Response to EM Pulse Editorial April 2008
Link: em-pulse editorial April 2008

We have been following the medico-legal issues raised by the in-fighting in emergency medicine for some time now; occasionally with amusement, but almost always with disappointment and gravitas. We find Dr. Graber’s recent article, given her ascension to the position of vice president of the Florida College of Emergency Physicians [FCEP], sadly disappointing, and intemperate. We would hope that a physician at her level would strive to end the divisiveness that prevents the unification of emergency medicine, in order to provide excellent cost effective emergency care for Floridians and citizens of the United States. To that end, we felt compelled to address many of the issues raised by Dr. Graber.

The American Board of Physician Specialties [ABPS] certifies physicians in Emergency Medicine through BCEM, their Board of Certification in Emergency Medicine. BCEM certified physicians have completed residencies in a primary care specialty and practiced in an ER for at least five years, logging no less than 7,000 consecutive hours. This stringent and exacting qualification criteria mirrors the exact requirements for ABEM (American Board of Emergency Medicine) “grandfathered” diplomates (medical professionals who have not done a residency in emergency medicine, yet who according to ABEM criteria meet the requirements to be Board Certified emergency medicine practitioners).

BCEM certified physicians have not completed a residency in emergency medicine, similar to their ABEM certified “grandfathered” colleagues. Thus, when Dr. Graber and Florida College of Emergency Physicians [FCEP] lobbies the legislature to define a board certified physician as one that has completed a residency in emergency medicine and certified by ABEM, Dr. Graber in effect seeks to eliminate all non residency trained ER physicians from the workplace.
Dr. Graber seems willing to destroy the careers of ER physician members of her own organization in order to push for what she believes to be the gold standard, EM residency trained physicians. Why? Many individual BCEM certified physicians have been practicing emergency medicine for upwards of thirty (30) years. Surely Dr. Graber would not suggest in her current position, that new resident trained physicians replace senior experienced attending physicians. Or would she?
Notwithstanding Dr. Graber and FCEP/ACEP’s efforts, Florida’s Board of Medicine has evaluated and approved BCEM credentials, permitting BCEM diplomates to represent themselves as Board Certified in Florida. The only difference between BCEM and ABEM certified physicians is BCEM’s commitment to certifying physicians skilled in Emergency Medicine from all relevant disciplines, including but not limited to residency in Emergency Medicine.
The American College of Emergency Physicians [ACEP], and the Florida College of Emergency Physicians [FCEP],important organizations that purport to represent all emergency medicine physicians, really only support ABEM certified, residency trained ER physicians. ACEP’s position has created sedimentary layering and artificial lines of medical skill demarcation among all other emergency medicine physicians, including their own ABEM “grandfathered”, non ER residency trained physicians.

Dr. Mylissa Graber, vice-president of FCEP, has propagandized against AAPS (American Association of Physician Specialists) in recent editorials in FCEP’s EM-Pulse newsletter, of which Dr. Graber is editor-in-chief. Dr. Graber launched a seemingly vituperous and potentially libelous attacks against AAPS, chanting the ACEP party line, that only EM residency trained physicians are competent to practice Emergency Medicine. Dr. Graber has never stated what she expects non-EM residency trained physicians, including those grandfathered by her own organization to do, if Dr. Graber and FCEP are successful.

BCEM certified, non emergency medicine residency trained physicians have been rejected from numerous hospitals because they did not do a residency in emergency medicine. These doctors are limited in where they can live, by virtue of restrictions on where they can work. Even Frederick Blum MD, past ACEP president, admitted that he himself was a victim of this restraint of trade. While holding ABEM certification, he still could not work in many hospitals because he was not residency trained. Thus, Dr. Blum, in a letter to the ACEP certification section concluded:
“I understand why many of you sought certification with BCEM. In your position I would have done the very same thing. I will support your right to do so and your rights as members [of ACEP]….and your ability to practice unfettered.”
It is unfortunate that Dr. Graber and FCEP do not share this understanding. Instead, they engage in short-sighted and self-interested efforts to eliminate highly skilled competitor ER physicians from the market place by numerous attempts to eviscerate the law that the State of Florida has put in place to allow these skilled physicians to practice Emergency medicine.
As Dr. James Meade, Florida physician and lifetime member of ACEP wrote in response to Dr. Graber’s earlier editorial:
“The continuing controversy over board certification ABEM v BCEM is counterproductive and serves no good purpose. I find it baffling since we all have the same goals: to improve the practice of emergency medicine.
Furthermore, the Florida Board of Medicine after a 3 year study, decided that The American Association of Physician Specialists (which includes the Board of Certification in Emergency Medicine) is a legitimate and bone fide organization … and …should be granted approval as a specialty recognizing agency’.
The Florida decision has since been unsuccessfully challenged on five (5) separate occasions by ACEP/FCEP and its allies, even though the composition of the Florida Board of Medicine has almost completely changed during that period. Notwithstanding, ACEP/FCEP have resorted to other tactics, such as writing language into statutes that would have the effect of undoing and undermining the legislative intent of the Florida Medical Board e.g. the requirement that EMS medical directors be emergency medicine residency trained. A hearing before an administrative law judge recently reaffirmed the original decision of the Florida Board of Medicine.”
Relentless and undaunted, in March 2008, FCEP resubmitted yet another bill, in the hopes of subverting the original decision of the Florida Medical Board. This time, after another fair and unbiased hearing in the Florida Legislature’s Health Regulations committee, FCEP was forced to withdraw the bill after hearing testimony that revealed its many embarrassingly obvious flaws. Yet, Dr. Graber insists that the bill did not fail, and ominously points out that “Time is on our side.”

