Our Future in Healthcare?

Anyone who thinks that centralized, socialized healthcare is a great thing only needs to turn on the television set and look to the United Kingdom with regard to their current healthcare problems.

Anyone who thinks that centralized, socialized healthcare is a panacea that will solve our problems only needs to watch Prime Minister’s questions as their parliament debates healthcare in the United Kingdom.

It’s not a bowl of cherries.

It’s not a bed of roses.

They haven’t discovered the holy grail to healthcare.

People in the UK are not uniformly happy with the healthcare they’re getting.

What’s going on over there now is that nurses are going on strike.

They want more pay.

It’s creating quite the controversy.

Operations are being delayed.

People are upset.

What are they to do?

Well, you can’t have your cake and eat it too.

You can’t have centralized healthcare run by the government and not have countrywide strikes.

Big government invites big business and big labor.

There are no two ways about it.

If you don’t want countrywide strikes you have to decentralize your healthcare.

You have to break up the big corporations who are benefiting off healthcare.

Because big corporations siphon off huge amounts of dollars by virtue of the fact that they are buddies with their friends in the government there is huge waste of money in their healthcare system. Ours too.

That leaves less money for the workers.

It also means that services have to be cut back.

What ensues is a penny-pinching system for the poor and middle class, but a bonanza for the rich money grubbing corporations.

That’s our future here in the United States.

It used to be in the United States that healthcare and its attendant services were readily available.

You could get an operation at any time. You could get an MRI at anytime. You could get lab at any time.

That’s not the way it is now.

Increasingly it is becoming more difficult to get healthcare in the United States as insurers make patients jump through hoops to get their services.

That’s not what we want. We don’t want to become the UK.

We want the government to have less control when it comes to financing healthcare.

We want the government to do what it does best: regulate (and I don’t mean phony regulation designed to stamp out the small guy).

We want the government to stop doing what it does worst: financing.

Our solution is their solution.

They need to break up their large pharmaceutical corporations in order to drive pharmacy costs down.

They need to break up their large hospital system into a series of independent hospitals that compete with each other for healthcare services.

They need to limit the size of their hospitals while allowing the free market to create more of them.

They need to limit the size of all the corporations that are involved in healthcare.

Healthcare is not a place to get rich.

Healthcare is not the same as the Ford Motor Company.

Healthcare is a place where you can make a nice amount of money.

There is no place for Warren Buffett in healthcare.

There is no place for any billionaire in healthcare.

There is no place for crony capitalists in healthcare.

There is no place for poorly educated Wharton School graduates in healthcare.

There is no place for ignorant CEOs who say things like this: “At Iroquois Foods, we have a saying: If you don’t grow, you go.”

Nor is there a place for the ignorant, stupid Harvard Business School graduate, who says: “The purpose of a business is to make money.”

Veto, veto, veto, you big idiot.

Healthcare is different than other businesses.

You can’t possibly equate healthcare and the auto industry.

Your car dealer is only too happy to sell you the most expensive car. Whether you can afford it or not is your problem.

Healthcare is different.

Our job in healthcare is to get the patient better.

A patent’s financial condition is part of their health. For that reason, we have to be cognizant of providing inexpensive, affordable and accessible healthcare for people.

That means we can’t rape the people financially as the large corporations do.

We can’t put them out on the street with expensive healthcare costs.

We also can’t ration healthcare.

Nor can we strike across the country whenever it suits our fancy.

The only way to do that is to decentralize healthcare under sensible controls set by the federal government.

It’s not the government’s job to make crony capitalists rich.

It’s the governments job to create a level, competitive playing field which provides affordable and accessible healthcare for all.

That doesn’t exist in the United States.

Nor does it exist in the United Kingdom.

And if you don’t believe me, turn on Prime Minister’s questions.

What you see is going on there is our future unless we make sensible changes right now.

Sincerely,

Archer Crosley

Copyright 2022 Archer Crosley All Rights Reserved

Bye Bye Miss American Pie

Our beautiful federal government has offered a sweet deal for rural hospitals.

Are you ready for this?

Shut down your inpatient services and we will give you a pile of cash.

Patients living in the rural area who need inpatient services will be ferried, I presume by helicopter, to larger cities.

The federal government’s rationale is that costly inpatient services are draining the amount of money that could be spent on outpatient services.

What do you think of that?

Rural hospitals are somewhat nervous about accepting this deal.

They should be.

It’s a thinly veiled attempt at establishing and furthering a national health service.

It’s also a euthanasia service in disguise.

Rural hospitals are worried that larger hospitals in the city will be unwilling to accept their patients.

They fear that the larger hospitals will become packed to the gills during various pandemics.

They are right.

Not only that, our federal government, true to its nature, will put in all sorts of regulations and requirements that will delay or deny such transfers.

As I say, it’s a disguised euthanasia service.

Thousands upon thousands of elderly people will die through neglect, but not before the crony capitalist pigs who control the corporations have siphoned every last dollar out of them.

After all, these rural elderly aren’t human beings to them. Instead, they are product – raw material whose value must be maximized. Does this sound remotely like Robert McNamara and his approach to the Vietnam war – a war that was never meant to end, a war that existed to make money? It should, because many of the people who run our country today are disciples of Robert McNamara. They love the guy.

And they were trained at the same fascist business schools.

Eventually, the elderly and other rural patients will be transported, but of course, in a more weakened state. This will, of course, allow the hospitals to put them in the intensive care unit for a greater number of days so as to maximize profits.

Naturally, of course they will die in greater numbers.

Now, a normal person and a normal doctor would say: an ounce of prevention is worth a pound of cure. They would recommend treating the patient as expeditiously as possible in the rural area. They would also recommend breaking up the large corporations that are profiteering off healthcare, those being in the hospital and pharmaceutical industry, so as to create more competition and bring costs down. This would allow rural hospitals to survive and thrive as they did for many, many decades before the “smart guys” in the Harvard Cabal put their death grip upon America.

A normal person and a normal doctor would see this as a better solution. They would think this because their goal is to enrich and prolong human life.

But of course, this will not happen, and so many many people will die.

In the future, politicians will wail: Nobody knew.

Well, I’m telling you now.

The Third Reich never died. It was merely transported over to the United States of America.

What you have in charge of this country is a corrupt and elitist Harvard Cabal, greedy fascists to the core, who think of themselves as the smartest guys in the room.

They and their Ministry of Health and Central Planning will now make decisions for you.

Part of their plan is to cull the human population of less productive people.

That means the elderly. They are a drain, don’t you know.

Our leaders in the Harvard Cabal are a little bit more sophisticated than Adolf Hitler though.

They’re not going to send them to the gas chambers.

No, they’re going to invent viruses and pandemics that will wipe them out.

And, they will come up with crazy ideas like having rural hospitals shut down their inpatient services.

That’s what central planners do.

It’s done in the name of profits.

And, of course, the public good.

Sure.

Sincerely,

Archer Crosley

Copyright 2022 Archer Crosley All Rights Reserved

Residency Letter

A little prologue might be necessary.  Between 1980 and 1981, Jenny Jamison, an LVN, was alleged to have murdered children at Lion County Hospital in Pleasantville.  She allegedly carried her spree to the nearby town of New Heidelberg where she worked in the pediatric office of Dr. Nancy Germany.  

Everything in this letter is true in the way I remember it.  I changed the names to protect myself from the guilty.  I’m sure if you dig deep enough you can figure it out.

* * *

This letter has been a long time coming.  I don’t want to relive old memories; I’ve already done that, and it’s too painful.  Nor do I want this epistle to devolve into a loathing, self-pitying screed, which it inevitably must or else you won’t get the point; it’s just that I think you should know a few things.

First, I was almost there.  I missed it by one year, but I know enough and felt enough to understand the situation.

The year was 1982, July 1st of 1982, to be specific, and I was beginning my pediatric residency at Lion County Hospital.

Pediatrics was not my first choice; it was something I fell into.  I thought I wanted to be an emergency room physician, but God had other plans for me.

Since I didn’t match in emergency medicine, I could choose any program anywhere in United States. So, I figured, if I can’t do what I want to do, I may as well live where I want to live. 

Because I lived in Mexico for two and a half years, where I was going to medical school, I had  traveled through Pleasantville on my way back to Philadelphia where I had grown up.

The clean look of the city had appealed to me.

After doing my first years of medical school at the UDEM in Monterrey, the remaining medical school years in Kansas City, Kansas, and having suffered the brutal winters there, I decided warmer weather was for me.  

When I saw that a spot was open in Pediatrics in Pleasantville, I took it.

