Patients Rating Doctors: Let's Pay Popular People More!

Patients Rating Doctors: Let's Pay Popular People More!

Obligatory conflict-of-interest announcement: I am paid an hourly salary by a local government. My patients may fill out satisfaction surveys for other physicians in other settings, but they don't for me.

Part One of Three: My patient only had 20 minutes to wait for the van headed to detox. The people who had worked to get him into a detox program already numbered in the double digits. Sam (not his real name) was the classic public inebriate - he woke on sidewalks with the shakes, vomited blood on a regular basis, had lost most of his teeth, and was such a frequent victim of head trauma that depressions and scars ridged his balding skull. 

Over the last week, our substance abuse counselor had daisy-chained together an impressive series of phone calls, blood tests, and clearance forms to line him up for one of our rarely-available detox beds. 

Only 20 minutes to go.

But it was 20 minutes too long for him.

Sam wanted pills to help his shakes, and he wanted them now. When I told Sam the nurses would bring them as soon as they could and that I needed to examine him before the van arrived, his head turned away, and his arm-crossed rocking picked up speed.

With a sideways look at me, he pulled from his jacket pocket his trump card - a crumpled prescription. He showed me how, just that morning, an emergency room doctor had already given him a prescription for Librium (a long-acting withdrawal drug, with high street re-sale value).

He was telling me that he didn't need all this hassle.

Librium is, by any measure, a dangerous drug, with a narrow gap between helpful and lethal. If you shake out one or two extra pills to try to quell the violence of your withdrawal symptoms, or you take a dose, feel better, and then succumb to the lure of a readily available bottle, you can die. (Or, perhaps worse, go into a coma and endure prolonged, intensive, and expensive suffering.)

Librium is extremely dangerous to a serious inebriate and is a big cause of the markedly short lifespan of people like Sam. But Librium is also a really quick and easy way to get someone to leave your ER happily.

Despite Sam's shakes, coughing, and symptoms that indicated he might be vomiting blood again, he had spent less than an hour from check-in to discharge in his Librium-producing ER visit.

Sam saw me looking at his ER client satisfaction survey and discharge instructions, and he said, "I want my prescription back. I'm not waiting any more."

Read more...

Disclaimer: Identifiable patients mentioned in this post were not served by R. Jan Gurley in her capacity as a physician at the San Francisco Department of Public Health, nor were they encountered through her position there. The views and opinions expressed by R. Jan Gurley are her own and do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.

Lakeside Park at Lake Merritt in Oakland

Dick Ebersol, XFL Creator, Leaving NBC Sports

According to ESPN, Dick Ebersol, forgotten as the creator, with the then-called World Wrestling Federation, of the Extreme Football League, or XFL, has resigned in a contract dispute with Comcast.

The first thought that comes to this blogger's mind is apparently Comcast's not into paying what talented people are worth. Dick Ebersol, who not only formed the XFL, but developed and produced Sunday Night Football, now called Football Night In America, and many successful Olympics telecasts, and with Lorne Michaels, Saturday Night Live, is worth a king's ransom.

But Ebersol, who also lost one of his two boys in a plane crash in Colorado in 2004, also said he was just plain tired from all of the plane travel from event to event.

He deserves a break, but also that's a lot of talent just sitting around on a couch. Maybe too much talent.

Stay tuned.

Zazzle Bay To Breakers - Carol And Candy Want The Floats Back

Now that the 100th Bay to Breakers, and the first to be called "Zazzle Bay To Breakers," is over, it's time to consider improvements for the future. On that note, this blogger had the pleasure of meeting two runners (who were also participants and party goers, given the nature of things B2B) at the Park Chalet Restaurant after the race.

They were happy, talkative, and wonderfully opinionated.

Carol And Candy Want The Floats Back in the Bay To Breakers:



The sisters and San Francisco natives both said this year's event was "sparse" as Carol said "it's just the ambiance of everyone on their having such a good time. It seemed kind of sparse without the floats."

The Floats were disallowed for 2011 because they were seen as "rolling bars" distributing alcohol, leading to problems with falling down drunk people. In 2010, the party activity was so intense in the heat of the day that the Crossover Drive underpass was essentially blocked for emergency traffic, as this video from 2010 shows at the 4:42 mark:



This year, as upcoming videos will show, it was a lot tamer at the Crossover Drive underpass. In all, observers said the 2011 Bay To Breakers had fewer mishaps and problems than the year before.

The logical conclusion is that the new rules helped, but I still contend all of these problems would be almost totally eliminated if a big name group like The Rolling Stones or The Black Eyed Peas, or Lady Gaga took the stage at The Polo Grounds. Then, the action would be in that area, rather than all over the streets in Golden Gate Park.

Would it be perfect? No. But the crowd direction would be predictable; everyone would want to be in or close to the Polo Grounds. And the concert would go on until near dusk, insuring that people didn't have time to wander around because the Bay To Breakers was over and the Footstock was closed.

But we can toss around many different ideas for Bay To Breakers 2012. After all, we've got a year to go.