Dr. Graber in her editorial, accused the doctors that testified against her/FCEP’s bill in Tallahassee, Florida, of being on AAPS’s payroll. However, this writer found that the only people who were renumerated by AAPS was their contract lobbyist in Tallahassee and an AAPS national government affairs manager, both of whom were in attendance at the meeting and neither of whom testified. The doctors who spoke were volunteers who received no compensation and whose only motives were to speak the truth and improve the practice of Emergency Medicine. I wonder if as vice-president of FCEP, whether Dr. Mylissa Graber’s trip to Tallahassee was paid for by FCEP, and if so, are the FCEP members who are not ABEM certified aware that their dues are being spent on trips supporting a bill that effectively discriminates against them and essentially restricts their livelihood and careers?

Dr. Graber further asserts that “…emergency medicine has become very complex…”. Has it really become so complex that it necessitates the exclusion of qualified doctors from the practice of emergency medicine?

So, what the issue comes down to is this; FCEP’s many efforts, including bill writing, is not about quality of care or the future of emergency medicine. If so, there would have been a rather convincing and statistically substantive argument posited. Rather, it appears that its efforts are protectionist in nature and only supported by the Florida College of Emergency Physicians [FCEP].

AAPS is in business to certify physicians expert in emergency medicine to provide the highest level of care to the citizens of every State, not limit the market place to a few physicians who as a matter of timing, had full access to residency programs in emergency medicine, and who, without competition, would be able to fix higher costs for their services. AAPS also recognizes those physicians trained in other relevant fields, with many years of experience in Emergency Medicine. Thus providing for the nation, a larger talent pool of expert emergency physicians that would control costs, and minimize physician shortage in Emergency Medicine.

Dr. Graber’s editorial entitled “Time is on Our Side” poses far more questions than it answers. The big question is, whose side is Dr. Graber and the restrictive special interest organization FCEP really on? Certainly not on the side of patients, Florida residents whose access to quality emergency care service would be curtailed by their bill, and not their own FCEP members without ABEM certification and a residency in Emergency Medicine.
Perhaps Dr. Graber should take a lesson from New York, where AAPS was forced to bring suit against the New York State Department of Health [DOH], after years of unreasonable and unlawful attacks against them by New York ACEP and its allies. It seems that in New York, ACEP and its allies misrepresented AAPS to the NYSDOH and got the DOH to irrationally exclude ABPS as a legitimate Board. Thus, in New York, BCEM certified physicians have been unable to refer to themselves as board certified. I suspect, like Florida, New York will settle and include ABPS as a legitimate board.
Time may not be on Dr. Graber’s side if the NYS-DOH settles or goes to trial and loses. Certainly, all organizations upon which New York relied in excluding BCEM physicians would be called upon to testify as to their reasons for blackballing AAPS, perhaps Dr. Graber herself could give up some of the time that is on her side. That said, it is perhaps later than Dr. Graber thinks, and it would be wonderful if she had a change of heart and approached this issue in a manner befitting her office for the good of Florida and the nation.

Richard E. Davis, JD.
Director, Litigation Logistics,
Special consultant, PUMAMD

Links:
AAPS vs. NYS-DOH Update

by Tara Weiss
at Forbes.com
No one ever said being a doctor was easy. School and training go on seemingly forever; once graduation arrives, doctors work long hours and are faced with life-and-death decisions daily.

But there were rewards. For decades, doctors earned hefty paychecks, had autonomy and respect. But those benefits are fading, and as a result, so is the number of doctors. Within the next 15 years, the United States will experience a shortage of between 90,000 to 200,000 physicians, according to the recently published Will the Last Physician in America Please Turn Off the Lights: A Look at America’s Looming Doctor Shortage.

The American Medical Association recognizes there are shortages in certain geographic areas and in certain specialties. Part of that is due to the aging population and a stagnant number of medical-school applicants.

But there are other significant reasons. They include the increasing costs of medical malpractice coverage, higher practice costs, lower insurance reimbursement rates and insurance-company restrictions resulting in less autonomy over how patients are cared for.
Read Full Article at Forbes.com

Online Ratings Irk Doctors
By Kim Painter,
see original article at USA TODAY
Considering a new doctor? Hoping to learn more about a doctor you already see? Or maybe you’d like to praise or pan one.

You could do it the old-fashioned way and talk to friends and relatives or even the doctor in question. Or you could do this: Go online and read and respond (anonymously, if you like) to everything you find about that doctor, not only on basic search engines but on a growing list of websites that rate, rank and dissect the careers of physicians.

As of this month, you can even read and write doctor ratings at Angie’s List, the site where members in 120 metropolitan areas rank their plumbers, roofers and landscapers.