Quite frankly, I couldn’t have cared less if I ever saw a snowflake again. I grew up shoveling driveways.

So I wanted to come to Pleasantville.  I loved the city as much then as I do today.  My dentist is still there, and I like to visit from McAllen where I live today.

After having lived in P-Ville for thirteen years,  from 1982-1994, I am an official visitor there now.

As for living there?  No, I’ll never do that again. For while I liked the city, the city didn’t like me back.

Truthfully, much of it was my fault. I had an attitude problem.  I still do but only for abusers.  

After my grueling experience living in Mexico, the ritual beatings and humiliations in medical school at KU, leaving scars that I’m sure many fellow physicians share, I wasn’t in the mood to take any guff let alone snide commentary from some unenlightened, rude professor. You see, the worst they could do to me was fire me. So what? They couldn’t take away my medical degree.  

Besides, they had the deal of a lifetime.  For working eighty to one-hundred hours per week for fifty weeks a year, I received, drumroll, $13,400 a year.  I was making less than minimum wage, but I thought I was rich.

Graduating from medical school is like being an adolescent again. You have a little power, and you think you’re some somebody, but you’re really not.

I thought I was somebody. The professors soon let me know that I was not.  

I suppose some people have a natural ability to take abuse and smile; I was not born with that ability.  I was ready to fight back and let them know what I thought. I had plenty of opportunity to do that.

Let me begin first by saying that there are two divisions within patient care in a residency program. Inpatient and outpatient.

Outpatient medicine for me was like a dream come true. The work was hard and rigorous, but I enjoyed it. The professors were excellent.  People like  Billy Canada and Vickie Visigoth were patient and helpful. They were firm but fair. They were never cruel.  Debbie O’Reilly’s voice annoyed me but she was never as confrontational to me as I was to her.

It’s too bad as much cannot be said for the inpatient doctors, particularly those who work the ICUs.  Surgeons aside, intensivists and cardiologists have generally fancied themselves the supermen of medicine.  I suppose bold action rather than prevention confers upon the healer a sense of omnipotence and pride.

These traits were not lost on Doug Blade who ran the PICU.  Doug Blade, you may recall, was the man who ran the PICU during Jenny Jamison’s, should I say alleged, reign of terror in 1981, one year before I began my residency.  I did not know Jenny Jamison, nor did I work with her, but I worked with many residents and nurses who had.

The Jenny Jamison incident was spoken of vaguely when I was an intern.  I learned what had generally happened, the deaths at the PICU, and the events in New Heidelberg under Dr. Nancy Germany.  I once asked a nurse who had worked with Jenny if she felt Jenny had committed these alleged murders, and the nurse nodded while replying with a roll of the eyes, “Oh, yeah, she did it.”

One of my professors told me that after the deaths in the PICU a consultant was brought in to evaluate the program and the PICU.  The professor vaguely hinted that the consultants felt that Dr. Blade had contributed to the climate which enabled Jenny to carry out her crimes.  Beyond this I heard little. 

Of course I didn’t need a professor’s off-the-cuff opinion to think that there might be substance to this.  I had felt it.

A few months ago I mustered the strength to review the articles that had been written about the Jenny Jamison incident.  I was surprised how many professors, residents and nurses I remembered.  They were all there as if it were 1982 all over again.  I couldn’t read too much though; too much would be too dangerous to my soul.  I had been unsuccessfully trying to forget those years; there isn’t a day that goes by that I don’t think about the abuse that Doug Blade and others doled out. 

Words about Dr. Blade’s rounds don’t quite capture the terror.  

The PICU in those days was a very small ship physically; rounds were in the early morning, so it was usually dark giving the unit a claustrophobic feel.  Contributing to the closed-in ambience was the seemingly huge number of people attending the event; and it was usually sold out.  If I said the event was sitting room only, you might get the wrong impression.  Because the unit was so confined, extra attendees would sit in the center of the nurse’s station.  There was no more room to stand.  People who had no reason to be there at all, allergy fellows like Bill Bug and Dave Roach, were there nearly every day to watch and enjoy the bloodletting.  I called them Blade’s Dobermans.  Tension was so thick you could grab a piece from the air.  When a doctor presented, a dreaded dead calm projected itself; you could hear a pin drop.

What kind of individual, save a sadist, would come back for a repeat performance?  You didn’t feel uncomfortable for just yourself but also for others who were being skewered.

It was a circus, and Doug Blade was its ringmaster.  Doug Blade not only inflicted wounds; in my opinion, he enjoyed it.  He reminded me of Trevor Howard as Captain Bligh in Mutiny on the Bounty.  Cruelty with a purpose.

Suzy Disciple, a physician who was doing her fellowship, would affectionately refer to Dr. Blade as Dougbo.  Suzy was evidently one of Dougbo’s supporters.

Well, I’m sure Dougbo thought he was giving tough love, helping doctors be better doctors.  And if he thought that, he wouldn’t be alone; there are far too many professors who buy him into this flawed philosophy of teaching.  It seemed to be an endemic problem in the Pleasantville pediatric program.  Doug Blade was not alone.  Professor Johnny Bullman was a fellow believer in Dougbo’s tactics. He twice humiliated me in front of a group of people.  Another professor, Larry Flowers, a know-it-all cardiologist, upset and embarrassed that one of his patients crashed the night before he told the parents the child was to go home, specifically invited me into an ambush in the PICU.  Great men like Dr. Flowers can not possibly accept responsibility.  This is the same Larry Flowers who as my supposed mentor during my elective in the PICU spent not one minute teaching me anything about cardiology; and I’m being generous when I state one minute. 

To the best of my knowledge, Larry Flowers was not working in the PICU when Jenny Jamison was doing her thing. 

Larry Flowers was what I call a guest educator.  He was in private practice but evidently felt that he had enormous gifts to bestow upon medical residents.  Thanks but no thanks.  So sure was he of his prodigious gifts that he took it upon himself to counsel me one day.  He said to me:  “I hear you want to go into emergency medicine.  That’s the wrong field for you.  You need to go into research.”  Thanks, Larry. How long have you known me?  Did you spend any time with me, Larry?  Did you teach me anything?

Such a genius.

Okay, Larry, I get it.  I had a tough time with pediatric cardiology; but so do many students and residents as evidenced by the fact that so many of you pediatric cardiologists keep writing books trying – unsuccessfully – to explain it.

If you think my experience is unique, you are most decidedly incorrect.  As a medical student at KU, I did a one month preceptorship in a small town in Kansas.  One day my preceptor, we’ll call him Dr. Kind, related a  story of a humiliation he had received from one of his professors at least a decade earlier.  He told the story as if it had happened the day before.  Evidently the scars ran deep.  I must say that I couldn’t relate at the time because I myself had not been whipped sufficiently by a medical cat-of-nine-tails, but I was learning.  Indeed, on those days, I was always a bit mirthful.  “Why are you always smiling,” one classmate asked me.  “I don’t know,” I responded.  What I should have said was this:  “Because I haven’t had the shit beat out of me by ignorant professors who don’t bother to do their job.”  

Years later I discovered that Dr. Kind, who had been suffering from psychiatric problems, had given up his license. I wasn’t surprised.

I can’t speak for how residency programs are run these days, but in 1982 it was the blind leading the blind.  The professor was rarely there; most of his or her time was spent in a lab.  But why would that be?  To understand  we have to look back at how medicine evolved.

The best way to do that is to tell you about the day my father died.  He died on the kitchen floor in front of me.

I don’t need to give you every detail.  It was a Wednesday in late August, the 21st if you must know, and the year was 1968.  He came home from work and collapsed on the kitchen floor.  I was siting right next to him as we waited for the ambulance.  They came and put oxygen on him; that was it; that was state-of-the-art emergency medical care in 1968.  The ambulance looked stylish, though.  It was red and white, shaped like a hearse and had fins.  I have to believe that Henry Ford got together with the medical leaders and concluded:  “Well, since we can’t do shit for the patients, we may as well look good.  Let’s build stylish ambulances.”  And they did.  They were beautiful, nonfunctional and appropriate for the 1960s.

Ambulances with fins?

Let us flash forward 15 years, and the year is 1982. I’m in an ambulance, speeding up the highway to Lion County Hospital.  The ambulance looks like a small truck, what your modern ambulance looks like today, and we can do IVs, intubate, give epinephrine, do CPR and any other number of things.  

In fifteen years medicine had changed dramatically.   What we could now do was miraculous.  The complexity of medicine had exploded.

In the first part of the 1900s a doctor would be stressed out because there was little he could do for a dying patient save hold his or her hand.  In the latter part of the century a doctor became stressed out because he could do things.  With progress comes demand and expectation.

