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In the animal kingdom, there are some relative universals for each species as they interact. All cats seem to enjoy the cat’s social equivalent of a handshake, which is the butt-hello (see “The Butt Hello: And Other Ways My Cats Drive Me Crazy” by Ted Meyer).

As I am sure any of you who have owned pets have also noted in your critters, my cats each have their own personaliti​es. This includes their favorite scritch-spo​ts and activities. My six cats are not exceptions. F_ has a love for pens, particularly ones in active use writing; he loves to have his ears rubbed, and can be counted on for an affection head-butt. S_ loves to have her neck scratched, sometimes emulating Linda Blair as she twists around to help get the exact spot underneath my fingers. T_ prefers to be cradled like a baby and have her sides rubbed, all the while commenting on life and the world while simultaneou​sly purring; the appropriate state of relaxation is unfortunate​ly also accompanied by drooling, a small price to pay for kitty satisfaction. M_ is a slut for being brushed, and once the right level has been reached, cannot resist closing his eyes and rolling on his side. He also at that point is unable to keep his tongue entirely in his mouth - very cute. S2_ is happiest when he can cuddle up next to my wife and bury his head underneath her hair, nuzzling her neck. T2_ enjoys “towel-time​”, waiting until the shower door is opened and then jumping up to the highest towel-cover​ed zone (hazardous when my wife has wrapped a towel in turban-fash​ion around her head). T2_ then requires at least five minutes of complete body massage and petting. Any of you visiting are welcome to experiment; we will apply safety principles by cat-claw trimming on a regular basis to blunt the sharp-and-pointies!

With cats, the rewards of a vigorous purring and the kneading of paws (“making biscuits”) are usually a giveaway that the right scritch-spot has been found. Dogs may not purr, but they will lean into your hand when the right behind-the-ear spot has been found, will roll on their backs to allow their chests to be rubbed, and go into the spontaneous “can’t keep the back leg still” when the premier scratching spots have been found. And the enjoyment of a good scritch is not limited to cats and dogs. TV documentaries on bears may not identify their participati​on in the old “bear-Pope” joke, but will often show them using trees as convenient back-scratc​h posts.

Now, I view my job as a surgeon in the academic world as not just to operate, but to teach, motivate, re-direct, and hopefully inspire – the residents, the medical students, the nurses, the patients, and everyone else involved. As a behavioralist, I am thankful that these are learnable behaviors, and not traits or skills that one must be born with like Athena bursting full-grown from Zeus’ head. There is hope for all of us that we can learn and acquire these skills; I have to thank CGT for opening my eyes to many of these concepts.

For far too long, especially in the world of medicine, our interaction​s have been governed by an outdated mode of “leave-alon​e or zap ‘em”. On a daily basis, if no one hits you with an electric cattle prod, you assume that you are doing okay; but this just works at best to re-direct unacceptabl​e behavior; where’s the reward? Where’s the carrot (or chocolate, etc)? Fifteen days of not being called to the chairman’s office for a “severe chastisement” is not a reward, it just says you were successful in staying off the skyline.

I have never wanted to just “do okay”, and I don’t want the people around me to accept that “doing okay” is where the goal should be set. I want to come in every day and enjoy doing work that I am passionate about, and to share that enjoyment and passion with the people around me. I think that with passion and enjoyment, it is inevitable that people will strive to improve and excel.

So, back to “what I have learned from my cats and dogs". Enjoyment of the right scritch-spot being addressed appears common in the animal kingdom. As I have gone through life, I have realized that humans share this trait. No, we rarely see the purring, paw-kneading, or rhythmic leg-jerking in our fellow humans, and it is socially and politically incorrect to try the scritch-behind-the ear for all but the most intimate partners (and even then, approach with caution and humor!).

Rather, the human scritch-spot is more abstract. The book “The One-Minute Manager” recommends brief but meaningful praise as a part of effective criticism; but I have come to realize that one doesn’t need to and shouldn’t wait for conflict and criticism to give this sort of human verbal scratching. Thanks and expressions of respect and appreciation are how we most like to be scratched, and seem to hit the right spot most often when they are immediate, sincere, and relevant. Most humans do not spontaneously purr, but a quick smile is often confirmation that your attempt to find and address one of the “scritch-spots” has hit the mark.

The biggest requirement is an awareness of the people in the world around you. It does not take much time. It can start with one of the principles from Dale Carnegie’s old book, “How to win friends and influence people” – try to learn and use people’s names. Express your recognition of people’s efforts, and include how they affect you. For the housekeeper​s who have to come in and clean up the ORs and the ED trauma rooms, I try to remember to thank them for doing this dirty job, because without them we wouldn’t be ready for the next patient.

