Even though it’s (sort of) illegal, any time there’s a contest of any sort, someone is going to be taking bets on it.

Probably the most famous gambler still living is Thomas “Amarillo Slim” Preston Jr. Slim, who gained fame with his victory at the World Series of Poker in 1972, and went on to become notorious for taking just about any bet. Among his victories: He beat Minnesota Fats at pool played with broom handles; beat Evel Knievel at golf played with claw hammers; won $300,000 from Willie Nelson by beating him at a game of Dominoes; and won a sucker bet that he could hit a golf ball a mile—which he did on a frozen lake. He also won a bet in 2000 by correctly picking George W. Bush to win the presidency. But did he break the law in making that bet? Popular wisdom has it that it’s against the law to bet on the outcome of elections, a “known known” (as Donald Rumsfeld would say) that nobody bothers to check, because everybody knows it to be true. Except that it’s false. Sort of.

In fact, several jurisdictions do ban betting on the outcome of an election. The District of Columbia, for example, specifically prohibits betting on “contests,” but it is a law never enforced. About the only example of anyone actually brought to justice for betting on an election occurred in Arizona in the mid-1990s, when two elderly men, Jack Bird and Loft Hollamon, were brought up on charges of offering a wager on an election. Their crime caught the attention of authorities because they took out advertisements in the newspaper, in which they each urged voters to vote for their favorite so that they would win the bet. But even with that level of blatant disrespect for the Arizona law, Superior Court Judge Richard Anderson threw the case out as unconstitutional, and called gambling the “favorite national pastime.” An Arizona State Court of Appeals later reversed that ruling, deciding that the state is allowed to prohibit wagering on elections in order to maintain the integrity of the act of voting. By this time in 1995 both men had spent tens of thousands of dollars on legal fees, far more than the maximum $750 fine, and the case was eventually dropped by the Yavapai County attorney.

At the federal level, the Supreme Court has weighed in on two occasions in the last century. A 1973 Supreme Court case, Civil Service Commission v. Letter Carriers cited a 1939 civil service form that provides: “Betting or wagering upon the results of primary and general elections is penalized by the laws of most States and is improper political activity.” Hardly a stern and decisive admoniton. More recently, former Chief Justice and avid gambler William Rehnquist more accurately described the Court's opinion of betting on elections by organizing a betting pool wagering the state by state outcome of the 1992 presidential election. White, Scalia and Souter all recused themselves, but the remaining six justices enjoyed a lively contest, in which Sandra Day O’Connor was the clear winner, collecting $18.30. (Harry Blackmun was the only other winner, garnering $1.70. The remaining four justices had to pony up, losing a total of $20.)

In any case, even if a particular jurisdiction decided to repeat Yavapai County’s experiment with electoral justice, most gambling on elections is done online, and most of the hosts are outside the scope of US law. There’s not much to the mechanics of the betting: There are plenty of online houses that will take your credit card information and place your bet for you. It works just like football; the farther in advance you place your bet, or the more narrow your wager, the better the payoff will be if you turn out to be right. If you want to bet on the Bears today, if they win or if they lose by less than seven points, you’ll win the exact amount of the bet (put in two bucks, walk away with your two and two more). If you want to have a larger payoff, bet on the specific score that will occur. Or, if you had made your bet back in August, your payoff would be many times your wager. So what are the odds of a Hillary Clinton victory in 2008? Five to one (bet one dollar to win five more). John McCain is slightly ahead, running at nine to two, Giuliani and Romney at ten to one, Al Gore—who hasn’t even said he is running—at twenty to one, and recently defeated ex-Senator George Allen at a hundred to one. Want a chance at making some really big money? Bet on filmmaker Michael Moore; the payoff is ten thousand to one. Just don’t bet your life savings. And if you do bet on any candidate or potential candidate, don’t advertise the fact in the newspaper. You never know who might be reading.

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Yesterday's Protesters Can Be Today's Liability. Jane Fonda, infamous to the Vietnam War protests, wants back in the anti-war spotlight. But for many on the left, the best way she can help is by staying home.

