Editorials from the Executive Medical Director

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

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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

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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

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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

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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

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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

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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).

Irreverent opinions: How will nasal steroids going over the counter affect you?

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July 22, 2013

The FDA has decided that a bunch of drugs are going to go over the counter as part of its initiative to shape the medical system. Is that bad or good for you? Or does it make any difference at all? It’s not a new thought. We heard it a decade ago, when Claritin made the switch, but somehow most doctors never really thought that important and potentially dangerous medications, such as those used to treat migraine, hypertension, cholesterol issues, and allergy, would ever be entrusted to the unwashed masses. To go over the counter, a disease must be self-diagnosable, which includes allergy, asthma, gun shots, migraine, hypercholesterolemia, and hypertension. The drugs and devices must be generally recognized as safe and effective, which means antihistamines, asthma inhalers, Band-Aids, anti-cholesterols, and anti-migraine drugs are under consideration.

Irreverent opinions: Your EMD’s career-ending mistake

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June 26, 2013

“Code blue! Code blue!” my assistant nurse was yelling. My patient was flopping on the floor, clutching her throat, and screaming between gasps, for epinephrine. Her eyes were popping out, she was red faced and sounding really bad. The nurses had their cell phones poised for 911. People were coming from the waiting room to offer help. I decided to wait a bit.

It was another one of those people you see all the time, “I have a reaction to something.” But in talking with this 40-year-old lady accompanied by her husband the week before, the plot began to thicken.

Irreverent opinions: I used to want to work for Home Depot; now I want to be the Wal-Mart allergist

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May 23, 2013

To be truthful, I’ve always wanted to retire and work in the hardware department at Home Depot. I figured I could bring my amazing knowledge of how to “fix” almost anything (although not always in the most aesthetically pleasing manner) to the world as my final gift. But, with things as they are, I may have to work until my late 90s with my dream unfulfilled. That is, until I saw that Wal-Mart and Walgreens were going to add chronic care to their repertoire of services.

Sam’s Club set the precedent. You can now get RAST testing done there periodically, and it’s cheap. Get 10 RAST tests for $49.95. And, some days, they will throw in a gallon of non-E. coli peanut butter for free. Such a deal! We heard rumblings in 2011:

Irreverent opinions: Lanier and The Rockford Files

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April 24, 2013

Those of you who are older — and those like Phillip Lieberman, MD, FACAAI, and me, who publically admit to loving television — may remember James Garner playing a tricky private detective in The Rockford Files. Garner was part detective and part con man, who kept a little machine in his car to make business cards. If he was investigating a dry cleaner, he would print up an OSHA card. If the suspect was a builder, he might become the CEO of a supply company. It was a technique that gained him entry into any office.