I try to identify particular points that people have done well, and remark and congratulat​e them on these points, the more specific, the better – “your knot-tying has really improved over the past week in the OR”, “your operative dictations are getting clearer and addressing the appropriate details”, “I could tell that that irate patient was difficult, and I admire the way you kept your responses under control while under fire”. I also find that including how I feel about these particulars increases the effectivene​ss of the praise or thanks that I am trying to convey. And the side-benefi​ts of this for me are tremendous – I ENJOY the people around me more, and feel like a better and more positive person – more like someone that I would like to be around and be friends with.

So, everyday I try to look for what I can compliment in the people around me. Sometimes it’s hard; I may be having a bad day, or the person I’m addressing has truly taken a wrong path. That is when I have to concentrate and observe even more, and work at catching them doing something, sometimes ANYTHING, right, and commenting upon it.

Now, while I have mentioned cats and dogs, students, and co-workers, applying these practices should not stop there. Who are the most important people in your life? Your spouse, your family, your friends. My grandfather used to say “Don’t make excuses – your friends don’t need them, and your enemies won’t believe them”. But sincere explanation​s, praise, thanks, and admiration ARE necessary to build trust and respect. It is even more important to try to practice these things with my friends and family.

Another saying I recall from growing up was a famous line from “Love Story” – “Love means never having to say you’re sorry”. What a crock! Love, which is built on trust and respect, absolutely requires that you learn to say “I’m sorry”, and say it in a meaningful way. That does not mean saying “I’m sorry … but …” – that is simply a further attempt to rationalize and excuse yourself. Learning to apologize includes acknowledging your mistakes, recognizing how they affected people, and pledging to try to improve. Trying to rationalize is just one way of selfishly complimenting yourself – patting yourself on the back just builds up your own pride and ego, and distances you from the people around you. So, concentrate on finding and addressing the scritch-spots of the folks around you; stop worrying about your own scritch-spots, trust the folks you love to address them for you.

Last night, my old fraternity brothers held a wonderful get-together for me over at MS’s house. Some of us have stayed in regular contact; some of us have been away from each other for years. The bonds between us are not based upon time, but rather timeless principles of Christian trust, respect, and love. We found that 20+ years apart were just as the passing of a single day in our relationships. I am humbled that I have been blessed by having all of them in my life. As I have traveled down this road of facing my cancer, I have realized that I have been given a unique blessing and opportunity​; I have been given the chance to reach out and reconnect with people, and to tell them (and especially my brothers) that having all of you in my life has helped me to become who I am, and to be a better person. And I thank you.

And finally, I try every day to let my wonderful wife know that I trust, respect, and love her. I continue to be amazed that she puts up with me and my faults and eccentricit​ies. Every day with her is a gift from God for which I give thanks. Having her in my life is truly the best part of every day for me.

So, don’t wait for tomorrow to tell the folks around you how you feel. Love takes work, but it gets easier with practice. What I wish for you today to reach out to the ones you love, and express to them what them mean to you.

Well, that’s the mushy rambling part for today. As usual, my wife and I will find something to laugh about, and something in the world to appreciate with joy and wonder. I pray for the same for each and every one of you.

Until we meet on the other side, may God hold each and every one of you in the palms of his hands.

Too little, too late. If she truly believes that membership in this organization is proper, then why resign?

Well, the obvious answer will be implemented by Obamacare.

Don't need to go through informed consent. If you meet the bureaucratic definition of brain death, your organs will be harvested and transplanted into a patient who needs them. Cut down on the wait-list. Can't let those organs go to waste. Achieve cost-effectiveness.

"We've come for your husband's liver!"

A friend of mine’s mother died from gastric bypass.
Sorry to hear about that - my condolences.

The truth about it is that most of these surgeries do not keep the weight off. There a many that suffer complications and some do die.

Actually, the above is NOT true.

There are a number of different operations that have been proposed for weight reduction. These include the jejunoileal bypass (now decidedly out of favor), vertically-banded gastroplasty, roux-en-y gastric bypass, and the more recent gastric banding procedure.

There is no cook-book one-size-fits-all procedure. As with any surgery, risks must be weighed against benefits.

Appropriately performed procedures must also be part of a comprehensive multidisciplinary chronic regimen, including periodic nutritional assessment. Long-term followups have shown that indeed a significant amount of excess weight is lost and stays off. The complication rates are relatively low, but are not zero.

If you are considering this surgery, find a surgeon certified by the American Board of Surgery; a center that has been certified for bariatric surgery; and ask your surgeon and other physicians about the procedures and followup.

