Retirement Ain’t So Great

As mentioned, I managed to complete residency.

That was a few weeks ago, and I haven’t stopped celebrating.

Minimal blogging.  No professional reading.  Lots of sleeping.  Ice cream pretty much whenever I want it…as if I’ve just had my tonsils removed.

I’ve gone surfing twice and will go again in a few days, after I buy the GREATEST BOARD EVER KNOWN TO MAN.

It’s a far-cry from a bohemian life of decadence – no absinthe, no scantily-clad pixies, no pleasure nymphs to speak of – but I don’t remember being this lax, this flatly averse to self-denial.

But, I have to say, after a week of this…workin’s cool.

I like needing to be somewhere in the morning.  I like having a schedule and trying to be efficient.  Mostly, I just like the purpose that a job provides.  With so many people out of work around the country, I can understand how hard it must be to deal with such a life change.  Aside from the financial instability (which I don’t have), just the dramatic shift itself must be really difficult to bear.

Lucky for me, I’m working some moonlighting shifts at nearby practices.  So, we’ll have enough money until I start a real job next month.  And I have quite a few things to keep me busy until then also, because my next job will be in Germany.  So preparing takes lots of energy.

But after even just a week away from the job, I can see that I’m too young to retire.  There’s lots of things I would change about my last job, and I’m not depressed since leaving or wishing to go back.  NOT AT ALL.  But I am looking forward to many of those intangible things that a daily job brings.  Some people are built to work.  In many ways, I guess that’s me.

Graduated – No Crying

The last days of residency passed – perhaps with a bang, and certainly no whimpers – and I am now full into my first week as a real, live doctor.

Everything feels the same, but with more sleep.

My graduation ceremony occurred 4 days ago, on Saturday.  For as emotional as I felt that night, I managed to survive the entire ordeal without much blubbering.  This had largely to do with my particular approach to the ceremony itself, which involved a skateboard, a wacky helmet and some iffy poetry.

Since there are only 6 graduating residents from our program, each of us enjoys (or endures) a sizeable amount of limelight as we graduate.  It starts with a picture slide show of us from our earliest days up to the present.  Some of my shots were strange, if not embarrassing, as you might imagine.

We are then introduced – for an agonizingly long time – by a faculty member.  Here our history, foibles and dreams are put on display for all in attendance to see.  This part can also be rather painful too.

It was then my turn to speak.  We aren’t given time-limits on our speeches.  As mentioned, there’s only 6 of us, so I guess we have the berth and he right to ramble a bit if we want to.

I survived the process with almost zero public display of emotion.

I’m not sure why this was some sort of goal for me.  I’ve always been a lousy crier.  I’m good at complaining, whining, moaning and bellyaching, mind you.  Rather too good.  But my crying skills must have atrophied somewhere in my childhood.

If I were to guess, I suppose it happened when I was about 5 years old and my biological father had just punched his girlfriend in the face.  He then leered at me and asked, “You gonna cry about that like a little girl?” in a drunken haze.

“Nope.”  I said.  And I never have.  These days, I can only cry when Ariel gets her statue of Eric blown up by King Triton, or the Broncos trade their franchise quarterback to the Bears.

So, I have some issues.  Fine.  I’ll bet you do too.  Intellectually, I admire the Roger Federers of rhe world who can stand on the international stage with unabashed tears streaming down their cheeks when they lose (or even win, sometimes) their latest tennis match.  Emotionally, I want to smack them with their own tear-stained pink hankies, tell them to find their purse and go back to the parlour where life doesn’t hurt so much.

Anyway, I wasn’t going to cry.  Smash my thumb with a hammer…we’ll talk.  But for this?  No way.

So, my approach was to first ride my Sector 9 longboard skateboard up to the podium wearing a tin foil-wrapped, overly-festooned bike helmet.  Why such a rather dumb graduation display?  Why, especially, at a solemn ceremony for a new practitioner of the healing arts?

Aside from the fact that medicine is frequently too pompous and full of itself, I figured that if I could keep it fun and light, I could keep my eyes dry.  Plus, I ride my longboard to work most days, and I religiously never wear a helmet of any kind, much to the dismay and consternation of virtually every person I meet on the hospital campus.  For 3 years I’ve put up with near-constant haranguing to wear a helmet.