Well, unless Harold Camping gets his way!

End Of The World Not May 21st - Harold Camping Wrong

As this blog post is written, today is Thursday, May 19th, 2011. If Christian Radio Broadcaster Harold Camping has his way, Saturday May 21st will be The End Of The World. It's not necessary to go into a lot of detail to explain that Mr. Harold Camping is wrong.

Rather than immediately point to any Biblical scripture that reads "The World Will End On May 21st 2011," Camping points to a self-created math that leads him to that conclusion. But, really, it's a conclusion Camping would have come to an asserted without numbers.

It's just like Google using an algorithm to express what really is a set of opinions about how Internet search, and the placement of news, should work. Google execs are fond of pointing to this 'black box' that produces a result, but the fact is, if that black box comes up with a search outcome that's not in favor with their views, it will be altered.

Mr. Camping, originally a Berkeley-trained Civil Engineer long before creating the ministry of Family Stations, Inc., used a mathematical system of his own design to generate his result, which has really nothing directly to do with the Bible. In fact, in an interview in New York Magazine, Camping says...

— but there’s nothing in the Bible that holds a candle to the amount of information to this tremendous truth of the end of the world. I would be absolutely in rebellion against God if I thought anything other than it is absolutely going to happen without any question.

In other words, forget the Bible, the end of the World is nigh!

In this way, Camping is very much like another "expert" on what God is, does, and intends who was attacked in this space: Steven Hawking. Hawking is as certain that Heaven's a "fairy tale," much as Camping is sure that the World will end this Saturday, and both hide behind math and science to prove their points.

And the media gives them a ton of attention.

Yikes, man. Yikes.

Camping's backers are every bit as self-righteous as Hawkings's and just as annoying. Both are wrong, but in Camping's case, all it take is for us to wake up and see Sunday, May 22nd, 2011 to know it.

For Hawking, we have to pass away. Or talk to Don Piper:



Stay tuned.

Dominique Strauss-Kahn IMF Salary vs. Bay Citizen CEO Salary

In the wake of the arrest of IMF Manager Dominique Strauss-Kahn for sexual assault, CNN asked if the World leader's $440,000 salary was too much, given his responsibilities.

The Cable News Network compared the IMF with The World Bank, and came away with the point that observers say it's the right amount, considering that Strauss-Kahn had oversite for the loans to those of its 187 member countries who need them.

Well, let's compare Dominique Strauss-Kahn's salary with that of Bay Citizen CEO Lisa Frazier, who makes $400,000.

Is the Bay Citizen salary justified, given CNN's questions about Dominique Strauss-Kahn's salary? The answer's no. $100,000 salary? Yes.

But for Frazier to make as much as the Dominique Strauss-Kahn or President Obama, and yet be in charge of a regional news website, and not even a World news website, is outrageous.

It's not personal, only business.

And the business fact is that The Bay Citizen can't justify paying that high a salary given the small size and Internet traffic footprint of the SF Bay Area news website.

But will that change anything over at the Bay Citizen? No. It still has the outdoor ads that are more debate challenges on the future of journalism than a message to type "BayCitizen.org," as I talked about in this recent video:



Stay tuned.

Redskins Fans Want Donovan McNabb, Not Beck Or Grossman

ESPN.com has an interesting blog post titled "Donovan McNabb weighs in on QB talk," where QB challenger John Beck has already penciled himself in as the NFL 2011 Season starter, saying 'he sees himself as the number one QB' even though he's not taken a snap since 2007.

And Rex Grossman, known for coming up with timely interceptions and fumbles to lose games that matter, was quoted as saying he will "definitely" be the starter.

But according to this hard-core Washington Redskins fans this blogger talked to at the 2011 NFL Draft, Donovan McNabb's their man for 2011. Here's the Redskins fan interview video, made after the 2011 NFL Draft Red Carpet:



Frankly, and I agree with the fans I talked to, the Redskins problem is Head Coach Mike Shanahan. He needs to make a commitment to McNabb, and stick with it. What's not right, is that Grossman had a "brain-up" on McNabb, only because he played in Offensive Coordinator Kyle Shanahan's offensive system the year before in Houston.

If Mike and Kyle are really truly good coaches, they can work with a sure-fire NFL Hall-Of-Famer in Donovan McNabb.

And if they can't then it's time for new coaches.

Hepatitis C African Americans, and INCIVEK

Hepatitis C is a viral infection that causes swelling and infection of the liver, and is particularly active within the African American Community, and at a level called "chronic," representing 22 percent of all known carriers in America.

How this infection spreads by simple blood-to-blood contact and is difficult, if in some cases impossible to detect early on.

Hepatitis C impacts an estimated 270 million to 300 million people Worldwide, 30,000 people in Santa Clara County and 12,000 people in San Francisco, and 2,400 new cases were reported in 2010.

