Monday, March 22, 2010

having fun at home

I apologize that I have been absent from the blog scene for some time. I have been enjoying my past life with family and friends. There really is no more purpose for a blog on Afghanistan (unless of course the military invites me back). I have really enjoyed writing a blog while away. It was somewhat therapuetic and at times enlightening. If I get an itch and feel like I really have something valuable to say on a somewhat routine basis (that is a lot to hope for) then maybe I will start another blog for that purpose. For now I am going to go on blog hiatus and prefer to instead talk to you in person.


Wednesday, March 10, 2010

hurry up and wait

All you previous military will appreciate this titled blog. I am finished with leg three of my journey back home. I had to show up at customs more than 24 hours ago to start my second leg yesterday. From there we are marched into a room (with chairs this time) to wait for four hours which of course becomes more like eight with the obligatory delays. We finally took off after standing in the rain wiating to board and landed in Germany 8 hours later. Another three hours of waiting. Though this time we were allowed to partake in a German beer if deisred. I desired. I also wolfed down a couple of their bratwurst. Next we flew 7 more hours to Bangor, Maine where I am currently. We were supposed to have a 2 hour layover which is now announced to be 4-7 hours. It is 3 AM local time, however, there were still some retirees here to shake our hand when we stepped off the plan and they opened the coffee shop for some warm drink and food. God bless them!
Okay, next time I blog (if ever again) it will be from my home turf in San Diego. Thanks again for all the support these past few months.

Monday, March 8, 2010

pete's place

Here in Manas we are allowed to have 2 beers in a 24 hour period if our command is game. Well everyone is interested in having that cold one after 6 months in the desert. Problem is, how do you assure that everyone is safe and behaving. Well, you have the officers and staff NCOs do shifts in the pub to make sure everyone is good. So that is where I am this minute. The pictures I just published are already obsolete as about 30 military members just walked through the door. The music is blaring, the smoke arising and the beer is flowing. I can't wait until my 2 hour shift is done so I can partake.

Sunday, March 7, 2010


Many of you would say that getting a pedicure is not manly, and you're right. That being the case, I got a pedicure yesterday. There are few reasons why:
1) I have never had a pedicure before
2) There is very limited activities to do while in Manas, Kyrgystan
3) It was a bargain at $10
Let me take you through my experience. First I got my pleasant foot bath. After the clipping and trimming of my nails and cuticles she broke out this razor blade contraption. She grabs my foot and tells me to be steady. I give a quizical look? She explains that she is not intending to shave my toe hair (yeah I got some, so what?), but instead is planning on paring down the skin on the bottom of my foot. I asked if it was ticklish and is that why she wants me to be still so as to not cut me. She replies, yes it is ticklish and that she is not worried for my foot, but for cutting her hand if I were to withdraw my foot. Now that we scrapped away all the old tissue she takes out a paddle, she says emory, and proceeds to scrap away on the sole of my foot. At last she was done and the best part came. I got a foot rubdown with moisterizer. Now that made the whole experience right there.
I know you are all asking yourselves this question now. The answer is no. I did not get them painted.

You could start an IV on that foot!

Saturday, March 6, 2010

first leg home

So, yesterday was a looonnggg day. We loaded up ourselves on a bus at 2200 (10 PM) to go to the terminal for a flight out of Afghanistan at 0200. Things did not look good from the beginning as we encountered the worst sand storm of our deployment that evening. It was a complete brownout. However, it rained soon therafter which abated the dust.

At around 0100 in the morning we were told that our flight was delayed an hour which became 2 hours which became 13 hours. All the while we had to stay pretty much in this huge hanger. None of us planned for this and thus none of us had our warmest clothes on, sleeping bags or pillows. We had to make due sleeping on the plywood floor.

The good news is that we finally hoped on board a C-130 and took the 2.5 hour journey to Manas air field in Kyrgystan. It is in Bishkek, here is a link .... By the time we did all the formations, gear checks, weapons check, was near midnight local time. However, I was still on an adrenaline high so I went to the only place on base that serves alcohol to get me a little sedation in a bottle. We are limited to 2 beers in a 24 hour period for safety reasons. I have not had a beer in 6 months and for 2 bucks I got this 16 ounce beer called 9. Why is it called 9 you ask, because it is 8.6% alcohol and they round up. So I drank maybe 40% of the beer to be on the safe side and it did the trick. I woke up feeling almost like a minor hangover between the lack of sleep over past 2 days and my out of shape liver being exposed to alcohol again.

So anyhow, things are better here in Manas. I got a big gym, a big chow hall with midrats (that's midnight rations for all you non-military folk) and my room has wireless internet. I will be back in the States next week. See you all very soon.

Air traffic control.

Trying to get comfy.

Staging area for flight.

Marines can sleep anywhere.

