Wild Turkeys

When I think of wild turkeys and Nantucket, I think more people think this than this, but this afternoon I came across two loud and bold wild turkeys out in Quidnet.

Is this common on the island?

How the primary care doctor shortage threatens Obama’s health reform plan

Top story in The New York Times last weekend.


There’s hope that maybe, just maybe, we’re getting through to the decision makers in Washington.

The article itself is old news, and regurgitates many of the arguments impeding health reform, as well as the problems in solving them.

“Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.”

It doesn’t take a genius to see that Obama’s plan, which will likely replicate the approach taken in Massachusetts, is doomed to fail if there are not enough primary care doctors to see the influx of newly insured patients. Without access to physicians, these patients will further crowd emergency departments, and health care costs will continue to spiral upwards. And since, as the piece notes, “the ratio of primary care doctors to population is higher in Massachusetts than in other states,” I shudder to think of the disaster waiting to happen on a national scale.

It appears that both parties appear to understand the gravity of the problem, since the primary care shortage is one of the few points they agree on.

The proposed solutions are not new: “One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.”

None of these options will work. Increasing medical school enrollment will simply produce more specialists if the current physician payment system, which incentivizes students to pursue procedural care, remains. Greater use of mid-levels won’t have an impact either because, i) they too are drawn to specialty care, and, ii) even when including nurse practitioners and physician assistants, studies show that there still won’t be enough providers to meet the generalist demand. Finally, paying off medical school debt is not a good enough reason to dissuade students from becoming specialists, especially with the salary differential of several hundred thousand dollars per year, in some cases.

If politicians are serious about solving the issue, the easiest, and most direct, solution would be to increase Medicare reimbursement for primary care office visits by 20 percent. With the government making such a bold move, private insurers will likely follow. But whether or not it’s done in a “budget-neutral” way will be a point of vicious contention. Specialists will not like the fact that they may have to take a pay cut, and will fight any such proposal to the bitter end. A civil war among physicians seems inevitable.

As I mentioned, none of these topics are new. But it’s good to see prominent light shed on the topic, and perhaps, politicians are starting to realize this issue can single-handedly derail successful health reform.

Now that they’ve identified the problem, let’s see what they do about it.

State health reform is dysfunctional

What follows is a letter to the editor of the Boston Globe that was printed April 24. It’s succinct, and pretty much says it all:

High-performing health systems, with comprehensive primary care as their foundation, achieve better outcomes and care experiences and at a lower cost per person than the nonsystem we have in the United States. Comprehensive primary care is defined by patients who can say: I can get care when and how I need it; I have a primary care physician who knows me as a person; that doctor cares for the bulk of my needs; if I need care outside my doctor’s office, I know who to turn to; and my primary care doctor coordinates my care.

But this work is blocked by payment policies that make primary care a repugnant career choice and that punish primary care physicians for engaging in the full scope of comprehensive care. The solution is health reform, which requires three elements: Everyone has access; the money flow inside healthcare supports the desired health outcomes and the work it takes to get us there; the work of healthcare is redesigned to support the desired health outcomes. Massachusetts maintains a dysfunctional delivery system. It moved on the first element of reform without making a substantive move on the other two. The current plan was bound to result in an angry, disillusioned public and increased costs with no demonstrable improvement in health outcome.

If our nation continues on this trajectory, I predict a disappointed and angry public paying more for bad care in 2012.

Dr. Gordon Moore, Seattle

Turn Off TV Week Activities

I missed all of the fun, but apparently there are numerous activities after school this week, to try to help the week pass with the television sets off. One of these activities yesterday included Claudia Kronenberg giving the NES kids a photo workshop. I’m a little jealous!

Here are some pics from the event:


Gaiman’s “Blueberry Girl”

Neil Gaiman and Charles Vess’s Blueberry Girl is a beautiful, affirming, inspiring picture book based on a poem that Gaiman wrote for Tash, Tori Amos’s daughter (who is also Gaiman’s god-daughter). The poem is a set of benedictions for girls, wishes for a realistically joyful life where what pain that comes only serves to make the pleasure sweeter. Vess (a well-known fantasy artist) has a distinctive style that gives the book much of its charm.

…Dull days at forty, false friends at fifteen;
Let her have brave days and truth.
Let her go places that we’ve never been;
Trust and delight in her youth.

Ladies of Grace, and Ladies of Favour,
And Ladies of Merciful Night,
This is a prayer for a Blueberry Girl,
Grant her your Clearness of Sight.

