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1. Graduation Quandry
I attended an eighth grade graduation last night. It was uplifting to see these remarkable young men and women with their smiles and bright futures lying in wait. One young man, though, had me muttering to myself "You really don't have a clue, do you." He was giving his thank you tribute to his parents and talked about going to medical school and becoming a doctor. He told them "When I get out of medical school, I'll buy you a car!" I hope he meant one of those Hot Wheel cars or Matchbox Cars or a plastic model of a car. With the thousands of dollars of loan debt riding on his back once he completes his training, it will be a few years of very hard work before he will be able to fulfill his promise. I truly hope he realizes his ambition and goes on to be a doctor. We always can use great people in our profession. But, do I rain on his celebration? Should I give him the ultimate wake up call? Do I help him look at his future through the lenses of reality? He still has a few years to go before he makes his career choice. I hope they include an informed consent with his medical school application.

2. Animal Planet Lessons for Doctors
The Chairman of our Department of Surgery, Dr. Bruce Branson, used to tell us, as his residents in training, the description of the master surgeon. To be the master surgeon, you need to have the eyes of an eagle, the heart of a lion and the hands of a woman. Those qualities are indeed demonstrated by many of us in the operating room. Unfortunately, when we get back to our offices and have to deal with insurance companies or Medicare or Medicaid (Medi-Cal in my state), in most cases, we morph into a different organism. We become blind as a bat. We often don't see or anticipate or observe what is happening to our profession by these outside sources. We no longer roar with the heart of a lion, but cluck to the beat of our chicken hearts. We either keep taking the reimbursement cuts or the ongoing intrusions into our practices or we do our best Mohmar Khadaffi imitation by continuously redrawing our "lines in the sand", giving in to the ongoing onslaught. Or, speaking of sand, we do our ostrich impersonation by burying our heads in it, either ignoring the changes that are affecting us or wishing they would simply, magically go away. Instead of soft, healing, soothing hands, we have traded them in for those of a Tyrannasaurus Rex. Too small, in proportion, to help ourselves out of this mess. When we wave them to attract attention, we get ignored. Society says: "Why should they need any help when they're so big (so rich) and powerful(respected)?" Those days of being paid a fair wage for the hours of work and responsibility as well as the respect our profession has enjoyed are fading fast! Getting doctors to work together in anything is often described as herding cats. We tend to like our individuality and independence (although that is changing as well). And we like to be the center of our own worlds. However, that world, like everything else in life, is changing. Unless we adapt or at least fight the medical environment pollution, our practices will become extinct. There was a recent story of three large dogs, bull mastifs, that were killed by a swarm of africanized bees. Normally, a single bee or even a few bees would be no more than a nuisance to a dog. A swarm of relentless, organized bees defeated their perceived threat. The threats to our patients and practices are not imagined, but seriously real. I am not optimistic that our current organized medicine institutions can or are willing to put up a fight. They have been disappointing to say the least. I believe we need a grassroots movement that each physician can lead, starting with their own patients,. If we can start educating them, start telling our story to them, it will help take out the "middlemen" interference. We need to swarm together to defend our beloved profession.

3. Doctors gone astray
This past week, three physicians in Southern California were arrested for allegations of committing insurance fraud and performing unnecessary surgery and procedures in exchange for vacations or cosmetic procedures according to the Los Angeles Times. Insurance companies were charged millions of dollars for procedures and surgeries that are alleged to have been performed on people who were recruited by people who worked for the now closed outpatient surgery center. (I wonder what kind of marketing campaign they had?) Reports of deaths or complications were not mentioned.
If these allegations hold up, the physicians are not only looking at spending most of their remaining days in jail, but have tarnished the reputation of my beloved profession. To break your oath to "First, Do No Harm!" and even worse, to scheme to rake in millions by doing so is abhorrent. They would deserve their fate. The medical community should be the among the first to condemn their actions. We should hold ourselves up to a higher standard. How does one transition from an upstanding, well respected physician to the pictures shown on their mug shots? They have exchanged their white coats for orange jump suits. For someone to abdicate their position of trust is repulsive. The only attraction in their future may be coming when they meet their "new friends" in jail. They may not need prostate exams for quite awhile. It gives the "pokey" a new meaning. I hope the allegations aren't true, but I'm not going to hold my breath.