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Boston Physician Goes After Other Docs. Author and Physician Jerome Groopman goes after physicians' "flawed thinking." But Groopman himself is guilty of flawed logic.

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Obama Says He's Ready to Run, Right Wingers Start Slinging Mud. Throwing foul-smelling dreck at Democrats is an old stand-by for the Right Wing Hate Machine, but with the junior senator from Illinois, nothing seems to stick.

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Democratic Melting Pot. A woman, a black, and a Hispanic all declare their interest in running for the Democratic nomination. Are the Dems pandering, or are they just better at representing modern America?

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Ever wonder what Joe Lieberman is up to? The Connecticut “Independent Democrat” is certainly showing his independence, at least from Democrats, being the only Senate Democrat to back Bush’s escalation of the Iraq war. His stance is causing all kinds of hand wringing among Democrats, who feel the anti-war Ned Lamont should be occupying his seat in the US Senate, and Republicans, at least the ones up for reelection in 2008, who suspect Lieberman would sell his grandmother for body parts if he could get a few votes out of it. About the only person who mentions Lieberman favorably these days is the president, whose own party is deserting him in droves.

The liberal Fatalist-Pessimists (who are aligned closely with the Conspiracy Theorists) suspect that this is just the first foray into Republicanism before he switches parties and throws the senate back into the Red column. This is unlikely. Although Lieberman has used his status as potential defector to arm wrestle some choice scraps from a senate leadership that would just as soon see him boiled in Saudi oil, he is a man who knows the lay of the land. He is aware that 2008 is not far off, and with 22 Republican seats up for reelection compared to 11 Democratic seats, it is extremely unlikely that Republicans, if thrown the senate for now, would be able to hold it in 2008, after which revenge on Lieberman would be swift and decisive. Voters in Connecticut, including the Republicans who voted for him, would soon figure out that their state was routinely cut out of the federal pie. And that’s to say nothing of the other type of revenge, which is when you arouse the especial ire and hatred of the opposing party and they make you their Public Enemy Number One. Anybody remember what happened to Jim Wright? All it takes is enough money and enough accusations, and Senator Lieberman wouldn’t need to wait until 2012 to see his career come crashing down in flames. (Perhaps a better example of what unfounded accusation can do would be former New York prosecutor Steven Pagones, who was cleared of all charges relating to the 1987 Tawana Brawley fiasco and later won a defamation lawsuit against Al Sharpton, but had his reputation savaged in the process. A party-switching Lieberman might be the next politician looking at the ruins of his career wondering: To what office do I apply to get my reputation back?)

No, Joe is too much interested in long-term political survival to be likely to switch. Probably his discussions with Senate Majority Leader Harry Reid and other senate leaders went something like this:

“Being one of only two independents in a very narrowly divided senate, I’m sure you’d like to keep me in your column, Harry.”

“Sure, Joe, but we’d look pretty unfavorably on outright blackmail. Things could get very ugly.”

“Of course, of course, nothing like blackmail. But it would be nice to have something to take back to my constituents…”

“You can stay on Homeland Security and Armed Services, and I’ll throw in Small Business.”

“Deal.”

The second possibility for why Lieberman is supporting the escalation is out of pure mule-headed stubbornness. He would not be the first politician willing to sacrifice thousands of American lives (not to mention many times that number of the lives of non-Americans) and uncounted billions of dollars rather than admit a mistake (see, for example, Vietnam, History of American Involvement In). By always calling for more troops, he can lay the blame of failure on someone else. If this “surge” doesn’t work, he’ll call for another. Sooner or later, we’ll pull out, and he can always say that if we had just backed one more surge, we would have won. Among all the horrible possibilities of what might be going on in his twisted mind, this is the one I’d actually hope for.

