“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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AM Radio

These days radio seems to be almost the forgotten technology. When I was a kid, AM radio was the thing and FM was just starting out. The superior sound quality and reception of FM broadcasting soon ensured that AM was left behind in the dust. Then of course tape decks came along, then CD players, then satellite radio... now radio has been reinvented as the podcast and we have come pretty much full circle.

The humble AM broadcast band still has its points, though. If you're interested in learning a foreign language, listening to many of the Los Angeles stations might help you along. We have stations broadcasting in Spanish, Cantonese, Mandarin, Persian and probably other languages as well. There are also the all-news stations (Los Angeles used to have two, now we're down to one) and the many religious stations. These all seem to sound alike to me, though occasionally I catch part of a decent sermon.

And then there are the low-power public alert ratio stations, which I find fascinating. These usually are the property of cities, universities or other public institutions and broadcast to the immediate surrounding area. Reception is limited to three to five miles. They cluster either at the top or bottom of the AM dial. If you drive through West Los Angeles you may hear several: Santa Monica, Culver City, UCLA and Beverly Hills all have their own radio stations. Some are more elaborate than others: Santa Monica updates every week with information about street construction and other traffic problems. Beverly Hills talks about their farmers' market a lot, as well as parking on Rodeo Drive (the main shopping street) and upcoming city events.

Culver City, on the other hand, is what I call the zombie apocalypse station. It's nothing but a thirty-second loop of a man with a cheerful voice saying "Welcome to Culver City" and to stay tuned for information about emergencies and traffic issues. I've been listening for years and the message has never changed, which I find more than a little creepy. Sometimes when I'm driving through the area late at night I like to pretend that some unimaginable disaster has occurred and this endlessly repeating loop is the last remnant of civilization. Then I shudder and change the station.

Even freeways have a station reserved for (presumably) emergent issues. The 405 freeway, for example, has a looped "test" message which fades in and out depending on where you are. The most recent update is two months old, dated November seventh, and doesn't say much of anything other than the date. It's a close runner up for the title of Zombie Apocalypse Radio Station.

This website contains information about stations broadcasting alerts and public information around the United States, as well as an interesting bit on the history of such stations. Apparently it took the tragedy of September 11 for the government to sit up and pay attention to their potential in emergency situations.  They can now be found around the country. In my reading I found that low-power FM stations also exist, but these I think are mostly run privately rather than by governmental organizations. They seem to be synonymous with political ranters and conspiracy theorists, or maybe just people who want to run a radio station.

Lastly, under Part 15 of the FCC rules homeowners can apparently operate a tiny broadcasting station without a license on low power radio. (Range is something like 200 feet.) Imagine the opportunity to play Christmas music 24 hours a day! Or 1940s big bands, or anything else that tickles your fancy. The opportunities would be endless. Someday this could be a project for my retirement. The all-Esquivel station comes to mind...

Labels: Los Angeles, Technology

posted by Dr. Alice at #

 
In Praise of Five and Dimes

It's the holiday season, which for many of us in the workforce means it's Secret Santa time. Most offices have a self-appointed Holiday Fun Organizer, and my office is no exception. I use the term without snark, as I am grateful to these people; if I were in charge of holiday decorating and activities, nothing would ever get done.

You know the drill with Secret Santa. There are variations but basically you draw names out of a hat and gift the person with a few nice things. (If the organizer is organized, so to speak, you are also provided with a list of gift preferences written by your victim giftee.) You hope that karma operates equally and that you will get something you actually want, while trying to provide the same to the person whose name you drew.

But while I enjoy this tradition, it does add yet more errands to my ever growing list. Where do you go that's quick, convenient and hopefully one-stop shopping  to get these items? How do you find something useful, inexpensive, tasty, sparkly... if you're really lucky, all of the above in one single gift? Why, the stores that used to be known as five and dimes. In the States, Woolworth's and Newberry's were good examples of such stores. The term comes from the fact that many items in these stores could be bought for five or ten cents. The old chains no longer exist for the most part, but similar stores exist and are now known as dollar stores. Drug stores carry many of the same items.