Why don’t I wear a helmet?  Well, I just figure that anyone traveling less than a mile, at about a mile an hour, while less than 3 inches off the ground…should garner me the right to feel the wind in their hair.  Granted, there isn’t much wind at that speed…and I don’t have much hair.  But that’s my metaphorical argument, people, and I’m sticking to it.

I also think that Americans are too stupidly safe these days.  We think we have allergies to things that 6000 years of humanity had no problem with.  We pad every corner in our houses and put seatbelts on our T.V.’s just in case the wall trembles and pushes that deadly thing over on a kid.  We have warnings on things like plastic 5-gallon buckets and nylon shower curtains.  Frankly, the fact that my children will never ride barefoot in the back of a bouncing pick up truck, screaming like golden-haired eagles as the wind whips wildly into their eyes, brings me no end of sorrow.

I grew up burning leaves, shooting bottle-rockets out of my hand and hunting fish with a whittled stick.  I think life is risky, and living life is an exercise in managing that risk.  Knee-jerk safety measures without true analysis of risk leads to heard-mentality that rarely leads to anything but really really bad groupthink: racism, genocide, militant nationalism, day-glo, Milli Vanilli, toilet-seat-shaped pillows for airplane flights that everyone carries around airports but never actually use for more than 10 minutes, to name a few.

So, in truth, I don’t wear my helmet when longboarding because I’m determined to not become a Nazi.  Gotta admire a guy like that, right?

Anyway, I understand that most of you dear readers will find fault in my little tirade, and will probably want to admonish my opinion about helmets just like all of the faculty, nurses, staff and freaking maintenance workers I see.

But take heart!  You don’t need to worry!  I rode to the podium in a helmet for the first time.  Just to make everyone happy.  Just to acknowledge that I’ve finally heard the message.  I give up.  It’s time to be responsible and extra-duty safe.  I’m a doctor now.

‘Course, my helmet was covered in tin foil and had sticks extending from it in every direction with tinfoil balls on the end of the sticks…but it was a helmet.

Then I delivered a poem.  It was supposed to be a rap – with a thumping beat and maybe a couple of dancers and lights flashing/spinning with everyone on their feet, their hands in the air all hip-hoppin’ on the floor.

But I’m white.  I’m a doc.  I’m in a tie.

Forget it.  It’s a poem.  A really bad 1-2-3-2 rhyme sequence that rhythmically scans like ice cream might feel if you were dumb enough pick a pile of it out of a sandbox and eat it.  But, in honour of my creation and the initial inspiration for it, I allowed that I would not in fact be delivering a rap, OR a poem that night.  It would be an amalgam, a mixture…a PAP.

This is fitting, of course, since we were all gathered to celebrate my new status as a fully-trained family medicine doctor.

My Pap made my mom cry.  I think my Dad too.  Kinda my wife.  And most of the people I talked to afterward said it made them a bit misty.  My goofy, two-bit hyper-syllabic tossed salad?

Cool.  People cried.  I didn’t.  I was too busy looking goofy, or saying goofy things.

Dear old Dad would be proud.

The AMA – Trust At Your Own Risk

Adapted from an Op-Ed in today’s NYTimes by Nicolas Kristof -

Some fun facts about the AMA (American Medical Association):

• supported segregation
• opposed President Harry Truman’s plans for national health insurance
• backed tobacco
• denounced Medicare
• opposed President Bill Clinton’s health reform plan
• probably represent less than 25% of practicing physicians, most of which are specialists who dearly want to protect incomes from $250,000/year to over a million per year

Here is their current position on a National Insurance system:

“The introduction of a new public plan threatens to restrict patient choice by driving out private insurers.”

They might have been right about opposing Clinton’s freakish health care plan.  They should have shaped the medicare debate instead of obtusely opposing it, and you can be the judge on the whole segregation and tobacco thing.

I think for-profit medical insurance is morally wrong.  Insurers should not make more money than patients, and not doctors, either.  If you want to be available to help someone in a time of weakness and need…you shouldn’t make 20% returns on them until that time arises.