The third possibility is the most insidious and the one I fear the most. Among the most self-serving and deadly of policies being shopped around by right wing think tanks these days is that the spread of sectarian violence throughout Iraq is a good thing. The “best and the brightest” of the far-right (check out, for example, what's coming out of the American Enterprise Institute these days) actually believe that having sectarian violence spread from Iraq throughout the middle east would be good for American business interests. Even in Israel, which certainly has a lot more to lose from a destabilized middle east, there are those on the far right who think that it’s in their interests to fuel sectarian violence. These are the same people, both in America and Israel, who think that attacking Iran right now would be a dandy thing to do. It is frighteningly possible that Lieberman has aligned himself with this lunacy. He knows the Iraqis want a timetable for our withdrawal. He knows that Bush’s international policies foment a land-office business in the spread of extremism and recruitment of terrorists. Is he, already so deep into a failed policy, buying into a plan that says risk World War III on the outside chance that we can weather the storm and some huge corporations can make a few more billions? That possible explanation of the senator’s support of the escalation of the war is truly the stuff of nightmares, making the possibility of his wanting to just throw his hat in with the Republicans a visit to Disney World in comparison. For myself, I’m hoping he’s just plain stubborn, and that enough Republicans have seen the light to pull the plug on the president, so that Lieberman’s opinion, however he arrived at it, won’t amount to anything more than the braying of an ass.

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Advice to Michael Vick: Don’t take your stash to the airport! Even back in the very naïve, very hijack-friendly seventies, every stoner in the land knew that you never took your stash to the airport, and never EVER in your carry-on bags!

With the NFL playoffs raging along, it takes a pretty out-there NFL story that has nothing to do with the playoffs to appear in the news, so yet another drug bust of an NFL player would normally rank pretty low, unless the bust came while the player was driving to a playoff game. But when Michael Vick was arrested at Miami International Airport on January 17, 2007, after police discovered a secret compartment in a 20-ounce water bottle that contained a “small amount of dark particulate and a pungent aroma closely associated with marijuana,” according to the police report, the news smashed through the playoff-only news ban and ducked and weaved its way into the mainstream media in prime time.

Reasons for this are multiple, and all have to do with several unanswered questions: First, why is Vick, who two years ago signed a $137 million deal with the Atlanta Falcons, flying on AirTran? I’ve never seen Bill Gates on Jet Blue and don’t expect to, because Gates has enough money to fly in a private plane, or if he really wants to slum it on a regular airline, at least he flies first class. So Vick, who does not have the reputation of being financially parsimonious, suddenly ran out of cash? Not likely. Second, what in the world is he doing messing around with whatever amount of pot can be stashed in the water bottle’s false bottom? The man can afford bales of the stuff, delivered right to his doorstep. Did he expect to light up in the airplane john? Did someone forget to tell him that all flights are non-smoking, and even if they weren’t, with all the air being recycled on the plane, it would take about three seconds after he lit up before every man, woman and child on the plane would be smelling the damning “pungent aroma”? Third, didn’t he learn anything from the pot-bellied drug addict Rush Limbaugh who couldn’t even smuggle contraband Viagra onto a plane without getting busted?

To sum up the common thread as reported by the mainstream media: Hey Mike, what were you thinking? The answer is not that he wasn’t thinking at all, but that he was thinking he could get away with it the way all celebrities get away with all that they get away with: Rules don’t apply. Dave Barry once noted that dogs are not as stupid as we think; they know the rules, they just think there are exceptions to them. For example, a dog may know that he’s not supposed to dig through the trash, but obviously that rule must not count when there are delicious chicken bones to be found in there. Celebrities are very dog-like in this thought process. Absolutely everyone, including those currently hiding in caves, knows that you can’t bring bottles of liquids through airport security, ever since the arrest of 21 suspects last August charged with a plot to blow up several planes by sneaking explosives onboard using compartments hidden in the bottom of the bottles! While you’re at it, Mike, why not just stash a few box knives in your back pocket, and take a few flying lessons where you tell the trainers you only want to know how to take off but not to land?

But logic doesn’t apply to sports celebrities. Sports celebrities are an especially entitled group among the mega-entitled cohort of all celebrities. Most movie stars, for example, were not famous prior to their teen years, so there were at least a few years post-puberty where they did not have the world at their feet. But in sports, especially football, the star players have been having the world served up to them daily since junior high school. They learn, from age 11 or 12, that if they excel in their sport, no coach, teacher, parent, police officer, judge, college professor, tinker, tailor, soldier, spy can tell them what to do or when to do it.