A few links:
http://www.mayo/gastric-bypass/hq01465clinic.com/health
http://www.asbs.org/
http://jama.ama-assn.org/cgi/content/full/294/15/1986

Hard to argue with the math:
cost = $1 trillion
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for 16 million new coverage patients

= $62,500 / person

Who's smoking what?

Hmm. So, he calls himself a physician & surgeon, yet espouses jihad. An interesting cognitive dissonance; perhaps his comments were "taken out of context".
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A little background search for facts & data (always fun to interject these into discussions!) on Dr. Esam Salem Omeish finds:

Appears to have passed his General Surgery boards.

Is NOT a Fellow of the American College of Surgeons.

While he appears to have completed a general surgery residency, not sure where - perhaps Georgetown (med school also) or Newark Beth Israel Medical Center, NJ

Only peer-reviewed publication in the medical literature is:
J Vasc Surg. 1998 Nov;28(5):939-43.
Chondrosarcoma of the aorta: a rare source of bowel and lower extremity emboli.
Clark N, Goldenkranz RJ, Maeuser H, Brener BJ, Brief DK, Huston J, Hertz S, Omeish E, Manicone J, Aueron F, Parsonnet V.

If this is him, his only medical publication is as the -eighth- author of a case report.

Interestingly enough, he is currently listed as chief of the division of general surgery at INOVA Alexandria Hospital; he was elected by his peers, which does speak of some ability and competency.

Some of the on-line puff pieces comment on his number of operations (5000), and that he provides care for uninsured/indigent. Well, I did about 2300 operations in the space of less than 50 weeks as an -academic practice- trauma surgeon, with less than 50% of the patients having a paying source. So, these numbers represent a mid to low volume surgical practice.

The Sophists were correct. HOW you ask makes a difference.

Suggested question:
"We would very much like to commemorate the hard-working health care professionals who participated in bringing our president into the world. Would you please inform us in which Hawai'ian hospital President Obama was born?"

Well, there are a few issues here (thanks BC for deluding the public that blowjobs aren't sex, and thus aren't a health risk (/sarcasm)):

--------------------------------
Oral Sex Increases Throat Cancer Risk Scientists Say
May 10, 2007 ... In a new study, US scientists suggest that people who have oral sex with 5 or more partners during their lifetime have a much greater chance ...
www.medicalnewstoday.com/articles/70495.php

Oral Sex Can Add to HPV Cancer Risk - TIME
Doctors have connected the human papillomavirus (HPV) and oral sex to an increased risk of an oral cancer in both sexes.
www.time.com/time/health/article/0,8599,1619814,00.html

Clueless on STDs, Throat Cancer, and Oral Sex - US News and World ...
Feb 19, 2008 ... Clueless on STDs, Throat Cancer, and Oral Sex
... Granted, the major risk for STDs comes with vaginal sex, but the relative ease and growing ...
health.usnews.com/articles/health/sexual-reproductive/2008/02/19/clueless-on -stds-throat-cancer-and-oral-sex.html

Oral Sex Increases Risk Of Throat Cancer
Researchers at the Johns Hopkins Kimmel Cancer Center have conclusive evidence that human papillomavirus (HPV) causes some throat cancers in both men and ...
www.sciencedaily.com/releases/2007/05/070509210142.htm

--------------------------------
--------------------------------
See the following review:
Vaccine. 2008 Aug 19;26 Suppl 10:K53-61.
An update of prophylactic human papillomavirus L1 virus-like particle vaccine clinical trial results.
Schiller JT, Castellsagué X, Villa LL, Hildesheim A.

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And the following scenario is all too common:
Young girl/boy is sexually assaulted/molested by family member, runs away from home, living on the streets devolves into turning tricks & life of prostitution. Cascade of bad choices destroying life. When they come to the end of the road, obviously diseased with no job skills, etc., they still need medical care. Which costs money. Who pays? All of the rest of us.

--------------------------------
So, what to do?
If you or your children already have HPV, vaccinations don't help.
If you or your children DON'T have HPV, vaccinations DO help.
Someday, your child may get into a relationship with someone who has HPV. No one is carrying a scarlet letter for STDs on their foreheads. Vaccination may protect them for life. Talk to your doctor.

Hmm - anyone got names & contact numbers for these folks?

Hate to say, but there is little that is really new in this report. Suggestions for triage criteria have been around for decades.

There are essentially two different situations for triage:

1 - there are enough resources (people, supplies, room, etc.) to handle all of the patients. Practical application of triage involves getting the right resources to the right patients at the right time.