*Disclaimer:  The AMA is a putrid organization from the inside out (and hopefully will be obsolete in 10 years)…but they do have it right on tort reform.

Post-Call Warfare

Welcome home, OLD MAN..Mwhahaha

He waits for me.

Before I’ve even stumbled through the door, he scans me…probing for weakness. Huddled in shadows, he watches will all the patience he can command from his 3-year old body.

“Puffy eyes,” he reasons.  “Face a little long.  Weaving a bit.  Probably didn’t sleep last night in the hospital.  Excellent.”

Daddy’s home….may the best boy win.

I collapse on the mattress in our living room.  Placed there for my frequent late nights with the on-call pager, the patterned white expanse invites me in after nearly 25 straight hours of in-hospital work.

But I see him out of the corner of my eye.  The spiky hair, the blue eyes alive with anticipation, the little fingers wrapped around a pleather baseball.  Even a blink is risky.

Laying like a dead man, I pretend (with little effort) to sleep.  But I can’t relax.  Warily, I scan the room with the one eye not buried in a pillow.  He approaches, cat-like, on coiled springs for feet.  He’s nervous.  New to battle, he is.  He has none of the scars and experience an old hand like me carries into conflicts like this.  I’ve got the wisdom, but his energy stores easily transcend the average life-force of at least 2 functioning adults.

The Battlefield...

The boy is quite a shot, and he ends our fragile truce with his little baseball.  It slams into the bridge of my nose before I even see it coming.  Then with a shriek of joy mixed with complete and abject terror, he bolts.  Just out of reach on the far side of the mattress, the little perp streaks for the safety of the couch cushions; his legs an adrenaline-charged blur. I lunge, still on my stomach, grasping for quicksilver ankles that leap at just the right moment.  Another shriek of triumph becomes abruptly distant and distorted as a pillow wilts over my head.

Alright you little twerp.  Time to shake hands with DEATH!

I rise up on my knees, breathing fire and rrrowling with menacing finality.  Trapped in the “L” of our sectional couch that has endured too many such battles over the years, the boy realizes his exuberant mistake.  Quickly he tries to jump over the backside of the couch, but the seatback is too tall.  In desperation, he darts for the end of the couch, where the breeze of freedom swirls enticingly.

Now in control, I use his own weapon against him…and whip the pillow – AS HARD AS I CAN – at his little running feet.  If timed well and I hit low, that little kid is gonna flip upside down and land square on the far side of the mattress where I was trying to sleep! On the other hand, I could hit him high and watch in satisfaction as he curls over the pillow and crashes into the armrest.

I hit low.

With a squeal, he tumbles off the couch and onto the mattress – my lair – and I pounce.  Son or no son, the child receives no mercy.  Every tickle-point is fair game.  My cruel fingers send their message of revenge and he writhes beneath me like a possessed rabbit.  Once he gets too adept at protecting his vital ticklish flanks, I pick him up by a single ankle, and he stretches out like an accordion, exposing every protected square inch.

Just as he wriggles away, I smush him into the mattress with my entire body.  For a brief, blessed moment the living room settles into an eerie silence punctuated only be a weird, muffled warble.  But that, of course doesn’t last as his heel jams me in the gut.  I shift slightly.  Instantly he pops up, “GET ME, DAD!  HAHAHAHA!” loud enough to be clearly audible on a jumbo jet tarmac, and vanishes on those feet that never seemed to actually quit moving, even during his brief time as my prisoner of war.

The Armory...one cashe, anyway.

The boy vanishes around the back of the couch.  I rush after him, and he in turn squirts around to the mattress side.  We pause.  A kind of silence again, but filled with the deep breathing of two wounded Titans, warily forming their next strategy.

Suddenly a second pillow warps into my head, followed by 2 other balls of differing shapes and sizes.  From the other side of the couch, he pops his head up – fuzzy crown first – laughs hysterically and waits for my return volley of his ammo.  I oblige, he ducks, and an entire can of some sort of reed stand blasts into a thousand pieces behind him.  Slowly, the fuzz returns.  Then a pair of blue eyes, followed by a wide grin which, together with the eyes say silently, “YOU can explain that one to Mom.”