Michael Vick is not his younger brother Marcus Vick nor his keeper, but it might be that the younger brother’s hoodlum outrageousness on the field and off it may have been a result of the fact that seeing his older brother’s success and knowing that the world expected similar success of him may have put the world at his feet as young as age seven or eight. With the plasticity of the young mind, entitlement, narcissism and a disgust for everything and everyone in the world may have been hard-wired into the younger Vick’s DNA.

A careful reading of the initial police report of Michael Vick’s arrest shows many potential “outs” for Vick. The loss of chain of custody, for example, is mother’s milk to criminal defense lawyers. It is not likely that Vick will suffer much from this event. If it ever goes to trial, he is unlikely to be convicted. If he is convicted, he is unlikely to spend any time in jail, pay any fine that will be larger than pocket change to him, or receive more than a cursory scolding from the NFL. It will not affect his career, his endorsements, his living-large lifestyle in any way, because our society worships sports celebrities with more fervor than any religion, and no amount of "Ron Mexico" herpes lawsuits or rude gestures (check out wikipedia if you don't remember those Vick fiascoes) can alter that worship.

So while the rest of us toe the line, day in and day out, fight traffic to work, do our jobs, fight traffic home, and never even dream of crossing the line lest we end up in a damp, dark cell in Guantanamo Bay with a daily ration of bread, water and beatings, the Michael Vicks' of the world will continue to amuse us with their alarmingly flagrant stupidity. And the worst part of it is, the guy has no downfield arm whatsoever.

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The assassination of the English language is not the fault of immigrants, but our own cultural illiteracy

The tenure of the first newspaper ever published in what would become the United States, Publick Occurrences, published September 25th, 1690, was short. It lasted one single issue before being shut down and all copies confiscated, because of crown disapproval of inflammatory language contained within. The heat of the words, however, are not the first thing apparent to a modern reader, but rather the difficulty of reading it at all. In explaining why the newspaper is being published, the first paragraph of the document reads, to the modern eye, as:

It is defigned that, the Country shall be furnifhed, once a moneth (or if any Glut of Occurrences, oftener,) with an Account of such confiderable things as have arrived unto our Notice.

Misspellings, awkward capitalizations, and the frequent exchange of the letter s for a letter nearly matching f make for slow and awkward reading. Spoken language has evolved some, but written language has evolved greatly since the 17th century, due entirely to the rise in literacy. The more of us who are literate, the more we need a common set of rules to convey our thoughts in written form. And just as vandalism would mar a painting, poorly written English mars the thought that underlies it. While much has been gained in written English, there has been a considerable amount of backsliding recently. I have no desire to arouse ire, royal or otherwise, but I feel compelled to protest the conditions of modern English as presented in the mass media. Among the literary offenses that must be eliminated:

“What we oughta do…” Some writers of fiction (Mark Twain, JD Salinger) are able to accurately reproduce dialect and accent on the written page. They are able to do this because they have talent, something notably absent from the mainstream media. In place of talent, mainstream authors pepper their stories with what they see as folksy charm. Thus, even highly respected news sources will report a politician’s speech with such bastardizations as “shoulda,” “oughta,” “gotta,” and “ain’t.” This must be stopped. If speakers choose to imply humility, or to charm audiences with chicken-soup sentimentality, they have that right, but to attempt to reproduce a verbal slur in a written news article is to promote illiteracy.

“Alright.” There is no such word, and as printed it reads Al-right, as in Bundy. To say that all of something is right requires two words, and I hope it's all right if I sound a little frustrated.

“Is they’re a problem here?” English is a difficult language, full of many exceptions, but that it what makes our written language so expressive. There are three words—their, there, and they’re—that are phonetically identical but have very different meanings. There is a place, as in, “look over there.” Their implies ownership or possession of them as in “their chair” or “their lack of language skills.” (It can also refer to an individual of unknown sex; for more on that touchy subject, see below.)“They’re” is a contraction of “they are,” referring to a group: “They’re all out on the dance floor.”