Words can be worrisome, people complex;
Motives and manners unclear.
Grant her the wisdom to choose her path right,
Free from unkindness and fear.

Let her tell stories, and dance in the rain,
Somersaults, tumble and run;
Her joys must be high as her sorrows are deep,
Let her grow like a weed in the sun…

Tilt-shift photography

I want to learn to do tilt-shift photography. I love the toy effect. It involves using tilt-shift, perspective control lenses, to take a wide angle picture and make it look like a miniature scene.


The photographs are strange and inviting when done correctly.

However, on the video sharing site Vimeo, there is a Sydney photography (Keith Loutit) that combines tilt-shift techniques with time-lapse videography. The effect is mesmerizing.

Bathtub IV from Keith Loutit on Vimeo.

Here’s the problem. Perspective control lenses are expensive and hard to use! Maybe one day…

Swine Flu Scare of 1976

Here’s the story of the time.

Turn Off the TV

National Tune-off Tune-in Week began on April 20th, but since our schools were on Spring Break that week, and it would’ve caused a great deal of parental insanity to have had the kids in the house all day without the Big Box Babysitter, we’re promoting it this week.


According to TurnOffTV.com:

* Number of 30-second commercials seen in a year by an average child: 20,000.
* Number of minutes per week that parents spend in meaningful conversation with their children: 38.5.
* Number of minutes per week that the average child watches television: 1,680.
* Percentage of children ages 6-17 who have TV’s in their bedrooms: 50.
* Percentage of day-care centers that use TV during a typical day: 70.
* Hours per year the average American youth spends in school: 900 hours.
* Hours per year the average American youth watches television: 1,500.
* Percentage of Americans that regularly watch television while eating dinner: 66.

Moves like this are silly in some ways. All or nothing. Really, if 70% of day-cares use a TV, then find a day-care that doesn’t. And if 66% of people watch TV while eating dinner, then, don’t.

Nonetheless, the stats you see above result in shortened attention spans and expanding waistlines, and we need “weeks” like this to heighten our sensitivity to modern diseases as excessive TV. In fact, we should follow this up with National No-High-Fructose-Corn-Syrup Week and National Bike-to-Work Week.

And so, as painful as it will be, our family will follow these recommendations.

Thank Heavens for DVR.

Swine Flu

Today was my first day back from vacation and, with all the news stories circulating right now, it’s not surprising that there were calls with questions about Swine Flu. Here’s what we know as of now.

Swine flu, or Swine Influenza, is caused by the Influenza type A virus found in pigs and known as the H1N1 subtype. Until now, human infection has been uncommon, with most cases involving humans being exposed to infected pigs. Human to human transmission has previously been rare, with a potential single case in 1988. As of today, however, there have been about 70 confirmed cases internationally, 40 of which have been in the United States. In Mexico, although there have been fewer confirmed cases, it is suspected that this outbreak has caused over 1,000 people to become sick, with at least 100 deaths.

View H1N1 Swine Flu in a larger map

Symptoms of swine flu are similar to those of regular influenza, and can include fever, cough, sore throat, chills, fatigue and body aches. Gastrointestinal symptoms like vomiting and diarrhea can be present as well. The diagnosis is made by analyzing a respiratory specimen, which is generally collected within 4 to 5 days after the onset of illness.

You cannot get swine flu from eating or preparing pork.

The current strain of swine flu appears to be sensitive to the newer anti-viral medications, like oseltamivir (Tamiflu), but resistant to the older drugs amantadine and rimantadine. The CDC is recommending treating those suspected with swine flu with the first two drugs within two days of noticing symptoms, specifically those with known contacts as well as symptoms or those with recent or upcoming travel to areas of known outbreak.

Of course, common-sense infection control techniques apply. These include frequent hand washing, using a tissue to cover your nose and mouth when sneezing, avoiding close contact with those demonstrating symptoms, and avoid touching your eyes, nose or mouth.

This event may get worse rapidly, and considering that most of the dead were previously healthy adults between the ages fo 25 and 45, has the real potential to become a pandemic.

For a general overview, see the following CDC links:

Swine Flu and You
Key Facts
Jim Macdonald and the Making Light blog sums up the science

And for current updates:

Swine Influenza press briefings
Massachusetts Department of Public Health

Speaking of healthy foods

One of my favorite online retailers, ThinkGeek, has a new candy for sale. It’s a sour liquid candy that either comes in a blood sample vial or a urine sample cup.

blood urine

© 2009 ackdoc - Greg Hinson, MD 508/325-9981 info@ackdoc.com Purchasing help RSS feed