May 17

Why I am Leaving Medicine

Kenneth A. Feucht, M.D., Ph.D.

I formally decided to quasi-retire in October of 2016. This meant for me, getting out of the surgical oncology profession. My intention is to continue working until 31MAR2018 in an outpatient wound care clinic associated with the hospital in Puyallup, WA where I live. Remember that training in my profession consisted of 15 years past the 12 years through high school, so that I have completely identified myself as a surgeon, making my profession not easy to give up. I would have liked to continue practice until I was 65 or more, but frustration with medicine and the changes which have occurred since becoming a physician have led to my desire to leave medicine. This is not an easy decision. I have a deep love for my patients, and found the profession to be quite rewarding. It was particularly satisfying dealing with patients not only for the relief of their physical ailment, but also to help them psychologically and spiritually through a major crisis in their life, which is usually the situation when somebody is given a diagnosis of cancer. With my decision to retire a bit earlier than I had wished, I felt that chronicling the root causes for my decision would be appropriate. The list of my grievances with the health care profession is in no way intended to be comprehensive, but to cover the major areas of frustration for me as a surgeon. This is NOT an in-depth, heavily researched paper with references and documentation, but an off-the-cuff rendering of my feelings regarding the status of health care. Perhaps someday I will take the time to render a more academic version of this treatise.

Health Care Orientation

Hospitals began in the fourth century in central Turkey in a region called Cappadocia. At that time, the poor and destitute who were ill were abandoned by the community and sent away into the woods, where they were often eaten by wolves or other forest beasts. This allowed for containment of communicable diseases, but did not reflect well on the care of the ill patient. It was St. Basil who took these poor people and reincorporated them into a caring community environment. Thus, we get our word “hospice” or “hospital” from the latin word which would be translated as “hospitable”. Hospitals became defined as an agency that attended to and offered the patient an ability to return to the community of the faithful while under care.

Germans have two names for hospitals. The most common is “das Krankenhaus”, though they also use the term “das Hospital”. Translated literally, “Krankenhaus” simply means “sick house”. It is a vastly more fitting word for what we have today, and the term “hospital” should go out of existence. Hospitals are no longer places of caring, and they do not offer the patient a gracious return to the community, or hospitality. They are places where patients are treated with sterile rigor, where children dump aging parents once they have become a nuisance, where occupants are considered to be more work for already overworked nurses, where physicians rapidly fly by patients, knowing that they dare not say either too much or to little, but where everything needs to be documented in a complex electronic database, and where nurses spend most of their time making sure that those databases are replete with boilerplate (and thus useless) data to fulfill various government mandates over what needs to be documented. The entire orientation of healthcare is a narcissistic reflection on themselves looking past and ignoring the raison d’être for their existence, the patient!

Defining “Healthcare”

What is healthcare? What is involved? What is health? What is wellness? How do you define something nebulous? The dictionary defines it as “the maintenance or improvement of health via the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in human beings.” This definition can be strewn out to as broad of meaning as life itself. Is my mental stress over an upcoming test in school a part of healthcare? Is my desire to become and identified as a female when I started out genetically and physically a male a part of healthcare? Is my carelessness in attending to my mental state when I accidentally kill somebody while driving a motor vehicle under the influence of alcohol actually a healthcare problem?

But, why do we even waste the time to precisely define the full nature of healthcare? Is it really important that we have a narrow versus broad definition of healthcare? From a personal point of view, the manner of defining healthcare is unimportant, but from a health care policy perspective, it is vital. The government promises that healthcare will be paid for, but exactly what that means is quite vague. In Germany, going to the spa for a week or two rest is covered. In the USA, the breadth of coverage constantly changes according to what is politically expedient. Oregon attempted to identify and rank cost-effective treatments to determine what might be covered. Since physician assisted suicide is very cost effective, it ranked quite high up. Is this proper? Assisting somebody in suicide seems to be counter to the entire goal of the medical profession, but nobody could doubt that much expense is saved by terminating the patient. If trans-sexual surgery is covered by government policy, why isn’t all cosmetic surgery covered, since it is aiding to personal well-being and how a person defines themselves? Why isn’t food free, since it is really taken to prevent healthcare problems? Why isn’t our housing and the cost of maintaining housing covered, since it all contributes to me maintaining and improving my health?

What about health itself? How do you define health? Is it just the absence of sickness? If so, then obesity would not be a health problem, or smoking, or any other dangerous activity, until it caused a problem. Some people choose to live through disabilities that would be viewed as insurmountable by others and refuse to identify their disabilities as an “illness”.

A frightening result of having an all-encompassing definition of healthcare that is provided for by government, is that they then must adopt the role of supervising our behaviors in order to maximize the government definition of health and well being. Does somebody really want the government telling them that certain activities are forbidden? Does anybody really want government prescribing exactly what you can eat and how much you can eat in order to stay healthy. When Michelle Obama attempted to regulate school lunches in order to decrease obesity, it was found that the children actually became more obese who were on the lunch program. When do we decide that decisions in our life become none of the government’s business? If we allow that government is responsible for health and well-being, we must realize that we are then completely giving away our freedom.

In reality, the public definition of healthcare is impossible and it would be best if we remove any attempt at defining the realm and coverage of what we think as healthcare.

Government interference

We are constantly being bombarded in the news that a new regime of politicians will correct the messes that former regimes have created in federal health care policy. I will speak of ObamaCare specifically a bit later, but here address specifically issues of government policy in health care. Over the course of the last century, we have gone from a situation where there was no government involvement directly in healthcare, to where government pervades virtually every aspect of the healthcare scene. Government first became involved in healthcare in Germany during the tenure of Bismarck. In 1883, he created a national healthcare system which provided insurance to all citizens. Many countries today follow the Bismarck model, though we do not in the USA. (ObamaCare seemed to be a model that attempted to simulate the Bismarck model though not utilizing many of the most important aspects of the Bismarck model.) Through the introduction of Medicare by president Johnson in the 1960’s, there has been a slow invasion of government into the healthcare scene. Government continues to fund increasing amounts of healthcare, and thus has taken an increasing stance toward controlling health care costs. At the same time, the innocent introduction of internal means of quality improvement (such as the JCAHO, which was started by surgeons as a means of voluntarily improving surgical quality across hospitals in the USA) has evolved into a beast that neither improves the care of patient nor the quality of healthcare delivered. More will be spoken on JCAHO later.

In times past, physicians generally took the Hippocratic oath on graduation from medical school. If not the Hippocratic Oath, then a somewhat similar oath (see article on the Hippocratic Oath, referenced below) was offered. In the Hippocratic Oath, three parties are involved, which include the patient, the physician, and the god(s). Glaringly omitted from the ancient oaths were the health care system, insurers, the government, and anybody else outside of the three mentioned. This is only right, and an article I’ve written on the oath covers why such an arrangement is so vital to the doctor-patient interaction (http://feuchtblog.net/die-veroffentlichungen/the-hippocratic-and-other-oaths/ ). Healthcare is now run by a multiplicity of bureaucrats and idiot savants who love to tell physicians and patients what is best for them without any knowledge of either the patient or physician. Government makes a cookie cutter mold that all diseases and persons are supposed to fit into. Diagnoses have a number assigned to them according to the ICD-10 manual, and no diagnosis will fail to have a specific number. Treatments and procedures also have their number, called the CPT code, with a one-size-fits-all mentality.