4. Blue over the Blue
As a publicly traded company, our area Blue Cross provider has a primary responsibility to their share holders. As any company that you would want to invest in, they aim to optimize profits. They do this by increasing their revenue, thus the increase in the premiums that we pay for the health insurance coverage. They also improve the bottom line by reducing costs, thus the increases in Co-pays and a decrease in the treatments covered. They are going to further reduce their costs on the backs of the doctors. We received notification that as of June 1, 2007, our reimbursement for our most commonly performed general surgical procedures is being slashed 4-30% To be fair, we are scheduled to receive increases about 10% increases for breast biopsies, but most of these are now being done minimally invasively and not surgically. 10% increase of nothing is a whole lot of nothing. We also are getting a raise for an open appendectomy by about 6%, but still hardly worth the time and trouble and liability to get up in the middle of the night to perform. ($612.51). That figure covers the surgery, the post-operative rounds at the hospital and the post-operative care including any dressing or supplies that are provided by the surgeon. We are certainly in for the blues! Do we take it like usual or make a stand? You have to make your own decision.

5. The Ghost of Trauma Past
Three o'clock in the afternoon is a strange time for a haunting to occur. I was seeing the last few patients of the day in my office when my nurse spoke a name from my past. It hit me like a shot. All the cliche responses occurred. I felt a knot in the pit of my stomach, goose bumps, and shivers ran up and down my spine. I was about to face an apparition, J.D. (not his real initials). A part of my life flashed before my eyes to a time five years earlier. . . . While dozing in an uneasy sleep, I was jolted awake by the shrieking of my cell phone, 2 hours past the witching hour. On the other end of the call, the emergency room doctor was summoning me to the hospital to manage the injuries of an 18 year old male with multiple gun shot wounds. Since I was on call for trauma that night, it was my dubious duty to come in and assume his care. In my first few years of practice, when the trauma calls came, I would feel the adrenaline rush, the body and mind instantly charged and focused on the challenge at hand. After a few years, the novelty wears off. Whether it is a building cynicism or experience that these types of cases involve hours and hours of intensive, hard work, sleep deprivation, being away from the family, an added, mostly unwanted burden to the elective patient load, increased liability risks as well as demands of your time from the victim's family, the law officers and hospital administration with very little or no compensation to show for it tends to blunt one's enthusiasm. All those conflicting thoughts and feelings were debated on the drive into the hospital. But, on arrival, you step onto your stage. The mind is cleared. All the training and experience come together in this moment to manage the injuries professionally. No more complaining or whining. Do the job. It's Show Time. I'm expecting to hear the usual tale of the victim. I'm not disappointed. "I was minding my own *&%^$#@ business when some dude shot me. No I don't know who it was. No, I don't know why." This time, and not just because a bullet hit his jaw, it seemed a little different. Later, after the fact, I learned that J.D. was indeed minding his own business, visiting with a relative on his porch at home when a juvenile delinquent, bent on joining the local gang, randomly picked J.D. and shot him, hoping to kill him and fulfill one of the initiation requirements. As I began trying to get more health information from him, he quickly deteriorated. He went into shock as his belly was filling up with blood. We ran him over to the operating room and began his resuscitation with fluid and blood products. As his abdomen was so tense and I feared that opening it would release all the pressure that was tamponading the bleeding site, I cracked open his chest and compressed the aorta to improve his blood pressure and give the anesthesiologist a chance to place more lines and replace as much of the blood loss as possible. He did a miraculous job and bought precious time to get caught up with the fluids. We were finally able to explore his abdomen, finding multiple bowel lacerations and an iliac vein that was the culprit for his hemorrhagic shock. His other wounds were to his jaw and hand which were temporized while his resuscitation continued once we got him out of the O.R. and into the intensive care unit. Over the next two months of hospitalization, with the help of many specialists, several more surgeries, including fasciotomies of the right lower extremity, several more exploratory laparotomies, including a colostomy, hand surgery, oral surgery, and a tracheostomy, he survived and went home. We successfully took down the colostomy a few months later. His overall recovery was slow and painful. His disabilities were substantial and, I thought they would be permanent. Because of the gunshot wound to his left hand, he lost a finger and there were contractures to rehabilitate. He had a foot drop and had to use a brace and a cane in order to walk. The one positive, despite all the hypotension, was that his mind remained sharp and clear. Even though the payments from Medi-Cal were so low they were insulting, I had invested too much work and time in him to turn his treatment over to the County Health System. After a few months, he was finally able to reach the point where he no longer needed my help and was discharged from my care. My last memory of him was a weak shake of the hand and watching him slowly limp down my office hallway, cane in hand, his mother walking alongside and the sad feelings and pessimistic thoughts that I had for his future tragically altered. That last encounter was over three years ago. But at this moment, a visitation was about to unfold. J.D. was in the waiting room, asking to see me. I opened the hallway door and discovered a young man reborn. He walked over to me, beaming, back straight, without a hitch in his step, and shook my hand with vigor. He gave me an update on how he was doing. His parents were going through a divorce and he was applying for a job, but he was enjoying life, thanks to a lot of hard work and God's help. He was able to participate in pick up basketball games and league baseball now. He had to leave to fulfill an obligation and the time we shared was all too short. As we once again parted, he shook my hand, gave me a hug and whispered something that froze me in my tracks: "Thank you, Dr. Lowe. You're one of my heroes." One of my professors told me, "Doctors don't remember the good things that have happened. We remember the bad things: the deaths, complications and unintended consequences that occur in the practice of medicine." They scar us, turn dreams into nightmares, gnaw at our souls and change us and the way we provide care, hopefully for the better. This time, J.D., the ghost of trauma past, dragged me back into realizing what we're here for and why we've devoted our lives to promote the health of our patients; Why we put up with all the frustrations, physical, mental, emotional and relationship challenges, the ongoing interference by the Government and the insurance companies to do what we do. It's not all about the Benjamins. We want to make a positive impact in the world. We want to relieve pain and suffering. We want to snatch patients from the grasp of the grim reaper, at least for as long as possible. Maybe it's smiply that we want to be someone's hero.

