credible courses with one promoting a biblical worldview or complying with the University’s recommendations. The Judge also upheld ACSI’s claim that the UC’s censoring of Christian viewpoints likely violated the First Amendment.

The Judge wrote "Fundamentally, the government is forbidden from engaging in regulation of speech based on its substantive content or its message, and while the Supreme Court has said universities may legitimately judge course content, the court has also ruled that schools may not, in doing so, violate individual constitutional rights."

This case truly is about discrimination against the Christian worldview. The content of the science in the books is very similar and is noted to be even more detailed in the texts that were denied acceptance. But because they openly had a Christian perspective they were banned.

The university's Board of Admissions and Relations with Schools claims that students who take these physics courses based "may not be well prepared for success" at its schools. They expanded this to also include four other disciplines including history, government, literature, and biology when they came from a Christian perspective.

The double standard arises when UC accepts the following courses as adequate for history: "Western Civilization: The Jewish Experience" and "American Popular Culture, "Feminist Issues Throughout U.S. History and Race" and "Class and Gender in Modern America"

When the University went on to claim that students taking rejected courses "may not be well prepared" for state university success they couldn’t give rational explanations for the fact that on the Stanford Achievement Test in spring 2005, students from ACSI-member schools outscored students from public and private schools by 18 to 26 percentile points.

I always thought standardized testing was a method to help elucidate different teaching and make comparisons easier, but I guess UC felt otherwise.

This is a big win for all private schools and we’ll be waiting to see the final outcome.

Ethical dilemmas

More and more teaching is being done in Medical School trying to help with some of the ethical dilemmas that face physicians every day. For years, we have focused on end of life scenarios, but there are many less dramatic choices that have to be made every day to survive in medicine. These issues are heightened because of more pressure coming from 3rd parties and government oversight.


Some of the more common ethical issues are as follows:

• Are you always obligated to honor a patient's advance directive?

• How aggressively should you treat an irreversibly comatose patient who doesn't have an advance directive?

• Should you write a prescription in a way that saves the patient money or write a prescription in a family members name to help the financial burden of the patient because of insurance reasons.

• Should you give little Johnny an excuse to keep him out of PE because of a parent request even though he is overweight and the kids pick on him?

• Are there times where you should withhold information from patients?

• Should you honor a family’s request not to inform a patient that he/she has a terminal illness?

• Should you inform a spouse who is your patient that their husband/wife has an STD?

• Is clinical decision-making compromised by gifts, trips, and other perks from pharmaceutical industry representatives?

• Is it ever ethical to write a bogus medical excuse for a patient who wants to collect disability payments, take time off from work, or get a refund from an airline?

• What do you do if you suspect that a colleague has a substance abuse problem or is clinically incompetent?

• What's your obligation to a patient when you make a medical error affecting that patient?

• Under what circumstances should you "fire" a patient?

• Should you exaggerate symptoms in order to keep a patient hospitalized longer because you believe or the family believes it is their best interest, even though you know the insurance would want them discharged?

• How do you deal with prescribing the morning after pill or referral for abortions?

• How do you deal with patient demands for tests that you know clinically are not warranted, such as MRI’s, CT scans, etc.?

• Do you give antibiotics for illnesses you are pretty confident are viral in nature?

All of these are issues that occur every day in primary care practices. Is there a right and wrong answer to each of these and, if so, who decides? But in the end, who will be faulted for the decision being made or the actions taken?

Practicing medicine in the 21st century is more than treating allergies or the common cold. There are numerous ethical and moral dilemmas that are decided every day.

CEO Double Standards

The CEO of Floyd Memorial Hospital and Health Services has once again displayed a double standard when asking the Board to approve adding another Vice President to the Administrative Staff.

His request comes just a couple of months after he instructed each manager to cut their budgets by 5 percent because of the current declining financial situation at Floyd and not meeting the stated budgetary goals. He announced these cuts at the Medical Staff meeting and he made everyone believe that only essential patient care positions would be filled during this time. He assured us that patient care related areas would not be affected by the cuts. Again, this was not accurate.

Many of the associates are "quietly" exasperated and angered at this announcement. An employee came to my office and stated that at her last staff meeting, they didn’t pass out minutes and were told it was because of the budget cuts. Many nurse managers and non patient care managers have several open positions they would like filled and as of this writing, there were 68 open positions posted on FMHHS’s website.

