Editorials from the Executive Medical Director

Irreverent opinions: ABAI has a severely flawed educational theory


June 25, 2014

You are afraid to say it; I am not. The ABAI has jumped the shark. For you millenniums, that’s a “Happy Days” reference, which is now used to mark the episode when a TV series has gone too far. In this case, while stretching a plot line, Fonzie water-skied and jumped over a huge shark in a freshwater lake.

The ABAI is using severely flawed, outdated educational theory, and, like the Fonz, it has jumped the shark. I am sitting deep in my bunker, heavily fortified awaiting your response, lovingly fingering my “gold card,” which means I don’t have to recertify because I am grandfathered. It also means I have the right to be grouchy and speak the truth a lot without worrying what anybody says, such as “don’t pay any attention to him, he’s getting long in the tooth, you know.”

Irreverent opinions: The College goes to Capitol Hill


May 28, 2014

Those of us out there in “flyover” country — which I’m defining as outside the Washington beltway — would be well advised to visit our capitol in the springtime. It is glorious! It’s green, the cherry blossoms are still hanging on and the government grounds are just gorgeous.

And to see the hoards of children decked out in their school colors, departing from buses and marching with troop leaders to visit their Congressmen is truly impressive and inspiring. Walking down the streets looking at the massive edifices, one has to think that America could never end. It’s just too big to fail, too glorious, too blessed. It fills you with a sense of pride. We did this. Men in my family died for this.

Irreverent opinions: A lot of help from my friends


March 26, 2014

Although it is well known among members that the College and Academy collaborate in a number of areas — such as the JCAAI, Certification/Maintenance of Certification Board Review Course, the Program Directors Assembly Winter Meeting, practice parameters and other joint task forces — the staffs of the two organizations also collaborate behind the scenes. They often work together and help each other with massive undertakings. I’ve asked Rick Slawny, our executive director, to provide his insight on these inner workings.

Having just returned from the AAAAI Annual Meeting in San Diego, I want to personally thank Kay Whalen, AAAAI executive director, and her staff for the assistance they provided.

Bobby Q. Lanier, MD, FACAAI
Executive Medical Director


Irreverent opinions: Your journal club as a marketing effort


February 26, 2014

A very distinguished internist of Indian origin in a finely tailored suit, who has risen to the ranks of CEO of a major health consortium, commented to me during a lecture question and answer session. He said, “We never see you, not in the doctors’ lounge, not in the hospital cafeterias, not at our staff breakfasts. Finding an allergist is like finding the Abominable Snowman.”

Irreverent opinions: A “messiah” is coming; get ready for her


January 22, 2014

I am going to stick it out another year (maybe a bunch more), but I resolve to enjoy it more and worry less about the things I cannot control. I am waiting.

I have some big advantages over you younger guys: the ABAI harassment doesn’t bother me, my house is paid for, and my family is healthy. Heck, I have the best job in the world, but sometimes I get depressed about being supervised and systemized. You kids out there, you are the ones to have the gripes and groans, but strangely you are not the ones complaining. There are two reasons, I think. First you may be afraid to complain, much for fear of retaliation, and just keep your head down and not make trouble. Old guys — having no fear, and confident in our assessment of our own competence — don’t mind speaking out. Both groups have something to learn from each other.

Irreverent opinions: Documentation is way overrated


December 18, 2013

On your way home tonight, think about documenting your little trip. Be careful to mention anything you saw, such as children playing or stop signs that were a little crooked. Then write it down — every day, each way, for the rest of your life. At the end, you would have a perfect tome, which documented absolutely nothing. It’s not enough to have eidetic memory, it has to be documented. Do you get the feeling this is an electronic records rant? And ethics — oh yeah.

Irreverent opinions: Tyranny of the password


November 26, 2013

I gave up my iPhone when iTunes started making me change my password every week or so. It’s been a year, and they still send me a “non-reply” email asking me to change every two weeks. I just want them to leave me alone.

Twenty-five is allegedly the average number of passwords we all have to remember. Odds are, you use virtually the same password on all the sites, right? If not remembering passwords is a sign of Alzheimer’s, somebody write me a script for Aricept please.

Irreverent opinions: Clinical pearls and free stuff


October 23, 2013

As a truly informed millennium physician, I love free stuff. Something of the academic equivalence of Ritalin and, like all young physicians, I have favorites. Need the short protocol for cough? How about the pearls on the algorhythm on initial angioedema? Bookmark this site for some great clinically useful charts, tables, algorithms, textbook scans, PubMed links, and article PDFs: http://ainotes.wikispaces.com/.

Irreverent opinions: Pros and cons of “out of office” immunotherapy


September 25, 2013

Have we drawn a “red line?”

Lots of talk is occurring these days about the concept of drawing red lines, and what happens when entities cross them. In the allergy world, one issue boils down to whether “out of office” immunotherapy is acceptable. An editorial in the Journal of Allergy and Clinical Immunology: In Practice has repainted a red line that has been part of practice parameters for some time. The motive in repainting, while not specifically stated, is the economic competition pushing us from non-allergists. There are no reported explosions of reactions being reported in “out of office” settings.

Irreverent opinions: Don’t mess with Texas


August 28, 2013

We are big and we are bad, and we have a unique state motto: “Don’t Mess with Texas.” But we are being messed with now, and it has a lot of doctors here really irritated.

Maybe it’s just that it’s hot – Texas hot – and none of us are looking forward to the humidity festival. Or, personally, maybe I am especially irritated because the gun rack I have installed on my riding lawnmower is loose, and I am afraid it will dump my brace of double-barreled shotguns into the prairie I am plowing.

For whatever reason, we in Texas are beginning to see the future and want to share visions of our bureaucracy with you. The Texas Medicaid formula has just been released as a testament to ignorance (or reality, as you consider both sides).