Thursday, March 4, 2010

hectic days

These have been hectic days indeed. We are in our last weeks here in Afghanistan which means that we have to turnover with the new crew, pack our bags and get last minute missions done. For medical it means having to do a final screen of all 470 Marines in our squadron. We also have to go through all their records to make dure complete. This has occupied most of my last week.
I also finally got to pin on my FMF last week. We were waiting until both medical officers and the chaplain had a chance to finish up so we could all pin on together. I have included pictures below. I am hoping ot blog more soon.

CO doing the pinning

The three of us post pinning.

Thursday, February 25, 2010

my health care manifesto

So, I posted a story about a Canadian Premiere coming to the U.S. for his health care the other day. When talking to a colleague about health care reform he asked me ‘well, what would you do to fix it?’ I thought that was a fair question. So here are my thoughts about what is broke and some ideas on how to fix it.

The first question to ask is whether health care is a right? I do not think so. However, when you are in a country with the means to do so, I think that you need to be able to delivery some form of basic health care. Now you have to define who you want to cover when you talk about ‘universal health care’. I think that if you are a citizen, that you should qualify for basic health care. Next, you have to decide what type of health care coverage. I think that everyone should have a base level of health care that covers you for emergencies and for preventative medicine. After that, I think that you should have options, either through work plans or personally financed, to increase your coverage.

It is easy enough to say ‘everyone should have health care’. However, how will one pay for it? Another thing to contemplate is, just who is going to see the patients? We are in a time when we are short primary care providers in this country. If we increase the patient pool without increasing the number of primary care providers (which takes years to accomplish) then we overwhelm the system. I have some ideas of how we can address these issues.

The very first thing that must be done is medical tort reform. You need to limit how much in damages one can get through legit or perceived medical malpractice. Medicine is not an exact science and there will always be the chance of adverse outcomes and there will always be mistakes. However, people like John Edwards have made far too much money through ambulance chasing. The days of channeling dead babies in the courtroom should end. This is a tough one since most congressmen are lawyers, but it is a must, because once you cap medical malpractice payments it has more positive impacts.

If malpractice is limited, then malpractice insurance goes down as well which means that physicians do not have to charge as much (kind of a reverse trickle down effect). Some medical specialties have obscene monthly medical malpractice insurance rates.

Also, when there is a fear of malpractice suits then a primary care provider will quickly refer patients to a subspecialist to make sure they are not missing anything. Let me give you an example. A family practice doctor hears a murmur which he thinks is benign (okay). However, he does not want to miss something and get sued so he refers the patient to a cardiologist. The cardiologist says ‘well if he sends this patient to me, then I should do a full workup’. So the cardiologist gets a chest x-ray, EKG, echocardiogram for a full cardiologist evaluation. Most likely, the patient is told that their murmur is benign. So the cost for this patient just went up exponentially. This patient could have been followed by the family physician to see if any changes or symptoms developed prior to sending to a specialist. However, they did not because of the fear of being sued.

Let me now talk about health care insurance. We need to open up competition between insurance companies. In many states there are near monopolies for health insurance. There may only be two companies to choose from. If you allow competition of insurance companies between state lines then you have more companies competing for your business. It is a basic principle of supply and demand that if more companies are allowed to do business then the price of insurance will go down.

We also need programs like Medicare to pay out better. They basically dictate how much they will pay for a procedure or a doctor visit. Many times the doctor gets 70% what he or she bills. So what happens next? The doctor will have to see more patients and do more procedures to try and get enough compensation to account for what he or she is not reimbursed by Medicare. This leads to unnecessary procedures. It also means less time per patient by the doctor.

When a primary provider is getting slammed seeing more patients (to make enough money) they get frustrated that a) they are working overly hard b) they are not practicing the medicine they envisioned. Most primary care providers went into that area of medicine to spend time with their patients and do preventative and anticipatory care. That is one of the reasons I got out of pediatrics. I wanted to spend time with the family to develop a bond. I wanted to help with preventative counseling. It is impossible to do in a 10-15 minute appointment. So, what happens? They become a sub-specialist like I did. Why do you think we have a lack of primary care providers in this country?

So we have established that doctors get driven out of primary specialties due to fear of malpractice, dissatisfaction with compensation and frustration about type of medicine they are doing. I think that there is another reason as well. Most civilian doctors have a huge debt after medical school. You are talking hundreds of thousands of dollars in debt. They become doctors when they are about 26. Then they do internship for a year where they make probably 35 thousand. Then they go into residency for 2-4 years where they make maybe 40 thousand a year. So they are now in their 30’s, have a doctorate degree, have a huge debt still and have not yet made any money. So they go into fellowship to become a specialist because they know they will get paid better. Besides they have talked to enough primary care providers to know they do not want to go that route. Maybe we should subsidize some of medical school costs and pay residents a bit more money so they do not have such financial pressures. They work 80-100 hours a week when a resident, I think they deserve it.

Well, there you have it, my thoughts, whether you wanted them or not. I am happy as a military physician. I had a good time being a pediatrician and I am glad that I did an allergy/immunology fellowship. If I were to do it all again (and that is a huge if) then the only way I would do it would to go through the military again. I am really struggling with whether I would want to practice medicine as a civilian post my military career.