6. What you see is what you get
I just got back from snowboarding. We went with my youngest son's school. It was, "Totally Rad!" (I think that's the latest term, but none of the "shredders" want to talk to an old fogey!) I was remembering how painful the process of learning this new sport was in the beginning, as I had been an avid skier before. That's another story I'll be sharing in the future. I recall those early terrifying days of learning how to snowboard and trying to avoid certain death, permanent disability or injuring others. One of those early instructions that came to me as I was brushing the snow off after a fall was: "Wherever you look, that's where you will go." That is so true in everything in life. Whatever we focus our attention to, that's where we will go or that's what we will attract into our lives. If we pay attention and focus on what's really important, we will be rewarded with riches beyond measure. For an example, if you focus on and are truly committed to your wife or husband or signiificant other, there is no room for distraction or temptation from others. Your bond is secure. It is when we are looking away from what we should be concentrating on, we end up in places that we shouldn't be or didn't intend to be. It works on the slopes. It works in life. Look for the positive and you will be drawn to that aspect and in return, attract positive things.

7. Warning Will Robinson!
I read an article yesterday in David Horowitz's Consumer Watch column in the Costco monthly newsletter. He quoted the Federal Trade Commission investigation into home based business offers. Most of the get rich quick without having to work "oppportunities" are big money makers. Unfortunately, the only ones making the money are the schemers and not us who are trying to supplement our incomes. They are taking advantage of people's vulnerability and sometimes their desperate situations. Preying on fear. I wonder if they can sense it through the electronic mediums of today, like a sharp senses blood in the water. It is a rare day when anything good comes without hard work. If you get approached by someone who promises thousands of dollars in a few days or weeks with a few hours or even less work, don't ignore that voice in the back of your mind saying : "This is too good to be true!" Just like the robot in "Lost In Space", this is YOUR warning! There are unscrupulous people looking to take advantage of you. There IS danger. Do your homework before siging on that dotted line.