Government healthcare is run by bureaucrats. These are the self-serving policy wonks and bean counters that control the health care of all occupants of the United States, citizens and non-citizens, consenting and non-consenting, the sick as well as the healthy, the only exception being the politicians themselves. Most often, these healthcare pundits have been in the health care profession as either physicians or nurses, but are now removed from actually providing care, and thus not experiencing the consequences of the policies they implement. Being removed from health care, they may act with heartfelt concern for their colleagues in the trenches, but will never be able to properly address the constantly changing healthcare scene that affects healthcare delivery. In addition, their policies will fail to address all contingencies and variations in the disease process or patient goals and needs.

The government, since they intend on paying for healthcare, are obsessed with the cost of healthcare. Yet, they strangely seem to be the most clueless as to why healthcare costs so much. Perhaps healthcare costs are high because of government interference?

Two organizations from the federal government have been particularly harmful to healthcare, that of the food and drug administration (FDA) and the other the center for disease control (CDC). The FDA started as a well intentioned idea to protect the public from potentially dangerous drugs. The thalidomide incident in the 1960s is instructive. Thalidomide is a medication designed to decrease morning sickness in pregnancy, but was noted well after the fact to occasionally cause phocomelia, very short limbs, in some of the babies exposed to this drug in utero. I’m not sure that thalidomide babies could have been prevented even if the FDA was functioning as they do now, but a good crisis has not gone to waste by the government. It now takes many more years for a drug to go from creation to market in the USA as compared to Europe and other countries in the world. Drug development costs have risen to exceed a billion dollars to get an new drug to market in the USA. Yet, American patients are not safer than European patients, though we are denied rapid access to potentially useful medications.

While the FDA “protects” us against dangerous drugs, the CDC is here to “protect” us from various communicable diseases. I have less of a problem with the CDC than the FDA, though the CDC remains over-reaching in so much of what they do, and persist in trying to justify their own existence. The flu vaccine is a perfect example. It is close to impossible to predict which flu antigens would be dominant in any flu season, and the antigens of choice are made by “educated” guess. I know of no randomized trials that have proven within reasonable doubt that mass forced administration of the flu vaccine decreases morbidity or mortality from the flu. Health care personnel that work for hospitals are mandated to take the flu vaccine, and we have no other options. It matters not that we might have strong personal preferences against the flu vaccine. Another example, Gardasil, the vaccination against HPV, is sold to prevent genital warts, and thus cervical cancer, and is recommended for all males and females between 10-12 years of age. It is of value only for the sexually promiscuous female, but is strongly encouraged that all children receive this vaccine. Long term effects of the vaccine are essentially unknown. The CDC would love to have this vaccine mandated, and there is great pressure on all children to receive the vaccine, even from family physicians. This represents an over-arching hand that doesn’t allow for patients to make personal choices regarding their behaviors and actions, but assumes that all patients (or children) will be irresponsible and not have to take account of their actions. The CDC in effect takes the roll of parent, and displaces the biological parents as having a say in the behavior of your children.

ObamaCare Mess

ObamaCare is presented as the great revolution in healthcare, the solution to all of our problems, the defining policy that will allow all people in America to have adequate health care without obstruction from inability to pay. The health care bill was so voluminous that nobody in congress was able to read it in its entirety, and the proponents demanded that the bill be passed before one could discover what was in it. I won’t belabor the nature of ObamaCare because I have not read the bill, nor have any interest in reading the bill. What I will discuss is how it has affected physicians attempting to care for patients.

Obamacare wished to improve everybody’s access to healthcare, including that of illegal aliens. To do so, health care insurance was mandated to all. If you didn’t purchase healthcare, you were fined. You could either purchase private insurance, or the state would provide options. The rules were tightly defined for enrolling or switching health care plans. The presumption is that all people then had health care. Wrong! The cost of healthcare has continually escalated, and all plans had a copay for any service rendered. Copays were intended to prevent flippant and casual care. In actual fact, it has served to be more restrictive than anything to actual access to care. There are many patients that have turned down a proposed treatment plan for them simply because they could in no way afford the copay. In essence, care became more difficult to get.

ObamaCare also sought to assure that increased value was offered. This had multiple aspects, including patient satisfaction surveys, increased demands on providers to be fully “educated” through CME (more on this later), and increased demands of JCAHO. Patient satisfaction surveys were reported through what are called Press-Ganey scores. For employed physicians, bonuses were heavily dependent of the Press-Ganey scores. While Press-Ganey scores reflected how patients feel about their physician, it had minimal correlation with the competence of the physician. A physician that is the bearer of bad news, no matter how well it is delivered, will often be viewed with less favor than a physician bearing good news. Physicians oftentimes need to reprimand patients or cajole them into healthy behaviors, which is usually not viewed favorably by the patient. Some physicians are quite excellent, but do not have jovial personalities, which patients don’t like. Or, they have a jovial personality but are incompetent, something that a patient might not realize until it is too late. ObamaCare has allowed feelings to supplant honesty and truth, and the end-result will ultimately be disaster. Meanwhile, ObamaCare has flunked in its attempt to define quality in health care, and I’m not sure the ObamaCare act really cares about quality; they simply want the illusion that everybody is getting quality healthcare.

Are people truly having good coverage of their health care problems? The answer is complex, as there are a few people that have coverage that otherwise would have been out. Before government got involved in healthcare, most large cities and all counties had a county hospital that would take care of the indigent. Everybody ultimately received health care. Pharmaceutical firms were good about providing reduced rates on expensive drugs to the poor, and almost all people were able to survive. Now, coverage is actually worse, and many no longer have actual coverage of expensive treatments because they are responsible for a copay, which might be unaffordable. The only group of people who are better covered are those who should not have coverage, such as illegal aliens, or those who are mostly responsible for their own illness, such as burned out drug addicts.

Are the physicians getting rich? Definitely not! Over the last thirty years, physicians had to work harder and longer and more hours to make commensurate pay of the past. As a result, physician burn-out has become a true problem. The solution for physicians has been to become employed. I won’t belabor the problems of employed physicians, save to mention that employment essentially strips them of the definition of a true professional. They are nothing but expensive, sophisticated hired hands, and they will behave as such. People who serve administrative positions in health care are getting rich, and hospital CEOs as well the insurance companies are making out quite well. For the most part, physicians are getting poorer.

