Sunday, May 1, 2011


Rhetorical questions, questionable rhetoric and whimsical observations about the absurdities of contemporary life:
  • "Sure is a lot of standing water around here," someone said, referring to a huge snow melt and several days of rain.
  • Me:  "It's not just standing, it's loitering!"
  • The three nastiest words you can say to someone in northern Wisconsin:  "Spring is here."  (As a wise man once said:  "There's a vast difference between the first day of spring and the first spring day.")
  • "It was a flood of biblical proportions."  "It was a firestorm of biblical proportions."  "It was a plague of biblical proportions . . . ."
  • Of biblical proportions.  Why do those words always seem to be used in a dire/negative/catastrophic context?
  • "It was a sublime Sunday afternoon of biblical proportions."  You never hear that!
  • "Donald Trump needs to call a press conference and present his official Certificate of Live Hair."--The Vent at
  • If you give up smoking those so-called "e-cigarettes," do you get "e-withdrawal"?
  • "Analyzing humor is like dissecting a frog.  Few people are interested, and the frog dies."--E.B. White.
  • The box of staples I bought recently contains 5,000 of them (200 per strip).  Let's see, at a generous estimate of 100 staplings a year, that's enough for 50 more years, meaning I won't have to buy any until I'm 118. (One less thing to worry about and budget for!)
  • "I remember in school someone asked just before a test if cheating was allowed. The teacher said, 'Yes, but getting caught isn't.'  And wine pairing is like that. If you break the rules, you have to make sure it works."--Renowned sommelier Aldo Sohm.
  • If you ever have some classified information you want hidden, put it in the middle of a privacy notice.
  • “Atheists have license to scoff at damnation, but to believe in God and not in hell is ultimately to disbelieve in the reality of human choices. If there’s no possibility of saying No to paradise, then none of our No’s have any real meaning, either. They’re like home runs or strikeouts in a children’s game where nobody’s keeping score.”--Ross Douthat in The New York Times.
  • Overheard:  "He was dressed to the eights!"
  • From a blurb touting the 2nd Annual Milwaukee's Taste of Great Brewers:  "Sample more than 200 craft and import beers from more than 50 different breweries."
  • (At the risk of coming off as a latter-day Carrie Nation:  Don't we have enough alcohol on the market already?  The proverbial "juices of the devil's brain"!  Do we really need more?)
  • A pox on all those companies (and that would be about 100 percent of them) that tell you everything you might possibly want to know on their Web sites. . . except their phone number!  (And automated, "Touch Tone Tango" 800-level numbers don't count.)
  • Did you know that the guy who invented the little metal clasp atop the fly of men's (and women's?) pants made $8 million from it?  (And that was when $8 million was real money.)
  • My lawyer lives in such an exclusive neighborhood,  the McDonald's has separate drive-through for stretch limos!
  • Idea:  Why doesn't the government hunt down and hire all the guys who come up with all those ingenious tax loopholes that are hugely responsible for our revenue shortfall and deficit?
  • Memo to those people who say "in-a-resting" and "re-la-tor" instead of "interesting" and "realtor":   Get some treatment!
  • All those who have ever flushed out their water heaters at the intervals mandated by the owner's manual, raise your hands.  (And then you should get some treatment!)
  • All those who could put their hands on their high school or college diplomas within two hours, raise your hands.
  • I'm getting so good at changing the vacuum-cleaner bag, I bet I could do it professionally.
  • Today's Media Words (words you encounter in newspapers or TV/radio newscasts but never heard an actual person use in real life):  Quell, ire and ardor.
  • How much respect can you possibly have for a doctor with a pot belly?
  • Obituary Headline Nickname O' The Week:  "Tree." As in Patrick "Tree" Phelps Jr. (Green Bay Press-Gazette obituary, April 7, 2011).  R.I.P., Mr. Phelps.
  • Twenty-first entry in the Wisconsin Town I Didn't Know Existed Until I Saw it Mentioned in a Newspaper Obituary  sweepstakes: Poygan, Wis.  (R.I.P.,  Lorraine E. Seifert , Green Bay Press-Gazette obituary, March 2, 2011.)  Previous entries: Athelstane, Walhain, Duck Creek, Breed, Anston, Sobieski, Amberg, Osseo, Angelica, Brazeau, Waukechon, Sugar Camp, Kossuth, Lessor, Kunesh, Pulcifer, Cato, Florence, Greenleaf and Eaton.
  • Jim's Book Title of the Week:  "The Big-Ass Book of Home Decor," by Mark Montano.
  • Today's Bulgarian Lesson: Какво ще те мислят за следващата?  ("What'll they think of next?")


A doctor's take on digital medical records

This was a response to "Medical records going digital; Electronic systems expected to reduce costs, improve care" (Page 1, April 12),  by Chicago Tribune reporter Bruce Japsen. The story touched upon the privacy concerns of the patients; however, many other logistic concerns were ignored, in the view of the doctor whose Voice of the People letter follows:

 In my successful suburban solo family practice of several years, I did not use electronic medical records. Knowledge of each patient I served was on the tip of my tongue when an emergency-room doctor seeing one of my patients called in the middle of a night. I was available 24/7 with few exceptions. The paper records were organized such that I was able to access clinical details quickly when needed.

As I stepped into the role of a chief medical officer and a teaching faculty member at a Federally Qualified Community Health Center dedicated to serve our safety-net populations (uninsured, underinsured and Medicaid patients), with 25-plus physicians, including residents in training, we all realized that a popular brand of EMR in place was no panacea! It prevented us from functioning efficiently, caused frustration and lowered staff morale. The system was slow generally, froze up a few times a day and crashed every few months, requiring us to reschedule patients. Pricey service calls, multiple system updates, periodic shutdowns, user training and hiring of a full-time IT expert at a significant cost helped some, but the dissatisfaction persisted. Our experience taught us that:

• IT systems are still in development; warranties and service agreements often leave a buyer unprotected.

• Federal incentives for adoption of EMRs come with complicated bureaucratic requirements.

• Small practices and already challenged safety-net hospitals cannot afford on-site dedicated IT support.

• Documentation and accessibility of information in EMR is more time-consuming than paper records.

• Significant user training and practice are necessary; more than just email skills are required for EMRs.

• Data backup is a prudent need and often requires additional investment.

• Physician office EMRs may be incompatible with the systems used by hospitals in that community.

• Some pharmacies sell electronic prescription data to drug companies. Does that pose risk to patients?

• HIPAA laws and local facility rules can discourage unauthorized access but do not fully prevent it.

On the flip side, compared to paper records, the information in EMRs is legible and relatively easily available for quality measurements and reporting purposes. It is doubtful, following my review of hundreds of EMRs, that English grammar gets any more respect in the EMRs, if patient care is any better or safer, or if there is a built-in cost saving attributed to the use of EMRs.

I guess, after spending the next several million dollars that we do not have, we may gain a better understanding of the value and "meaningful use" of the EMRs.
--Dr. Arvind K. Goyal, clinical associate professor, Family Medicine and Preventive Medicine, Chicago Medical School/Rosalind Franklin University, past president, Illinois State Medical Society