8. First impressions
My wife is an avid animal lover. This includes even the six-legged variety. A few weeks ago, she came back from a store specializing in supplies for supporting the wild bird population in the backyard. (If she had her druthers, she would support the entire wild bird population of our state!) She brought back a book about bees and announced that she was going to raise bees in the backyard. Images of the standard bee hive and killer bees sprung into our heads. All kinds of objections were raised by the family. I'm a big sissy about getting stung and a few of the in-laws are allergic to bee stings. Rather than putting my foot down and say "over my or at least my in-laws dead (from anaphylactic shock from getting stung) bodies". I started to read the book that she brought home and to learn about what she was wanting to do. The bees that she was thinking about raising are not the honey bee that most of us instantly think of. Those were brought over from Europe. The bees of interest are native, solo type bees that are quite harmless, but do a great service of being better pollinators of the surrounding crops. As we are often apt to do, we jump to conclusions based on past experiences, good or bad, when presented with change or something new. When you hear about a home based business or multi-level marketing, most often, there is an immediate and sometimes audible recoil. But, take the time to truly look into the opportunites that it presents. Is it something that you could be passionate to promote it. Is it something that you would use and be helpful to others? Before totally dismissing a new idea, thought, oropportunity, take a step back, look at it objectively, evaluate all the good and bad before you totally reject it. I'm looking forward to the new bees in our backyard!

9. What Sounds Will We Hear?
I just received a shiney new pamphlet, advertising the FOURTH Annual Non-Clinical Careers for Physicians Conference: Your Action Plan for the Future. Apparently this has been successful as this is the fourth year for it to be offered. It states that the course is designed for physicians who: "Don't enjoy going to work anymore. Are frustrated and dissatisfied with their current career. Would like to eliminate the stress and time commitments of their current career and spend more time with their families. Are deciding whether to change careers;" and more. This conference caters to physicians who are nearing retirement or to a growing number who have seen their incomes shrink or at least not keep up with the cost of living. It also provides answers to physicians who are tired of providing the best medical care possible while fighting the hassles from insurance companies, government regulations, hospital administrators trying to cut their costs and the constant paranoia of doing everything possible to avoid getting sued. The sounds society is hearing now is the stampede of doctors leaving medical practices. Will the sounds of the physicians' footsteps in the hospital hallways be replaced by people cries, asking who will take care of them?

10. What Sounds

11. What Sounds Will

12. What Sounds Will

13. Weight loss progress
Well, I'm five days into the program and so far have lost 5 1/2 pounds. Not too bad. The first night, I did a Linda Blair impression with some nausea and vomiting and felt a little shakey for the first two days, but I'm doing much better. I'm not sure if I was not feeling that well as I stopped drinking the diet colas as well. I'm using the shake meal replacement product called the Amigo Trim. It's the Vanilla flavor. It's a little sweet for my liking, but it works well. If you add less water, it will make a pudding that I find to be more palatable. Others on this weight loss program have lost more, but I'm satisfied with my progress so far. We'll see how it goes!

14. The Final Day
I'm not a morbid person, really! I was watching Grey's Anatomy with my wife last night. (I really try not to watch many medical shows since I get enough of it in my regular life!) It was a rerun, but the opening and closing lines really struck home with me. The narration goes: "What would you do if you knew that this was the last day of your life?" What would YOU do, or think, or say if you knew that this was the last day of your life? My wish for everyone would be that they would be with the ones that they love, to right any wrongs, to be able to think back on good memories, to forgive themselves for mistakes or regrets that they may have and to say that they have fought the good fight, that they lived to their fullest potentials, that they made the world around them a better place and they were ready to meet their Creator. We need to live this gift of life like every day is our last day. I'm making changes in my life so that it will be my experience. It's not a goal because as Val Smyth would say, goals are negotiable. It is my inevitable expectation to be able to say that I was significant and have no regrets.

15. Here we go
I received the weight loss product from National Health Labs yesterday. My overall weight loss goal is not so much the total number of pounds, but less problems with heartburn and sleep apnea (smaller pant sizes would be great too!). But, I like tracking if there is any progress or not and the weight change will help to gauge that. I started it today. The program consists of shakes, a thermogenic weight loss tablet and intestinal stimulant. I was pleasantly surprised at how good the shake tastes, even without being completely dissolved. It reminds me of a malt. The tablet, though, has a bit of a nasty taste. We'll see how it goes!

16. Valentine's Day
Cupid just got run over by Daimler-Chrysler today. It might take some plastic surgery to remove that three pointed star impression from his forehead. The company announced that it, like GM and Ford, is cutting thousands of jobs. Unfortunately, their financial books matched the traditional color of Valentine's Day. My heart goes out to those who got a pink slip instead of a card. Don't look through rose colored glasses, but, in every challenge lies an opportunity. It may be a chance to become your own boss. No more dependency on an employer who has the company's best interest in mind and probably not yours. There are many home based businesses that may bring financial freedom and control over your life again.