ObamaCare has not addressed the reason why healthcare is so expensive, and has diverted the attention from health care costs to health care availability. I am grateful that illegal aliens can receive the best health care in the world for free at my expense. In fact, I am waiting eagerly for anybody to provide an honest analysis of health care costs, and an explanation as to why health care costs in the US are much higher than in Europe or the rest of the world. I can think of many reasons, and simple explanations such as the absence of free markets deflects from serious analysis of costs, which has multifactorial roots.

Physician Regulations

The state has deemed it vital to make sure that physicians are competent. In order to define competence, the state has had to set some sort of prevailing standard, which is an amalgam of current practice and best practice recommendations based on the latest research. This assumes that best practice can be codified and then enforced. It assumes that current prevailing practice is the standard for all physicians and all patients,  and that our knowledge of disease pathology and physiological processes for disease are correct and well understood. Sadly, history is replete with countless times where the medical profession has been wrong and has had to eat their words. It is no wonder that much of what I had learned in training had to be unlearned as simply wrong. Medical practice is in constant change, and not necessarily in the correct direction. One dares not fight the system if the system is going in the wrong direction.

The state needs a way of making sure that physicians are keeping up with the latest and greatest developments in health care. The current standard is to require physician recertification, usually every ten years. The other is the requirement for continuing medical education, or CME. There are serious problems with both of these systems. For recertification, the physician needs to be placed in a box that defines who they are. These boxes are the selected specialties that the physician identifies with, whether that be in family practice, pathology, internal medicine, general surgery, or a host of other specialties. But, these specialties are too vaguely defined, such as in my specialty of general surgery. I am a surgical oncologist, and the American Board of Surgery only recently created a board specific for surgical oncology. Surgical oncology itself is heavily fragmented, between melanoma surgeons, breast surgeons, hepatobiliary surgeons, sarcoma surgeons, and a smattering of other organ specific surgeons. Within the last 20 yars, surgical oncology has essentially lost head and neck surgery, endocrine surgery, thoracic surgery, and colorectal surgery. True, one would like their surgical oncologist proficient in all aspects of cancer surgery, yet reality states otherwise. Regional referral patterns and practices also affect a surgeon’s expertise. Certain diseases are just more prevalent in some areas as compared to other areas of the county. In Chicago, I saw much pancreatic pathology. In Seattle, there is very little pancreatic disease, but a proliferation of other diseases. The truth is that as a professional, one is always reading and educating oneself, and each individual physician will develop a differing broad area of expertise. A simple test imposed by the state is not capable of defining what only the test of real life scenarios can clearly define. Recertification has become a horrid pain to take. I’ve re-certified twice, have done well in my re-certifications, but swore on the last re-certification that I would never do it again, ever, for any reason. Most physicians reach the same conclusions as I have, and the net result is to drive out the aged but experienced physicians. The only exception is in academia, where the surgeon is somewhat protected.

Keeping up with CME is a pain. It is not enough to simply subscribe to various specialty journals and read them on a regular basis. Now, one must answer sets to test questions to assure that you’d acquired the information attempted to be taught by the article. The Journal of the American College of Surgeons would do this for four articles each month, and I dutifully answered their questions for a number of years. About 2 years ago, I realized the stupidity of most of the questions, and how they were usually completely unrelated to my field of practice. The questions were intended to quiz whether you had read the article, but often assumed you had knowledge well beyond that of the article; thus, there was no education of the physician, and failure to judge whether I’ve read and learned from the article. The problem is compounded when articles relate to my own specialty, since I usually read into the question the controversies involved and uncertainty about the information in the article. The multiple guess questions really fail to assess my true knowledge of a subject, yet is mandated in order to assess whether I’m actually staying on top of my specialty. CME updates are demanded by the American Board of Surgery every three years, and I will be letting the next update slide.

Increasing surveillance of physician behavior is happening. This relates to both social behavior, as well as practice outcomes. Hospitals are simply not turning a blind eye to behaviors that would be publicly unacceptable. There has been a change from historical norms, where previously the physician acted mostly without accountability. This is a good thing, and physician antics with the treatment of patients, colleagues or nurses must be now accounted for. The only problem is that it is the hospital that is performing most of the policing, and they have a very strong bias for protecting themselves. Thus, there is predictably unfair judgement against unemployed physicians, and usually it is by someone clueless. I recall, for instance, being reprimanded by the chief medical officer at my hospital for not responding in person to an emergency room call, even though I was in the middle of a case in the operating room. I informed the CMO to no avail that it would be considered unethical and immoral by the American College of Surgeons for me to leave a patient open on the table to attend to another person. Such madness has only gotten worse under ObamaCare. Physicians are still held liable as “captains of the ship” yet are not given the power or authority to maintain that captainship. We are constantly being told to alter our behavior or practice in the most minute ways that have no real bearing on patient outcomes or hospital well-being. The focus has turned from outcomes to process, without any evidence-based data to suggest that behavior changes would be good.

The discussion of “captain of the ship” bears more intensely on issues of hierarchy within the hospital structure. Traditionally, physicians were the main drivers for hospital decisions, dominated the board of directors of a hospital, and were held as primarily responsible for the success or failure of the hospital. Now, responsibility falls to the CEO and his minion of subordinates, most of whom are not physicians, though they might be nurses, pharmacists, physical therapists, or simple business types with no training in medicine. Because of the increasing commercialization of medicine, spread sheets and the color of the bottom line have become the most vital aspect at determining the survivability of a hospital. The physicians have silently gone from being the leaders of the hospital to being nothing but another cost center to be dealt with.

Documentation/HIPPA issues

Until recently, documentation was performed in paper charts, usually a combination of typed text and handwritten notes along with printed reports, lab work, and outside information. Marginal notes would be made in the chart to facilitate jogging the memory of the physician. A typical note would take a few minutes to write, but would be highly effective at documenting an encounter. With the rise of third party indemnification (insurance), the desire to have confirmation of services rendered demanded improved documentation. The saying, “If it isn’t documented, it wasn’t done” became the hallmark message for mass documentation. This led to automation of means of documenting, including boiler plating encounters and procedures. This naturally led to the reverse problem of the past, in that much “documentation” might not have ever been performed. Because boilerplating made possible getting information quicker into electronic format, and with the rise of improved databasing and need for distribution of data, the electronic medical record (EMR) saw its rise. What was once a convenience became a mandated necessity. Many payors no longer accept handwritten charts, and the federal reimbursement systems require EMR for full reimbursement. EMR systems are very expensive, not only to implement, but also to maintain. They solve the problem of a plethora of charts and storage of these charts, as well as issues of lost charts, and the need for multiple simultaneous access to these charts. The down side is harder to see but more destructive. With a combination of requirement for increased documentation, and through the use of boiler plating, excess information now exists, and it is quite challenging to quickly identify the relevant information on a patient. Because of multiple sources for input to the EMR and restricted ability of access users to correct faulty information, the EMR slowly becomes less and less reliable. Errors become quite plentiful, from basic patient information, to diagnoses, medications and treatments.

