If You Want Big Success Build A Business That Responds to A Big Trend – Footnote No. 4 in Gary S. Smolker’s Mentor’s Journal

 

April 23, 2014

It is time to ask the right questions and to grasp the gist of the American Healthcare System’s predicament.

Question One: In view of the large number of adult Americans who now have at least one chronic disease – over 50 percent of the American adult population now has a preventable chronic disease caused by poor living habits [i.e. eating the wrong foods] and lifestyle [i.e. not getting enough exercise or sleep] –  does society need an American Health Association to represent and advocate for health and patient care, to advocate solely the interests of patients?

Question Two: In view of the fact that about three out of our Americans are obese and obesity leads to diabetes, Alzheimer’s disease, heart attacks, stroke and many types of cancer – does society need an American Health Association to represent and advocate for health and patient care, to advocate solely the interests of patients?

Question Three: Is it time for society to recognize that the American Medical Association is a trade association, a trade association that tries to advance the interests of its member doctors?

Question Four: Is it time for society to recognize that hospitals are about keeping beds full, just like hotels but without the mints on the pillow?

Question Five: Is the present day American Health Care System sustainable?

RESPECT AND VALUE

A friend of mine recently told me,

  • In a ranking of the ten most respected professions, doctors ranked number two; only behind astronauts.
  • The qualifications for both is the hardest in the world.
  • Many apply and only a few are chosen.
  • There’s a reason so many mothers want their children to grow up to be doctors: Doctors are about as respected as any occupation can possibly be.
  • If you consider monetary compensation as an indicator of value, they’re right at the top, and the talent and effort required to become a doctor is awe-inspiring.

Another friend of mine responded,

  • More people can name more entertainers and sports stars than they can name doctors or astronauts and spend more time thinking about them and talking about them.
  • How many towns have a medical bar or an astronaut bar?  How many have a sports bar or two or three or . . . . ?
  • If  greedy mothers were more knowledgeable, they’d encourage their children to become good investment bankers or read estate developers or energy traders and so on.

When I said, “In terms of qualifications, I assume the qualifications to work at Google are more stringent than the qualifications to become a doctor or work as a doctor and I’ve been told that if medical schools admitted applicants solely on the basis of merit, all the medical students at the Harvard University School of Medicine would be female Chinese” my first friend replied:

  • A surprising false premise coming from you.
  • In a true learned profession, doctor is one of the most selective.
  • Prequalifications to become a programmer, or engineer is not as selective but these are the requirements to apply to Google which has a limited number of jobs available.
  • Becoming a fighter pilot is more stringent than getting a job at Google.
  • Not only is the number of jobs limited but the process kills those who pass the entrance requirement but fail to acquire the necessary skills.
  • And I do mean, kill, or if the failures are lucky they get “washed out” and can go on to something more suitable.
  • Finally you had made a comment about Chinese Women being the ideal doctor candidate because of their exceptional academics.  Fortunately medicine requires more than mere academics.

My second friend replied:

  • If I am sick, I’d rather be treated by a good Chinese woman doctor than a lesser doctor from some other statistical profile.

THE FUNDAMENTAL QUESTION: WHAT IS THE ROLE OF A PHYSICIAN?

A layman told me that doctors are not fiduciaries?

Is that true?

Would things be different if physicians were subject to the same rules of conduct as a fiduciary?

Perhaps the best rule would be for the medical practitioner to be a fiduciary – not about finances but about health.

The American Medical Association is a trade association that tries to advance the interests of its physician members, not to advocate for health or patient care, not to represent the interests of patients.

What does that tell us about the profession of medicine?

Does that in any way explain the current state of health of the adult population in America?

Is there any reasonable reason why physician’s conduct should not be held to the same high standard of conduct on “health issues” as a fiduciary?

Recently, a 72 year old [age approximation] friend of my was diagnosed with prostate cancer in California.

He was told by his California based prostate cancer specialist that he needed surgery to treat and/or remove the cancer, proton beam surgery.