17. Lions, Tigers and Bears
The producers of nutritional supplements as well as herbal and natural remedies are not regulated by the government. Their survival in this competitive environment is dependent mostly on free market principles. There is the occasional company and marketing spokesperson who either has an inferior product that is camouflaged in glitz and fancy packing or who makes exaggerated, or worse totally false and unsubstantiated claims not supported by scientific studies or were based on studies taken out of context or mistakenly applied to human physiology. Although many medications that are used in traditional medicine owe their discovering to plants or other natural phenomena, natural does not always equal safety. Other than Daniel and his friends, would you walk into a lion's den, a tiger's path, or an occupied bear cave? Those companies who earn their consumer's trust and create products of excellent quality that people need and want and are the ones who survive. Natural Health Labs is one of those that has thrived for 20 years. Naturally, of course.

18. Focus
Directing all your attention, effort and energy to make your dreams a reality is what allows our subconscious mind to be fully integrated wtih the conscious mind. However, when things don't seem to be happening the way we think they should, we might need to step back and take another look. To redirect our view of things, or our focus. Sometimes we get so focused on the tree that we can't see the forest. The other day, I was rushing to try and get into an online classroom. The sign in page was different. There was now a password that was required. I was so focused on the fact that I didn't know the password, that I could only see the box that required the input and COMPLETELY missed, right below it, with a LARGE RED arrow pointing to the password! Sometimes we need to take a break from our every day scrambling and make sure our focus is on the right things. Things that are important and really matter: Our relationships and what we want our legacy to be. As Stephen Covey succintly wrote: "Begin with the end in mind." How well did we live and use our God given time and talents? Do the decisions that I make daily support the ending that I want oram I sabotaging it. When I near the end of my life, I know I won't be regretting that I wasn't able to do another few surgeries. I want to be satisfied that I was a good husband and father and that I made the world around me a little better by helping to alleviate pain and suffering in those that entrusted their lives to me.

19. Hospital Use by the Obese
I came across a recent article in Medscape that stated that the number of hospital stays of obese patients more than doubled between 1996 and 2004. The obesity problem is increasing the use of hospital resources. They accounted for 1.7 million hospital stays in 2004. Of these 126,000 were admitted for treatment of their obesity by weight loss surgery at a cost to the hospital (and not what the patients or their insurance paid) of $11,700 per stay. Other diseases that were responsible for the other 1.2 million admissions include hardening of the arteries, congestive heart failure, osteoarthritis, skin infections, depression, diabetes and lung problems. An effective weight loss program can be effective at preventing a lot of these illnesses and could reduce the need for surgical treatments. I'm still awaiting my weight loss products to arrive, but will continue to add to this blog as things progress.

20. The Magic Bullet?
I was watching the news last night to learn about a new pill that was being tested that promised weight reduction. There were interviews of people who had lost 40-60 pounds over 6 months. I haven't seen this medication described in my medical journals yet, but I'm sure I will get exposed to it soon. I tend to take a wait and see attitude on new medications, treatment or surgical procedures. All the benefits are well publicized. The promise of better or improved health with little or no work or need for only a short recovery or very little pain is always appealing to us. We all want the magic bullet that will change our lives in an instant. I hope that this new medicataion option for weight reduction pans out. But, remember the complications that cropped up with the Phen-Fen treatments? Although the numbers were small, the complication of severe heart valve and lung problems were more life threatening than the weight that was lost! I will wait and see how this does in the market, but until then, I'll get a head start on my own with some old fashioned work and sweat!

21. A Dose of my own Medicine
It's time I take my own advice! I am the only one accountable for my well being. The current nutritional supplements do make me feel better and much less tired. However, I've been carrying around an extra 20-30 pounds that I would like to get rid of! It is so hypocritical to tell people to live healthier lives when I'm one of the worst at doing so. I don't eat properly, I don't sleep enough and the "tire" I'm carrying around my stomach is getting much too large! My weight has caused some esophageal reflux and maybe even some sleep apnea. I think getting some of this weight off will help. I've started and stopped dieting and exercising so many times and have rationalized it everytime. BUT, no more excuses! I just ordered a new weight loss product from the same company that I get the supplements from. I wanted to give it a try. I want to see if the claims they make are really true or another empty promise. I'll post the progress on this blog regularly.