But I’m ready – with balls 2 and 3, and a second pillow I found.  I pelt his accusing smile full-force.  He topples backward onto the mattress, his legs straight up in the air.  I jump up and shower him with balls of every size and make.  Some squish into him, others carrom from his body off into lights, windows, the aquarium (sorry, fish…it’s life and death out here).

He rises, a bit woozy….looking about finished.  I’ve won.

Suddenly, girls stream at me from every direction.  Hair flying, screaming like highland goddesses, 6 hands descend upon me and topple me to the ground with ease.  Balls, pillows, blankets and an occasional doll rain upon me.  I am powerless in the onslaught.

Just before I black out, I see that terrible, terrible boy.  Jumping up and down in irrepressible excitement, he watches his secret weapon conquer his adversary with cruel efficiency.  Who can ever hope to conquer a boy with 3 older sisters?  This kid commands kryptonite, a cloaking device and a bazooka all rolled into one.

Some wars just can’t be won.

Weasel

Exactly how lame is it to sign a contract to work for an organization…then back out of it before you even start working?

Pretty lame?

Just plain ‘ol lame?

Monster freak-out you’re a loser from hell lame?

Well, whatever you pick…I did that.

My travails in choosing a job after residency have thus far not been chronicled because each interview, etc seemed like it should be kept confidential.  Plus, even for those like myself with a bent toward terminal honesty, you just end up saying things in interviews that don’t often match – perfectly – with reality.

“Dude, this practice is the coolest thing since the ice machine.  Pu-leeaze let me work here.”

“Frankly, your clinic is the Jay-SUS Christ of the medical industry.  Where do I sign up.”

My job search took very close to a year.  We have finally decided where we’re going.  It’s final.  And I’ve left a good number of torqued interviewers in my wake.  

My coup de grace came when I actually signed a frequently-negotiated contract.  I signed it.  Done.  I’m there.  You got me.  Landed the fish.  I’m in.

Then something better showed up and – per the contract – I’ve just given my 6 week notice of resignation.  No mention in said contract about whether or not he 6 week notice is enforcable when I haven’t even started working yet…but just for good measure, I gave the notice.

They hate me.

Overkill

I decided not long after I started this blog – quite some time ago now – to never apologize for not writing.  I’m a doctor.  Stuff comes up.

So, I haven’t blogged in awhile.  If you’re still one of the regulars, my thanks.

This latest distraction involved graduation from my residency program.  Or rather, not graduating…the specter of it, at least.  And while the problem is resolved…the emotions on my side still simmer with grim ebullience.

Arriving in the infuriatingly innocuous manner of many catastrophic announcements, I received the news recently that I had not spent a required week with an orthopedic surgeon during this last year of residency.  Setting up that week is one of what feels like 4 bujillion stipulations that lead to graduation.  I’d missed this one, and it was too late to change my schedule to fix it.

Through some fuse-burning mental gymnastics on my part, and some heroic situation-framing on my advisor’s part, the faculty of my program have just decided that I will, in fact, graduate with my class.  In essence, we found a workaround that keeps me on-track to finish with my peers in less that 4 weeks.

This experience however, reignited an old resentment in me that essentially boils down to oft-repeated theme in the “Jason Bourne” movie series about being required to give vastly more than expected when signing up.

The frank truth is that all the permutations of mid-level medical providers – from ARNP’s to PA’s to Dr. RN’s – have one thing in common…they’ve been subjected to roughly 1/3 the amount of training as I have.  Subsequently, they have 1/3 the debt, and probably have 1/3 the family problems, health problems, and 1/3 the incidents of depression, substance abuse and suicidality.

The result of that limited training?  They do the exact same job as me…and get paid about 80-90% what I will make.

Calculate how much money I lose in training when they’re out actually working, and I probably make less than your average P.A. over the course of a career.

I was so upset over this graduation snafu, that I rammed my fist through a wall in our house, and ended up driving hopelessly around the beaches of Washington until 7am this past weekend.  Then, thankfully, I got with the program and figured out a way to address the problem a little more professionally.