Meanwhile, privacy of the data has become a greater concern. Physicians were instructed not to talk about patients in the elevator with outside people present, or to share patient data with people outside of the immediate family, unless given permission by the patient. Now, privacy has become a fanatical issue. In the past, I would walk onto a ward, and at the nurses station, a chalkboard list of all the patients and their room number was present. At the door of each room, the patient(s) name(s) were again posted, allowing for re-identification of the patient. This doesn’t happen any more, all in the name of patient privacy. The problem is that it is now easier to confuse or mix up patients, and more errors occur because of that.

Privacy in electronic data is a greater issue. The need for highly secure servers to manage patient data has become the norm, all mandated by HIPPA (federal policy). Yet, the skill of hackers has not been thwarted from obtaining any private patient data that they wish. True privacy is a myth, but the expense that we go through to maintain this illusion of privacy is astronomical. Indeed, true privacy is impossible. Perhaps all patients should present themselves to the physicians office or hospital in full covering like a Burqua or KKK outfit? Yet, the one area where privacy is zilch is with the government. They now know EVERYTHING about you. I fear the government more than I fear some stranger knowing that I happen to be on a β-blocker or some other medication. Yet, the feds have access to every aspect of my health care record.

Big Pharma

I don’t view big pharma as an intrinsic evil, and much of their perceived evil comes from government and legal policy imposed upon them. There is no doubt that the large equipment and pharmaceutical firms have vastly improved the quality of healthcare in our country, as well as throughout the world. It is without a doubt that drugs exist and are available today that never would have been possible without these large companies. But, the large pharmaceutical and equipment firms comes at a terrible cost to all of us.

The large pharmaceutical firms must deal with a host of regulatory agencies, the FDA being the largest of them. One would think that big pharma would be fighting the FDA tooth and nail, yet the opposite is the case. The pharmaceutical firms have seen the FDA as a wonderful means of keeping out smaller competition, which is why you don’t see small pharmaceutical firms in this country. The assistance of the FDA in the assault on the nutritional supplement and vitamin industry is shameful. Big pharma has relished the protection to their industry by the FDA, leading them to become even more powerful at controlling the drug market. Concomitantly, we see larger firms buying up the smaller pharmaceutical firms, and thus becoming ever more powerful.

A secondary problem is created when insurers pay for medication costs, so that the consumer never sees those costs. This becomes problematic if a patient is unable to perform a cost-benefit relationship to determine whether a drug is worth taking. A perfect example are the statin drugs to lower cholesterol. I wait eager to see any statin demonstrate improved survival over the best alternative therapies out there. Statins have a high chance of significant side effects, yet has never been shown to be significantly effective at preventing death from atherosclerotic heart disease. And, they are expensive drugs. Too often, the patient assumes that the physician is using critical judgement in determining the need for a drug, yet the greatest determinant tends to be how good of lunch the drug representative brings to the doctor’s office.

Insurance

A system of third party payment for health care has created the worst possible solution for healthcare. It is a serious misnomer to title health insurance as such, since it does not operate like insurance, but simply as a mode of funding. Insurance supposedly should be most active when there is an acute need, such as with a car accident or a heart attack or a new diagnosis of cancer. Instead, it covers every possible aspect of health care, including runny noses in kids to health maintenance examinations. Under ObamaCare, health insurance is not an optional decision, but mandated by the state. In such a situation, you would expect the health care insurers to making out quite well, and for the most part, they are, with executives of the major insurance companies making exorbitant profits. Yet, there are strains on the system. Insurance is not able to reign in the ever-rising cost of health care, and can only raise premiums and copays to a limit before the system breaks. And, the system is about to break.

Ultimately the big winners in todays system are the insurance companies, but that is a bittersweet win, as they continue to merge with other systems in order to survive. Time will ultimately pass a severe judgement on insurance companies.

Legal Aspects

If you read the popular press, they would suggest that legal issues are a small portion of what’s “broken” in medicine. Whenever malpractice tort reform becomes a subject of referendum up for vote for the public, the advertisements and press attest to litigation being a small part of costs for doing medicine. Yet, those most entrenched in the health care system and actually paying attention what is going on realize that legal aspects of medicine are probably our worst enemy, and that politicians and lawyers who know little of the actual functioning of healthcare are essentially orchestrating how things should be done in the health care world. If a physician suggests changes in the legal world, lawyers tend to attack the physician as ignorant, befuddled, or clueless as to how law actually works. Perhaps outsiders see the legal world a little more clearly than lawyers? Yet, it is most true that lawyers and political meddling in the world of medicine have only left medicine far worse off.

When a physician attends conferences, there are numerous sessions offered on how to avoid or deal with lawsuits. It is made very clear that the physician should understand that everybody gets sued, and that a lawsuit often is the “luck of the draw”, and that a physician should never take a lawsuit personally. Yet, in court, it is presented as just the opposite, and the claim is that there is something wrong with the physician that caused the medical “error”. I place the word error in quotes because it is too often that an error is not an error at all but simply the course of the disease. The lawyer presents a disease process as an entirely controllable phenomenon, and that good outcomes will happen when the standard of care is closely followed. Of course, they will deny this mentality until they are in court, where acts of “nature” serve to reward the lawyer quite generously. In public referenda regarding tort reform, there are usually two most serious claims. The first is that bad physicians need to be punished in order to improve the system. This goes contrary to all evidence yet seen. The second claim is that the tort system preserves patient rights. In actual practice, it does just the opposite, and patients end up with less options and choices in their care because of the malpractice climate which physicians and hospitals have to work in.

Whenever a referendum for tort reform hits the public, the claim defending current practice is that malpractice claims are actually decreasing and that malpractice premiums continue to be less expensive on the physician. Especially after a referendum, this is briefly the case, until the public forgets about matters, after which lawyers come back in force, hungry for more litigation. The malpractice situation has not improved, but remains a crapshoot, where a physician remains highly likely, no matter how excellent they are as a physician, to get sued and lose. The tragedy is that physicians can oftentimes see colleagues that truly are dangerous and yet manage to avoid suits. Cases that hit the public scene are often the most revealing. A few years ago, the leading transplant center in the USA made an error in typing an organ, leading to a hefty lawsuit. But, to what avail? This transplant center defined excellence in care for their service. Does human error necessitate lottery type outcomes for the lawyers and unfortunate patient? That is what happened in the transplant error to a distinguished center of excellence. There are many more similar stories.

What about if the legal profession is eventually proven to be wrong? Do they refund their ill-gotten gains then? I recall the colossal sums won against Dow Corning for the silicone breast implant lawsuit. Not very long later, it was proven beyond doubt that the manufacture of the implant or the nature of silicone did not lead to the alleged autoimmune diseases that the lawsuit purported to have happened. In this situation, the funds should have been returned, at least in part. This only shows that truth and justice are not served in courts of law, and the legal system has no interest in pursuing what is right.