“His or her or its…” Ownership by a male makes it his but for a female to have something it must be it must be hers. For example: It is her car but the car is hers. And as a fine example of the complexity of English, although it seems as if it should be her’s, there is no such word. In any case, the expression is tedious: “Whatever a person wants out of his or her education, repeatedly referring to his or her knowledge base, and his or her facility with language, will soon have him or her sending his or her audience fleeing the room.” This is to say nothing of the criminalities of his/her which reads as “his slash her” or the literary abortion s/he, which renders either as “s uh he” or “s slash he.” Use of one is correct, but sounds both pompous and dry, as in, “Whatever one thinks of this sentence, one certainly cannot argue that it is not grammatically correct, no matter what one’s education may have been.” There are many solutions to this conundrum. The easiest option is to make it plural: “Christians acknowledge their sinful nature” reads so much better than “A Christian acknowledges his or her sinful nature.” Alternatively, pick a sex: “A person will often vote based on his emotions rather than his understanding of the facts.” Or, if the female singular is preferred, thus: “A person will usually want her opinion respected.” Either is correct, but choosing sides and always picking one sex runs the risk of sounding sexist, while switching pronouns back and forth is cumbersome and interrupts the flow of the narrative. Probably the most used yet most controversial choice is the word “their.” Some grammarians argue that to use a word that implies plurality (as in, they have their point) when referring to an individual is incorrect. But the history of the evolution of the word “their” shows that in it’s origins, dating back at least to the 13th century, and continuing to the present, it was used and continues to be used when the sex and/or number referred to is unknown. This argument will continue, but if ease of communication of ideas is the principal purpose of written language, surely it can be argued that asking “Will anyone get their due?” reads more smoothly than “Will anyone get his or her or their due?” To put it another way: Anyone who disagrees can go soak their head.

Proper! use, of punctu-ation? Punctuation, used correctly, adds versatility to language, allowing a more accurate representation of a writer’s thought. Examine, for example, these differently punctuated sentences: Yes it is. Yes it is! The former implies agreement, the latter excitement. A comma indicates a pause; a period the end of a thought; a paragraph, the end of a closely related group of sentences; a question mark, a question; quotes, something that was spoken, or something that is implied to be not really accurate. When a large sign at a car dealership declares “Sale” This Saturday, is the implication that one of the owners is being quoted, or that, nudge-nudge-wink-wink, it’s only a discount from their artificially inflated prices? A final plea: Italics can be used for many things, including emphasis, but ALL CAPS renders as SHOUTING and is very hard to read, ESPECIALLY WHEN THE ENTIRE SENTENCE OR PARAGRAPH IS IN ALL CAPS!

Iz profreading rely so hart? In spoken language, everyone, even the most uneducated, will correct an error of speech. Having lisped, for example, “The American Flag and the bald eagle are thimbals of our democracy,” the speaker will be quick to repeat the sentence without the lisp. If our natural inclination is to immediately correct a spoken error, which no one will remember 30 seconds hence, why do so many shy away from correcting what is written, which, especially if published anywhere in cyberspace, will likely outlast their grandchildren? If a boy, wishing to gain favor with a girl, sends an email that states: “I think yor eyes are rely great,” what will his level of embarrassment be when she forwards that series of typos to her five hundred closest friends? We live in an age of great scrutiny, and we are held far more accountable for our written words than our spoken ones. Five or ten seconds of proofreading eliminates the problem.

Hey. Cn u rd this txt msg? Text messaging is useful, and there is both a large generation gap and a large gender gap with how useful different groups find this technology. No one can be blamed for not writing out the entire sentence that begins this paragraph on a cell phone because it would be extremely tiresome and time consuming, defeating the purpose of texting in the first place. But it is not acceptable when the language of cell phone text carries over into other mediums. An email that reads “wht do u wnt tdo Sat?” marks the sender as possessing a second-grade education, and may have long-term consequences for the sender (see previous paragraph).