But before you start clicking, know this: Your doctor may hate being treated like a plumber — or a dating show contestant.

“Imagine there was a dating site where every time you went on a date, someone could rate you,” says Delia Chiaramonte, a family physician and patient adviser in Towson, Md. “That would really change the way you saw dating. … It definitely makes (doctors) paranoid.”

Doctor-rating sites — especially those that include patient ratings and comments — have the potential to sour already strained relationships between the nation’s patients and physicians, Chiaramonte and other critics say. Though doctors care very much what patients think and welcome scientifically valid patient surveys, anonymous online ratings and rants can ruin reputations and destroy trust, says Nancy Nielsen, president-elect of the American Medical Association.

Patient care suffers, the critics say, when doctors are made defensive and fearful.

But the creators of such sites say they offer essential information. Some, including HealthGrades.com and the newer Vitals.com, include details on training, experience, certification and disciplinary history along with patient ratings. Some include information supplied by physicians: At HealthGrades.com, physicians can pay a fee to add details and even a video to their profiles, says spokesman Scott Shapiro; at Angie’s List, physicians are welcome to respond to members’ posts, says founder Angie Hicks. Vitals.com also invites physicians to respond, says co-founder Mitchell Rothschild.

Consumers are smart enough to consider the thoughts of other consumers as just one factor when choosing a physician, just as they have traditionally considered the opinions of friends and neighbors, Shapiro says. At HealthGrades.com, consumer ratings (on factors ranging from office cleanliness to a physician’s listening skills) are just “one data element among many,” he says. The site does not include free-form comments.

Angie’s List does, and the comments are useful, Hicks says: “People are still looking for that over-the-back-fence kind of recommendation.”

But the fact that Web surfers can’t see who’s behind that fence bothers many physicians. “One disgruntled patient” could cause a lot of trouble, Nielsen says. And, she says, “doctors are not going to want to spend their time going into a (site) and correcting a smear.”

Hicks, Shapiro and Rothschild say their sites block multiple negative or positive postings from the same source. And, they say, the bottom line is that we live in an age in which consumers seek information from many different sources before making major decisions. The sites just make relevant facts and opinions more accessible, they say.

“A lot of information is good,” Rothschild says. “More is better.”

HOW TO TAKE THE MORE TRADITIONAL ROUTES

Here are some other options for checking out doctors:

Ask for referrals from a physician you trust. Be sure to ask why your doctor recommends particular colleagues.

Read doctor profiles at websites maintained by hospitals and physicians’ offices.

Check with state medical boards for records of disciplinary action against a physician. Get started with the Federation of State Medical Boards at fsmb.org.

LINK:
How to Find a Doctor Online at CNN.com

ABEM “GRANDFATHERED” PHYSICIANS NOT CONSIDERED BOARD CERTIFED IN NEW YORK

For years, ABMS/ABEM/ACEP/AAEM have sought to eliminate competition from ABPS board certified physicians. In New York State, they seem to have tricked the DOH (Department of Health) into accepting their version of the facts: that only residency trained ER physicians are qualified to practice emergency medicine. Unfortunately, by so doing they may have also stripped board certification in Emergency Medicine from their grandfathered members, who are NOT residency trained in ER medicine.

In their rush to exclude competition from ABPS certified physicians from the practice of Emergency Medicine, ABMS/ABEM/ACEP/AAEM should have heeded the advice in the Proverbs of Solomon, regarding wisdom, or the common prudence, that everything cuts two ways!

ABMS/ABEM/ACEP/AAEM lobbied NYS- DOH to list only ABEM residency trained physicians on their website as being board certified in Emergency Medicine [http://nydoctorprofile.com].
ABPS sought the same privilege but were repeatedly, irrationally and arbitrarily denied. After being unfairly denied on multiple occasions, ABPS finally brought suit against the NYSDOH under Equal Protection, seeking to have ABPS certified physicians listed on the NYSDOH website as board certified, as other boards have successfully done in other states. (see ABCS case)

This issue has been contentiously argued. ACEP officials such as Dr. Melissa Graber
and Dr. Carol Rogala have vehemently castigated ABPS for filing this suit, asserting their lack of basis and ABPS’s reluctance to share their world view, that the only way to practice emergency medicine is after a residency in that specialty.

In other words, why can’t ABPS just keep quiet and allow ABMS/ABEM/ACEP/AAEM to continue their monopoly of Emergency Medicine?

Didn’t Daniels [Daniels v. ABEM] lose his case asserting monopolistic practice in Emergency Medicine by ABMS/ABEM/ACEP/AAEM? Not exactly. Daniels lost, but not on the merits.
Daniels was not dismissed on the merits. The error in the Daniels case was, when asked what he was seeking he said he wanted to practice emergency medicine, and if ABEM let him take their test then he would be able to practice. Simple enough, right? Daniels knew that ABMS/ABEM/ACEP/AAEM were lobbying so that for him to practice ER medicine, he had to join their group. He knew, that ABPS would face constant attack, notwithstanding the equivalency of their examination and certification process. That’s just the way it was and is.

But how could Daniels sue ABEM because ABEM won’t let him join them?