My claim that litigation raises cost of everything is quite easily supported. Think about matters for a brief second. When you stay overnight in the hospital, with minimal attention rendered to you, you could expect a bill for upwards from $20K. I cannot think of any but the most exclusive hotels in the world that would even approach a fraction of that cost, even with servants and the most lavish attention. Why does it cost so much? Medications that are sold for veterinary use typical cost under 10% of what they charge for exactly the same medication with adults. Why? Medical equipment tends to be quite unreasonable in cost compared to similar products in the non-medical market. Oftentimes it is absurd, from a simple little staple gun costing several hundred dollars which if sold as a non-medical item would be several dollars. Why? Incorporated in those costs are both the higher cost of development for the human market, and the potential for litigation. Cows don’t sue, but people do. Yet, there are other subtle cost drivers. Physicians assuredly often act against their best judgement by over-ordering tests and x-rays, and over-treating, all in an effort to protect themselves against litigation. The patient is not given a choice in the matter, or allowed to assume risk. This is because with informed consent, it is still assumed in court that physicians should know better and not have offered choices to the patient if one choice was not assumed to be “standard-of-care”. The physician can’t win, and so plays the game by following the rules, even when the rules are wrong or don’t make sense.

JCAHO

This actually belongs in the “government interference” paragraphs, since the JCAHO is a government organization. Yet, it is so pervasive to all aspects of healthcare, with such overreaching influence on the way medicine is practiced, that it deserves a category of its own. As I write this, my hospital is currently undergoing a JCAHO inspection, and the anxiety of the administration is sky high. They have come by, and declared how various improvements must be made, how there are defects to the system which has so capably served patients. In essence, they are fixing “issues” that are not problems, never were a problem, and never will be a problem. Typically, the fixes are expensive, time consuming, but also require extensive documentation to prove that the fix is actually implemented by the hospital.

One of the most troubling changes in recent years has already be discussed, which are regulations imposed by HIPAA in order to preserve patient privacy. Sadly, HIPAA has failed to recognize that if somebody wishes to bust into the system, it can be done regardless of how intense the security measures are applied to the electronics of the system. The result is the physicians can no longer speak easily with each other about a patient’s care, and the detriment is ultimately to the patient.

JCAHO has long filled any possible useful purpose for itself. Yet, it has become a burgeoning business that must be sustained at all cost. Thus, they have sought desperately to find ways of justifying their own existence. They have accomplished that by creating new and novel regulations each year which they impose on hospitals. They will review hospitals every third year, and if sufficient inadequacies are found, will return a year after their visit to review the hospital for correcting their “mistakes”. During the triennial visit, they will disclose the new regulations, holding the hospital immediately responsible to correct their behaviors and adapt to the regulations. This causes a fleury of anxiety, panic, and hasty development of new hospital policies to match the new regulations. One year, they decided that if a patient was placed in restraints (usually in the ICU), then the order for that had to be renewed weekly. This had never before been a problem, and when there were restraint problems, they were of a nature that a policy would not fix. Another year, it was decided that used instruments or laundry could not be transported to their appropriate destiny in an open environment but had to be completely enclosed. One could hypothesize that bacteria could be spread with these instruments and laundry in open air, yet there has never been an instance where this had ever been a problem. The fix is indeed costly, and must be done in order for a hospital to continue operations. But, the hallway transportation rule defies notion that the hallway itself or the patient room could be transmitting disease between patients. Perhaps the entire hospital needs to be systematically sterilized between patients?

But, JCAHO will continue to work their evil deeds. Health care will become more complex, impersonal, and expensive, and ultimately, less safe. JCAHO is an organization that holds others responsible, but submits to nobody else’s authority. It is a true creature from the black lagoon.

Commercialization of Healthcare

It used to considered immoral for physicians or hospitals to advertise. Pharmaceutical firms were forbidden to advertise prescription products to the public. The American Medical Association held policies forbidding their members from advertising, as found in their code of ethics. The goal for these rules was to keep medicine out of the realm of commercial enterprise. All of that changed in the year 1975, when the federal trade commission considered the AMA policy as an illegal restraint of trade. The AMA rolled over dead. What was immoral one day was considered right and proper the next day. Advertising among health care emerged slowly. Early in my private practice, there was a rule that physicians in our community would not advertise, or even to have their name in bold print in the yellow pages. That disappeared slowly. Soon, one could see a plethora of drug advertising, with elderly patients in perfect health dancing vigorously across the tv screen, proclaiming the miraculous benefits and health giving effects of a medication with multiple side effects and toxicities. A few little lies won’t hurt, would they?

The end result of healthcare commercialization is that it has caused anybody and everybody to seek for a portion of the health care dollar. The highest paid person in a medical community is often the CEO of the hospital. While hospitals still designate themselves as “not for profit”, the non-profit hospital has gone the way of the dodo bird. Quite often, the most vigorously trained physician taking the greatest risks and responsibilities get the least cut of the health care dollar. The pharmaceutical and medical equipment suppliers are making massive profits unheard of in yesteryear.

One could argue that commercialization has led to improved competition and desire for innovation. Yet, competition has always occurred in health care, and innovation has also taken a great toll on our profession, not commensurate with the benefits offered. The most heavily advertised physicians are oftentimes the most marginal physicians. It would be hard to argue that patients are truly better off with advertising. For the reader interested in a erudite discussion of this issue, please read this article… https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563279/ .

The Flexner Report and its Evil children

The Flexner report was funded by the Carnegie foundation, supporting Abraham Flexner in a review of the existing medical schools in the early 20th century. The report was published in 1910, and intended on promoting standardization of medical education and the removal of marginal medical schools. We now see the evil children of the Flexner report, with regulation of the health care professions at an unprecedented level. The net effect we have had on physicians is increased regulation and requirement for continuing education, which was previously discussed. It has restricted the number of physicians in the health care community, and medical schools have not been able to keep up with the demand, especially in an age where increasing numbers of physicians retire early. It is difficult to just build more medical schools, since the cost of medical education is prohibitively expensive, and the state has had to bear part of the burden of these costs in order to keep the supply of physicians at adequate numbers.

There have been several ways in which the health care community has met the demand. First is through the influx of ever greater numbers of foreign medical graduates (FMG’s) from countries where health care education is not so aggressively monitored. The second is the rise of alternative providers, which include physician assistants and nurse practitioners. Both of these groups of providers have much shorter training periods, which would fail the current minimal standards for medical school training as defined by the results of the Flexner report. In essence, the Flexner report has forced its own extinction, and bred an alternative to the physician.

Conclusion

I am not unhappy that I ever became a physician, and feel that it has been a rewarding career. I am very unhappy with what has happened to medicine. It is like a public good has been stolen and no hope for recovery.

I am particularly sad that most people do not identify root causes for problems, but continually ask for immediate, self-serving, quick fixes to the health care problem. It is a truism that until congress and all of government has to live under the same health care plan that they impose on others, there will be no hope for improvement. I wouldn’t count on it ever happening in my lifetime.

