Tuesday, October 13, 2009
Bad boy.
Friday, August 21, 2009
Perspective on universal healthcare - please read
reform is being reduced ad absurdum. There is not rule that says an 85 year
old person cannot have an operation. It all depends on the medical status of
the person and the benefit that the operation will have to a patient.
Medical care in the UK is given free at the point of delivery based on
medical need, not the ability to pay. If an 85 year old person has a need it
needs to be balanced with the risk of the operation to the individual and
the needs of others for the same intensive care bed after the operation. If
the 85 year old person does not need an intensive care bed they are likely
to get their operation, even if they do they are likely to get their
operation but it may be delayed if a 25 year old person has a car accident
and jumps the que (line) into the ICU bed.
The point that the scare mongering congressman made is that all 85 year old
patients in the UK have the right to be considered for an operation and they
have had that right all their life where as the 85 year old patient in the
USA will have to deal with co-pays and deductibles and bureaucracy and bills
and may not feel empowered to even attend the doctor because until they were
65 years old they did not have medical care at all.
When you come to see a doctor here in the UK you don't pay, you don't sign
anything no one is counting how often you came or looking at what conditions
you have -- you simply get the care you need -- that may be different from
the care that you want. Much of the care for people who have insurance in
the states is care that scientifically they don't need or is of marginal
benefit.
The best example is the yearly pap smear. Medically a low risk patient probably needs
one every 5 years. The pick up rate for a screen every 5 years is 87% when
you increase the frequency to every 3 years it jumps to 96%. The increase
to every year jumps to 97%. In the USA women are told to go every year. The
false positive rate is about 20% Therefore, 20% of the women who are being
screened are being told they may have cancer when they really don't -- this
leads to a lot more tests and a lot more potential harm in the USA because
you are screening 3 times as often with only a very marginal benefit. And
who makes all the money from that -- doctors who should know better. It will
and does lead to women having unnecessary surgery and even death from
complications. The major point is though that all Women in the UK get their
pap smears because it is free where many American women wont because it is
not.
There is truth in that we do not spend as much on the elderly but that is
more a national attitude than a government policy. Here there is a more
straightforward expectation that you have to die of something sometime and
when people of an elderly disposition get their fatal illness -- which
necessity dictates they must get, the British are more reserved and resigned
to the fact that they will die someday. There is none of this heroic
fighting against the odds that goes on in the USA. That is not to say we
don't try to do the best for people but at the same time they aren't
throwing good money after bad trying to save the life that just can't be
saved. We also care better for people. We have a hospice network and our
terminally ill mostly die at home with a nurse and sometimes me by their
side, not in a hospital hooked up to machines which is what happens in the
USA.
The NHS has its problems and is wasteful but its waste provides a peace of
mind that no American will ever imagine. It is coupled with a Welfare State
that ensures you will not starve. Everyone has a right to be housed and
everyone has a right to subsistence. It isn't great for some but it allows
most to feel that they are not alone in the world.
The longer I live over here the less I am proud of the USA. My cousin in
Ohio is currently being treated for Leukemia. She waited 30 days of feeling
deathly ill because she had to wait for her workplace based insurance to
start before she would go to the doctor. Then she missed too much work and
she lost her job, Ohio Medicaid picked up the tab but now she has no money
and she had to be unemployed for 60 days before she can claim disability.
That is not a moral society and the richest country in the world should know
how to deliver health care and basic welfare to its poorest without making
them into criminals. My cousin is a nurse and she has been treated badly by
the system. It would have never happened here.
Basically, the example that the congressman brought up would never happen
because we would never have gotten to the point that an 85 year old woman
would need an operation. We would have taken care of the problem years
before because that woman would have had health care - free healthcare --
her entire life!
The UK wants the NHS to be better but it would never and will never trade
its system for something like the US or even Germany. The NHS and the BBC
are 2 institutions of which the British Public are incredibly proud and they
have given the BBC to the world. We are going to keep the NHS for ourselves."
Wednesday, August 12, 2009
The Perils of Going Home & Getting Serious Again
Tuesday, August 11, 2009
Julie & Julia + Awesome Chinese in High Point!
So tonite, my wife and I decided to go out for an impromptu date. We have both been looking forward to seeing the new movie Julie & Julia, based on the book which was based on the blog that inspired this blog. Very, very enjoyable, especially Meryl Streep's portrayal of Julia Child, one of my heroes.
Monday, August 10, 2009
Diet Drinks = Diet Killer
Wednesday, August 5, 2009
Saturday, August 1, 2009
Day 35 - Slacker (blogwise) - Down 14 pounds though!
Monday, July 27, 2009
Day 30 - A New Week
Thursday, July 23, 2009
Day 26 - Getting blogged down
Tuesday, July 21, 2009
Day 24 - Staying On Track
So the weekend off, without blogging definitely put me off track, and I find it amazing how easily I can lose momentum. So I am blogging yesterday today, and plan to be more diligent, at least until I reach my weight goal of sub 200.
Monday, July 20, 2009
Day 23 - Perfect is the Enemy of Good
Thursday, July 16, 2009
Day 19 - On the road again
Wednesday, July 15, 2009
Day 18 - The Munchies
Tuesday, July 14, 2009
day 17 - No Waste = Mo' Waist
Monday, July 13, 2009
Day 16 - Hectic workday, nothing special diet
Sunday, July 12, 2009
Day 15 - "So Doc, what about exercise?"