An exciting new drug called INCIVEK, made by Vertex, is said to be the breakthrough drug of the future, today. Moreover, Vertex claims INCIVEK beats the current 40 percent to 45 percent cure rate; patients have a whopping 80 percent cure rate in clinical trials done thus far. But with all this, it's not a vaccine, and it's not yet approved by the FDA, but it reportedly increases the chance that someone undergoing treatment for HVC will be cured by the end of treatment.

This is an interesting - hell, exciting - new development that this blogger will be following in the coming weeks.

Stay tuned.

Steve Mariucci at NFL Draft

Sam, Stephanie,and Courtney - masters of Bay To Breakers PR and media

John Russo: City Of Oakland "Morally Questionable"; Part One

As of June 13th, John Russo 'transforms' from Oakland City Attorney to Alameda County City Manager, under a five-year contract that immediately give the hope of stability to a small island town that's seen a lot of instability, with five interim executives over the last six years, alone. In moving across the Oakland Estuary, Russo ends a period of both living and working in Oakland that started when he was 28 years old; he's now 52 years old.

It also ends a long string of City of Oakland-related video interviews with this blogger, that totals 15 and together have been seen, as of this writing, 21,307 times.

The next video interview will be after June 13th, when Russo sits down as Alameda, California's CEO, or more normally called, City Manger.

But on Monday, Russo, in conversation that produced the 38-minute-plus, video, had a lot to say about why he's leaving Oakland. He was relaxed, especially since cases and office management c decisions now fall to his three chief deputies, Randy Hall, Barbara Parker, and Vicky Laden, who handle litigation, Oakland City Council matters, and personnel decisions, respectively.

On that Monday, they didn't need to check in with Russo, but he was on hand to provide advice, and to finish projects and prepare for his move to Alameda.

On The Decision To Leave: Mixed Feelings

Russo says he has "mixed feeling" about the decision to leave Oakland. Not that he's unhappy about it, but, as explained above, he's leaving Oakland professionally for the first time since he came here from St. Louis in 1987, and before than from Brooklyn, where he's from. I've known John since 1990, and his entire life has been devoted to Oakland, so this move's a huge deal, for him and for his supporters. Like me.

While I have had different feelings, Russo doesn't feel he was "pushed out," of Oakland as we talked about in the video. "There are some people who are opposed to the gang injunction, there are other people who are opposed to the Fed's position on pot farms," he said. "Which was not my position; it 3was the Fed's position. There are some people who are opposed to the gang injunction who have this fantasy that 'The voice of the people has spoken,' and I have left as a result. That's really an ignorant position on so many levels. But on a private level, I can tell you, it's totally not the case."

John says that contrary to the views of some the gang injunction ordinance, which sets up boundaries and cracks-down on targeted gangs in Oakland, is "very popular. Particularly in the neighborhoods where we are seeking them."

John says he's leaving because he has "strong fundamental legal disagreements with the new leadership. (Oakland Mayor Jean Quan) and those who are speaking most loudly at the Council. And because I have fundamental moral disagreements with the direction that this government is taking in dealing with the crises that face Oakland."

Why Russo Did Not Stay And Fight

As I said in the video, Russo could "throw a punch that would be a nuclear bomb." Russo could publicly call out Oakland officials, and, in the most extreme case, bring a lawsuit against his own government. (And Russo did not, I stress, NOT, offer those as options; that's strictly from me).

But he didn't do that.

"Yeah, there's no doubt, if I wanted to stay here, and wanted to do what some of those opponents of mine claim I'm doing, If I wanted to gum-up the works. Somebody in opposition to what the government was doing in this role, could bring the government to a dead halt. And on certain issues, believe me, I'd love to take a different posture than this government has taken," he said.

"I think it's ethically inappropriate, because the city attorney has to follow the policy of the Council. It doesn't mean we have to tell the council what they want to hear about the law, but we have to enforce the policy of the council," he said, and by extension, the administrative policy of the Mayor of Oakland.

Russo says he's not the right person for the job.

Russo says that Oakland's problems in public safety and finance are "gripping the city," and he's totally opposed to the debt-based solutions being considered. And he said "The directions that the government is moving now are morally...not..uhm... They are, I think, morally questionable, and I could no longer serve, ethically, as City Attorney..." Russo, struggling to find the right words, said.

That's part one; part two on Wednesday.

NY Giants Expert John Fennelly On The NFL Draft 2011

John Fennelly is one of the top NY Giants bloggers, and a perennial expert on the doings of Big Blue at Giants Football Blog. In this rare video, Mr. Fennelly took time with this blogger to talk about the New York Football Giants performance in the 2011 NFL Draft. He's now joined Zennue62.com NFL Draft expert Bill Chackhes at Football Reporters Online.

John says that the Giants "did exactly the opposite of what everyone expected them to do" in the 2011 NFL Draft. He says Jerry Reese took the best players that fell to the Giants, starting with Nebraska Cornerback Prince Amukamara, and then UNC Defensive Tackle Marvin Austin in the second round, and who didn't play football in 2010 because he was suspended. "The Giants have a long memory," John says. "They don't care what you did as a senior, can't you play football."

For more of Fennelly's observations, check him out at Football Reporters Online, and at Giants Football Blog.