If what Daniels said was true and ABMS/ABEM were unlawful monopolizers, then a monopoly existed and he was being economically excluded. The court said, you can’t come to us to help you join a group you claim are unlawful monopolizers under the Sherman antitrust act. We the court, can’t help you join the monopolizers. Dismissed.

But what has occurred in NY is not much different.

Daniels should have joined ABPS and obtained their certification. His practice would have been impeded as well, since hospitals do not consider ABPS board certification and New York State won’t list ABPS as a legitimate board, because, ABMS/ABEM/ACEP/AAEM have lobbied to get NY State to help them eliminate their competitors.

New York listened and will not list a physician not residency trained in ER medicine as board certified on its website. This is inconsistent, since NY lists all the grandfathered ABEM certified physicians who definitely did not do residencies in ER medicine, as board certified.
ABPS cried “Foul!”

Of course, what’s interesting is that if the training was so unique, then any physician not trained in EM, would fail tests of the subject matter. But we know that’s not so…since ABEM grandfathered physicians have managed to do just that, and Daniels and many other excluded physicians are certainly no different in training from the physicians permitted grandfather status from an arbitrary closure of the practice track in EM.

In fact, all of the certified ABPS physicians are convinced they would also pass the ABEM board examination, just like their grand-fathered colleagues. Dwight Collman [ABEM certified], arguably the best ER Board Preparer in the country, did not do a residency in ER medicine. No one doubts his fund of knowledge nor his likely skill in the actual practice of EM.

And of course, what’s so wrong about using NY State to burden ABPS under the guise of jurisprudence or concern for the patient even if the relationship between the means and the ends are irrational? The fact that NY State ends up protecting ABEM/ABMS/ACEP/AAEM from economic competitors, though not a legitimate government purpose, well, that’s alright too, ABMS/ABEM/ACEP/AAEM knows best! Since the legal standard of review would be “rational basis” it seems that ABMS/ABEM/ACEP/AAEM took their chances. Anything can be deemed rational and many courts have found rationality when there was none.

The deck stacked in their favor, ABMS/ABEM/ACEP/AAEM pressed on in lockstep, with their self righteous, strong arm tactics, oblivious to cogent arguments against their positions from the State, who quite frankly, never investigated. What ABMS/ABEM/ACEP/AAEM/NYSDOH forget is that “rational basis” also cuts two ways and ab initio, does not mean abdication of judicial review.

If, as it is said, “Nothing cleanses like daylight”, then ABPS’s contention that its
certified member physicians are under unfair attack by unlawful discrimination, and that ABMS/ABEM/ACEP/AAEM have enlisted the State as aider and abettor in their attempt to destroy ABPS appears to be true.

Under the current NYSDOH rules, only ER residency trained and ABEM certified physicians can list themselves as board certified on the NY Physician Profile website.
(http://nydoctorprofile.com). The website defines “board certification” as:
“If a doctor is Board Certified, this means that he or she had graduated from medical school; completed residency (training in a hospital); trained under supervision in a specialty, and passed an exam given by a medical specialty board.”

That’s right. Under this rule, ABMS/ACEP/ABEM/AAEM, seeking to eliminate ABPS competition, also strips board certification in New York from ABEM grandfathered physicians, not residency trained in Emergency Medicine

Technically, those grandfathered physicians cannot promote themselves in NY State as “Board certified” because they did not do an EM residency. Also, on applications to hospitals that ask for Board Certified physicians, they are as precluded as are ABPS physicians from getting those jobs, although we all know they are just as qualified.

Should the NYSDOH de-list ABEM certified non ER residency trained as not being board certified? ABPS does not think so. To their credit, ABPS does not seek to disenfranchise ABEM grandfathered physicians, but regards them highly, and would be happy to provide them with a new home in AAPS [American Association of Physician Specialists]. All they seek is for their own certified physicians to be treated fairly.

links:
Fighting to “Level the Playing Field” for ABPS Docs in NY

Hear! Hear! Judge Decides NY AAPS Case Goes Forward

Disposable Doctors 2: ER Docs Fight Back in NY

by Joyce Sutphen

The second half of my life will be black
to the white rind of the old and fading moon.
The second half of my life will be water
over the cracked floor of these desert years.
I will land on my feet this time,
knowing at least two languages and who
my friends are. I will dress for the
occasion, and my hair shall be
whatever color I please.
Everyone will go on celebrating the old
birthday, counting the years as usual,
but I will count myself new from this
inception, this imprint of my own desire.

The second half of my life will be swift,
past leaning fenceposts, a gravel shoulder,
asphalt tickets, the beckon of open road.
The second half of my life will be wide-eyed,
fingers shifting through fine sands,
arms loose at my sides, wandering feet.
There will be new dreams every night,
and the drapes will never be closed.
I will toss my string of keys into a deep
well and old letters into the grate.

The second half of my life will be ice
breaking up on the river, rain
soaking the fields, a hand
held out, a fire,
and smoke going
upward, always up.

* Alok Jha, science correspondent
* The Guardian,
* Tuesday January 29 2008

This article appeared in the Guardian on Tuesday January 29 2008 on p12 of the UK news section. It was last updated at 09:23 on January 29 2008.