It should be noted that this same position was turned down at least twice last year while I served on the Board. Three of the current Board members spoke articulately at the meeting why this move was poorly timed and a bad idea and these three voted against it. The vote was 3-3 with the Chairman casting the deciding vote in favor. These same Board Members voting in favor have a consistent voting record never in opposition to the CEO, regardless of the issue. With this much controversy amongst the Board, tabling the issue for further discussion would probably have been more appropriate.

Evidently, three Board members are unafraid to speak up against an obvious double standard and a poor choice by the CEO. I believe these Board members are frustrated by always being in the minority this year while some other Board Members have never voted against a single major issue that the CEO requested.

The timing of this appointment places the Board in a very difficult situation trying to explain to the associates, physicians, and the public why this position was needed now.

The administrative line goes something like this: “This VP position will give the employees a voice at the most senior level of the organization.”

If this is true, is the CEO now admitting that for the last 13 plus years of his tenure, the employees have not had a voice? Which is it?? This appears to be more double talk from the CEO.

Just two months ago, he publicly told everyone including the press and medical community that the recent financial adjustments were necessary and only patient care positions would be added when needed. The question remains “why this position and why now”?

The credibility of this CEO is once again further fractured by poor judgment. There should be no missing this double-standard action toward his own workforce, the managers, board of directors, the physicians he wants a trusting relationship with, the public and the commissioners that he works for. In this single action he has demonstrated his complete lack of sensitivity to his own associates and managers and of course the medical staff.

Many people once again believe this action demonstrates a poor perspective on his image as a leader. He once again places his Board and Commissioners in a difficult position of how to defend such poor judgment. The public should be asking more questions on this issue, and other issues like why we are on diversion in the middle of the summer, and about the potential decline in our Bond Rating because of the financial situation.

I think everyone should ask him directly why he hired this position in contradiction to what he told his associates and physicians a few months ago. I hope the press will ask him and that he will be publicly required to make himself available to answer this question. He held his associates accountable for staffing "adjustments"-----he should be held accountable as well and the Board should have said "no" as the CEO has with his subordinates.

Humor and sex differences

This is no laughing matter. Men and women are different in many ways. A recent study from Stanford has shown that gender actually affects how our brains respond to humor.
[ Sex differences in brain activation elicited by humor -- Azim et al. 102 (45): 16496 -- Proceedings of the National Academy of Sciences ]

The study used a special type of MRI for the imaging and it revealed that women activate the certain parts of the brain involved in language processing and working memory more than men when viewing funny cartoons. Women were also more likely to activate with greater intensity the part of the brain that generates rewarding feelings in response to new experiences.

These results help explain the results of other studies that also suggest women and men differ in how humor is used and appreciated.

Previous researchers have shown that a certain area of the brain called the mesolimbic reward center is activated by events such as financial successes and cocaine use leading to the rewarding feelings of these events is also activated by humor.

In this study, 20 healthy adults (10 men and 10 women) viewed 70 black-and-white cartoons and then rated the cartoons on a one-to-10 “funniness scale.” During the screenings, the researchers used functional magnetic resonance imaging to monitor participants’ brain function.

The results showed that men and women share much of the same areas in the brain for humor but the women’s brains were activated more in certain areas corresponding to emphasis on language and executive processing and the nucleus accumbens that is part of the mesolimbic reward center.

The researchers were reportedly caught off guard by this. They theorized that because the women in this study used more analytical machinery when deciphering humorous material, it signaled that they weren’t necessarily expecting the cartoons to be as rewarding as did the men. When a woman’s brain encountered the punch line, her reward center lit up. According to the researchers, “the activation of this center not only signals the presence of something pleasant, but that the pleasure was unexpected.”

“Women appeared to have less expectation of a reward, which in this case was the punch line of the cartoon,” said Reiss (one of the researchers). “So when they got to the joke’s punch line, they were more pleased about it.” Although it could be that they have lived with men long enough that they are used to being disappointed and therefore have fewer expectations at the onset.

The researchers also found that the funnier the cartoon, the more the reward center was activated in women. That was not the case in men who seemed to “expect” the cartoons to be funny from the start.

In a related study, researchers also found that personality traits, such as extroversion and introversion, affect how humor is processed and most women find men who are humorous to be more desirable.

So guys, keep it humorous. The women won’t expect it and it will stimulate their reward center more intensely.