iPhone madness

Bought an iPhone on Friday. It' great. The activation was hell.

Posted my experience at this apple support discussion thread.

Happy New Year

That's right, new year. Here's the new crowd. We send out the old crowd with a grand soiree tomorrow night.

Am I a Mr. Hollland? If so is this crowd my opus?

Touching Base

My three month juggernaut of travel is, briefly, halted. I'm home for a month.

But Heather's not - she's in Malawi for a project and is actually taking pictures!

Kent is in Italy, but blogging is the last thing he'd do.

And the kids are at home, having finished another year of school. I left the hous today with a freshman and junior. Now we have a sophomore and senior to deal with.

Where've I been?

Austin, TX - work
Florida - Play (!)
Las Vegas - more work
Gettysburg - ditto
New York - ibid
Kansas City - not enough work so I worked some more.

Hmmmm. Not enough play in there.

P4P again

A Health Affairs web publication discusses downsides of P4P in urban underserved populations. On target.

"Will Pay-for-Performance and Quality Reporting Affect Health Care Disparities?" (pdf 128k)

How I feel this month

My residency just matched with six great interns for the coming year, but not all program directors feel the same about their prospects. Many directors have called for reductions in the number of spots available for training in Family Medicine, thereby (so the theory goes) increasing competition for the remaining spots.

I'm all for high quality students entering my specialty, but think reducing the number of training slots is the wrong way to go. The country needs primary care badly. But just as we need to lose weight and fix the mess in Iraq, some things are easier said than done.

I have two different patients in two different hospitals slowly dying of cancer and substance abuse, respectively. My experience with each provides a sobering contrast with our recent successful recruiting year, a contrast echoed by Sandra Miller's excellent essay "Endangered Species" (pdf 40k) from last week's Journal of the American Medical Association.

Get rid of stuff

Here's why.

The choice

The first comment is the one that resonates in my household.

Jon Haloto: Macbook it is.

It always snows on St Patrick's Day

At least it seems that way.

Is the US ready for the Smart Car?

A co-worker of mine owns Philadelphia's only 'legal' Smart Car. She lives in the city's Art Museum area, driving it around to commute when she's not riding her bicycle. Unfortunately it's been vandalized twice while parked on her street. Clearly not all the attention it garners is positive.

She's reported the latest smashed windshield and driver's window to the police but there have been no leads. Look closely and you'll see that's plastic on the driver's side held in place with duct tape - you'll also see the smashed windshield just below the inspection stickers.

Can you help find out who did it?

Write your play

Robin is a new co-worker of mine. She enters charge entry data and reconciles payments against charges for our busy residency practice at Penn. But her real ambition in life is to win a Tony for best new play. While talking to her I was reminded of my former life with Actors' Guild of Lexington (as president of their board many moons ago) and also my love affair with Actors Theatre of Louisville, whose Humana Festival of New American Plays continues to feed new material to Broadway and elsewhere. Actors' Guild is easily the more grass roots and exciting to me, in part because of their mission to present compelling modern american theater. Seeing their production of Angels in America is still a highlight of my live performance watching experience.

The discussion with Robin also reminded me of a question I once had during a job interview: "Do you write every day?" The wisdom of this being that if you didn't now you were unlikely to do so. No need to wait for an assignment, a job, or for more time. The barriers (for me anyway) were all internal.

Robin: Write your play. I'll come to see it - even if it's only a reading.

Smell the Moussaka

Walking to an early morning meeting yesterday I walked past the spot that sealed the deals - both my marriage and our honeymoon. Walking by one morning in the Fall of 1987 my future wife and I smelled food and walked in to a greek glendi in progress. Being introduced to spanikopita, baklava, and moussaka and shortly thereafter being *forced* to dance. No sitting was allowed. Now that's a culture we just had to explore further.

This is a poor phone cam picture but I couldn't resist. There are too many memories in this town!

Compact Parking - not

Wish I'd orderded some of the bumper stickers Leo pointed to last month.

Stopping for Life

Clark DeLeon posted a shot from Fairmount park's Belmont Plateau last
Fall. Ever since I've been telling myself I'd stop along the drive
south on 34th street in front of the Philadelphia Zoo to get a shot
of the boat basin under the Art Museum. Today I brought in my camera
to catch some pictures of my new doctoring class, which meets for the
first time today. Having the camera with me, I stopped for the shot but the light was better for this one - a tunnel of trees waiting for spring. I need a higher resolution camera to catch the details in these branches.

Bruiser

Test picture. Cute dog, huh?

Spring?

If daylight savings time starts, baseball is on the radio (Phils give up 4 in the 7th inning to lose the lead - will they get it back?) and the temperature is 45 degrees warmer than five days ago is it spring yet?

Jacob gets it right again

Why don't the FFM or IHI folks talk this way?

Physician identifiers and Pharma marketing

After receiving the umpteenth mailing from a prescription benefit manager (PBM) at my home regarding a patient medication issue, I finally took the time to write one of the managers responsible. Getting these at home drives me crazy. The misuse of my DEA makes me crazier!

Some info: I never use my home address in any patient related matters. The only reason the PBM's have it is because they use my DEA registration address. Why? Because that's how they track my prescribing, even for non-DEA schedule medications. Today's mailing was about a beta blocker, and they list my 'prescriber number' which conveniently is identical to my DEA. What a completely wrong and market (not patient) driven problem.

The FDA, DEA and multiple medical organizations have weighed in against this misuse of DEA numbers. There are great alternatives (like the pharma driven National Provider Identifier), but pharma is slow to adopt them. Why change when the old system works fine for them? Who cares if your number is stolen so easily. Narcotic abuse? - not our problem.

I just wish Pharma wasn't so friggen mercenary about this. All their talk about "best for patients" is complete bullsh*t when seen in the light of their marketing behaviors. And to top it all off is the conversation I have with pharmacists who are likewise stuck in the middle between the patient and their PBM - "I'm sorry doctor but the insurer won't pay for the medicine without your DEA number." This for a diphenhydramine prescription - an over the counter anti-histamine. And if I don't cough up my DEA the patient hears "your doctor didn't approve it."

Damn right I don't approve it.

Sigh.

Let the record show...

That while Prince Charles was in town celebrating the Academy's 150th, I was watching Penn - St Joe at the Palestra. You can take the boy out of Kentucky but you can't take the basketball out of the boy.

Getting meta

Like Stephen Colbert? I take mine extra medium.

Finishing 06 the right way

So; Philly gets to keep the picture after the extortion game played by Bob Barchi and Jefferson's board. My town really stepped up to the plate on this one - true philly spirit at work.

My just completed nine day hiatus is just the thing for the mid-year recruiting/accreditation/holiday chaos that is my life in Winter. A few days in North Carolina with family, a few hours struggling to survive my son's driving (on I-95, in the rain, during rush hour, at night), and plenty of time to putter around the house and finish up some BIG work projects.

Not only that: I finished Tony Bourdain's new book The Nasty Bits. His commentary on the various chapters is real whipped cream on a satisfying collection of life's lessons. Sure, it's about the food on the surface, but in the end it's about Tony and his addiction to life. I'm just jealous that he's getting paid for it.

And the iggles pulled it off. Andy Reid's workmanlike affect may not inspire the same kind of loyalty as Knute Rockne, but it'll do, pig.

I even saw Rocky Balboa. What a great bookend to the break for anyone who loves Philadelphia and its spirit - and I do. I even teared up a few times at what is admittedly an average picture. Am I a sucker for sentimentality or what?