People are most likely to become depressed in middle age, according to a worldwide study of happiness. The team of economists leading the work found that we are happiest towards the beginning and end of our lives, leaving us most miserable in middle years between 40 and 50.

The results, published in the journal Social Science & Medicine, showed that people’s levels of happiness followed a U-shaped curve, a pattern that was remarkably consistent in the vast majority of countries the researchers looked at, from Azerbaijan to Zimbabwe.

For both men and women in the UK, the probability of depression peaked at around the age of 44. In the US, men were most likely to be unhappiest at 50, while for women the age was 40.

Andrew Oswald, from the University of Warwick, and David Blanchflower, from Dartmouth College in the US, led a study of more than 2 million people from 80 countries to find if happiness was related to age.

They found that the signs of mid-life depression were consistent across many groups of people, irrespective of socio-economic status, whether they had children in the house, were divorced, or were facing changes in jobs or income.

“Some people suffer more than others but in our data the average effect is large,” said Oswald.

“What causes this apparently U-shaped curve, and its similar shape in different parts of the developed and even often developing world, is unknown.

“However, one possibility is that individuals learn to adapt to their strengths and weaknesses, and in mid-life quell their infeasible aspirations. Another possibility is that cheerful people live systematically longer.”

A third possibility is that older people might compare their lives with their peers’. Seeing their friends die could mean people value their remaining years more highly.

Oswald added: “It looks from the data like something happens deep inside humans. For the average person in the modern world, the dip in mental health and happiness comes on slowly, not suddenly in a single year.

“Only in their 50s do most people emerge from the low period. But encouragingly, by the time you are 70, if you are still physically fit then on average you are as happy and mentally healthy as a 20-year-old. Perhaps realising that such feelings are completely normal in mid-life might even help individuals survive this phase better.”

A total of 72 countries were found to follow the U-shaped pattern of happiness. In the eight countries that did not seem to follow the pattern - mostly developing countries - Oswald said that the available data had been less robust, so discerning patterns had been difficult. He added that shorter lifespans might skew the results of a country.

Links:
Positive Psychology: The Science of Happiness

Happiness Takes Effort

All Emergency Physicians Now More than Ever
Mar 2008

Help Us NOW !

Please Contact these Florida Senators in the Next 24 hours!

Email Senator Atwater of N. Palm Beach
or Call (850) 487-5100 and/or Fax (561) 625-5103
Email Senator Alexander of Winter Haven
or Call (850) 487-5044 and/or Fax (863) 298-7980

Email Senator Aronberg of Greenacres/W. Palm Beach
or Call (850) 487-5356 and/or Fax (561) 434-3995

Email Senator Fasano of New Port Richey
or Call (850) 487-5062 and/or Fax (727) 841-4453

Email Senator Jones of Seminole
or Call (850) 487-5065 and/or Fax (727) 549-6413

Email Senator Lawson of Tallahassee
or Call (850) 487-5004 and/or Fax (850) 487-5086

Email Senator Peaden of Crestview
or Call (850) 487-5000 and/or Fax (850) 689-7932

Email Senator Siplin of Orlando
or Call (850) 487-5190 and/or Fax (407) 522-2153

also Email the Lobbyist on this Issue: Bob Asztalos
and/or Fax (850) 224-7968 so that he can also hand deliver

Please note the fax numbers in Tallahassee are unlisted; those listed are for their local office and are probably less effective than a Personal phone call to their staff member.

Help ER docs in Florida and the US - ACTION NOW !!!
Act Now

Help ER docs in Florida and the US - ACTION NOW !!!

Members and Friends of AEP, ER docs in Florida need your help TODAY. NOW!!!

Please read and act below.

The Florida Chapter of ACEP and others are at it again. The attack of non-EM-RT docs is on again. Senate Bill 1184 in Florida is scheduled for a hearing in Tallahassee Wednesday March 12 at 2:30pm. The bills unintended consequences will lead to:

increased staffing shortages in rural and small ERs
increased worsening of the ER doc shortage
creation of an “artificial” shortage of BC ER docs
increased migration of ER docs out of Florida
We need you to act today. The following are members of the Fla Senate committee hearing the bill on Wednesday. Please take a moment to email, fax and/or call these legislators and lets bombard them with the other side of this issue. All you need to do is explain who you are and that you oppose this bill. There is power in numbers. If you have friends or family who are voters in Florida please have them to make calls too.

On the other side of the camp is the Florida chapter of ACEP who is having their annual legislative meeting in Tallahassee that very same day and they will be out in force.

For more information you can go to:

Senate Bill 1184
OR
www.myfloridahouse.gov
and review SB1184 and HB 0509.

S1184 GENERAL BILL, by Saunders (Similar H 0509)
Board-certified Emergency Physicians [SPCC]; Prohibits physicians and osteopathic physicians who complete their certification after January 1, 2009, from holding themselves out as board-certified emergency physicians unless they meet specified requirements, etc.
EFFECTIVE DATE: 07/01/2008.