Ultimately, health care will kill itself. It is unsustainable. It has lost its soul. Its original driving force was a Judeo-Christian Weltanschauungen, specifically, the belief that all people, young and old, born and unborn, of all races and creeds, were created in God’s image and of intrinsic value. Humans were not viewed as the accidental product of the primordial slime. Human relations were viewed as important as health itself. Suffering had meaning, which oftentimes led patients to delay in seeking a remedy. Pleasure and euphoria (feeling good) were not considered goals of worthy pursuit. Among health care professionals, the pursuit of “health” and prolongation of life seem to be more in line with personal challenges and a game to be played, the chance of honor for a great discovery, rather than the sympathetic concern for the whole person, body and soul. Purpose and meaning in life are oriented around maximizing pleasure and minimizing pain and suffering. Healthcare is the agent responsible for restoring maximal pleasure, either to the individual or to the community, when things go mentally or physically wrong. The greatest creed of healthcare, the Hippocratic Oath, provided the framework for practicing our profession. Without either a framework or a direction, we flounder. Healthcare, rather than being a true profession, becomes the utility of the state to maintain function and order, rather than the pursuit of a higher good. We have lost our soul in medicine. I am leaving medicine because my profession no longer is a profession of Hippocratic orientation. I have no interest in being a duped servant of an evil state.

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Mar 31

The quirks of Presbyterianism

in relation to my Anabaptist roots

My wife and I are religious schizophrenics—we are deeply rooted in both the Presbyterian and Anabaptist traditions. These traditions seem to be polar opposites, though in many ways, the opposite is true. I would like to briefly explore my thoughts on their similarities and differences.

History

My wife and I grew up in the Apostolic Christian Church (ACCA [Apostolic Christian Church in America] and ACCN [Apostolic Christian Church Nazarean]), which are actually two denominations of the Amish-Mennonite Anabaptist tradition that split in the early twentieth century. It is a denomination, in spite of their quirks, that is still dearly loved by me. I consider myself as having a world view shaped by their teaching, notably that of fervor for God’s word, of intense love for the Brethren (which is a non-sexist word and includes females), and anti-militarism. For various pragmatic reasons, our family attended Moody Church while we were living in Chicago, Illinois when I was in surgery residency, a church we also dearly loved, especially with the preaching of pastor Irwin Lutzer. We attended a Baptist church while I was in the Air Force in Biloxi, MS, and really did not like it at all. There was a PCA (Presbyterian Church in America) church in town, but did not attend there because we felt the Presbyterians were heretics and totally off base. It was during my time in Biloxi that I started reading intensely on Dispensationalism versus Reformed theology, and became convinced that Reformed theology (Calvinism, if you wish), had a more consistent approach to Scripture in its entirety than either Dispensational or Anabaptist theology. I also realized that the description of “Calvinism” by Anabaptists and Dispensationalists was entirely in error. On moving to Puyallup, WA, we attended a generic Christian church for a little over a year. I absolutely hated it for its irreverent worship style and weak theology. On recommendation of a close colleague at the hospital, our family broke down and started attending Faith Presbyterian Church in Tacoma, WA, a member of the Presbyterian Church in America denomination. The pastor was the son of the first president of Covenant Seminary in St. Louis, Missouri, and well acquainted with Francis Schaeffer. He was a large drawing point for us. We have been there ever since, with no plans of leaving. We had never formally left the Apostolic Christian Church, and have no idea whether they still consider us to be “members”. Our departure was more by incidence of our life’s journey, rather than a formal choice to leave the ACCN. Thus, my wife and I still consider ourselves to be a part of both worlds.

Comparisons of Anabaptist/Reformed theology

Theology was the driving force for leaving the generic church and going to a church that has Reformed doctrine. Contrary to many thinkers, Calvinism is everything but “once saved, always saved”. This is especially true of the covenantal manifestations of Calvinism. In fact, what is portrayed as Calvinism and what is the true meaning of Reformed doctrine are unrecognizable. I’ll offer several examples. Perseverance of the saints as a doctrine means that the saints will persevere in holiness. It never was intended to mean that a person could never “lose” their salvation, except for that if one is truly saved, they will persist in holiness. The discussable issue on this topic for both Anabaptists and Reformed thinkers relates to assurance of salvation, even though arguments for assurance will follow different lines of thought. Both Anabaptists and Reformed thinkers share the necessity for godly living. A second topic of contention is that of limited atonement, which is a terrible phase that means particular redemption. Most Reformed thinkers advocate a universal calling, and bona fide offer of the gospel for all. The only realm of contention regarding particular redemption is that the Reformed thinkers will say that Christ’s death was EFFICACIOUS only for the saved, something that even Anabaptists would ultimately agree with, unless they hold to the doctrine of ultimate universal salvation for all. The doctrine of total depravity would be an area of contention between Anabaptists and Reformed thinkers that would not be resolvable. Oddly, this is not an issue commonly fought over. Nobody wishes to consider themselves to be Pelagian, so one will usually default to a semi-Pelagian position regarding total depravity, which in my thinking is a most confused approach to depravity. As GK Chesterton has noted, total depravity is the one and only doctrine which is easily verifiable in real life.

The baptism of infants is a point of contention with Anabaptists which is usually terribly misunderstood. Baptism is considered neither a confirmation of salvation nor a witness to the world of salvation. Rather, it, like circumcision, is a representation of a covenant with God.  This covenant has both promises as well as obligations. Much of the obligation is on the parents to raise their children as Christians, and duly expect them to make a profession of faith throughout their life. Many non-Reformed churches have a dedication ceremony which is neither Scriptural or meaningful, save for trying to imitate the ceremony of infant baptism. In terms of when a person actually becomes a Christian, the Reformed doctrine refuses to define a precise method. In fact, virtually every New Testament conversion that is discussed is different. Some children of believers may be converted in utero, others in childhood, others after a period of sinful life, and others never. The point is that the Christian will always need to persist in their profession of faith until death.

Some of the ramifications of the doctrine of predestination may be troubling to the Anabaptist until they give worthy pause to what is actually being said. Predestination most certainly is NOT fatalism, i.e., that the course of history has been set in motion in which nothing will change. I would refer the reader to J.I. Packers’ “Evangelism and the Sovereignty of God” to grasp this issue. It is certain that we are both totally determined yet totally free in our decisions and actions. The explanation for this remains in the divine wisdom of God which cannot be explained. Finally, I wish to note that when one looks at both the Anabaptists and Reformed churches, there are multiple splits numbering in the hundreds to thousands. Most of these splits are related to some subtle doctrinal issue which presents itself as irreconcilable to the church leaders. Even in my lifetime, I’ve seen a number of splits in churches (both Apostolic Christian and PCA) that are inexplainable save for our persisting depravity.