He then went to a prostate cancer specialist in New York for another opinion.  The New York based prostate cancer specialist told him, “Yes, you have prostate cancer.  I predict if you do nothing about your prostate cancer it will kill you when you are 140 years old if you live to be 140 years old.”

My friend asked the New York specialist, “Why did the doctor in Los Angeles tell me I needed surgery and you are telling me I don’t need surgery?”

The New York prostate cancer specialist answered,

  1. “Medicare will pay for the surgery.
  2. “I don’t own the proton beam surgery equipment. 
  3. “I don’t have to pay for that machine.
  4. “I don’t need the money.”

 

I repeat: Does society need an American Health Association to represent the interests of patients?

TIME STARVED PHYSICIANS

During a Passover Seder Dinner on April 14, 2014, I had a discussion with a physician-friend about patient care.

I expressed concerns about the medicine I am taking to lower my cholesterol level.

My friend told me if I wanted to “know” details about the medicine prescribed for me to prevent having a heart attack, and the risk posed by that medicine of increasing the probability of me eventually having Alzheimer’s disease, I should

  1. Call a local medical school.
  2. Ask for the name of an expert in the medical condition I am being treated for.
  3. Offer to pay that medical expert by the hour to answer my questions and that I should not expect my own physician(s) to make time available to answer my questions about the prescription medicines they have prescribed for me.

My doctor-friend told me that front-line doctors practicing medicine, meeting patients in their offices and treating patients in their offices and in hospitals, don’t have time to answer such questions; doctors cannot spend more than ten to fifteen minutes in a “normal” office visit.

He told me that physicians have set amounts of time to talk to patients.

  • The amount of time a physician spends with a patient is set by insurance companies, is determined/set by fee schedules insurance companies give to physicians.
  • Insurance company fee payment schedules allow a physician to spend ten or fifteen minutes per normal office visit with a patient, and that this system works.

I told my physician-friend that the public wants to feel “cared for”, that patients have feelings.

I told my friend that the attitude of physicians which he describes is arrogant; that attitude does not reflect care about patients as people or a desire to prevent their patients from having heart attacks, or to help people avoid getting Alzheimer’s disease to to help people avoid becoming obese and/or teach people how to diet and lose weight.

I told my friend that to the extent his description of the practice of medicine is accurate the human dimension of medical care has fallen by the wayside; doctors are not putting patients first/patients’ interests first nor are they putting the public’s interest first.

I know from talking to members of the general public in the United States that the American public is frustrated by the impression (which is glaring obvious whether true or not) that their interests as patients and the American medical profession’s interests are not aligned.

The American public knows when physicians do not appear to be putting their patient’s interests first.

PHYSICIANS CAN INCREASE THEIR POWER OVER THE HEALTH OF THE NATION  BY PRACTICING PREVENTATIVE MEDICINE

Beyond keeping people who are extremely ill alive, look at how effective or ineffective the medical industry has been at protecting the health of the American people:

Toby Cosgrove, MD, CEO of the Cleveland Clinic, states in his book “The Cleveland Way” at pages 136 and 137:

  • Because of preventable chronic diseases, America spends twice as much on healthcare as Europe and Canada do and four times as much as Mexico, Japan and India.  The United States also has 80 percent more high blood pressure, 110 percent more heart disease, 40 percent more diabetes, and 800 percent more strokes than other developed countries.
  • “Rates of diabetes have more than quadrupled since 1990, with growing numbers of young children developing this chronic condition.
  • “Obesity may be responsible for up to a quarter of some of the most common and deadly cancers, including gallbladder, ovarian and pancreatic cancer.
  • “Behavior-related factors now account for 81 percent of all hospital admissions in the United States, 91 percent of all prescriptions, and 76 percent of  physician visits.”

Mark Hyman, MD, in his book “The Blood Sugar Solution” at page 24 states: “Obesity takes nine years off the life of a normal person.”  It is not a genetic disorder.  It is a direct outcome of diet, life style and environmental factors.