Senate Bill 1184

Act Now

Print out this News Flash
Create a Generic Letter Saying You Are a Doctor (patient, citizen, etc.), Concerned about the Unintended Consequences and that you Oppose SB 1184
Have Your Office Staff Fax Your Letter 9 times
Make 8 Quick Phone Calls and Leave Your Message
Forward the Info on to Any Family or Friends Who Vote in Florida
atwater.jeff.web@flsenate.gov,
alexander.jd.web@flsenate.gov,
aronberg.dave.web@flsenate.gov,
fasano.mike.web@flsenate.gov,
jones.dennis.web@flsenate.gov,
lawson.alfred.web@flsenate.gov,
peaden.durell.web@flsenate.gov,
siplin.gary.web@flsenate.gov,
bob@baahealth.us

Act Now

ER doctors in Florida need your help today. Email, Fax, and/or Call before Wed at 2:30pm

Join our mailing list!

web: http://www.AEP.org

Association of Emergency Physicians | 911 Whitewater Drive | Mars | PA | 16046

Susan Abram
L.A. Daily News

A growing group of singles spent Valentine’s Day celebrating the power of one. Call them quirky, but don’t call them loners. For the self-described “quirkyalone,” Valentine’s Day was all about thinking outside of the heart-shaped box of chocolates.

“For me, being a quirkyalone doesn’t always mean you are single,” said Sasha Cagen, who coined the phrase nearly 10 years ago in an essay that spawned a book called “Quirkyalone: A Manifesto for Uncompromising Romantics.”

“It just means you have another perception of life. It means being single is not a life sentence. It means you disapprove of settling.”

Since writing her essay and starting the Web site quirkyalone.net, a movement has sprouted, with thousands embracing the concept. They celebrated Valentine’s Day as International Quirkyalone Day.

The quirkyalones are not anti-love, just against contrived notions of coupledom, according to their creed.

“It definitely has struck a deep chord with people,” said Cagen, who is surprised that her word - the one she coined one “kissless New Year’s Eve” - has blossomed.

“It’s something people relate to in a deep way. It’s a movement in that it challenges the prevailing notion that you have to be in a relationship to be happy.”

In fact, quirkyalones are defined as fierce romantics. But they don’t date for the sake of dating, Cagen said. They believe in the magic of love, but only if the right pieces fall into place.Until that happens, a quirkyalone’s best mate can be his or her own soul, as well as a good group of friends.

Defining the term

Quirkyalone traits include displaying a talent for self-reflection, believing that life can be prosperous and great with or without a mate, creating and maintaining chosen families of friends, and treating life as one big choose-your-own adventure, according to the Web site, which also includes a quiz and a list of famous quirkyalones. Margaret Cho, Morrissey and Walt Whitman seem to fit the bill, Cagen said.

At a time when more households are being headed by the never married, divorced, separated and widowed, some find the quirkyalone concept empowering.

Recent U.S. census figures show that slightly more than 50 million American homes are maintained by unmarried men or women, or 44 percent of all households nationwide. The Census Bureau found that 30.5 million people live alone in the United States, up 17 percent from 1970.

For Shane Meserve, 37, learning about quirkyalones gave her a sense of place in a society that seems eager to see everyone in pairs.

“I’ve had significant relationships, but I have had long gaps when I wasn’t necessarily in relationships,” she said.

“The book made me realize I’m not abnormal. I’m just a very independent person. I’ve traveled on my own. I have my own goals and a need for my own time.”

What she liked about the quirkyalone concept is that it allows those who are single to feel good about it, something she often doesn’t see in the media.

“It’s not something often portrayed on television shows,” Meserve said. “The over 30 and unmarried are portrayed as people you should feel sorry for. That’s not realistic. There are lots of us who are single, who are not married.”

But the concept has had some detractors, Cagen said. Some people don’t like the word “quirky.” And others still can’t imagine why someone would be happy being single.

“Sometimes people will say it’s an excuse, that you are celebrating a dysfunction,” Cagen said. “They’ll say, ‘You’re too picky or scared,’ or something like that. Once I was on a radio program and a man just called me and accused me of being cold to men.”

Though most who define themselves as quirkyalone are women, men also have found the word validating. A survey on the quirkyalone.net Web site conducted in 2005 found that 21 percent of the 750 respondents were men. Almost half of quirkyalones were 35 and older.

Quirkytogethers

Quirkyalones do find love, sometimes even with each other, or what Cagen calls the “quirkytogether.”

Los Angeles resident Elline Lipkin, 40, a self-defined quirkyalone, found her mate and was married recently.

But she still connects with the quirkyalone concept because she found a man who can respect her need to be alone, to pursue creative projects.

“I came upon Sasha’s book years ago, and it was a bold moment,” she said. “I thought, ‘This is me. Here’s a name for a feeling I’ve had that I never had before.’ “

West Hollywood resident Irene Forrest - who would give her age only as “I could have had generations of children by now” - said she has many friends who are like family, a definite quirkyalone trait.

Forrest has attended International Quirkyalone Day parties in Los Angeles and San Francisco and always found common ground.

“The concept speaks to me in many ways,” she said. “I actually enjoy going to the movies by myself, and I love to walk, to roam around the city on my own. It’s sometimes intrusive when I have to talk to someone.”

Forced dating and holidays don’t appeal to Forrest and other quirkyalones.