Both the Reformed and Anabaptist traditions are quite intense about their theology and hold it of great importance. The Reformed thinkers have approached theology in a more systematic fashion, and win out in terms of have a more consistent and organized theological base. Unfortunately, the Reformed church knows this, and it tends to breed a very strong sense of arrogance on their part for having “the best” doctrine. The Reformed folk also manifest a sense of divisiveness in their theology, discussed kindly in a recent internet article by John Frame (http://frame-poythress.org/machens-warrior-children/). This article discusses 21 topics that are highly divisive in the PCA church—I think that he is kind, and under-estimates divisive issues, and I mean divisive enough that various groups would hold charges of heresy against contrary thinking. I have seen Presbyterians approach theology with such opinionated aggressive as to wonder if they were not terminally constipated. A recent move in the PCA condemning the theology of federal vision had a vitriol of extreme proportions, yet one had a challenge even defining what one meant by federal vision!

Anabaptists also excel in divisiveness, and there are countless sub-factions of Amish, Mennonites and the like. This Anabaptist divisiveness can either be theological (like a recent ACCA split debating whether or not a Christian could/does sin) or practical (like whether it is permissible to grow beards or have lightning rods on your house). In the Anabaptist circle that I grew up in, theology was a constant discussion. Our discussions as kids were quite crude and seriously misinformed, but we took theology quite seriously and it was a typical subject of discussion when we would get together. I don’t see that fervor in the Reformed church youth—after all, since they hold the “correct” theology, by bother discussing it?

Church polity/discipline

While this may sound strange, both the Reformed and Anabaptist traditions tend toward the Presbyterian model of polity, in contrast to the Congregational or Episcopalian models. Anabaptists do not generally have a paid clergy, though there are exceptions to this rule. Yet, there are central Anabaptist structures, and national meetings of the elders that are akin to the annual presbytery/synod meetings that occur in Reformed circles. The interest of both traditions is to maintain commonalities in theology and worship that define the denomination. To the surprise of Anabaptists, the conservative Reformed denominations (such as the PCA) take church discipline very seriously, and do exercise member expulsion for various sins or absence of repentance. The terms of expulsion or other forms of church discipline differ, but yet there is a very strong sense of the necessity of the church to exercise discipline of its members, and preach the value of a godly lifestyle in all things.

Worship style

The similarities between Anabaptist and Reformed worship is greater than their differences. Both hold a very high estimation of worship and formality in their church meetings. This is true, even though the Anabaptists do everything possible to remove distinctive display elements to their worship, including the display of crosses in church, the wearing of special garments by the ministry, or other outward displays. Oddly, Anabaptist members usually are required to have special garments, such as specially defined head coverings for females, and distinct dress for men. The Anabaptists would never call their service a “high-church” style, yet it has a formality and regulation that is uniform and consistent between churches and enduring through the years. Both Anabaptist and Reformed thinkers have an equal problem with the current contemporary worship service, which consists of worship as entertainment.

Music

The Reformed churches would love to think that they have the great advantage in music. In this regard, they are sorely wrong. As a matter of fact, Presbyterians simply cannot sing. It is true that many Reformed members go on to become professional musicians and that musical instrumentation in the church is of high value. Many Anabaptist churches, including the ACCA denomination which my parents came out of, never even used a keyboard in their services. Yet, I would estimate that most Anabaptist members had home musical training, and greater than 90% were able to sing in 4 part harmony during worship services. They would stay on tune, even singing a cappella. If you examine closely their hymnody, the Anabaptists mostly drew on the German Lutheran/Bach choral tradition, with far more complex harmonies and melodies than could ever be found in a Reformed/Presbyterian congregational hymnal. In addition, the Anabaptists would sing those songs quite well. Playing or singing the ACC hymnal (Zion’s Harp) is far more challenging than playing or singing the PCA Trinity Hymnal. The Presbyterians are slightly more cautious regarding good theology in their songs, but even there, the ACC hymnal has much better tunes for praise, consecration of one’s life, the afterlife, suffering, and general worship than any Reformed Hymnal. The British and Scots just were not as artful in music as the Germans!

Fellowship

In the Anabaptist family, one feels like family. It doesn’t matter where you go in the world. If you encounter another “AC”, you might as well consider yourself a real brother or sister. You are always welcome in their home, as you would welcome them into your home. Much of your free time would be spent at church or with fellow AC’s. The Presbyterians also maintain a sense of community, but no where near the intensity that is found in traditional AC circles. It is common in Anabaptist communities to see them going out of their way to care for each other. An example are the nursing homes that the ACC’s have developed in conjunction with their churches. These serve several uses. First, they care for the debilitated elderly while keeping them out of the ward of the state. Secondly, they allow elderly in the nursing homes to be useful and active, rather than simply shuttering them in. It is a shame that Reformed churches cannot develop such a modality—I presume that they are in fear of “offending” the state or its ordinances.

The fellowship among Anabaptists extends in other ways. Most of the brethren of the AC church could be assumed to be “trustable”. By that, I mean that if there were business contracts or other dealings that transpired among two brothers in the AC denomination, even if the agreement was verbal and not in print, one could assume that the agreement would be faithfully adhered to. It is not the case in the Presbyterian world, and though members all consider themselves as Christian and adhering to the laws of God, your probability of integrity among the “faithful” in the Presbyterian church isn’t much higher than you’d find from somebody randomly picked from the telephone directory or pulled off the street. Indeed it is a sad state of affairs when professing Christians are no different than the world.

Influence in the world/Politics

The Anabaptists tend to stay out of politics. Yet, a number of its sons do go into politics, such as one of the long-standing senators from Illinois who grew up in an ACCA home. The first Presbyterian politician of great acclaim also shamefully happened to be among our worst presidents—Woodrow Wilson. America would have been better off without Presbyterians in government. Presbyterians have served as a positive influence in society, the best example being that of Francis Schaeffer, though often his actions were at odds with those of the Presbyterian church, explaining why he tended to act independent of any Presbyterian mission board. To this date, Presbyterian actions in politics frighten me. While I appreciate their willingness to act as salt and light in the world, and influence the political structure for good, many of the actions of devout Presbyterians have been more detrimental than good on society. I wait pensively for how Donald Trump proves to be as president since he states that he is Presbyterian—his saving grace might be that he is despised by many prominent Presbyterians of both the conservative and liberal stripes. Contrariwise, the action of Anabaptists have also been a touch problematic in that they have not been willing to confront society in the public square and speak truth. Their policy of “letting the world go to hell as we will maintain our private devotion to God” might absolve them from taking a stand for truth and righteousness in the public square, but their failure to speak out will be ruled against them at the last judgement. In my final analysis, I will act like a Presbyterian in the public square, but will shy away from getting political advice from the Presbyterians and vote like a traditional Apostolic Christian.