William Davis, MD, in his book “Wheat Belly, at pages 96 and 97 states: “One person with diabetes incurs $180,000 to $250,000 in direct and indirect health care costs if diagnosed at age fifty and dies eight years earlier than someone without diabetes.  That’s as much as a quarter of a million dollars and half the time spent watching your children grow up that you sacrifice to this disease, a disease caused in large part by food.”

On page 1 of “A Short Guide to a Long Life”, David B. Angus, MD, states:  “At least twice a week, I tell a patient that I have nothing left in my arsenal to combat his or her cancer.  It’s over, and in most cases the end is near.  I’ve never gotten used to this gut-wrenching conversation  But I do it as part of the role I’ve accepted.  That we are no better at treating cancer today with a few notable exceptions then we were fifty years ago is maddening.  More infuriating still is that many of my patients could have prevented their cancer or other life-altering disease had they done a few things differently early in life.  That makes these conversations even more upsetting.  I’m pretty certain that most people could delay or totally prevent a vast majority of the illnesses we see today – including not only cancer but heart and kidney disease, stroke, obesity, autoimmune disorders, and dementia and other neurodegenerative disorders – if they just adopt a few healthy habits early on and avoid the ones that lead to illness.  The best way to fight not just cancer but all the other ailments that typically develop over time is to prevent them.  A staggering seven out of ten deaths among Americans each year are from chronic diseases like the ones I just named.  Heart disease, cancer and stroke account for more than 50 percent of all deaths each year.”

IF THE GOAL OF THE AMERICAN MEDICAL ASSOCIATION AND THE MAJORITY OF THE AMERICAN MEDICAL PROFESSION HAS BEEN ON KEEPING PEOPLE HEALTHY – PREVENTING PEOPLE FROM GETTING CHRONICALLY ILL IN THE FIRST PLACE – THEY HAVE FAILED.

Pastor Rick Warren, D. Min., Daniel Amen, MD, and Mark Hyman, MD, state in “The Daniel Plan” at page 36:

“One in two Americans suffer from some chronic disease:  Heart disease; diabetes; cancer; dementia; autoimmune disease; allergies; acid reflux; irritable bowels; neurological problems; depression; attention deficit hyperactivity disorder; thyroid, hormonal, and menstrual problems; skin problems including eczema, psoriasis, acne and more.  We spend almost $3 trillion a year in our health care system, and almost 80 percent of that is for chronic lifestyle preventable and reversible disease.”

However, Mark Hyman, MD believes there are things we can all do with the guidance of the medical profession to avoid those health problems.

On pages 49 through 53 of “The Blood Sugar Solution”, Mark Hyman, MD, states:

  • “To really change our obesogenic environment, we need to create healthier choices for everyone.  We must focus on specific actions we can take personally, politically, and in our communities to alter our food landscape.
  • “Other than drinking sugar-sweetened beverages, the number of hours of screen time is the single biggest factor correlating with obesity.
  • “The average American spends nine and a half hours a day in front of a screen, mostly television.
  • ” In addition to the metabolism-slowing, hypnotic effect of watching television, relentless food marketing targeted to children is one of the major factors driving this problem.  The average two-year-old can identify by name, junk food brands in supermarkets, but many elementary school children can’t readily differentiate between a potato and a tomato.
  • “The average child sees 10,000 ads for junk food on television each year.
  • “The food industry spends $13 billion a year marketing their products to children.
  • “If you spoke to your child before every meal about healthy eating, you couldn’t compete with the onslaught of coercive messaging from industry. 
  • “A Yale study found that kids who watched food ads ate 50 percent more of the snacks placed in front of them.
  •  “The visual stimuli trigger the brain to eat more.
  • “Published data show that the breakfast cereals with the worst nutritional value have the most advertising.  See http://www.cerealfacts.org.
  • “The Center for Science in the Public Interest [not the American Medical Association] brought a lawsuit against Coca-Cola for deceptive marketing practices of its “Vitamin Water” product.
  • “Coke hired celebrities like Kobe Bryant and Lebron James to tout its healthful effects.
  • “At 125 calories a bottle (drinking one bottle a day would make you gain about 10 pounds a year), the minuscule amount of vitamins in the bottle is irrelevant compared to the sugar.
  • “The lawsuit is base on the Jelly Bean Rule, which prohibits companies from selling junk foods with minimal health benefits by marketing them as healthy foods.
  • “The lawyers for Coca-Cola are defending the lawsuit by asserting that ‘no consmer could reasonably be misled into thinking Vitamin Water was a healthy beverage.””