“It’s really awful sitting at a table with someone to generate some sort of conversation when you are thinking, ‘I’d rather be (going) home to my slippers.’ “

But Forrest believes true love in some form exists. She hopes she finds it on her terms, on the path she has chosen for herself.

“I just feel that I am starting in so many ways to live my life now,” she said. “It’s still an adventure. There are still dreams to be had.”

LINKS:

Positively Singular

Quirkyalone: A Manifesto for Uncompromising Romantics

Quirkyalone.net

Take the Quirkyalone Quiz

First Chapter

By SANDEEP JAUHAR
Published: January 11, 2008
New York Times

I had been an intern less than an hour, and already I was running late. The sloping footpath leading up to the hospital was paved with gray cobblestones. My feet ached as my oversize leather sandals slipped on the rounded irregular rocks. The hospital was an old building browned by the passage of two centuries, with spidery cracks in its façade. Founded in 1771, New York Hospital is the second-oldest hospital in the United States, a mecca for doctors and patients from all over the world. I had been in the building once before, six months ago, for a residency interview. I spun through a revolving brass door, nearly running into the burly security guard reading the New York Post. He looked up from the tabloid just long enough to point me in the direction of the elevator.
The tiled corridors were dark and dull, mixing shadow and light.

I darted past the chapel, past the café, around the information desk, which sat in the middle of the huge atrium like a fort, and entered a bank of elevators. Hanging on a wall was a portrait of a gray-haired lady in a blue dress sitting in dignified repose before an open book. She was a graduate of the medical school, class of 1899, ninety-nine years ago, who built a medical college for women in Northern India, on the banks of the Ganges, near where my father had his early college education. Nearby was a metal tablet in bas-relief: “She cared for all in need. For each, she made time to guide, to teach, and to heal.”

When I arrived on the fourth floor, other interns were still filing into the auditorium. A woman handed me a manila folder, and I went inside and sat down. The orientation packet contained several essential documents: a house-staff phone card, directions for obtaining autopsies, instructions on how to use the hospital dictation system, and the residency contract. I leafed through it quickly. My salary was going to be $37,000 a year, about eight dollars an hour, I calculated, given the number of hours I was going to be working, but I didn’t mind. Though I was a year shy of thirty, it was more than double what I had ever made.

My classmates, though younger than I, appeared older than I expected, casually dressed, all thirty-five of them, in khakis and polo shirts, faded jeans and sequined tops. Some of them evidently knew each other, because they were already chatting in small, insulated groups. They were from some of the best medical schools in the country: Harvard, Yale, Cornell, Columbia. Though I too had gone to a top school-Washington University in St. Louis-I had been feeling insecure about the prospect of working with them. For months I had feverishly been reading Harrison’s tome on internal medicine and review articles in The New England Journal of Medicine to prepare for this day.

Someone in the front row stood up and turned to face us. It was Shelby Wood, the hospital’s residency director. He was a serious-looking man of medium build, with straight brown hair and a long, aquiline nose. He was wearing a white coat and a fat blue tie that might have been in fashion twenty years earlier. My elder brother, Rajiv, a cardiology fellow at the hospital, six years ahead of me in his medical training (though only two and a half years older), had warned me that Dr. Wood was a bit of a grouch, but had added that he was also fair and decent and a strong advocate for his house staff. Wood, I was to learn, hailed from the old school, where you were expected to live and breathe medicine, stay late in the hospital, neglect your family for the sake of your patients, and emerge on the other side a seasoned physician.

He cleared his throat and began to speak. His voice was deep but incongruously soft, and because I was sitting in the back of the sixty-seat auditorium, I only managed to catch snippets of his remarks. It was going to be a busy year, he said, as thirty-five heads stared motionlessly back at him. We were expected to devote ourselves fully to medicine. “You don’t learn French by taking classes at Hunter College. You learn it by going to Paris, sitting in the cafés, talking to people.” Likewise medicine: we would learn it by living it. “You are now ambassadors for the profession,” he said gravely. “So don’t let the students hear you complain. It sets a bad example.” If everything went as planned, he added, by next June we’d be ready to supervise the next batch of interns.

I glanced over at the pretty brunette sitting next to me. She looked back at me, rolled her eyes, and opened her mouth in mock panic.

Continued at New York Times.com

Links:
‘Intern’ by Sandeep Jauhar

Twenty strategies adapted from the scientific research and applied to New York living.

By Ben Mathis-Lilley
Published Jul 9, 2006 New York Magazine

Decide where to go to college by picking two decent schools and flipping a coin.
The relatively unexamined life is worth living. Barry Schwartz’s The Paradox of Choice documents numerous studies in which thinking too hard about multiple choices leads people to preemptively regret the options they’re going to miss out on. This triggers a stress reaction that tends to focus narrowly on random variables—producing unwise decisions, paralysis, and superfluous law degrees. Those who seize the first option that meets their standards (which don’t have to be low, just defined) are happier than those who insist on finding the perfect solution.

Don’t go to law school.
Lawyers are 3.6 times more likely to be depressed than members of other professions, and it’s not just because their jobs are more stressful. For most people, job stress has little effect on happiness unless it is accompanied by a lack of control (lawyers, of course, have clients to listen to) or involves taking something away from somebody else (a common feature of the legal system).