A doctor was no longer asked to help; he was expected to save lives.  Failure was not an option.  The technology had advanced immeasurably.

What didn’t change in those fifteen years between 1968 and 1982 was the basic structure of the residency program.  Residents were so named because they resided in the hospital.  The professors came during the day and went home at night.  The resident worked all day and all night and got sleep when he could.  As medicine advanced, due to a massive influx of government money, much of the professors time became invested in research rather than education.  Residents were expected to do the bulk of the work, then and now.  What became different and mandated a change, in this author’s view, was the complexity that high-tech devices introduced into medicine.

It would no longer be acceptable for a resident to work with little sleep.  The technology and greater expectations of preserving life mandated that change.  Sadly, no change was forthcoming.  Even bus drivers knew better.  I knew that because I traveled by bus when I attended medical school in Mexico.  You get to know the bus driver when you spend forty hours on a bus.  Did you know they can’t drive more than eight hours per day?  See if your genius academic knows that. How could he?  He’s too busy looking at himself in the mirror imagining himself holding up his Presidential Medal of Freedom.  Or he’s oiling up his cat-of-nine-tails.

Additionally, it would not suffice anymore for a professor to sit at home and then come in screaming the next day.  This was the standard methodology for teaching in the early 1900s.  It was akin to whipping a horse to get it to run better.

Professors, particularly surgeons, reveled in their ability to debase.  The stories told of these men are legend.  Compounding this was the machismo of the profession itself. 

Machismo is cultivated religiously in medicine.  Never admit you’re wrong.  Pretend that you know it all.  Never ask a stupid question.  These are wrong traits to promote, and it is the structure of group rounds itself that contributes to this.  Roundsmanship is valued in healthcare.  The professors encourage it by insisting on group rounds.  Group rounds suits their ego well.  I suppose they imagine themselves as a weird fusion of Aristotle and George Patton walking down the halls, their robes flowing as they dispense pearls of wisdom.  The problem is that the pearls are in short supply while the insults are plentiful. 

The problem with insults is that they hurt, and they are of little value.  The idea is to stimulate the student to learn much as George Patton thought he could make that shell-shocked soldier in Italy better by slapping him.  It’s an errant methodology without one ounce of support or evidence.

As they were doling out their beatings through flippant remarks such as, “I would expect someone at your level to know this,” I wondered why these professors who took so much care in their research cared so little when delivering their meritless comments and evaluations.

Since they were rarely there on the ward, they had no no idea who was working and who was not.  They had no idea who was Machiavellian and who was not.  They had no idea who was an ace bullshitter and who was not.  Consequently, their evaluations were without value.

It occurred to me early on in my training that none of them had been trained in the psychology of teaching, and even fewer cared.  For example, suppose Person A with an insecure personality admits he doesn’t know at a knowledge index of 90 (out of 100), whereas Person B with a superiority complex admits he doesn’t know at a knowledge index of 25.  Person A will always appear to be the stupid one.  Are the professors aware of this?  Do they care?  Not in my experience.

This was what rounds were like in the year 1982.  I have no reason to believe that things have changed.  It was a humiliating experience.  And it was so unnecessary, for none of those beatings made me a better doctor.  Everything I can do well in medicine is because someone gave some personal attention to patiently explain things.  Everything I can’t do well is because some professor thought screaming and insults were a superior method of education.

***

Many years after I finished my residency, a friend remarked to me that it was a shame that doctors didn’t get any education in finance while in medical school.  Putting aside the harsh reality that medicine and moneymaking don’t always mix, I replied, “Well, first they have to teach us medicine.”  Okay, gratuitous insult acknowledged.

I think this would be the opportune time to ease your burden of these unfortunate truths I am laying upon you.  Truth hurts, I know.

You see, the professor does not have the time to either educate or evaluate properly.  I came to realize this early in my career while at KU.  I had just arrived back in the United States in January of 1980.  My first rotation was in Pediatrics.  The first two weeks went fairly well.  The next two weeks were spent at an outpatient clinic in Kansas City.  At the beginning of the rotation, I was told by the Associate Dean that I would need to get the school an official copy of my full transcripts from the UDEM in Mexico. Without those transcripts I would not be able to graduate.  The problem I was facing was that the government of Mexico had passed a law forbidding the release of transcripts for foreign medical students until a course in Mexican History and Geography had been passed.  It was a test a third-grader would take.

This test was a good idea – I think Americans should learn about other countries, especially the ones in which they go to school – but it was a hindrance to my progress.  I needed those transcripts.  It just so happened that the UDEM was giving this particular test on the last Friday of my rotation at the outpatient clinic.  So, staring reality in the face, I informed my professor in Pediatrics that I needed to take this test.  I asked her if this was okay, and she responded in the affirmative.

I drove  –  I was poor – twenty-four hours from Kansas City to Monterrey, Mexico, pretty much non-stop.  I left on a Wednesday morning and arrived one day later.  I had one day to study for the test.  It was quite a test. I had to know the states of Mexico, their capitals and their chief exports.  I also had to know the important people in Mexican history and, of course, El Padre de la Independencia.  That would be Miguel Hidalgo.  I will never forget that fact.  

I passed the test, got my transcripts and left Mexico a few hours later.  I arrived back on Sunday.  This time I stopped to rest. On Monday morning, the Associate Dean called me into his office. He showed me the evaluation that my professor, the one who had given me permission to leave, had written. The evaluation was laced with scores of 2s and 3s out of 10.  She wrote specifically that I had taken off to go “gallivanting around Mexico.”

Yeah, I even took in a bullfight.  Me, Ernest and John Dos Passos.

After thinking about the evaluation, I realized that with the scores she had given me it would be near impossible to pass the Pediatric rotation – there was still one month left to go.  I had to make a strategic decision.  I decided to withdraw and take some time off.

During that sabbatical, a professor, who was supposed to be my mentor, tried to convince me that I had emotional problems; he wanted me to join his support group.  When I replied that he was not a psychiatrist, but an endocrinologist, and therefore not qualified to make such an assessment, he became upset and called me a loser.  I had never been called a loser before, and that night was when I began to question labels and their value.  

I might have lost it completely, and I did, sort of.  I wept, I admit it.  I probably would have quit right then and there, but, you see, there are good people in the world.  Prior to my decision to withdraw, I had spoken to the Dean of the Medical School.  His name was James Lowman, and he came from a regular school.  Prior to a student withdrawing, the Dean likes to hear you out; and so I told him everything that was going on.  I told him that I had just moved to Kansas City three weeks ago and that I was still living in the Holliday Inn.   

Dr. Lowman patiently listened to me and then asked me one question:  “What’s your support system here?”

“What do you mean,” I replied.

Dr Lowman: “Well, your family?  Do you have any family here?  Any friends?”

I shook my head in silence.  

When I walked out of the Dean’s office, I knew that Dr. Lowman had taught me everything I needed to know to be a good doctor and that, with all due respect, there wasn’t anything KU or any other university could teach me that was more important than what he taught me in that brief conversation.

You have to listen to people and ask the right questions.

* * *

I remember well the immediate days before Doug  Blade left Pleasantville.  They had a farewell party for him on the ward, and I was dragged to that party by Suzy Disciple.  “Come on,” she said.

Reluctantly I went.  

To tell you the truth, his farewell party was three years too late.  He should have been fired the first day he humiliated a resident on rounds.  

He had admirers, though, and still does today.  Don’t kid yourself if you believe otherwise.  Many doctors, I suspect, have internally justified his abuse and the abuse of others. “He made me a better doctor,” they might feebly say.  I doubt that, but these doctors are there, and they repeat this unsupported nonsense. I can assure you this false belief exists today.

I met Nancy Germany once around 1987.  She was covering the nursery at Santa Cora and had come down to the ER to help me with a difficult intubation. I never spoke to her about Jenny Jamison; it wasn’t my place.

After reading the old issues of Texas Monthly, though, I found it intriguing that it was Doug Blade who told Nancy Germany to not hire Jenny Jamison.  Others had seen no problem. So why did Nancy Germany not listen to Dougbo if she thought highly enough of him to solicit his advice.  After all, Dougbo was the King of Pediatrics.  What gives?

I’d be willing to bet that Nancy Germany herself was psychologically abused by Doug Blade when she was a resident at Lion County Hospital and had rejected his advice out of a subconscious resentment of having been so abused.

Perhaps not, but the phenomenon exists and helps illustrate why abusers make such poor and effective leaders.  The toxins they spill clouds people’s optimal functioning and better judgment. A toxic environment then multiplies upon itself.