In the past week I've hit a few of these stores and come away newly impressed. Their virtues are many and they're extremely popular: Their parking lots were jammed. What did I see there: Kids' toys, wrapping paper and decorations, food (I found a kale salad at one). Candy, lots of it. Candy canes (does anyone even eat these?), storage items including the disposable food storage containers I had been looking for all week, cleaning supplies, ornaments... you name it. My favorite were the near-generic cookies labeled "Break Time" distributed by a bakery I had never heard of. Need a carb to go with your work caffeine? A Break Time cookie will do the job.

Inside the dollar store you'll see families, lots of them, doing their excited holiday shopping. You'll hear many different languages. I'm reasonably certain that I was the only native English speaker in my checkout line, and I was truly amazed to hear Russian and Chinese as well as Spanish. I was part of the gotta-get-ready-for-the-holidays rush and I enjoyed it.

Some folk may dream of the Lexus in the driveway come December 25. The rest of us shop at the dollar store. I'm happy to be among them.

Labels: Holidays, Los Angeles

posted by Dr. Alice at #

 
One of my CEO's favorite sayings is that the only field more heavily regulated than health care is nuclear power. Whether it's true or not, it certainly feels like it. Today medical practitioners are at the whim of online reviewers, insurance companies, federal and state inspectors... and on and on.

I would agree with those who feel that quality (meaning keeping screening tests up to date, checking cholesterol and sugar levels, and so forth has improved with these reviews. However, it does take time and overall the doctor's job has become more difficult while reimbursements are going down. The rate at which doctors are retiring is increasing significantly. A lot of the burden of documentation falls on the shoulders of primary care doctors, with the result that fewer doctors are going into primary care. How to handle this situation?

Right now my medical group is trying to solve this dilemma by changing our practice workflow. What that means is, we are trying to minimize no-shows, work down our backlog or wait time for new patients and see as many patients as we can per day. This all sounds good though so far I am not especially happy with what it takes to accomplish these goals.

First, it is a given that we are going to see other doctors' patients as well as our own. These are called "team visits" and if we have any open slots patients get slung into them up to three days in advance. We also have to "groom" our charts (sounds like a bunch of chimpanzees working on each other) to open up slots. In other words, if a patient is coming in for a follow up on diabetes or thyroid issues, maybe they just need labs. Maybe we don't actually have to see them. Fair enough; but I have wound up overbooking my own patients on top of full schedules, and it feels as if I am going mad.

__________
I wrote the above a few months ago. We have now been practicing in this new way for eight months and I have to say that I am not a fan. For one thing, we've had two female physicians out on maternity leave for a large chunk of this time which means that we other doctors have been seeing a lot of their patients as team visits. For another, the front desk staff do not seem to have a good grasp of the art of scheduling patients appropriately (one of my fellow MDs had two rather unnecessary visits scheduled this morning). We no longer have our own front office staff (aka secretaries) who knew our practices well, and most of the patient phone calls are being managed through a central call center.

The patients hate this. The doctors hate this, and the staff hate this. Our MD administrators have gone from assuring us "After the first year you will love how well this system works!" to "The groups we consulted with say this is a continuing learning experience even three years in..." Said MD administrators are practicing physicians who had to give up part of their practices so that they could administrate more - guess who winds up seeing their patients when they aren't in the office? Uh huh.

This system of "doctor widgets," as one of my co-workers calls it, is apparently the wave of the future. It is a future I do not want to be part of. I've been giving this a lot of thought and although I would like to keep practicing medicine for many reasons, I am becoming more and more certain that I will not be a practicing MD all that much longer. Maybe another year or so, but I would like to retire as soon as I can.

Sorry for the pessimistic attitude. Did I mention I'm on call tonight? That isn't helping.

Labels: Medicine, The Doctor's Life

posted by Dr. Alice at #