22. Courage to complete
Have you heard the motivational saying: "Commit to completion." It is a short way of saying that you must have the integrity in yourself to finish a task or project or whatever in your life that you wanted to accomplish that was important to do. I think it takes a lot of courage to do so as well. To step out of your comfort zone and change your life or do something totally different takes courage. It is not that we don't fear the ridicule that may come, but we continue to work towards what we envision our lives to be despite the fear. We continue to work towards our dreams despite the set backs and bumps in the road because we know that our lives will be better once we do get to "complete". It is not an easy journey. Most of what is good in life is seldomly easy. But, it IS easy to give up, stop trying, and make excuses for not getting things accomplished or not making changes in our lives. It is easy to blame others for our failing. It is the courageous who have the integrity to realize that the only one who is accountable for your success or failure is you.

23. Surprising Source of Air Pollution
An interesting fact was recently brought to my attention from American Medical News. Did you know that indoor air pollution is among the top 5 environmental risks to public health? Who would have thought? The pollutants can be bacteria, mold, or even formaldehyde. Indoor levels can be 2-5 times higher than outdoors. With the need for more energy conservation, there are tighter seals on windows and doors. This may lead to poor air flow and more exposure to the dangers. Anti-oxidants help fight against the toxins that we are exposed to in our daily lives. I didn't think I might have to use them to protect me from my home or office!

24. Death and Taxes
The question to the answers in the Jeopardy Gameshow would be: Things we can not avoid, Alex? Even though we can't live forever, why not live the best we can? Even though we were given our own genetic pattern, something that so far can't be changed, we do have some control over the environment (or what we subject our selves to) that is exposed to what we were born with. Did you know that onlyl 1% of the health care dollars spent in the U.S. goes towards prevention and public health research? How much better wellbeing could be achieved if each of us individually would be more proactive in his or her own health? We need to do our preventive check ups and procedures as unpleasant as they may seem. We can make this journey through life much more enjoyable! There has been more evidence showing that anti-oxidants can help prevent heart disease and possibly lower our susceptibility to other diseases. We can get these by eating more of those foods that contain them: blueberries, cranberries, grapes, etc. However, a lot of us, in our busy lives, are not able to get these into our diets. We turn to nutritional supplements to fill in the gaps that we experience. It is a pleasure to be able to provide products at a reasonable cost which can lead to improved health and well being!

25. Things of beauty
My father was a family physician and two of my older brothers also are physicians. So, there was a little pressure to follow in those footsteps. But in those "rebellious" college years, I was going to do anything but medicine. I didn't burn my bridges, though, and still did the premed classes while I pursued a piano performance major. All through those years, my piano professor and mentor would tell me that if I did pursue a medical career, I would need things of beauty in my life to combat those events or times when the ugliness rears its head. She has been so right. I'm so appreciative of that advice. One of the hardest things we have to do in medicine is to tell a patient that you have nothing more to offer them, nothing more you can do except provide comfort and be there for them. It absolutely sucks. Being able to offer a product that helps people feel better or that may slow or prevent disease is very satisfying and is one of those "things of beauty" that I have added to my life. It helps bring in a light to chase away those dark times. We can never have enough "things of beauty" in our lives.

26. Faith, Hope and Trust
On my previous postings, I have talked mainly about my feelings about my profession and briefly mentioned home based businesses. The nutrition and supplement business is a multi-billion dollar business in North America. One of the first classes we received in my medical school was on "quackery" and how unscrupulous people try and take advantage of an unsuspecting public. People would pay large sums of money for products that had no proven benefit or advantage over other, less expensive products that were easily available. Maybe we were "programmed" to have a bias against non-conventional treatments and products. There are plenty of products out there that make outrageous claims. They can "treat" numerous diseases and even cancer! Too bad there aren't advertised products that would help make people's skepticism healthy. The saying: "If it sounds too good to be true, it probably is" would be a good motto to keep in mind when evaluating any type of product. Despite advances in traditional medicine that have increased the average life span, many have lost faith in our abilities and motives. They see the pharmaceutical companies having huge profits while some juggle their budgets and have to choose between paying for their prescriptions or other needs. They see the medication that was the newest and best thing to prolong their life end up recalled because of some bad complication that may not have been disclosed in their studies. Some health conditions or diseases still are not completely understood. People suffer and in some cases, traditional medicine does not have much to offer. People need hope. When one option is exhausted, we turn to others to relieve pain and suffering. That is the allure of alternative medicine. Unlike traditional medicine, there is a mysteriousness about it that is appealing. We all have friends or family who have stories about alternative medicine and or nutritional supplements that made their lives better. Unfortunately, there are unscrupulous people out there willing to exaggerate the truth or use information way out of context to take advantage of our vulnerability in order to fill their bank accounts. They profit on people's pain. In traditional medicine AND in whatever venture you choose if you develop a homebased business, we need to be able to gain people's trust. In order to do that we have to be trustworthy. We need to be able to talk about our treatments or products or services in an honest, ethical and open manner. The discussion must be factual and not deceitful. The alternatives and options should be provided. What we have at Amigo Juice is a great product. I started using this because of the anti-oxidant capability of the contents. I was skeptical at first, but I actually do feel better. I don't get as fatigued as I did before taking it. Do I think it's going to prevent me from developing hypertension, diabetes, or cancer? No, but as more evidence that taking anti-oxidants may prevent heart disease and other diseases, and since I feel better and the cost is not any more than other vitamins and supplements, I'll keep using it.