A toxic environment is what existed in Pleasantville in 1982.  It wasn’t just Doug Blade.  As I say there were many others who were of his mindset and who acted similarly.  If they didn’t act as badly as him, they certainly looked the other way. 

What about professors like Johnny Bullman who, by the way, was my attending physician when Dougbo was abusing me in the unit?  Dr. Bullman did try to help me by teaching me to present patients better, but what he should have done was stop Dougbo from “teaching”.  What about the Pharm D. professors?  One of them was there nearly every day.  How about the chairman of the department?  There were many others.  They witnessed this carnage for three years?  Did they say anything?  Did they do anything?  They should have known better.

I had to laugh when I read in Texas Monthly that Bryce Prince, the cardiovascular surgeon at Lion County Hospital, was upset at the deaths in the unit.  Well, you were there, Bryce.  You saw what was going on.  You saw how Dougbo ran his rounds.  What did you expect?  Why didn’t you speak up?  If you weren’t aware that abuse and humiliation demoralizes a unit, then you shouldn’t have been in your position in the first place.

The reason why none of these doctors spoke up was because they had too had suffered or seen abuse when they were residents; they had come to accept it as normal.

It was this tense environment which emboldened Jenny Jamison to make her move, to appear the hero. Perhaps she became addicted to stress; or perhaps she felt the need to enhance her own prestige.  After all, a hierarchical ladder of good doctor versus bad doctor had been set within the unit by Doug Blade.  Good doctors got praised; bad doctors got lacerated.  Good people went up the ladder; bad people went down.  What better way to go up the ladder than to rescue a child in distress?  

Jenny was one of Dougbo’s favorites.  She wanted to go higher.

From what I have read, Jenny was very intelligent.  Being a bright LVN in the midst of doctors who may have been not as bright must have been incredibly frustrating to her.  Over the years I have encountered many LVNs and RNS who should have been doctors.  Perhaps Jenny felt similarly about herself.  Since attending medical school at her age would entail too many years of sacrifice, an important position in the PICU might suffice.  And, hey, Doug Blade liked and trusted her.  

What do you think, doctor?  

Patients ask me that question all the time, and more often than not I say to them, “Well, I was going to ask you the same question.”

Let’s mull that over.  It’s important to listen; no matter how smart we think we are, we’re not.

Doug Blade, from what was told to me, felt he had been screwed after the dust had settled, and to a certain extent he was right.  He was only a symptom of a toxic process that gets reinforced in academia.  You see, these people in academia believe that there exists such a thing as a good doctor and a bad doctor.  This doctor is good; that doctor is bad.  This doctor is competent; that doctor is incompetent.  You hear that a lot in the snake pit of academia.  

My response to that is this:  comparing what and compared to who?  It only takes a little time outside the poisonous confines of the Mecca, as they like to call it, to realize that there is no such thing as a good doctor or a bad doctor.  What exists are doctors with strengths and weaknesses.  When doctors and people are viewed under this light, hope exists and remediation is possible.  When silly labels are employed, no hope is possible.

It is this belief in the good doctor versus the bad doctor that gives rise to these so-called high-powered programs of which Doug Blade was an attendee.  He trained at Johns Hopkins, and, in the silly world of academia, this pediatric program along with CHOP (Children’s Hospital of Philadelphia), Toronto and Baylor, are considered high-powered programs. Academics revere CHOP above all; they talk about it constantly ad nauseam.  You would think Jesus himself had done a residency there. Fuck CHOP.  I’m sure Doug Blade bought into this nonsense.  So did many others.  They still do.

Check out CHOP’s website, and what you’ll find is a lot of bragging.  CHOP is affiliated with the University of Pennsylvania, founded by Benjamin Franklin.  Well, I’ve read The Autobiography of Benjamin Franklin; and in it, Franklin’s advice for a young man or woman is to imitate Jesus.  

“First Hospital … dramatic firsts … saved countless children’s lives … come to CHOP from all over the world … earned us a spot on the U.S. News & World Report’s Honor Roll of the nation’s best children’s hospitals?”  That doesn’t sound like humble Jesus to me.  

No wonder its graduates think they’re all that.

In my book, pediatricians who do great things can come from nowhere and anywhere, and doctors who come from so-called prestigious universities can commit the most boneheaded mistakes.  The high-powered program is a myth and a dangerous one at that.  It gives a false sense of prestige and omnipotence to its graduates.  The handbook of your particular religion will tell you that; unfortunately medicine has drifted from far its moral base and now more or less follows the dictates of the Third Reich.

Not surprisingly, Larry Flowers taught at The Hospital for Sick Children’s in Toronto.  It must have been a heady experience.  Johnny Bullman came out of Vanderbilt, another one of these high-and-mighty programs.

The concept of  greatness is seductive, and the result is what you got in Pleasantville from 1979 to 1982.  Is this what you want?  If it isn’t, then you better get moving for the seeds of the next catastrophe are there.

There exists today in Pleasantville a group of doctors, self-anointed, who very much buy into the nonsense I have described above.  They fancy that their shit does not stink, and they stride around confidently and smugly that they are the good doctors.  I know a few, and they have no problem freely eliciting their foolish judgments.  In a way they are like that clique of cool kids you knew in high school – strutting around like they own the place.  They think they are all that.

After my residency, I felt like a beaten dog. I worked downtown across from El Mercado, then for a short spell at the emergency room at Santa Cora where Nancy Germany bailed me out one night on a difficult case.  I got my first lawsuit about that time.  I was devastated.  It was a minor lawsuit, a nuisance suit the lawyers called it, but it only reinforced all the negative shit those professors had heaped upon me.

A colleague of mine, Devon Maximus, told me at the time:  “Look, Arch, there are only two types of doctors, doctors who have been sued and doctors who are going to get sued.”  

Good advice.  Let’s tell academia.

I took a year and a half off to write a book which admittedly was a piece of shit, went nearly broke and made the slow climb back out of the abyss. I began working again, and what I discovered slowly was that the patients liked me.  I never got that sense while I was at the Mecca because professors don’t care about that kind of stuff.  What they care about are doctors who fit into their bullshit Nazi paradigm of spitting out a lot facts, presenting flawlessly and eloquently, and pretending that you do know when you don’t.

One of my fellow residents was an expert at roundsmanship.  He would never say that he didn’t know; he would cleverly say, “I can’t answer that.”  That’s pretty cool, right?  That aside, the three most important words in medicine are:  “I don’t know.”  All knowledge begins with those three words.  

Quick, someone tell academia because they will chew you up if you tell them you don’t know.

They don’t like honest people at the Mecca.

What I would say to a young doctor today is this:  “If they don’t like you in academia, it’s probably because you’re a very nice person who actually cares about people.  Don’t worry; you’re going to do just fine when you get away from them.”

Fuck them, and fuck the doctors who support them.  The doctors in private practice who support these academics are worse. They are like the Poles in WWII who inflicted more damage on the Jews than the Germans.  Even the German soldiers were astonished.

So after working my way back into medicine, I worked in different towns for ten years for different people.  I had a blast, and I enjoyed every place I worked.  I worked in Tyler, Corsicana, Houston, SA and most cities of the Rio Grande Valley.  I worked at Wilford Hall and at the PRIMUS clinics in Killeen and Copperas Cove right outside Fort Hood.  I lived in motel rooms, and the Gideon Bible was my best friend.  Along the way, I developed Crosley’s Law which states that your quality of life is directly proportional to your distance from the Mecca.  I guess it takes time to work stuff out.  Along the way I gained enough confidence and contacts to start my own practice.  I shouldn’t have had to do that though. 

Ten years is a good chunk of one’s life. 

Part of a training program’s job is to build you up, not tear you down.  But they do tear people down and not just while you’re there.  They are the gift that keeps on giving.  Six years out of my residency program, I worked at Wilford Hall for about nine months in their Pediatric clinic.  I would have finished out the year, but I had a minor dispute with a colonel who one day flipped an Amoxicillin prescription I had written on my desk.  He said to me, “I don’t want you writing this anymore.” He was an old-school guy who believed that kids should only get penicillin for strep throat. He didn’t believe in broad-spectrum antibiotics for strep throats.  Well, to begin with he’s not even allowed to tell me how to practice medicine; that’s the law.  Number two, he was rude.  I decided I didn’t need that kind of attitude, so I informed the agency who hired me that I wasn’t going to work there anymore.

The guy who ran the agency told me, “Look, we had to fight for you to get this.  They didn’t even want to hire you.”  