No, working an extra week after graduation wouldn’t be the end of the world.  But in so many ways I feel I’ve reached the end of my rope.  And, for lots of logistical reasons, another week of “work” would have really been tough on me and my family (and probably our walls).

I should mention that what I was deficient in – observing an ortho doc – falls into my category of ‘watching doctors be doctors’.  I’m not sure where anyone came up with the idea that people learn from this particular brand of education-theory rack-stretching, but frankly at my level if I don’t have responsibility, I don’t care.  If I don’t care…I don’t learn.

Watching doctors be doctors is  easily the least valuable learning experience I’ve had in my entire medical training…and residency is rife with this vacuous requirement.  I’m quite sure that the endless hours I’ve spent delivering Oscar-level performances of intellectual interest could be completely removed from my training and I would still be the same doctor I am today…just less poor because I would have started working at least 6 months sooner.  Maybe a whole year.

Simply put, I believe that my medical training is outmoded.  It’s destructively expensive.  If people can do my job with 1/3 the training, then I’m effectively over-qualified. 

The backside to this is that M.D.’s themselves will eventually become irrelevant in the marketplace because we’re just too expensive.  We spend so much money on school and inefficient training, that nobody can afford to pay off all of our debts.  How long will it take me to pay off the $330,000 I spent on my training?  How much more do I owe on that since I’ve piddled away another 3 years on training – watching orthopedic doctors and acting interested – while a number that big generated interest on itself?

I’m deeply grateful to my advisor especially in this case, because he presented my situation to our residency faculty in a light that was very favorable to me.  He is probably the reason I’m not in a padded room at the moment. I don’t really blame my residency program, either. 

The problem is the system:  tone-deaf, needlessly arduous, inefficently stubborn.  The mid-level system was created by smart people who realized that it just doen’t take this much to make a doctor.  You shouldn’t have to sell your soul for the honor and burden of taking care of sick people.

In the end, I approach graduation almost devoid of any elation at all.  Instead, I feel like I’m sitting in a field, blood and feces spilling into my lap from the mortal shotgun wound I’ve received to the gut, looking plaintively up at the shadow hovering over me – at my colleague and killer – and wondering aloud, “Look at this mess…look at what they make you give…”

Eye-Button

Open the pod bay door, HAL

-Noun

The smoke-colored circular sensors that allow a person to enter a bathroom in our hospital, use the toilet, apply soap, wash their hands, dry them, and walk out the door without ever actually touching anything.

Credit my 5-year old daughter for coming up with the term.  It’s taken her about 2 years to interact with these semi-sentient creatures without losing her nerve.

Who Dies from Typhoid?

Hardly anybody.  In America, anyway.

This is why it was so shocking to hear that one of our translators in Haiti – a healthy father with children – died of typhoid fever recently.

I didn’t work much with this particular translator, Daniel, mostly because he spent so much time interlocuting between our group and the local community leaders, especially in Noyo.

I spent my second week in the very rural village of Noyo, and my experience there was vastly different than the one I had during my first week in Thomaseau.  The physical village looks like a bunch of twig huts that all unrolled themselves from one giant ball as it bounced down a mountainside.  

Despite this scattered layout, the people there were a tight-knit bunch; working with them required constant communication.  Work of the kind we did in Haiti brings with it nearly endless opportunities for misunderstanding.  Daniel was a big part of that because he was well-connected with the local leaders.  

A few times, I wondered what besides common humanity kept the locals from simply overrunning our tiny isolated clinic, taking all the medicine and holding us hostage.  We’re not just talking about picking up some bling bling, either.  They could demand HUGE ransoms for each of us, and never be in poverty again.  

I thought about this frequently in Noyo because the village clings to lost and forgotten hillsides so far from roads that you can’t find it on most maps.  We hiked for over an hour to get there.  And the road that brought us to the beginning of our hike arguably ended miles back from where we actually stopped our battered 4-wheel drive monster trucks.