The health statistics cited above, the story of the Coca-Cola “vitamin water litigation” and the amount of money the food industry has been allowed to spend however it wants with few restrictions marketing to children on television set out above leave no doubt that these are dangerous times.

Which leads me to conclude that this is an opportune time for the American Medical Association, and the members of that association, to make a good faith wholehearted energetic effort to promote and to protect good health.

I repeat: Health-wise, these are dangerous times for the American public.

The rule “nature abhors a vacuum” applies to medicine as it does to all other fields.  As a result of the widespread ill-health businesses are springing up and major employers are taking action to help Americans stay healthy and/or become more healthy.

See my article “Ongoing Trends that Are Changing the Practice of Medicine, People’s Health and Making Many People, Companies and Organizations Wealthier”, first posted on January 22, 2014 on The Gary Smolker Idea Exchange Blog at http://www.garysmolker.wordpress.com.

If 80 percent of American’s healthcare cost is preventable by adopting healthy lifestyles and properly labeling unhealthy foods, it is time for the American Medical Association and for all medical doctors practicing medicine in the United States to join the other organizations and businesses now taking affirmative actions necessary to help Americans stay healthy.

BIG FOOD’S AND APOLOGISTS FOR THE MEDICAL PROFESSION’S REJOINDER: PEOPLE CAN CHOOSE FOR THEMSELVES HOW MUCH UNHEALTHY FOOD THEY CAN OR SHOULD CONSUME.

Big Food, government agencies and apologists for the medical profession’s response to the fact that junk food is making us sick is that “individual choice” drives decisions – that people can choose for themselves how much unhealthy food they can or should consume.

Dr. Mark Hyman’s response to that argument is,

  • “… there are significant problems with this stance. 
  • “… processed food is addictive. 
  • “…  research in behavioral economics shows even when people think they are making free and rational choices they are not. 
  • “The addictive biology, pervasive advertising, cheap prices and other social and environmental factors all work together to shape our food preferences.”

According to Dr. Hyman:

  • “A recent study found that replacing sodas in school vending machines with ‘sports drink’ had zero impact on weight or health. 
  • “It was good public relations, but just led to bigger profits for big food companies and bigger waist sizes for kids. 
  • “Big Food will not voluntarily sacrifice profits or change their food practices. 
  • “Its primary method for increasing profits is to get people to eat more.”

IT IS YOUR DECISION

You decide:

  1. Should there be a tax on sugar sweetened beverages if the money is used for obesity prevention and treatment programs?
  2. Should there be changes in school nutrition?
  3. We stopped Joe Camel.  Should there also be an outright ban on junk food marketing to children?
  4. Should it be against the law to sell sugary beverages to minors?

THE PRACTICE OF MEDICINE IN THE FUTURE

The history of healthcare has moved in progressive stages, each of which can be measured in terms of the longer, more productive lives that individuals have realized.

In the twentieth century medicine transformed human life.

Doctors took what was fatal and made it survivable.

Advances in medicine fundamentally changed our  ideas about the nature of life.

Advances in science, engineering and technology are moving medicine and our understanding of how our bodies work, of what life is, and what it means to be human forward at a breakneck pace.

Science is advancing so fast that nobody knows where the lines are drawn anymore.

We are on the verge of new technologies and new philosophies that we can’t yet even imagine.

However, people know whether they feel cared for.