Illustrations by Knickerbocker

Fire your therapist if he so much as mentions your childhood.
Contra Freud and pro common sense, much of Authentic Happiness author Martin Seligman’s research suggests that rehashing events that enraged you long ago tends to produce depression rather than sweet closure and relief.

If someone tells you he’s still pining for his ex, ask the ex out.
Stumbling on Happiness author Dan Gilbert is currently conducting a study designed to show that the best way to predict how much you’ll enjoy a blind date is to ask the last person to go out with your date how much fun he had.

If you can’t decide what TV to buy, walk across the hall and ask your neighbor if he likes his.
In multiple studies, subjects felt they’d be better able to predict their reaction to an experience by imagining it, rather than hearing somebody else’s testimony. Even regarding such seemingly straightforward activities as deciding whether to eat pretzels or potato chips, they were wrong. Turns out, people are happier following advice.

Illustrations by Knickerbocker
Send the kids off to day care, summer camp, and boarding school.
On a day-to-day basis, caring for children creates roughly the same level of satisfaction as washing the dishes. In fact, surveys of parents invariably find a clear dip in happiness after the Blessed Miracle of Childbirth, which continues unabated for twenty years—bottoming out during adolescence—and only returns to pre-birth levels when the child finally leaves home.

But make sure they’re busy once they get there.
Seligman cites research indicating that children who develop hobbies and interests besides loitering and watching TV are much more likely to be satisfied later in life.

If you go on a shopping spree, throw away the receipts.
In one study cited by both Schwartz and Gilbert, photography students were allowed to keep only one picture taken during their course. Some students were later allowed to swap their choice for a different photo, yet those who couldn’t change were much happier. How did they deal with inflexibility? By rationalizing how much they enjoyed their new decoration.

If you’re on the fence about whether to sell your stock, sell it.
Most people predict that they’d be more unhappy if they sold a stock that went through the roof than if they kept one that tanked. They’re wrong—aggressive actions that go awry are mentally catalogued as valuable learning experiences.

Take the local, and don’t wait for the express.
Inaction, on the other hand, gnaws away at the mind relentlessly, like so many rats chewing on an empty Mountain Dew bottle someone dropped onto the tracks as you idly waited for the 4. You should have just jumped on the 6.

Give up the great American novel, and start temping.
Some poor countries (China, Brazil) are happier than others, but few nations are mired in spiritually fulfilling poverty. Money, when used to feel secure about your ability to shelter and feed yourself, can, in fact, buy happiness.

But don’t work overtime . . .
The marginal life-enhancing value of each extra dollar quickly levels off, however; hence the existence of James Bond villains and studies showing that lottery winners and Forbes 100 members are no more likely to be satisfied than anyone else.

Illustrations by Knickerbocker
. . . As long as you’re content socializing within your tax bracket.
Nevertheless, being aware of how much less money one has acquired than one’s peers is quantifiably frustrating.

Join a church, a yoga studio, an Alcoholics Anonymous group, or an underground fight club.
People who have more friends and belong to community-building groups are happier. To paraphrase the Norm MacDonald–era “Weekend Update,” perhaps that’s the kind of finding that could have been published in the scientific journal Duh, but there it is.

Illustrations by Knickerbocker
Order from the same takeout menu every time.
Researchers found that subjects asked to choose their meals weeks in advance mistakenly predicted that variety would make them happier, while those who simply decided what to eat on the spot were completely satisfied with the same thing each week. (Although eating macaroni and cheese endlessly, like repeating any pleasant experience over and over, reduces its appeal—so switch it up with cheeseburgers.)

Take advantage of your exercise machine’s “cooldown period.”
One study found that men who underwent short, uniformly unpleasant colonoscopies found them more repulsive than men who had long procedures with a brief respite near the end. Adding a slightly less grueling epilogue to a grueling but valuable experience—like a workout—makes you more willing to repeat it in the future, even if it means an increase in the overall gruel endured.

Patronize King Cole’s and other establishments that employ a “mixologist”; avoid any bar named after an Irish person.
Spending your alcohol allowance on a few finely crafted cocktails is probably better than guzzling giant troughs of beer, since the ability to limit one’s indulgence is one of the baseline characteristics of happy people. Researchers aren’t sure whether moderation is chicken or egg, but they do know that teetotaling doesn’t confer any particular advantage.

Ask the next person you meet on Match.com to marry you.
Studies show that married people are happier than unmarried people. Too much choice, whether over tonight’s dinner or your partner for the next 50 years, can create paralysis and anxiety. If you make a mistake, you have the capacity to rationalize the worst decisions. And if all of that doesn’t work, well, we’re able to find happiness in even the most hopeless situations.

Splurge on a restaurant after the Yankees playoff game.
College kids surveyed in the weeks before emotionally high-stakes athletic competitions tended to dramatically overestimate how happy they’d be after wins because they forgot victories don’t eliminate sources of irritation. Similarly, they overestimated how upset they’d be after their team lost because they failed to remember that they could be comforted by other sources of pleasure.

Don’t watch the Knicks.
Not related to any recent scientific findings. Just sound advice.