“Oh really,” I thought.  “Well, you should have told me and I wouldn’t have even bothered to work there.  I don’t go anywhere where I’m not wanted.”

A year later, I related this experience to two colleagues who I met up with in New Orleans.  They said to me:  “Well, you know where that came from, don’t you?”

“No,” I replied, “I would have no idea.” 

“It came from the school,”  they added.  

One of them then proceeded to tell me her own horror story of a professor at the school who had trashed her career.   

Well, as it turns out, they were either correct or very close to it.  Time has a way of outing people.

I should not have been surprised, though.

When I was a resident, I was in a room with a specialist as he was interviewing a patient. The patient’s parents explained that they had visited another doctor. They mentioned the doctor by name.  My attending specialist then replied:  “Oh, we know her; she’s no good.  We know; we trained her.”

Yep, these professors don’t get it that when they trash their trainees, they indict themselves.

Okay, you get the point.  You’ve heard enough and you want to know what good can come from this. What are you going to do about it, Crosley?  What do you propose?

Why, I’m glad you asked.

We can begin with replacing numerical evaluations with a personal investment in time by the attending physician, a dedicated teacher, who will have the time to patiently explain what does work and what does not work in the real-world practice of medicine.

If everything I as a pediatrician do well is because someone took the time to explain it, then it makes sense that the more personal time I receive, the better a pediatrician I’ll be.  And it would help immensely if the teaching physician was schooled in how to teach, what works in teaching, what doesn’t work and why students have particular learning difficulties.

If a student asks a question, it’s because he needs to know the answer.  Telling him that he should know this already, or that the question is stupid, doesn’t solve the problem.  Students need help, not abuse.  Additionally, students must emphatically learn that the three most important words in medicine are:  “I don’t know.”  It’s always better to know.

If the teacher can’t subscribe to that philosophy, then he should be directed to another profession.  Students must have recourse and a Bill of Rights that removes them from an injurious teacher.  

Here are some suggestions.  I’ll dress it up with a little comedy so that you’ll read them.

  1. Every school needs an independent ombudsman who is specifically there to represent the resident or student should he or she be suffering psychological abuse from a professor.
  2. Let’s draft a ‘Bill of Rights’ for residents and medical students which specifically states that a professor does not have the right to humiliate.
  3. Professors must attend classes on the science and psychology of education.
  4. We need full-time educators who do NOT do research. There is no place in a medical school for a dilettante.
  5. A specific ban on professors from making the following comments:
  • I would expect someone at your level to know this.
  • You have a poor fund of knowledge.
  • You are a loser.
  • You should know this.
  • That’s a stupid question.
  • Well, I think we need more database here.
  • Well, I think we need to back up here.
  • Well, I don’t think you’re asking the right question.
  • The Boards likes to ask this.
  • You have to know everything.

If a student asks a question, it’s because he needs to know the answer.  There are no stupid questions.  And nobody cares, Mr. Professor, what you think somebody should know.  I took a course once where the professor stated literally after every arcane and esoteric fact, “The Boards likes to ask this.”  Well, let’s see, Mr. Professor, you’ve stated this 5,000 times already; how can this be if there are only 250 questions on the Boards?

Here are some other suggestions:

  1. Replace the current monthly evaluation with personal attention whereby the professor MUST spend individual time with the student in conversation discussing patients, diseases and how to manage those diseases.
  2. Mandate the professor to spend his full time on the ward.  That’s where he works.  He has no other responsibilities.  He’s not an administrator, he doesn’t present conferences at grand rounds, and he sure as shit isn’t a researcher.
  3. Ban the professor from wearing a coat and tie; otherwise he might think he’s somebody. Forbid him from accepting any awards or any attending any cocktail parties with politicians or other people of self-importance.
  4. Ban all researchers from even showing their face on the ward under penalty of death. Their unsolicited snide comments will no longer be welcome.
  5. Ban the local doctor from acting as an attending.  He has no training and is 100% unqualified to teach.  If you think he does, then I’ll get a guy off the street to perform an appendectomy on you.
  6. Eliminate group rounds which brings out the worst in people.  There is no reason why the professor can’t do individual rounds with everyone; after all, he’ll be there.  He’ll have PLENTY of time.  I’m willing to bet that customized education tailored to the individual will result in better doctors.
  7. Ban researchers from interviewing or selecting prospective medical students, or else we’ll get a bunch of cruel, Machiavellian brainiacs just like them.  Who we want in medical school are compassionate, honest doctors who can relate to regular people.
  8. This one’s for fun but not really.  Any professor who buys a DeLorean (or its modern equivalent)  or personally monograms their own shirts may be more interested in themselves than the student’s welfare.  It might be wise to keep an eye on these guys.
  9. In education, respect must replace bullying.  Whipping someone into shape is a lazy substitute for teaching. As Benito Juarez, a former President of Mexico, once said, “Respect for the rights of others means peace.”
  10. Young physicians must have the following drilled into their hearts, minds and souls:  The three most important words in life and in healthcare are “I don’t know.”  It’s okay to say these words to yourself, to your professors and, most importantly, to your patients.

Finally, you may ask, how will full-time educators be financed?  Well, we have too much half-assed research and only one half-ass of education.  Figure it out.  Half the researchers aren’t needed.  The grant money and set asides for research will be better spent on education.  The professors can retrain and teach.  If that doesn’t suit them, hasta la vista, baby.  When it’s all said and done, we’ll get better research and better education.

How’s that sound, soldier?

Wives of the dear old professor need not respond.  Yes, I know he’s a good family man and a loving father.  I also know about the seventeen grandchildren and seventy-eight great-grandchidren.  Spare me.  Hitler too bounced toddlers on his knee.  

But let’s be fair.  Hitler was a product of a pernicious environment; if it hadn’t been Hitler, it would have been somebody else.  

You may find the Nazi analogy a bridge too far, but I use it specifically to illustrate a point.  Historians will affirm that the German Army during WWII possessed superior armaments.  Too, there was never a shortage of German brains or work ethic, and yet they lost.  They lost because we live in a moral universe where how you treat people is important.  Humility counts.  The Germans created a toxic environment where titles, power and prestige became more important than caring for people.

Ultimately, Lion County Hospital and its affiliated university placed their own power and prestige above that of the patients.  Their first duty was to the patients, not to themselves, not to their own glory, not to future lawsuits, not to the sanctity of their reputation.  What they lacked was humility.

It was the toxic environment of our medical schools and the errant values that are passed from one generation to the next that inevitably caused these doctors and many others to behave they way they did.  It was this same toxic environment in which Jenny Jamison operated and thrived.  If it hadn’t been Jenny Jamison, it would have been someone else.  And it will be someone else.

Values are important.

If we can change those values and emphasize compassion and humility, we can prevent the calamity that occurred in Pleasantville from ever happening again.  

Archer Crosley, MD
McAllen, TX 78501

Copyright 2022 Archer Crosley All Rights Reserved

Minor Surgery

I love minor surgery.

It’s so, so .. minor.

Let me tell you what I was taught in medical school years ago: there is no such thing as a simple operation.

Even the most simple of operations have complications.

I’m going to give you my experience with extraction of wisdom teeth.

This article is primarily for older people.

I am sixty-seven years old.

In as few words as possible, the take home message here is this: stock up on Motrin.

If you are a young person, your recovery time and pain will probably be equivalent to what you can read in many publications online.

If you are in your 60s, your recovery time will be significantly slower.

Let’s just say that my recovery time was not in days. It looks like my recovery time will be in weeks.

I am in my eighth day post surgery; I am still experiencing pain.

No, I am not infected. I do not have fever. The oral surgeon has already looked at my teeth. Just a few days ago he told me that my sockets looked good.

So why am I experiencing pain?

Well, here is what I think.

Here’s what I have learned so far.

To begin with, when you grow older, your metabolism is not going to be as good. You are going to heal slower.

In addition to that, your existing teeth become more integrated with the bony structure of your jaw.

Flexibility is lost when you grow older.

Consequently pulling out your wisdom teeth at an advanced age is like pulling bone from bone. It’s going to be tougher.

As a result, pulling out wisdom teeth is like Floyd Mayweather punching your jaw over and over again.

It’s almost like breaking a bone.

Your broken bone is not going to heal within a few days.

Your broken bone is going to heal over a period of six weeks.

Likewise, the socket is not going to fill-in right away

I suspect that in my case there are a few live wires on the inside of those sockets. Consequently, it’s going to take time for my body to bury those live wires again with bone and gum tissue.

That’s why I think I am experiencing pain.

The air from the outside is coming into contact with those live wires.