2 - there are NOT enough resources to handle all of the patients. This situation sucks. You KNOW that some, probably many, of the patients will die. You fix the ones that you can treat, and you try to make the ones that you cannot save at least comfortable.

While I sincerely hope and pray that none of us face this second situation, as an attending surgeon practicing trauma and critical care medicine for over a decade in the "ivory towers", I can tell you that it is really the "ivory trenches". Our EDs nationwide are already overflowing, and not just from the worried well.

At my institution, our orthopedic surgery team operates around the clock. Several of my recent call nights have involved responding to over 20 major trauma cases a night. A quick glance at the trauma pager over the last 24 hours (a light Saturday night): 6 MVCs, 1 fall, 4 GSWs, 1 burn, 3 blunt assault. These are just the trauma patients that the ED doctors could NOT handle, and does not include the emergent general surgery patients that came in (acute appendicitis, cholecystitis, bowel obstruction, abscesses, etc.)

Despite the volume of trauma climbing (trauma visits alone up over 100% in the past 7 years, going from about 2200/year to over 4400/year), we have FEWER attending surgeons covering the trauma surgery service. The 80-hour work week rules for residents have further reduced the available resources; when gaps in resident doctor coverage occur, the attending has to deal with it. I have to make triage decisions about resources every day.

Just do a Google search on physician work force, much less surgeon work force. The storm is coming - fewer doctors, much fewer general surgeons, increasing population.

Some of my suggestions for what you can do if you are not a doctor/nurse:

1 - learn CPR (in a disaster, this experience will help you identify those who have problems that you can maybe fix with your own hands (e.g. airway), as well as those that you cannot

2 - volunteer at your local hospital, especially the ED.

3 - prepare your own medical supplies kits for home and car - don't need to buy the ready-made kits, but you do need to read what is in them and why in order to make your own decisions about what you need and are prepared to use. If you don't know how to intubate, carrying an endotracheal tube and laryngoscope is not likely to help anyone.

4 - take a disaster preparation course if you can. And be prepared to realize that disasters are NOT pretty. The triage choices that have to be made in the second situation are ones that can haunt you for the rest of your life.

Nice list with good points. Yes, the media is not your friend, but they CAN be useful tools. Re-read Alinsky's Rules for Radicals - there is NO liberal monopoly on these tactics.

One suggestion for attention-grabbing: big punchbowl with punch, toss a bunch of Baby Ruth bars in there and stir, then have someone wearing a mask of your targetted politician try to serve people. You can come up with your own lines from the obvious "turd in the punchbowl" concept; can personalize with little toothpicks with a message flag on them, e.g. "Stimulus / Porkulus Package of 2009" shoved into each candy bar.

But once you've gotten attention, GET YOUR MESSAGE OUT. Keep it simple, concrete, name names, and STAY ON MESSAGE. The attention-grabbing stunts are fun window-dressing that can be used to advantage, but don't let the stunts obscure the message.

Perhaps he was referring to the US-Arab relationship during the period 1939-1945? /sarcasm off

“Stop the Bullet” - can easily be fixed with some printed adhesive labels to the correct slogan “Stop the ACORN FRAUD”. Go for it - become a “reform community activist”

So...what's the best mailing address for Rahm now?

And what note would be most appropriate..."Looking forward to working with you"?

Or would a quick alert such as "You've got a leak ... fix it before you sleep with the fish" have just the right punch to kick his latent paranoia into hopefully self-destructive overdrive?

This leads to an obvious strategy.

Sue all of these Secretaries of State for not doing their job and placing Calero on the ballot. Start with these cases as slam-dunk issues.

Establish the lines of responsibility and accountability. Get the courts to rule.

THEN expand to address Obama’s eligibility.

Welcome to the epidemic disease of trauma. I am a general surgeon who specializes in trauma and surgical critical care. These are my patients.

Trauma-related injuries are the leading cause of death for Americans between the ages of 1 year to 44 years (CDC data, look it up yourself).

Trauma removes more citizens from productive life, either temporarily or permanently, than any other disease.

(If you want to get into the horribly technical details, google "Disability Adjusted Life Years" or check out http://www.worldbank.org/html/extdr/hnp/hddflash/workp/wp_00068.html).

With some editing and rearrangement of the original post, I have a few thoughts and comments.

A few days earlier, a federal agency had released figures showing the average number of motorcyclists killed in crashes had doubled in Louisiana in the first two years after the state repealed its mandatory helmet law.

Departing Gov. Mike Foster, a biker himself, signed Louisiana's repeal into law in August 1999, saying it represented a move toward "less government."