Pencils, Lead, Number Two, One Each. Request Submitted 10 January 2007. The Texas oilmen currently in power have done much to erode freedom, but even with the Patriot Act essentially placing the country under martial law, it is absolutely going too far that the militarization of our society extends to written language. Who, inside or outside the US Military, ever answers a question about the date as: “Today is 10 January 2007.” The responder would be thought of as a pompous fool or mentally deficient. Why, then, has this crept into written language? If the printed media have done it as a cost-saving measure because of the saving of a comma, surely this argument cannot be used on the megabyte-rich Internet. It should be written as it is spoken, because that is how it renders in the mind.

Language Nazis Need Not Apply. Some Ivory Tower types use their knowledge of English to look askance at those who know less. I have no such desire. The basic tenet of a common language is that it is inclusive not exclusive. But for the language to be common to all, all must agree and abide by some basic rules. After all, don’t we all just want a little understanding?

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It will be very interesting to see what the media and the public make of Chief Justice John Roberts assertion that $160,000 a year is slaves’ wages and that anybody with any sense could make much more than that in academia or the corporate world. In medicine, the massive rewards to be had by ceasing to actually work with people and become a corporate shill are not seen as a major cause of brain drain. Any doctor can multiply by a factor of 10 his or her salary by becoming an “adviser” to the drug companies, product manufacturers, congressional lobbyists, or trial lawyers suing other doctors. But only a few choose this route, because we do what we do not for the money but because it’s who we are. (See Millionaire Doctors? for more on that sore subject.) I would have thought the same thing would be true for lawyers, that the chance to have such a tremendous influence over the way this country operates as to be a federal judge would outweight any monetary concerns. So far, the public has reacted with a big yawn, which works heavily in Roberts’s favor: no complaints=no controversy=easy amendment to massive spending bill=big raise for him and his cohort. Prediction for 2007: Lawyers’ pay will rise, doctors’ pay will fall.

Doctor or Waiter?

Ask any doctor, especially those who have been practicing since before the insurance giants ruled the land, what the biggest loss to his practice has been, and the answer is likely to surprise you. The predicted answer is dramatic salary reduction, but actually that is far less troublesome than the loss of autonomy. First it was the HMOs that said, You must prescribe this not that, or No this patient is not a candidate for surgery. (If you ever wonder why doctors are sometimes seen as icebergs, imagine the emotional stamina that it takes to have spent 16 years, working 80-100 hours a week, to become an expert in subspecialty surgery, and after examining a patient, reviewingthe chart, discussing the case with colleagues, and consulting current literature, all in agreement that the patient needs surgery, only to be told by a 23-year-old MBA who just fell off the beer float that the patient is NOT a candidate for surgery.) Next, hospitals, which having much more bargaining power (dollars, lawyers, congressional lobbyists), get a very large chunk of cash for its services, turned around and said that as a cost-cutting measure doctors must ONLY use certain drugs, products, or devices. Never mind that other devices, drugs, products work much better. And to complete this Sisyphean triad, doctors are now being told how to practice medicine by their patients. Thanks to direct advertising and our short-sighted Entitlement Society, patients now come in and demand certain drugs, procedures, tests, or equipment: Don’t bother with the physical exam and I don’t care that you went to medical school thank you very much, this is my body and your job is to do as you’re told. “It’s just like the waitress job I had in college,” says one Denver pediatrician who asked not to be identified. “I used to go from table to table, ask them what they want, hint at a few suggestions but never contradict them act like I knew more than they did, and then make it happen just the way they ask. Now I go from room to room and do the same thing with my patients.”