What I have found that works best is Motrin.

I am taking the max dose that is considered safe.

I am taking 800 mg four times a day.

The Motrin seems to work better than aspirin, although so far I have not maxed out on the aspirin.

For me Motrin has been a miracle drug.

It will reliably kill all the pain within thirty minutes to an hour after ingestion.

My case is a little different in that I have experienced one complication from my extraction.

When you pull out a wisdom tooth at my age, it is customary sometimes for the socket to expand and disrupt the bone architecture at the myelohyoid ridge on the inside of the jaw.

Consequently, I have a bone spur rubbing against my tongue.

It has made it difficult for me to talk and to swallow.

I have learned how to talk in a different way.

I now speak like a ventriloquist, that is to say I move my tongue as little as possible.

The oral surgeon says this is a short term problem which will only last three to five weeks.

He states that the body will extrude and remodel the bone shortly.

I will keep you posted.

In closing, remember what the wise man said about minor surgery.

Minor surgery? That’s the other guy’s surgery.

Note: What you read here is only my experience. This is not a substitute for a dental professional’s qualified advice. Please consult your dental professional.

Sincerely,

Archer Crosley

Copyright 2022 Archer Crosley All Rights Reserved

Evidence-Based Lies

As I’ve stated many times before, Harvard University is the enemy of our liberty and freedom.

It is also a threat to any reasonable quality of life. Examples are boundless. Today I will talk about evidence-based medicine.

Recently an article appeared in the British Medical Journal entitled: The Illusion of Evidence Based Medicine.

In a nutshell the authors argue that corporations have corrupted the professors and in turn their studies that evidence-based medicine promotes as truth.

As a pediatrician this is not surprising to me.

About a decade ago, cold medicines were being promoted by insurance companies, and the supporters of evidence-based medicine, as being useless to children.

Evidence-based medicine, the insurance companies claimed, proved that the cold medicines were not really working.

There was no shortage of puppets in academia who went along with this.

I found this confusing because moms had been telling me for decades that certain cold medicines worked. They would make comments like this: “Well, the medicine worked for a few days, then wore off.” This made sense to me as the body will in many cases acclimate to a medicine. Moreover, it told me that the medicine initially did have effectiveness.

Additionally, I had tried out many of these medicines myself over several decades. So I knew from first-hand experience that the medicines worked.

Nevertheless there was no shortage of academic puppets who were telling us that these cold medicines weren’t working in children.

Well, I asked myself, why wouldn’t they work? These cold medicines are working on basic cell receptors which are essential to life itself.

It would be inconceivable that babies would be born without these receptors.

I reluctantly concluded that evidence-based medicine was a sham that was being used by insurance companies in order to justify not paying for medicines. After all if the insurance company doesn’t have to pay for a medicine, it makes more money for itself and its executives.

To be honest, I never liked the term evidence-based medicine in the first place.

This term came into being more commonly in the 1990s after I had finished my training.

I took offense to it.

I asked myself: “What were we practicing before? Fantasy based medicine?”

Yes, it’s true there was a lot of quackery in the field of healthcare, but I did not notice much of this coming from regular doctors.

Even back in my training I remember doctors questioning many of the quack medicines that were being put out by Corporate America.

It seemed to me that the quackery was coming from Corporate America.

Medicines like Baby Percy should have been eliminated from supermarket shelves decades ago.

Yet, evidence-based medicine was not used at all to remove these products from being sold.

Evidence-based medicine was being used to remove valid medicines from the doctors prescribing arsenal.

What does that tell you?

Enter David Sackett.

David Sackett was a physician, Harvard trained, who was a prominent early pioneer of evidence-based medicine.

This is not surprising to me that he was trained at Harvard.

You wouldn’t have heard of the name David Sackett if he hadn’t gone to Harvard.

David Sackett wasn’t the pioneer of evidence-based medicine; Harvard University was the pioneer of evidence-based medicine.

David Sackett was merely the vehicle that Harvard University used.

If David Sackett was a small time doctor, non-Harvard trained, sitting out in the middle of nowhere, writing articles calling for the elimination of quack medicines on supermarket shelves, you would’ve never heard of him.

He would be like me, unheard of, not permitted to speak.

But he was permitted to speak. And that should tell you volumes.

Harvard is first and foremost an agent of the empire.

Harvard exists to promote the domination of the corporate wealthy elite over the world’s population.

That’s why Harvard exists.

Harvard accomplishes this by training and promoting the officers of Corporate America.

Implicit in this training is that such officers will promote corporate interests.

Perhaps David Sackett had good intentions when he attended Harvard.

Perhaps you have good intentions as you attend Harvard.

Well, let me tell you something, Mister. You aren’t going to change Harvard; Harvard is going to change you.

Whatever good idea or good intention you may have, Harvard will find a way to twist that and use it to further corporate interests.

This is the problem we face today.

We now live on Mr. Darcy’s slave plantation.

Mr. Darcy, Mr. Darcy, Mr. Darcy.

Fuck Mr. Darcy.

Harvard works to promote corporate interests that work against us, our health and our welfare.

The university must be destroyed.

Debunking evidence-based medicine is a good start.

Sincerely,

Archer Crosley

Copyright 2022 Archer Crosley All Rights Reserved

CalCare: DOA

Will CalCare work?

Poorly.

CalCare is Governor Gavin Newsome’s ambitious plan to cover healthcare for all Californians.

Assuming it does pass, it will work poorly, escalate healthcare costs, and cause a further widening of the wealth gap between rich and poor.

That it will do so is a mathematical certainty.

It will do so because in a government run healthcare system decisions are often made not in the best interest of the patient but in the best interest of the politician’s friend.

You can expect cavernous clinics in the middle of nowhere that sit empty.

You can expect a massive surplus in hospital supplies that are unnecessary.

You can expect programs and projects within CalCare to teeter on the edge of bankruptcy.

The fraud and waste will be incredible.

Complaints, emergency meetings and stopgap funding will become the norm.

Expect the likes of the London ambulance company and its 45 minute response times.

It can’t be anything but this.

Ultimately single payer in California will pass.

It will pass not because its time has come, as the politicians will crow.

Nor will it pass because it’s the best thing for the people.

It will pass because the wealthy thug elite will have already laid out a plan to rape the system bare.

Fraud will be in the cards.

It’ll be a done deal.

That’s the future we face in the United States today.

It doesn’t have to be that way.

If California truly wants to provide affordable and accessible healthcare for everybody, all it needs to do is to create a competitive healthcare marketplace.

This would entail breaking up the large healthcare monopolies and insurers.

It would mean breaking up large pharmaceutical conglomerates.

These current corporations are bloated, ossified dinosaurs that make an aged and overweight Elvis look like a ripped stud with a chiseled six pack.

Competition works!

Only with true competition can you get better quality of care at a cheaper cost.

Currently we don’t have that.

Thus far politicians have been unwilling to spend the political capital to take on the large corporations.

Indeed, they are puppets of the large corporations.

That’s the way it is.

And that’s why CalCare will fail.

Sincerely,

Archer Crosley

Copyright 2022 Archer Crosley All Rights Reserved

Mother’s Medicine

My mother wants to tell you something.

She wasn’t a doctor, but that shouldn’t matter.

She should’ve been.

She could’ve been.

She could’ve taught those “fine” professors at the Mecca how to treat their students.

Had she been in charge, the first thing she would’ve done was tell many of them to go away.

Mom: If you can’t treat people nicely, why should you even be here?

She would have put a stop to their unwarranted and unsolicited condemnations.

Too many professors there believe in the whip.

Cruelty with a purpose. That’s what Trevor Howard, the ultimate British villain, the benchmark of British villains, playing Captain Bligh in the film Mutiny on the Bounty, said.

Those misguided professors believe that George S. Patton was correct in slapping that soldier in Italy around.

They really do. They believe that their humiliations and debasements will inspire their students to do better.

They are wrong.

My mom didn’t value smarts and know-it-all-ism as much as she did congeniality.

That is sadly missing in American healthcare today.

Indeed the current day Mecca drums the niceness out of doctors.

My mom must have understood on a certain level that arrogant doctors who scream and yell are often the doctors who make the most mistakes.

That’s what I noticed in my career.

I found that to be true in just about any field.

So if somebody treats me poorly, I walk away from that individual no matter how talented they are touted to be.

You have to treat people with respect.

Next in line would be hard work and diligence.

A doctor has to be thorough, diligent and hard working.

This is not valued in the Mecca today. Natural talent bums who wow the professors with esoteric facts are prized.

Worse than this, doctors who play Machiavellian tricks often win the day.

