Editorials from the Executive Medical Director

Irreverent opinions: Lanier and The Rockford Files


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.

Irreverent opinions: Everybody is going to be an old allergist one day


March 27, 2013

James Claflin, MD, FACAAI, an older allergist trying to “run out the clock,” and Stephen Wasserman, MD, FACAAI, the San Francisco-based ABAI guru, are at it again. Sparks fly and semantics sizzle as these two key opinion leaders meet on the field of MOC for mortal conflict. This year’s email from Steve to Jim designating him as “Certified but not participating in MOC” led to this exchange:

ABAI: We are writing to inform you that as of Feb. 1, 2013, your ABAI Maintenance of Certification (MOC) status is “Certified, Not Meeting MOC Requirements.”

Irreverent opinions: A breathless way to teach your staff about anaphylaxis


February 27, 2013

Looking for a way to do education for your staff that is less painless than a formal lecture series? You used to do this, didn’t you? You faithfully presented some topic once a month at lunch for your staff. And then you missed a month. And pretty soon nothing at all, right?

When times are good, you might even bring a bunch of staff members to the ACAAI Annual Meeting. But when that’s not economically feasible, it’s back to the lunch-and-learn!

Everyone has crash cart drills, but there is a richer, more fundamentally interesting recipe for educating your staff and having a good time.

Irreverent opinions: Are you going to see urticaria in the future?


January 23, 2013

You might think, “Well sure – I don’t like it, but I’ll see them.”

The reason I ask is that recent literature suggests that screening lab work just isn’t justified from cost effectiveness. Now make sure you get this: “testing” doesn’t mean skin testing – it means any lab. Lectures given during the annual ACAAI meeting quoting data from Tarbox et al suggested that screening testing of any type in chronic urticaria was rarely helpful in management of this disorder. This concept was reinforced with the joint AMA/AAAAI program of “Choosing Wisely,” which the College did not endorse.

Did we make a mistake? You’ll get your chance to comment on the leadership decision in the mini-survey below.

Irreverent opinions: Put on your big boy pants and keep trucking


November 28, 2012

I admit freely to drinking generously of the Fox News Kool-Aid and being stunned by the results of the election. But like the rest of you, we’ve all decided to put on our “big boy pants” (a term introduced to me by the wife of my most respected allergist friend) and get on with it. The ACAAI Annual Meeting was the first step in my rehabilitation. It felt good to have friends around me.

FITs are the most enjoyable part of the Annual Meeting for me. I asked one particularly cocky young FIT how much he learned about eosinophilic eosophagitis during the meeting. He confidently answered, “I now know everything in the world about EE. Ask me.”

Ah-hah! A challenge from a whippersnapper to a graybeard — and I took the bait.

Irreverent opinions: Patients were right on asthma? Asthma guidelines challenged by new studies and FDA


October 24, 2012

Somewhere there is a graveyard full of truths and commandments carved in stone.

“Thou shalt use theophylline as thy first line anti-inflammatory.”

I think you will find it right after the one that touts cromolyn as an effective controller. We heard those truths and we preached those truths. But the Asthma Guidelines we thought were “Truth” with a capital T have always been doubted by patients. Now the FDA and new independent large studies add their weight. How will the truth about asthma evolve?

Irreverent opinions: Severing your relationship with a patient: Be careful


August 22, 2012

A crusty, old otolaryngologist once stealthily followed a consistently abusive patient out to the elevator following a visit.

He had just removed a foreign body from the fellow’s ear and emplaced a drain. Instead of being grateful, the guy berated the staff on the way out, as usual. With his nurse in tears, the doctor reached his threshold. As the elevator dinged, the old doctor snatched with tweezers, in a deft stroke worthy of a Samurai, the drain he had just emplaced in the patient’s ear. He didn’t have to say anything. He didn’t write a letter of termination, he just did it old school, in what is known as “cowboy termination.” The story is forever a portion of this surgeon’s legacy, but it’s doubtful any one of us could get away with that today.

Irreverent opinions: Everything’s new – opportunities abound


June 27, 2012

I had to move my office. It couldn’t wait – I’ve been putting it off for years, but a new era was upon me. I have a new partner coming – maybe two, and the old office was creaky and cracky and poorly designed. The only way you ever clean up is to move. I took a deep breath and ripped the band aid off, and it hurt like the dickens. The agony was both mental and physical.

Irreverent opinions: “A latte, an allergy shot, and a large order of fries to go please …”


March 28, 2012

One of you allergists recently asked me to sign a contract before giving your allergy extract to a patient who moved to my area. Hey, I thought I was doing you and your patient a favor by not “re-testing” and making up my own serum. And here you want me to sign a contract that assures YOU that I will do the immunization according to YOUR desires. I am a full-blooded, card-carrying allergist with 40-year water marks on my legs. How dare you! How are you planning to check on that?

But something this week let me see the wisdom you demonstrated. Mea Culpa. And to disprove the adage that old dogs can’t learn new tricks, I am going to follow your leadership and do it myself, and here’s why.