I think the moral fabric of Haitian culture gets most of the credit for keeping us protected during our time in the mountains.  But some also should be given to people like Daniel, who moved easily between native, locally-powerful villagers and obtuse, big-hearted, mildly-guilt motivated Americans.

 More than once I saw disappoinment in the faces of patients as I sent them out the door with not much more than a toothbrush and some TUMS.

I’m sure I projected a bit, but often I felt their dismay at my ineffectiveness in the midst of so many very real problems.  I could almost hear some of them say, “This is all you have for me?  Look at all that medicine in the back of the church!  Look at those nice tents you live in!  Look at that nice watch and thousand-dollar camera you have.  All you have for me is some antacids?  Do you know that I could feed this child for weeks with just the money I could get for your sparkly watch?  How is it worth that much to you?  How can you still cling to your expensive camera when it could feed a family for months?  Is that moral?

If you claim to be a Christian…how is this not a sin?” 

Often I reflect on how much I care about my children – the lengths I would go to protect and provide for them.  In that light, I do not think I would be nearly so gracious if it were my child wasting away in my arms and some rich foreign king gave me only calcium tablets and a toothbrush (until we ran out of them and just gave the calcium).

Although the Haitians displayed celestial graciousness because I believe they are by nature a gracious people, translators like Daniel helped undergird that goodwill.

Being Haitian, he could agree that yes, these people come from a rich country and enjoy many things that people can’t even dream of in Noyo.  

But he could also point but these particular people don’t have as much as it seems.  He could explain that these kings used a very large amount of their own money just to be there, in the suffering, trying to help however they could.  He could explain that even with the best medicine, their children might still be very sick.  He could point out that ALL the medicine we have left over will be given to the village, to the most in need.

 

It takes over 100,000 of these (Salmonella) to cause typhoid fever in an average human. A closely-related organism - Shigella - only needs about 100 to cause disease.

Typhoid fever shouldn’t kill anyone.  It causes some fevers, some abdominal pain, some gnarly diarrhea and maybe some delerium.  Throw any of a number of antibiotics at the problem, and the odds of dying from it drop to about 1%.  If I gave you a 99% chance of winning big in Vegas, I bet you would put a good part of your inheritance on those odds.

 

Even untreated, typhoid fever is fatal in only about 30% of cases.

So Daniel’s story is a tragedy simply because death is a tragedy.  His death is a tragedy because there is a wife somewhere who loves him and is now alone.  It is a tragedy because there are children huddling around their mother wondering in pain and incomplete understanding what happened to Daddy.  It is a tragedy because his role was so valuable to our work and efforts in Haiti.

But most agonizing…Daniel’s death is a tragedy because it didn’t need to happen.

Guantanamo Quote

In response to America’s befuddling fearfulness at the thought of putting Guantanamo inmates in U.S. jails so they can actually have a trial:

“Nobody escapes from maximum-security prisons. But even if they did, who would you rather have on the lam in your neighborhood — a native of Afghanistan whose history suggests an affinity for jihad? Or a resident of your own state whose history suggests an affinity for breaking into people’s houses, tying them up and torturing them?” Gail Collins – NYTimes

America is less safe than you think. 

And MUCH less free.  Nobody - ever, anywhere – should be held by Americans for years without a fair trial.  Some don’t even have charges yet.  Who in their right minds still believes in that ‘Land of the Free’ blather?

Doctor Sells Insurance For His Own Procedures

**The following is another installment in an SW101 exclusive series entitled Medicine In America (MIA), covered by our crack journalist team scattered around the globe.**

TULSA, OK – “Just in case I screw something up,”  Dr. Jason Hines says, smiling, as he helps an elderly man sign a form and pay for his “procedure insurance.”

Dr. Hines, owner of New Day Family Medicine, a small group practice here, is one of a growing number of primary care doctors who are getting creative as they struggle to increase falling reimbursements.

“I got the idea from my very own Family Medicine Academy,”  Hines says excitedly, holding up a postcard with bold, red letters emblazoned across the top reading LAST CHANCE!  “They’ve been trying to get me to buy their life insurance policies for about 2 years.  This is the 14th ‘last chance’ notification I’ve gotten.