The professors value what they call roundsmanship.

Conniving gamesmanship would be a better term for it.

Students and residents are pitted against each other.

It’s a cockfight, and some professors revel in the bloodbath.

Style defeats substance. The professor, who is often buried within his research lab, can’t tell the difference between the bullshitters and the hard workers.

Or maybe he or she can.

The bullshitters come out ahead because they understand that rounds are a game. Plus they know how to answer questions that put themselves in the best possible light.

When I trained I had one fellow intern who would never say that he didn’t know. He was very clever. He would answer: I can’t answer that.

Isn’t that brilliant? He’s not saying that he doesn’t know. Yet at the time we all knew that he didn’t.

My mother believes, as I do, in hard work and honesty.

She wasn’t big on style.

Through her son she believes that rounds should be working rounds. In other words, jettison the beautiful presentation in favor of a working man’s approach to solving the days problems.

This is the true recapitulation of how a doctor works in the real world.

Get rid of group rounds which sets people up for humiliation and embarrassment. Very few students are learning from group rounds. They are too terrified.

You have to be fair to people also. That means you have to go the extra mile in putting your emotions aside when evaluating people.

Do the professors in academia do that today?

I’m not sure.

Many professors aren’t properly trained to do their jobs. Worse, there are a lot of part-time professors who don’t know a thing about education or evaluating people.

In fact, it is these part time professors who are the most dangerous.

You can’t wear two hats in life. You can’t be a practicing doctor and a good teacher at the same time. Nor can you be a researcher and a good teacher at the same time.

It’s not possible.

Let me be fair though. There are many good people there at the Mecca.

When I was in my first months of clinical rotation at University of Kansas I was having some difficulty in adjusting.

I had recently moved back to the United States and was having a difficult time coping.

It’s called culture shock in reverse. If you think going to a different country is tough, try coming back.

It’s difficult to return to the pristine nicety of the United States when you see how the other half of the world lives.

The experience transforms you.

One professor had given me what I thought was an unfair evaluation. It seemed to me that I wasn’t going to be able to pass the semester with that low grade. She had made it low enough so that it would be difficult for me to recover.

I was traumatized, so I decided to suspend my medical education for a bit.

Before I did though, I was able to talk to the acting Dean, James Lohman. I recounted my circumstances and what had transpired and my request to suspend my studies.

After carefully listening to me, he looked at me and asked one question: What is your support system here in Kansas City?

I wasn’t sure what he meant, so I asked him to clarify his question.

Well, he continued, do you have family here? Where are you living?

Since I had just transferred into the school, I told him I was living at the Holiday Inn. I told him that I didn’t have anybody here. I had no family here.

He didn’t have to make a comment after that.

With one incisive question he not only revealed to me what was going on but everything I needed to know to become a quality doctor.

This is the kind of doctor my mother would have approved of.

I knew surely as I speak these words now that there wasn’t anything that the University of Kansas could teach me that was more valuable than what he taught me that day.

To be a quality physician, you have to be empathetic, and you have to ask the right questions.

Knowing all the details and statistics about alpha-1 anti-trypsin deficiency and other esoteric diseases would have to take a backseat.

That was true then, and it is true today.

You can have all the facts and still miss the boat.

If we want to improve healthcare in the United States today we have to start with the medical schools and the kinds of people who are permitted to attend.

Currently the GPA and the MCAT score are used to measure the potential of a future doctor, but that in itself may be a poor measure.

What about empathy?

What about being a regular person who people can relate to?

Placing a premium upon GPA and MCAT score favors the malicious grade hound who will do anything to get a higher grade.

It also favors brainiacs and mathematicians, who may be over-represented in healthcare.

I tend to trust people who have studied biology and the life sciences.

Biology is a messy science. It’s an imprecise science. It’s filled with blood and guts. Biologists aren’t afraid of getting dirty. They aren’t afraid of imprecision either.

The field of medicine is too heavily weighted down by analytics, mathematics, P values, and Cox regression analysis. The people who embrace these methodologies tend to not like people. These are the kind of people who were running Sobibor.

My mother was a regular person. She was not a snob or an elitist. And she certainly did not instill in me any love for formality and pretense.

Formality and pretense are the hallmark of corrupt institutions.

Crooked people dress up to compensate for their crookedness. The mob dresses in a suit; Congress dresses in a suit; Wall Street dresses in a suit.

So do the officers of the Mecca.

They equate professionalism with fine dress.

My mother does not define professionalism by how well you dress.

Professionalism is better defined by how well you attend to your patients; how well you follow through; how well you listen to your patients.

The Mecca also believes in a formalistic, hierarchical methodology to teaching, learning and diagnosis.

Carol Linnaeus is their Jesus.

St. Carol the Dangerous codifies diseases into rigid categories; and these diseases in order to be diagnosed must be approached according to rules.

One, all symptoms and signs must be condensed according to Occam’s Razor or the Law of Parsimony. It’s impossible, according to orthodoxy, for people to have two things at the same time.

Two, you have to know precisely what you are looking for in order to order a test. No fishing around or hunches are permitted.

Three, a massive time-wasting differential diagnosis must be developed before proceeding to diagnose. According to orthodoxy you won’t consider all the available options in any other way but this way.

Four, diseases must be taught and diagnosed from the top down according to this bizarre classification scheme as pumped out by St. Carol and his successors.

This is not what my mother teaches. Of course my mother is not a physician, but she did inspire me.

Here is what my mother teaches:

Diseases, not classification schemes, come first.

Diseases do whatever the hell they want to do. They don’t follow any rules, and they haven’t read any books. They do what they do. They don’t even know who Carol Linnaeus is. Nor do they care. They consider him a loser and a third-rate piker.

People certainly do get two things or even three things at the same time.

It’s impossible to know everything that you are looking for in order to order a test. You’ll never be smart enough to figure everything out. The world is too vast. Diseases are too large in scope.

Skip the massive differential.

Diagnose from the bottom up, not the top down.

How do we do that?

By thinking practically, and by asking what tests will add value to our thinking or plan.

What do we want to know?

I used to call this a chef’s soup approach to diagnosis, but in honor of my mother who passed away yesterday, I am going to call it Mother’s Chicken Noodle Soup approach to diagnosis.

What will make Mom’s little boy or little girl better?

What will help Mom?

This seems to be a more humanistic way of diagnosing.

Yes, you are right, it lacks the precision that is taught at Harvard and MIT.

Since my mother does not approve of swearing, I will not say: So fucking what? I will say: So what?

MIT and Harvard are wrong, dead wrong.

Let’s start from the beginning. Suppose you see a rash on a patient’s face. Other than asking a basic routine history and physical, what would you do?

Would it be to your benefit to construct a massive differential diagnosis?

Do you have to know exactly what’s going in order to order anything?

The geniuses at Johns Hopkins think so.

Suppose you had no idea at all what was going on, what would you do?

Well, what did you do as a baby?

You cried for mommy.

That’s precisely what you need to do here. You need to call for help. In fact, the first thing that any medical student or resident needs to learn how to do is to call for help.

Indeed a medical student or a resident shouldn’t be allowed to write one single order unless they first make a phone call to a specialist for help.

That should be the first thing that a young doctor should learn.

Call for help.

This is ridiculed at the Mecca. If you wake that professor up he’s likely to chew you out or say: I would expect someone at your level to know this.

Nevertheless, the proper response is to call for help.

In this manner the young doctor learns that the fall back pitch is to call for help.

You don’t need to construct a massive differential in order to do that.

Let’s suppose though that you do know a few things. What would be the next step?

I don’t want to get too technical here, but let’s say that the rash is a pinpoint rash that does not blanch when you press on it. Let’s say that it looks like petechiae. Let’s say that it’s confined to the face.

Do you need to do a massive differential at this point? No.

You might be thinking that this rash is due to pressure from screaming. So you ask the patient whether they have been screaming, because when you ask a question, you are really ordering a test in a different form. It’s all information. Mom wants to know. Mom does not want you wasting your time and brain energy on nonsense.

The patient says: No.

The patient has also already said no to a basic set of questions that you have preliminarily asked in your history.

You might also ask whether there was any trauma, or whether they had put a band around their face or neck.

Maybe they were goofing around with a toy.

Assuming, that they were not, you might order a CBC to check for their platelet count.

Do you need a massive differential at this point? Not at all.

You don’t even need to know specifically what is going on.

Let’s say, though, that the platelets come back at 15,000. What are you going to do then?

What would I do?