HUMAN FEELINGS

Today many people in the United States feel they are not being properly cared for by the American medical profession.

Those people are in revolt, or soon will be, at the focus and priorities possessed by those members of the American medical profession who appear to put their own interests ahead of their patients’ interests.

It appears that the practice of medicine in the United States in the future will be transformed because of public reaction to a perceived disconnect between the profit making goals of the American fee-for-service medical industry from the emotional needs and the wellness goals of patients who live in the United States.

A great number of people that doctors are pill pusher driven to maximization of volume of patient office visits, maximization of tests and of medical procedures without giving their patients enough information to decide whether or not to take the medicine or of available alternative courses of action.

TECHNICAL EXCELLENCE IS NO LONGER ENOUGH

The current practice in the United States of America of making payments to members of the American medical profession – in the American healthcare system – on the basis on volume/number of office visits, number of laboratory tests and number of medical procedures is unsustainable.

Making payments to payments to physicians based solely on the volume of office visits, and the treatments and procedures they perform at a time when over 50 percent of the adult population has one or more chronic illness is in the process of becoming history, is in the process of being phased out.

The United States is the only industrial country that does not have universal health care.

The handwriting is on the wall; that will not last.

Many people in the United States tell me they frustrated by the inferior quality of their patient experiences.

As a result of the ill health of at least 50% of the adult population in the United States, American medicine stands at a crossroads.

Questions about finance, regulation and the organization of medical services hover at the forefront of our national discussion.

Every thinking person realizes that neither the public nor the government can afford the way medicine is being practiced today in the United States of America.

I predict as patients become savvier,

  • Patients will increasingly judge healthcare providers not only on clinical outcomes but also on their ability to show compassion, to deliver excellent, patient-centered care – including meaningful educational information that enables patients to make informed decisions on how to live a healthy life, and how to keep healthy.
  • No healthcare provider will be able to afford to offer anything less than the best clinical, physical and emotional experience.
  • New programs will reward the delivery of healthcare results instead of make payments to physicians based solely on the volume of procedures that doctors perform.
  • Surveys will ask patients about the interpersonal treatment they received: What attitude did your physician show you?  How friendly was your physician, and how much time did he or she spend with you?  Did he or she address your emotional needs?  Did your doctor treat you with warmth and respect?
  • When a patient experienced a lack of intellectually meaningful consultation (in a typical healthcare encounter) with their physician, the patient is left with a horrible taste in the patient’s mouth and a distressful memory.

MEDICINE HAS ENTERED THE DIGITAL AGE

The practice of medicine is being transformed by technology.  Among other things, wireless medicine is here.

Patients with a chronic disease can be monitored in real time from their own homes.

The use of electronic medical record keeping is expanding.

Electronic medical record keeping enables doctors and scientists to scour hundreds of thousands of patient records in seconds to find specific pieces of information they need in their work.

For the first time it is technically possible to plug every doctor, every patient, and every hospital, university and laboratory in the world into a single healthcare data system.

The power of such a unified system to improve health and fight disease is almost beyond imagining.

At the most fundamental level, data and information technology promise to transform medicine from what it has long been – an art – into much more of a rigorous, objective science.

According to Dr. Cosgrove, Cleveland Clinic as of 2013 had invested about $1 billion in information technology.

  • As of 2012, Cleveland Clinic’s Electronic Medical Records System contained more than 6 million patient records, and physicians had used the system to give orders more than 240 million times.
  • About 1.5 million patients are/were able to access their own medical records at home through an ultrasecure portal.
  • Patients can now make appointments, fill prescriptions and communicate with their doctors’ offices online.
  • Their doctors can share lab results and prompt patients to schedule preventive screenings and checkups, while community physicians who refer patients to Cleveland Clinic can track their patients’ care online in real time.  The system even automatically notifies a doctor if a patient qualifies for one of Cleveland Clinic’s ongoing clinical trials.
  • As of 2013, most American hospitals don’t use Electronic Medical Records.  Fewer than 2 percent of American hospitals have what the government calls a “complete electronic medical record.”
  • Dr. C. Martin Harris, chief information officer of Cleveland Clinic, estimated that fewer than 20 percent of all physicians’ offices use Electronic Medical Records to write orders, document care, write prescriptions, capture diagnostic images, and performed computer-assisted support (for example, identify all patients who need a certain blood test).
  • Kaiser Permanente spent $4 billion getting its system online, linking almost 16,000 doctors and 9 million patients.