I decided in the beginning of this experiment, that 1 major life change at a time was enough. I didn't feel I could cope with sore muscles on top of being a bit hungry. Now, 2 weeks into it, I am pretty settled into my diet routine, and not suffering from any significant cravings.
Saturday, July 11, 2009
Day 14 - Same Salad, New Day! / New rule
Once again, I listened to my own advice and had a good breakfast before scooting out the door this AM. There is no doubt that it makes a difference in the day, and my hunger level. The paradoxical added benefit is that showing the body calories early in the day, ramps up the old metabolism, and helps to lose weight. All of my patients who weight 300+ basically eat 1 meal per day in the evening, and I was slowly getting there myself.
Friday, July 10, 2009
Day 13 - Awesome Thai Salad
Dinner started as a struggle to find something my 5 year old would eat. His older sibs are omnivores, and eat most anything put in front of them, especially veggies, but this one is trying my patience. After nearly coming to a stalemate, he agreed that pasta with "red sauce" would be OK.
Thursday, July 9, 2009
Day 12 - Rush, rush, rush - Top 100 Diet Tips
Although I had a fairly light schedule today, I had to squeeze in time to eat. Breakfast was grabbed on the way out the door, lunch was between surgeries and dinner was between work and T-ball. Fortunately I had some healthy stuff ready to go, so I didn't end up eating crap as usual. This is one of the pitfalls for many busy adults - eating bad food because there is not enough time to make something better, or no decent options when out.
Wednesday, July 8, 2009
Day 11 - Birthday Cake!
Tuesday, July 7, 2009
Day 10 - Mindfulness & Diet Control
Monday, July 6, 2009
Article on obese physicians from Medscape
I found this article on Medscape while trying to see if my blog pops up on Google Search. Thought others might find interesting, as it reflects what I am trying to do.
Is that white-coat feeling a little tight? Many physicians are overweight or obese for the same reasons our patients are.[1] Many of us do not eat right and get enough exercise.[2] We work long hours, making it seemingly impossible to squeeze regular exercise into our busy daily routines. We eat on the run and unhealthy food (often served in our own hospitals) is commonplace.
Physicians rally against obesity, and yet, we are not doing all we can. Sadly, those of us who fail to embrace lifestyle recommendations in our personal and professional lives promote a public perception that lifestyle change is ineffective or unrealistic.[3] Despite dramatically increasing obesity rates, we have failed to improve our dismal obesity counseling rates.[4] The physicians who fail to recognize and treat obesity are often the ones who personally fail to heed lifestyle recommendations,[5] and these doctors may sometimes lose credibility with their own patients.[6]
I know we can do much better. First, we must recognize that the human body needs at least an hour of exercise daily for optimum health, and every able-bodied physician should strive to achieve this. Second, we should eat at least 5 servings of vegetables and fruits daily, and third, those of us with excess body fat should literally count our daily caloric intake and aim for about 12 calories per pound of ideal body weight.[7]
If we can commit to these goals, both as individuals and as a medical community, imagine the example we would set! As individuals we will feel better and stronger, and as a medical community we'll serve as better role models for our patients. To succeed in healing others, we must also heal ourselves.
That's my opinion. I'm Dr. Michael Dansinger, Obesity Researcher at Tufts-New England Medical Center.
Day 9 - Learning from mistakes
Sunday, July 5, 2009
Day 8 - Grazing + Chicken Curry dinner - 235 lbs
Weekends are always weird for me food-wise, since I do not have to adhere to a strict schedule. In the past, I would often skip breakfast, and even forget my coffee, sometimes getting a caffeine withdrawal headache! (I admit it - I'm an addict)
Saturday, July 4, 2009
Day 7 - 4th of July/Birthday Party/ Goat cheese
Friday, July 3, 2009
Day 6 - "Just the facts, ma'am"
Breakfast (6 in a row)
Thursday, July 2, 2009
Day 5 - The Daily Plate/Eat Smart bagged veggies
Day 4 - Late night cravings
Wednesday, July 1, 2009
Day 4 - Boring leftovers/yummy Moosewood Moroccan Stew
Tuesday, June 30, 2009
A Brief Note on Chopping Bell Peppers
Chef-types will undoubtedly laugh at this but I am unashamed to admit that for years I made the task of cleaning bell peppers much harder than necessary. I cored out the pepper like an apple, washed out the seeds, then halfed the pepper before slicing, taking care not to let the knife slip on the steep curve of the edge of the pepper.
Day 3 - Dinner - Temptation
Day 3 -Lunch - Not very Fast Food
My wife called and asked whether I would pick up a Subway sandwich for her for lunch, and so at noon I headed over. It took almost 20 minutes to get 2 sandwiches, after standing in line with the lunch crowd. I thought about how that compared with my cooked from scratch breakfast which took 4 minutes. Not exactly "fast food".
Day 3 - Mexican omelet in 4 minutes
Monday, June 29, 2009
Day 2 Tuna Rice Bowl - (Tekka-don)
After work I ran by the grocery to see what was fresh on special. I always hit the meat section first, then the produce section, the fill in the gaps.
A Plug for Frozen Dinners / Shopping Tips
Sunday, June 28, 2009
Day 1 - Pasta alla Puttanesca/Italian Pot Roast on Polenta
I have been rereading "Julie & Julia..." a fun little book, soon to be a "major motion picture", that started as a blog, in which the author Julie Powell spends a year cooking thru Julia Child's "Mastering the Art of French Cooking". As I read it, I thought to myself, if she, a marginal cook but good writer could blog about cooking, then I, a marginal writer but good cook could blog about eating. And so here we go.