Case Files

Fine, except that waitstaff are not asked to make life or death decisions about their patrons. Case in point: A patient comes to my clinic with abdominal pain. I perform an exam and order tests. The result is that the patient’s pain is caused by a stomach condition, but one that will heal with medicine not surgery. A prescription is given to the patient for the appropriate medicine (after checking with the patient’s insurance company, to make sure the medicine is covered, of course). Additionally, the patient is given a prescription for a narcotic pain medicine, and advised that the narcotic is just a temporary stopgap, that if the pain persists, it means the insurance-approved stomach medicine is not working and we will have to discuss other options. A followup appointment is made for three weeks later, with the standard admonition that if things get worse to call or come to the ER. Two weeks later this patient, having not communicated any problem since the office visit, shows up unannounced in clinic and demands of my secretary that she page me out of the OR to write a refill prescription for the narcotic pain medicine, because the patient still has some pain and is going away on vacation the next morning and has no time to be seen in clinic or the ER.

Nevermind what we talked about at the first visit about the possibility of needing other treatment. Never mind that the patient is quite capable or reading a calendar and knowing about her vacation ahead of time. Never mind that the patient is quite capable of counting pills in a bottle and noticing when they are running out before reaching the very last one. I should mention that this was not a drug-seeking patient, as in, someone who is addicted to pain medicine trying anything and everything to get more pain medicine. Those patients are not that hard to spot and referred to addiction specialists. This was rather the more common entitled patient who figured she knew better than her doctor and just wanted me to do as I was told. Let me also mention that I bend over backwards for my patients, seeing them between cases in the OR, early mornings, in the middle of the night in the ER, wherever, and my pager is always on. I get pages at three in the morning from patients wanting to know if they can reschedule an appointment that is still three weeks away. But I draw the line at them sacrificing their own health through ignorance.

No more Mr. Nice Guy

The end result for this patient was a stern lecture, a change in medicine, and close followup by phone while she is away on vacation. To some degree I am lucky, in that I can get away with this. As a surgeon, I already have fewer patients than an internist or pediatrician, since I have to spend a lot of time actually doing the operations, and with a smaller pool of patients, the number of headache-causing patients is smaller. Plus, as a subspecialist in a tertiary-care center, I’m the last stop. If they don’t like what I have to say, there aren’t a whole lot of other options. Which is not the case for most physicians. For most docs, patients see things they like on television or in a glossy mag, they show up for their 15-minute appointment and demand it. So now the doc has a draconian choice: Give them what they want and speed them on their way, or spend 30 to 60 minutes arguing with and educating the patient. The textbook answer is that the ethical thing to do is educate the patient. Except that there are forty more patients to see, and every hour spent on a “problem” patient makes everyone else that much more late, and adds another hour to what is already going to be a 60 to 70 hour workweek. And even if you opt for spending that extra hour with each and everyone of these “problem” patients (and there are many of them, believe me), they will then just go to another doctor, and another and another, until they get what they want, adding additional burden to an already overwhelmed medical system. And they will call their insurance company and complain about that “insensitive” doctor and you will get a snarling phone call from the MBA frat boy, telling you that if you’re going to continue to irritate “his” patients, he will remove you from “his” group.

An impossible task

I watched this scenario play itself out many times as a medical student, and fought this uphill battle many times myself as a resident before conceding the inevitable. (Sissyphus had the advantage that when he rolled the rock up the hill, at least he was able to get out of the way when it ran back down the hill. Every boulder I tried to strongarm out of the valley just ended up rolling over me and crushing me like a bug.) This had a lot to do with my chosen career, in that being the “last stop” I had a little (a very little) more freedom to fight back against this grim trend away from medical practice and into “service excellence.” Emphasis on service.

What can be done to stop the assualt on health care? Patients can try to see their physicians as equal partners. If the aura of “doctor knows best” is long-gone, at least trust that your physician, with decades of very arduous training, might know something worth listening to. Would you try to tell your plumber how to fix your pipes? You might try, knowing that the worst result will be a wet floor. But are you likely to ignore your electrician’s advice and wire things any which way? Not likely, because the results could be deadly. Same thing with your health.

As for what physicians can do to stop the erosion of good healthcare by the tsunami of know-nothing CEOs, we will continue to fight Big Insurance and Big Pharmacy and Big Government, so that we can always get you the best medicine, product, treatment or device. And we’ll do it with a smile, and for a lot less money than your average lawyer.

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