"Government ought not tell us what we can do to protect ourselves," he said. "We should have enough sense to protect ourselves."

And Americans by now SHOULD have enough sense not to use alcohol or drugs and then get behind the wheel, get in a barroom fight, etc. Yet over 50% of my trauma patients have ingested alcohol or other substances of abuse prior to their trauma. Let's not use arguments made up of straw-men that are perfect; it's not a perfect world.

A motorcyclist is now 26 times more likely to die in a crash than an automobile passenger, with 3,141 killed in 2001. Researchers are still exploring the causes of the sudden rise, and possible culprits include more motorcycles, bigger engines, older riders, increased alcohol consumption, and the repeal of helmet laws.

A report prepared for the Louisiana Highway Safety Commission and issued this year showed that in cases where helmet use was known, bikers not wearing helmets and dying in accidents outnumbered those who did, by 1.6 to 1, after the repeal.

"You can make numbers look like anything you want, say anything you want," said Travis "Blackie" Lawless, a St. James Parish motorcycle officer who wears a helmet on the job but does not when he is off-duty unless the weather is bad.

"Not wearing a helmet does not cause an accident," said Lawless, ABATE-Louisiana's vice president.

True, and completely pointless. This is not about preventing the crash, but about decreasing the risk of fatal or permanently disabling injury. Google "Haddon matrix".

"And just because you have a helmet on does not mean you're going to survive an accident."

No, it just dramatically increases the odds of survival in your favor, reduces the total cost of survivors' care, and reduces the loss of productive man-years to society. See above.

The Louisiana study said a possible key factor in that state is that most bikers in Louisiana apparently have not taken a safety course needed to get the license endorsement to operate a motorcycle. Bikers without a motorcycle endorsement account for 62 percent of the fatalities in Louisiana, the report said.

Lawless and Elkins, a retired chemical-plant worker, agreed that many bikers do not have the safety skills needed to ride motorcycles.

"If [a biker] doesn't know his limitations, he is setting himself up for failure," Lawless said.

No, he's setting himself up for permanent disability or death. If you own a gun, learn how to use it safely and responsibly. If you own a motorcycle, same deal.

Still, the study said, "there is convincing evidence that a decline in helmet use is the most important factor contributing to death and severe injury."

If you want to improve things, start with the areas where even small changes can have big effects. Or, "go where the money is"; speaking of which:

Under the Louisiana law, bikers 18 and older do not have to wear a helmet as long as they have proof of at least $10,000 in medical insurance coverage.

Jim Aiken, an emergency-room doctor at New Orleans' Charity Hospital, ... said the $10,000 in insurance coverage bikers are required to carry to ride helmetless would come nowhere near covering the cost of a lifetime of care, which often falls to the state.

$10,000 won't TOUCH the costs of even ACUTE hospitalization for a serious injury. With just the typical ICU costs of about $2000-3000/day, this will go in a flash.

The cost of the acute care alone falls heavily on the trauma centers. Depending upon the percentage of uninsured trauma patients, the overal reimbursement rates can range from as low as 15% up to maybe 40%. Try keeping any other venture open with those rates.

But to the bikers, getting out on the highway on a Harley unencumbered with a helmet is a freedom issue, one with risk but a matter of choice.

Freedom isn't free; privilege is bought by responsibility. If you can't cover the consequences of your choice, you are being irresponsible and creating a burden to the rest of society.

Just because a person is in handcuffs does not mean that he cannot present as a lethal threat.

Look up the case of the unfortunate St. Louis policeman who was shot to death by a handcuffed suspect. Mistakes made in the arrest (the two policemen failed to find a concealed handgun on the suspect, possibly due to an abbreviated pat-down under chaotic circumstances) reflect unfortunate human error, and do not invalidate the concern of risk.

For this and other instances, try

http://www.lineofduty.com/library/volume_7_program_10.pdf

I'll posit the following: 1. Malpractice claims overwhelmingly involve only 2% of the doctors - the same doctors that the profession won't police.

This is *FALSE*. Get your facts straight before you post straw-man arguments based upon blatantly false data.

Need some help? Try here, for example:

http://www.tsbme.state.tx.us/statistics/pls2002.pdf

From the last page:

Total number of physicians (MD and DO) with active license status and a practice address in TX: 38,093 Total number of the above physicians with one or more claims: 19,388 (50.90%)

Gee...I believe that certain digits are associated with Satan, and thus are an offense to my religious freedom, thus I will tape over any prime number digits on *my* car license tags to express my beliefs. Think that a judge would be understanding?