“Then it struck me!  Even the AAFP is getting in on insurance, why can’t I?  I mean, we can’t all be lawyers and dentists, right?  Gotta make the bucks somehow. “

Dr. Hines’ fledgling business-within-a-business had a rough start.  “Nobody saw a need for it,”  he said.

Debbie Lawrence, one of the first patients to sign on, described her initial doubts.  “It seemed a little strange, you know?  I’ve already got insurance for my car, my house, for medical bills.  I even usually get that extra insurance for rented DVD’s.  But then, as the doctor described the procedure of removing a mole on my back, I saw this slight tremor…and then he read me the consent form!  Boy, it just seemed like the safest thing to do.”

“I had to figure out some way to promote things.”  Hines explained.  “The postcard idea was already taken by the AAFP, so I wanted to do something more creative.”

His solution was to enroll in an acting class at the local community college.

“Watch this!”  He said excitedly.  “I’ll just reach for this piece of paper, aaaaannd NOW, I’ll have this nearly-imperceptible tremor just before I pick it up.  See that?  We really worked on the subtle-but-obvious thing in class.”

Then he modified his legally-mandated consent form process.  “So, they make you blah, blah, blah about the risks and benefits of every procedure, right?  Well, I just figured I should capitalize on that.”

His consent form reads:

My signature is proof that I consent to the forthcoming procedure.  Procedures are dangerous.  Most are not proven to actually improve anyone’s health.  I understand that I risk serious pain, including but not limited to severe disfigurement such that my children and spouse might recognize me only by mannerisms.

Often, procedures of this kind result in lasting nerve damage, potentially to the genital area.  I understand and fully consent to an ambivalent and uninspired sex life from this point forward.

Bleeding is usually something that can be stopped.  If not, I am willing and happy to slowly dwindle into a shivering unconscious blackness from which I may never emerge.

I also agree to not underestimate the risk of infection.  I realize that flesh-eating bacteria exist everywhere, at all times, and are constantly attempting to gain access to my body.  I understand that should infection occur, I may wake up with parts of my body unexpectedly reduced to nothing more than exposed skeleton held together by rotting fascia.

“That’s the mellow one,”  Hines’ states matter-of-factly.  “I use it for wart removal and immunizations.”

After the slow start, business now is booming.  Dr. Hines calculated his acting class cost – “110 bucks a unit for a 3 unit class” – at $330, which he claimed on his income taxes as a business expense.  He sells insurance for any procedure in his office, usually at a cost of $25 to $350 per procedure.  “I’m thinking of adding waiting room insurance – you know, in case the roof collapses – but we haven’t worked that angle yet.”

What has been developed is the “Cabo” insurance package, which includes a special waiting room with palm fronds, seltzer water, a chaise lounge and soft music.  Aside from guaranteeing the procedure to be safe and “up to standards”, the patient also receives a massage at the conclusion.  “Sometimes, we’ll give their dog a massage also.” He said charitably.  “After signing my consent form, people are pretty keyed up.  I usually just throw the dog in for a reduced fee.”

The AAFP did not return calls for comment, but did release this statement,

The AAFP does not condone the practice of selling non-medical products within the environment of medicine.  We believe in assisting our doctors as they provide the best care possible for the entire family.  Just look at the success of primary care medicine in America over the past 30 years for evidence of our presence in Washington.

Although the insurance business does offer unbelievable profit margins and investment returns of nearly 50%, we strongly believe that individual doctors do not have the expertise to get into the business.  Individual family doctors should leave the big business and real financial gains to organizations that are qualified to actually make money.

Finally, although we typically keep information about doctors confidential, it should be mentioned that Dr. Hines appears appears to have let his board certification lapse.  He is soon to be rejected from our community as a “fellow” if he doesn’t pay his dues by cash, check or debit/credit.

“They can say whatever they want.”  Replies Hines.  “I got the idea from them.  The AAFP opened my eyes to the fact that there’s lots of ways to make money on the medical field, as long as you don’t waste much time actually practicing medicine.  I can’t believe it took me so long to figure it out.  I’m just glad I got in on the gig now, when the para-medical business is still in it’s Golden Age.”