Scribit Veritas

Protecting the Child, Preserving the Family, and Honoring Life

Welcome to the Blog page of the American College of Pediatricians.  Each issue of the Blog is intended to assist parents, encourage children, and enrich the family.  Read our most recent issue below, and scroll to the bottom of this page to read earlier issues.

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Harvey Milk day

Harvey Milk a hero – really?

The state of California recently came up with a new state holiday:  Harvey Milk Day.  The US postal service even came up with a Harvey Milk commemorative postage stamp.  So….Who was Harvey Milk?  The short answer is that he was a San Francisco city commissioner.  He became famous for being one of the first openly homosexual candidates to achieve public office.  Therefore, he has become a hero to the homosexual movement.  However, if you look deeper, things become very worrisome.  Mr. Milk was also a rapist with a preference for underage boys that had substance abuse problems.  He apparently considered himself a mentor to these young boys.  He would encourage them to (among other things) run away from home.  One of his victims, Jack McKinley, unwisely listened to and followed  the” wit and wisdom” of Mr. Milk.  Years later, McKinley committed suicide presumably because of his angst  about his experiences with this  pederast.
What does it say about a movement, when it pulls its heroes from the ranks of people like Harvey Milk?
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little cowboy

Priorities

Today, my nurse’s son goes in for surgery.  Eleven year old Slayton has alveolar sarcoma (a rare type of soft tissue cancer) in his leg.  Slayton’s  mom has been out from work for over a week now due to this scary event.  Understandably, she is too upset to be able to function and  she needs to be present for her family.
We have so many battles to face these days:  Obamacare, Maintenance of Certification, political correctness to  the point of harming children, overly stringent CLIA (Clinical Laboratory Improvement Amendments) regulations etc.  Sometimes in the heat of the battle and in our frustration, it is easy to forget why we actually practice pediatrics.  An event like this, at least for me, causes me to refocus on why we do what we do.  For those of you that have children that are home and healthy, I urge you to give thanks and give them a little extra hug.  Try to look at the kids that you see everyday through the eyes of a worried parent.  And…..if you think of it, Slayton and  his family could use your  prayers.
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listen

Listen, listen, listen!

When I was a resident, a woman brought her child to me and told me “there is something wrong with my child.” I asked her what was wrong and she could not explain what was wrong; she just knew that something was wrong. I examined the child and finding nothing wrong, told her so.

She knew in her heart that something was wrong and so she brought him back over and over. She saw other residents (pediatricians just learning for the first time how to be a pediatrician) and more experienced pediatricians. Each time, the examining physician was not able to identify anything wrong. Until one day, when he did have identifiable symptoms. Then we all knew that something was wrong and it was terribly wrong; he had a brain tumor.

I and the other doctors listened to that mother; we conscientiously looked for what the problem might be. We didn’t find the problem for a while.

As a parent, if you know that something is wrong, say so! And keep saying so until you are satisfied that really nothing is wrong or the thing that is wrong has been found. And if you are in the medical field, listen, listen, listen.

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Health Care Delivery

My good friend Jim retired from the State Department after serving for many years. One of his chief responsibilities was making sure that animals destined for human consumption did not transmit any infectious diseases to humans.  He has worked in many countries and also worked for a spell at the Centers for Disease Control in Atlanta.

In the course of his career he has had an opportunity to study many health care delivery systems. He observes that no matter what health care delivery system, the system delivers care on two tiers. The upper tier is reserved for those who are favored. In the United States, that tier is comprised of those who have private health insurance. In Britain and other countries that provide universal healthcare, the upper tier is comprised of those who have connections.  How can that be? It is human nature. Generally those who are politically connected or have a personal relationship with an influential physician or healthcare administrator get top tier care.

Given the veracity of the observation that no system of healthcare delivery exists that does not have two (or more) tiers of delivery, I think the system of private health insurance is superior to a universal healthcare system provided by the government. What do you think?

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Jury Duty

I have been called for jury duty on more than one occasion. The last time I was called, I arrived at the court house at the designated time and was directed into a courtroom filled with other potential jurors. Twenty of us at a time were called to the jury stand and screened for participation as jurors in a specific case. Finally my turn came.

The lawyers for the case in question explained to us that the case would involve testimony by a convicted felon. We were asked if we would have any difficulty believing the testimony presented by this felon. I was the seventh person to answer this question. Those who answered before me averred that they would believe this felon’s testimony without question. I answered that it would be difficult for me to believe the testimony of a felon. The remaining 12 potential jurors then stated, one after the other, that they too would have difficulty believing the testimony.

This experience reinforced that one should be true to one’s beliefs and positions. It also demonstrated that once stated, others likely will embrace our belief and position on a given matter.