Electronic medical record systems are being designed to be able to make accurate useful predictions, based on scientific evidence concerning the outcomes of particular interventions.

Hopefully through the use of computers doctors will make better medical decisions based on actual data, not just gut feelings, medical decision making will not be cloaked in secrecy, patients will enjoy better outcomes, and the cost of treatment will be reduced.

The Cleveland Clinic has a computerized registry called the Cardiovascular Information Registry.  As of 2013, the registry includes data on more than 220,000 patients.

In “The Cleveland Clinic Way” Toby Cosgrove, MD says, “Soon a patient will be able to enter her information into a ‘comprehensive risk calculator’ that uses algorithms to calculate the patient’s risk of complications or success based on the experience of thousands or even millions of other patients, taking into account all the specifics of the patient’s situation. Cleveland Clinic already has some risk calculators online.  Although they’re primarily for doctors, consumers can use them as well.”

In “The Cleveland Clinic Way” Dr. Cosgrove also says:

  • In the twenty-first century, no provider can afford to offer anything less than the best clinical, physical and emotional experience.  As patients become savvier, they will increasingly judge health care providers not only on clinical outcomes but on their ability to show compassion and deliver, patient-centered care.
  • Patients who are sick and require medical attention should take the time to research not merely their medical condition  but the performance of potential doctors and hospitals.
  • They also should take advantage of the new opportunities afforded by technology in order to understand their own body and the treatments they receive.
  • Medical professionals are thus feeling increasing pressure not just to talk about empathy but to take steps to demonstrate real compassion, even while lowering costs.
  • Medical centers, like all businesses, need customers more than customers need them.

THE FUTURE

There is no doubt in my mind that as patients are able to go online to find more usable and accurate information,

  • their use of computers and smart phones to find out about their doctors and the procedures and medications their doctors prescribe will increase;
  • the spread of information about how the body works will increase;
  • the spread of information about healthcare options will increase;
  • opinions and survey answers on how well particular specific medical practitioners understand and respect how patients feel will be posted for all to see,
  • more and more physicians will strive to avoid dispassionate and cold care and will become become emphatic caregivers who take the time to treat people well,
  • more physicians will treat their patients with warmth and respect,
  • some day a majority of physicians will thank their patients for the privilege of taking care of them,
  • the focus of the medical profession will become keeping people healthy,
  • physicians will focus on helping individuals avoid getting sick in the first place – physicians will actively promote healthy lifestyles, discourage bad habits and help people make and sustain healthy changes.

To the extent insurance companies and bureaucrats have harmed the public by taking away doctor prerogatives, that has to stop; physicians and other concerned individuals must work to be an end to that.

Historically physicians have had an excessive reverence for tradition.

Precedent overruled observation.

Generation after generation of doctors performed procedures such as bloodletting without determining whether they actually worked.

That has to stop.

As individual physicians and their healthcare organizations acknowledge they have a responsibility

  • to teach patients and to demonstrate to patients what healthy behavior is,
  • to tell patients when their medical advice is based on gut instinct and/or not based on scientific proof of medical certainty beyond a reasonable doubt and
  • to become active as advocates for healthy living and

the way medicine is practiced will change.

Medicine will become more humane, more caring and more inspiring.

CHANGING MY MIND

I have had intense conversations with several friends about what doctors treating patients should tell their patients, how much time it is reasonable to expect doctors to spend with their patients, why doctors practice medicine the way medicine is being practiced today; the education, state of knowledge, and the audience to whom doctors (clinicians) speak; conflicts of interest inherent in the practice of medicine; and, protecting public health vs. creation of a Nanny State to protect public health.