I would order a different sort of test: I would go over my basic questions again, and I would redo the physical. I would check the spleen and the liver, I would check for lymph nodes, I would go over their medication history. I would carefully re-examine the skin on their body. I would especially want to know if there’s fever or has been fever.

I might even repeat the CBC.

Additionally, I am going to absolutely order another test: my fallback pitch. I’m going to call the hematologist and set up an appointment. I may admit the patient to the hospital.

And yet, I do not know specifically what is going on, nor do I need to know.

When the hematologist gets the patient, or when the hospitalist gets the patient, they will ask the same questions but proceed to a higher level. But they will go through the same steps.

Go away, Johns Hopkins.

Do you see what I am getting at, reader. It’s a colossal waste of time to approach a problem from the top down. Diseases do not follow rules. You cannot approach diagnosis or learning that way. It doesn’t work.

Think of diagnosing as a marble dropping down into a vertical maze of steel spikes sticking outward from a board. The spikes are your questions, physical exam, and tests. The marble will fall down and hit the first spike and move to either the right or the left. It will drop to the next level and hit another spike and again fall to the right or the left. Eventually it will reach the bottom which is where the diagnosis is. Sometimes the spikes repeat themselves at lower levels.

Your focus should be on not achieving a final diagnosis in your brain but in following the marble down to the bottom. Your focus should be on asking questions, doing a physical exam, and ordering tests.

You should not be emotionally invested in a final diagnosis from the beginning.

The traditional way, the academic way puts the cart before the horse. They want you to invest your emotional energy in a diagnosis. It’s very much like a player who focuses on winning the Super Bowl rather than taking the right steps that are required to win a Super Bowl.

Forget about the end result.

Now, this does not mean that you don’t take the time to learn about diseases and the characteristics of those diseases. You certainly do need to know how diseases present. You certainly do need to know the characteristics of various diseases. Knowing these diseases is what is going to allow you to ask the right questions.

Asking questions is important in healthcare.

There is no such thing as a dumb question, although you wouldn’t know it if you were trained in academia today.

Far too many academics laugh at people who ask dumb questions. They grade them down and laugh at them.

They’ll make a joke about the person and humiliate them in front of everyone. They have no tact.

Tact and agreeableness is important in life. You should never make people feel worthless.

That is important when dealing with students. Young students are like young seedlings in a garden. They are are fragile and need to be handled with care.

My mother’s name was Frances Ann Davis.

She could’ve been a doctor.

These are the kinds of things she believed in.

These are the values she taught me.

Sincerely,

Archer Crosley

Copyright 2021 Archer Crosley All Rights Reserved

Gimmicks

Today I read that Republicans think that Afghanistan is equal to Benghazi times ten.

What the news is trying to tell us is that Republicans think that they can use the Afghanistan withdrawal issue to gain enough political capital to win back the Presidency and the Senate.

What’s the point?

Why should anyone vote for the Republicans when they did absolutely nothing when they had the Presidency, the House, and the Senate for two years between 2016 and 2018?

The Republicans didn’t do a damn thing.

My advice to Republicans (and the Democrats) would be to forget the gimmicks and stick to the basics.

The Afghanistan issue is a gimmick.

If you want to win a football game, follow the advice of Vince Lombardi and block and tackle better than your opposition. Forget about the trick plays if you’re not going to take care of the basics.

When it comes to politics the same type of advice is worth heeding. Forget about the gimmicks; stick to the basics and develop a program which will help the American people.

Solve a problem, motherfucker.

America needs substantive healthcare reform to provide affordable healthcare for its citizenry.

The best way to achieve that is to break up the large healthcare corporations into true competitors.

Doing so would give us better products, better hospitals, better insurance plans at a cheaper cost.

That’s not hard to do. It’s not hard to limit the size of corporations. All it takes is political will.

To provide the uninsured insurance, one would need to give a tax credit for healthcare insurance premiums and copays.

For those too destitute to afford any insurance at all, allow me, or a business, or a corporation, or any other individual to purchase healthcare insurance for an uninsured and receive a tax credit for doing so. Allow me a tax credit for paying for their co-pays also.

Overnight everyone in America would be insured.

It’s not difficult to do.

It’s only difficult when you don’t want to do it.

But when you do do it, you have to stick to the basics and quit wasting your time on gimmicks.

Unfortunately the Republican Party and it’s media mouthpieces, people like Sean Hannity, keep the majority of the voters focused on non-productive issues like the Afghanistan withdrawal issue.

It’s a waste of time.

It keeps us from moving forward.

It’s very much like a football team that runs a bunch of trick plays to compensate for its inadequacies.

Hopefully, someday, one of our political parties will get a coach who understands the game.

Right now, we’re on a losing streak.

The fans would like a few wins.

Sincerely,

Archer Crosley

Copyright 2021 Archer Crosley All Rights Reserved

The Doctrine of Fauci

Welcome to our Kim Jong-un society.

Welcome to a society where the supreme leader is infallible and can hear your thoughts.

Welcome to a society where the elites can say anything they want and pass it off as truth.

They can do this because their smiling serfs cheer everything that they say.

We now live under the Doctrine of Fauci.

It’s a completely ridiculous doctrine, but we live under it nevertheless.

We live under it because there are so many serfs.

They are many, and we are few.

The Doctrine of Fauci says that facemasks work, that lockdowns work, and that vaccinated people are less likely to spread the coronavirus than unvaccinated people.

That’s the truth according to Fauci whether we like it or not.

There’s no convincing the certain serfs.

They know.

In their fallout chambers they call apartments, masked up and terrified, they know.

It’s settled science.

Just like global warming, just like acid rain caused by cow farts, just like the new Ice Age that was predicted 50 years ago, just like the end of the world in 12 years that was predicted 3 years ago, it’s settled science.

It’s settled science because Dr. Fauci says so, and everybody knows that Dr. Fauci is the nation’s top infectious disease expert.

Except that he isn’t.

That’s only something that Jim Acosta and Wolf Blitzer believe in.

We don’t elect top infectious disease experts in healthcare in the United States.

In fact, top infectious disease experts are at the top because they say wise things.

Dr. Fauci says unwise things.

Dr. Fauci says that hydroxychloroquine is dangerous.

Never mind the thousands of dermatologists and rheumatologists who have been using it safely for decades.

Dr. Fauci, a year ago said that herd immunity was almost impossible.

Well of course it is if you lock everybody up in their house.

But if you don’t lock everyone up in their house, and you allow the healthy to congregate with each other and share the virus, they will become immune and more likely to protect the elderly.

Herd immunity in the clinical world is a process not an end point. It is the progressive development of herd immunity that acts to protect the elderly. It works like a clasp knife. You slowly close the knife until you reach a critical point at which the knife suddenly snaps shut.

Herd Immunity works in this manner, only Dr. Fauci and the elites didn’t allow us to go down that path.

Children who are remarkably resilient to the disease are an important part of that herd immunity.

Dr. Fauci allowed corporate media to promote the myth that children were at risk. This was untrue. Children were never at any serious risk of dying from COVID-19 as you are currently now seeing.

Dr. Fauci and his frothing cheerleaders say that ivermectin doesn’t work.

OK.

Then it doesn’t.

Except that it is a valuable adjunctive medicine in the armamentarium against COVID-19.

Dr. Fauci says that super-spreader events can occur when people get together for a picnic.

He says that these events cause infection by respiratory droplet transmission.

Except that they don’t occur that way.

Super-spreader events occur because people don’t wash their hands.

The facemask is worthless.

The guests at Amy Coney Barrett’s reception got COVID-19 most likely because they shook hands and then ate hors d’oeuvres without washing their hands first.

In the background of her reception, the American flag was gently moving at about 2 to 3 mph (about 2.9 to 4.4 feet per second). This means that almost all of the coughed and sneezed viruses would have quickly dispersed through the atmosphere.

It’s very unlikely that a sneezed virus would make a beeline into someone else’s trachea and overcome the non-adaptive immune defenses of that individual.

Handwashing was what was needed.

If we’d had a top infectious disease expert, he would’ve promoted a first rate handwashing campaign instead of the silly face mask.

Never mind that though.

Never mind the fact that we could’ve been through with this pandemic with 150,000 US dead had we not done a lockdown, had we not engaged in the facemask, had we not opposed any reasonable medicines that might’ve helped people.

What’s most important is that Dr. Fauci is right and that the serfs have someone to cheer for.

Dr. Fauci’s infallibility must be maintained otherwise the emaciated serfs might lose heart and die.

Appearances are now everything.

Just like in North Korea.

Welcome to our Kim Jong-un society.

Sincerely,

Archer Crosley

Copyright 2021 Archer Crosley All Rights Reserved