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Make more bricks with less straw

My self-imposed goal is to get 200 hours of CME each year.  My state only requires fifty credits every 2 years.  I have my goal because I think it takes that much for me to keep up adequately and help me provide the best care for children.  However the MOC (Maintenance of Certification) requirements provide a huge barrier.  I have always participated in quality control programs.  Part 4 of the MOC now requires hours of my time in order for me to document what I am already doing.  Wasting time like that makes it harder than ever for me to continue to reach my personal goal of CME.  Likewise the government-imposed EHR (Electronic Health Records) makes visits take almost twice as long as when I used a more efficient paper system.  In this time of shrinking reimbursements, adding these extra time drains and expecting us to continue to provide quality care is unreasonable.  I feel like the children of Israel when they were told to make more bricks with less straw.

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Picking the “right” answer

I once heard a sermon about a moral man that went through the streets of an evil city preaching that folks should repent and start living right.  At first he was barely listened to.  Later he was tolerated.  Eventually he was ridiculed almost everywhere he went.  One time a person went to him and asked “why do you keep wasting your time preaching to these folks?  Do you seriously think that you are going to change them?”  The moral man answered.  “Once upon a time, I DID preach hoping to change them.  Now I preach so that they will not change ME”.

In a previous blog, I wrote that I had to pick what I thought was a morally wrong answer for my recertification test.  That bothered me because “If you do that kind of thing enough, the morally wrong answer becomes more acceptable to you.”  We like to think good of ourselves.  Therefore, we often spend a lot of mental energy trying to convince ourselves that whatever we do is good….or at least not too bad.  It is hard wired into our psyche.  Therefore when we are forced to pick answers that are neither moral nor in the best interest of children, it has an effect on us.  The way to fight back is to work harder to promote what is good and true.  If we can’t win, at least we can protect ourselves.

God calls us not to be successful, but to be faithful (by doing what we can!)‏
—-Mother Teresa

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The purpose of the M(aintenace) O(f) C(ertification)

I just got my scores back from my pediatric recertification test.  I passed much above the mean, thank you very much.  Upon taking the test, you must agree NOT to reveal any specific questions.  However, there were some questions where I KNEW what answer they wanted but I disagreed.  I felt that the “correct” answer was neither moral nor in the best interest of children (think emergency contraception).   I held my nose and picked the answer that I knew they were wanting.  If you do that kind of thing enough, the morally wrong answer becomes more acceptable to you. Now frankly I am of the opinion that the major purpose of the MOC is to line the pockets of folks associated with the ABP.  However, I think another purpose is to mold pediatricians more in line with the politically correct ideas of those same folks.  I suspect that with time, the MOC testing will become more and more politically correct.  Eventually only the most politically correct will be capable of passing.  Those of us that have moral scruples against some of these issues will be removed from the equation as our ability to practice diminishes.

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The recertification test – a matter of trust

I miss the days when you could recertify by taking a computer test at home.  That was fun.  Not only could you take weeks to do the test, you could look up answers, discuss with colleagues and actually LEARN.  Isn’t that the goal for which we should strive? Doesn’t that learning help us to provide better care?  Now the test is a six hour ordeal at a test center.   At the test center, I had to empty my pockets.  I had to take off my watch.  A packet of gum in my pocket was quickly confiscated.  I was incredulous that I could be expected to cheat with an unopened packet of gum.  I should have kept quiet.  The sneer I received made me feel like a particularly nasty sort of caterpillar found in a salad by a vegetarian.  Unfortunately, since it was a day off for me otherwise, I had worn some very relaxed yet comfortable overalls instead of my normal dress shirt and tie.  I had NO idea that they would wand me with a metal detector and the buttons would make the alarm go off.  I also had to lift my pants leg up so my socks could be checked for potential cheat notes.  It almost reached the point where I felt like saying “Ah…I see.  If one wants a prostate check, one merely needs to register to take the recertification test.”   I also learned that taking a bathroom break meant the entire security screen had to be repeated.  At last, I was allowed access to the computer.  One of the screens before the test actually started stated the following: (paraphrased) “ we know that we can trust you NOT to discuss the specific questions and answers on this test.”  Wow.  They trust me!!  Not enough to wear a watch but they trust me.  Not enough to wear comfy overalls but…they trust me….Not enough to chew gum but …they trust me. Not enough to take a bathroom break but…………

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Final advice on studying and time saving

My son asked me once about my college kidnapping experience that he had heard of.  I REALLY did have a set schedule of being at the library when it opened and being there until it closed with very brief breaks for meals (often missed) and classes.  I had just finished a major tough exam and my friends were surprised that I was BACK in the library working on a biology paper not due for a month (and it was a Friday).  So….they kidnapped me.  Complete with blindfold.  They put me in a car and drove me to Lake Tillary where one of my friend’s families had a vacation home.  They led me into a boat late that night.  It was so dark on the lake that you couldn’t see where the horizon began and the lake ended.  With almost NO manmade light pollution, the sky was filled with millions of stars that reflected on the water.  The Hallelujah chorus was booming out of a tape player and it looked as if the boat was thrumming through the water and into the sky.  I had not yet learned the military saying “Don’t run when you can walk, Don’t walk when you can stand, Don’t stand when you can sit.  Don’t sit when you can lie down.”  It actually was difficult for me to learn to relax but I had a nice weekend with friends and somehow STILL managed to make it into medical school.

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