Those conversations have caused me to change my mind about

  1. the reasonable way for doctors to handle office visits,
  2. what behavior is reasonable to expect from  doctors.

My analysis of the situation leads me to conclude we need to have laws banning the sale of sugary drinks and artificially sweetened drinks to minors; we need to ban the marketing of processed foods, especially snack food, sugary cereals and TV dinners, to children; we should highly tax the sale of sugary beverages to adults; healthcare is a commercial business enterprise; physicians should have the same duties to patients as fiduciaries have to their clients.

CONCLUSIONS

Human action is driven by the power of incentives.

You are never going to change human nature but you might alter the environment in which it is expressed.

Disillusion isn’t a useful emotion.

 

Copyright © 2014 by Gary S. Smolker

About Gary S. Smolker

PERSONAL PHILOSOPHY: No enterprise can exist for itself alone. Every successful enterprise ministers to some great need, it performs some great service, not for itself, but for others. Otherwise, it ceases to be profitable and ceases to exist. Imagination, open mindedness and flexibility are the most important factors in unlocking potential. Those who embrace innovation, improvisation, continuous learning, time management, are action oriented, high energy, passionate, creative, purposeful and intense individuals are best equipped to succeed. We all have ideas and the ability to make progress by sharing information and our ideas and also by changing our ideas when appropriate. We should always be on the lookout for teaching and mentoring moments. We hold time like water in our hands; however tightly we clench our fingers, it drips away. But, if it falls on a seed, a seed may grow to become something that will have a positive social impact. PERSONAL INTERESTS: I have a passion to learn, to innovate, to lead, to mentor and to teach. I seek to write things worth reading and want to do things worth writing about. I enjoy (a) driving a fast car, (b) having intense conversations (c) teaching/mentoring, (d) reading and (e) being involved in productive activity. PERSONAL: I believe in cultivating and backing passionate people, innovation, and old fashioned good ideas. I love making human connections and spreading good ideas. I am strongly motivated to achieve in situations in which independence of thought and action are called for. PERSONAL GOALS: I want to live life vibrantly, to be as sharp as a tack until my last breath and to change the world by being me. My personal goal is to be fully engaged in life, to lead by example, to set high standards and to continue to amass firsthand experience and knowledge in all that interests me. PERSONALITY: I love fun and mischief. I relish absurdity. I have an irreverent, facetious and satiric disposition. I dread boredom. I have spent a lifetime reading. I have no bias against people who have lived successful and/or complicated lives. I write to release tension, to get things off my chest. SOCIAL MEDIA: I post articles on the "Gary S. Smolker Idea Exchange" blog at www.garysmolker.wordpress.com, and "Dude's Guide to Women's Shoes" at www.dudesguidetowomensshoes.com. I also post images and comments on Instagram @garyspassion. CONTACT INFORMATION: Gary Smolker, Smolker Law Firm, 16055 Ventura Blvd., Ste 525, Encino, California, 91436-2609, USA. Phone 1-818-788-7290, e-mail GSmolker@aol.com.

Posted on April 15, 2014, in Uncategorized and tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink. 1 Comment.

  1. I have the privilege of having my own doctor with one of the nation’s largest HMO. Kaiser Permenante has had some terrible press in the past, and maybe still do presently, but I’m here to tell you that the staff at several Kaiser facilities have been caring, kind, and patient.
    For example, my doctor, Mark Peters, M.D, is located at the facility in Oceanside, CA. He is one of those doctors who takes his time with me. He doesn’t rush me out of the examination room after ten minutes. He proves over and over that he cares about me as a person, as a patient who is in need of helping both inside and out. I have had my three of four children at different Kaiser locales and each one treated me as if I were the only person in the hospital.
    My knee replacement surgery was done at a Kaiser facility in Northern California and he even came to visit me at my home!! How many doctors would do that these days? So for all of you who think that Kaiser is awful, think again.

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