27. Passion and the home based business
Do you remember when we sent in our applications in hopes of acceptance to medical school? I'm sure most of them had some phrase in there referring to the desire to serve our fellow sisters and brethren in the noble calling of medicine. Does that desire still burn in your stomach? Or, is it a distant memory. As in many other professions, teaching for instance, the practice of medicine is truly a calling. There isn't enough money to compensate us for some of the things we do and the sacrifices we make. However, how many of us can still say that we can't wait to start our days, to see that first patient, or to (quoting the movie Good Will Hunting): "Start the healing". Do you remember thinking to yourself: "I can't believe I get paid for doing this!" I do. I want to start feeling that again. I want that passion for my wonderful profession back again. I need to be unchained from all the worries, business aspects and personal sacrifice of practicing medicine to rekindle it. This may sound too much like an advertisement, but I know my home based business will be a part of that solution.

28. Why should doctors develop a home based business? part 2
Payment for medical care in the U.S. for those over 65 years of age and also for the permanently disabled is covered by a government program called Medicare. The physicians have "successfully" fought off a 4% reduction in pay in 2006 and for this year a 5% reduction. Hooray for us! As our overhead costs increase, the overall effect is still a reduction in take home pay. My specialty college, The American College of Surgeons, has calculated that we will overall have a 1% decline in payment compared to other physicians. In every challenge lies a great opportunity to succeed. Do we succumb to the insanity of doing the same things: see more patients, work longer hours, moonlight in other jobs, and expect to see different results? Or, do we decide to be courageous and improve our lives in another way? Can we still practice medicine and experience the joy and satisfaction it provides when we can help our patients improve their health? If we can provide care without the hindrance of government interference and limitations without having to worry about declining reimbursement, I believe we can. So back to the original question. . . Developing a second income stream from a home based business or other source can remove the worries and pressures to work harder and longer as well as the loss of time in our personal lives that we can never get back again. I'm tired of having to remind my family who I am. How about you?

29. Why does a medical doctor want a home based business?
Blogging is a new project for me. In starting this quest, a home based business, there have been a lot of new skills, terms and people that I have been learning about. I've got a long way to go still, but, fortunately, I have had the privilege of joining a real team of incredible people. They have been so helpful! Stepping out into this vast world of internet marketing is frightening yet exciting. Everything you see is shiney and attractive and you can be easily distracted. Having a team of experienced people helping you out every step of the way has made these first steps feel like I'm on solid ground and not the shifting sands or worse, thin ice! So why would a successful physician want a home based business? I need to do this for my soul. I need to be able to care for my patients without any external pressures. I need to be able to have the time to reconnect with my family. I need more balance in my life wihtout having to resort to 100 hour work weeks to make up for decreasing payments for the same or even more complex services. Despite how medicine is portrayed on the multitude of television shows, the essence of medicine is the relationship of the patient with his or her physician. We are dedicated to doing anything we can to restore our patient to the best well being as possible. Unfortunately, there are more and more forces that we, as a profession, should have foreseen and fought, that are intruding and interfering with that relationship and responsibility. The honor we have to be entrusted with our patients' lives is humbling. The joy and personal satisfaction in seeing them recover and return to productive lives is immeasurable. Yet, there is trouble ahead for medical care and coverage in the U.S. What are your thoughts?