Summary

My wife and I are caught between two worlds. We love our Anabaptist heritage, and we love our current Presbyterian situation. We see both the best and the worst of both worlds, and see neither as distinctly superior to the other. I could not have had a better time growing up in the ACCN denomination in Portland, Oregon. It nurtured me well in the faith. Yet, we remain most happy in my current situation in the PCA church. We have a beloved and wonderful pastor, our faith has grown steadily under his preaching, and doctrinally we’ve been challenged and grown in ways which never could have happened in nearly other setting. Thus, we feel doubly blessed.

In a previously quoted article, John Frame speaks at length about ceasing quibbling about petty doctrinal and behavior issues in the church. It is a plea for Christian charity and humility among other Christians. I saw this in action when I took a class in systematic theology from JI Packer, experiencing  graciousness of abounding proportions when angrily challenged and confronted on touchy topics in class. I wish that I could manifest the spirit of Dr. Packer! Francis Schaeffer also wrote much about Christians fighting among each other, and his book “The Mark of a Christian” emphasized that as important as doctrine and behavior may be, love for each other needs to shine out strongest.

We will remain Presbyterian for now, but our hearts (and hopefully our behavior) are Anabaptist. Without a doubt, in heaven, these issues will all work out, and we will not have to take sides as Catholic, Anabaptist, Generic Protestant, Lutheran, Presbyterian, Reformed, Anglican, Baptist, or Orthodox. Christ isn’t divided, and I pray that the church would seek more the spirit of unity in Christ than of obscure technical differences.

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Nov 30

trump

Trump: The Art of the Deal, by Donald J. Trump and Tony Schwartz ★★★★

I received this autographed hardback copy before Donald was elected president, and read it in spurts after that. The book’s value is in giving one an insight into how Trump thinks.  The book was written in 1987, and starts with a review of one week in his life, ending with a follow-up of what became of the decisions of that week. The intervening chapters are a limited autobiography of the man, starting from childhood, through his schooling, and then summarizing his early big deals up to 1987. The details of his wheeling-dealing is not terribly interesting save for realizing a few things. 1. Seeing how Trump makes decisions. He always looks for people that he could trust, and who are the best in the business. His biggest admiration is for people of integrity. 2. Seeing how politics affects the most mundane things in life, and how Trump was able to use as well as was hindered by politics. 3. Seeing how bumbling so many other business executives were. There were many examples of very poor decision making, not just in government real estate projects, but also in private interest projects that should never have gone wrong, but did.

This book is of value to read in order to understand the way in which Trump makes decisions. He is neither conservative nor liberal. He is not Republican or Democrat, his religious leaning is toward Christian predominance, and he is not an extreme moralist (or immoralist–he neither smokes nor drinks). Donald is very much a pragmatist, that tends to set goals and hold to those goals. He is not an ideologue, though tends to have guiding principles. He is a great negotiator who is used to holding his cards close to himself, which might irk the ever-snooping main stream media and liberals. He has a strong tendency toward honest success, which we will probably see in the next four years.

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Mar 12

24FEB2016

The campaign season is now in full force, and opinions flow freely about who will be our next emperor. The news media is quite busy at their subtle but fake “unbiased” spin as to who would be best.

Even Ron Paul, whom I voted for the last four elections, offers his opinion in which no candidate merits his support. This is all fine and dandy, save that some candidates are the “lesser of evils”, a write-in or blank vote will be worthless, and there is a sense in which some candidates would be truly intolerable. Thus, Ron Paul playing ostrich will not work in this election cycle for presidency.

The press has taken another stance. Headlines speak of “angry voters going for Trump”. Does the press really believe that Trump fans are more angry than Col. Sanders fans or Cruz fans? Do they interpret any sort of cool-headed rejection of the Republicrat Party as anger? How many buildings have angry Trump supporters destroyed, how many cars have been destroyed or street riots engendered with much human bodily injury?  If the press would like to see real anger, try revisiting Ferguson or Baltimore.

There is the milquetoast mass who would vote for Hillarious or Rubio, and certainly the press and Republican National committee seem to make Rubio the clear-cut choice for the Republican nominee, and the DNC and press with Hillarious for Democratic nominee. This is the New York Times stance. Why would I take advice from the most liberal rag in America that intends to indoctrinate the American public?

Fear mongering has been the approach of both Republicans and Democrats. Special interests drive select candidates, as the Feminazi influence in advocating for Hillarious. The press would like us to believe that Trump appeals to the less intelligent and under-educated masses, based on a comment by Trump that the less educated masses love him. The logic of concluding that his statement that “ONLY” the uneducated masses love him defies my sane reasoning.

So, I march through the available candidates for president looking at the pros and cons for each of the active candidates. I left out Vermin Supreme, but then, I decided that I really have no use for a free pony (google or u-tube search Vermin Supreme if you have no clue as to what I’m talking about).

Hillarious:
Con:
1. She’s an inveterate liar and never to be trusted.
2. She’s a war monger who will get us worse into war than Obama has done. We will probably see conflict with either China or Russia during the reign of Empress Hillarious.
3. She’s a part of the established Republicrat regime, and would continue business as usual.
4. We don’t need a Clinton dynasty. They’ve done enough trouble while Billy was in office. I don’t forget the lengthy list of scandals and offenses that occurred during his reign, many with Hillarious in collusion.
5. She has poor health and she is old, benefited only by massive use of make-up. Her VP would probably soon be president.
6. She is allied to too many special interests, such as the Feminazi interests, the gay/lesbian/trans-sexual interests, etc., Goldman Sachs and Wall Street, for a short list.
7. I don’t want a lesbian as president.
Pro:
Absolutely none

Col. Sanders
Con:
1. A socialist by any name is still a socialist. The banks are already teetering to unmitigated collapse, though we don’t know when. The Colonel will only accelerate that ultimate collapse.
2. He’s a fake. He could have voted his heart and supported the audit of the fed bill in the senate, but did not. I don’t trust him.
3. He is really old. I suspect that he is also partially senile. We’ll have a situation like the end of the Woodrow Wilson years, where a presidential advisor essentially runs the nation.
4. His solutions never have a basis is serious reality, whether it be economic solutions, public policy solutions, or foreign policy solutions.
5. His past life was miserably anti-American, which he needs to make account for.
6. The guy was a useless parasite on society before he got into politics, not even holding a job until he was 40 years old. He would remain a useless parasite if he became president.
Pro:
1. He sees the problem of America’s monetary system, and wants to do something about it. He clearly sees the corrupt banking system, the problem of the Federal Reserve, and how Wall Street is about as anti-American as ISIS or Obama.
2. He seems to have a shred of integrity.

Ben Carson
Con:
1. He has minimal familiarity with politics. He would be a lamb among wolves.
2. He doesn’t have a “leadership” persona.
3. He would involve America in war in other countries.
4. He hasn’t expressed a comprehensive stand on many matters of concern.
5. He would not make a great president but would  otherwise be fantastic in Washington on whoever’s cabinet.
Pro:
1. He is probably the smartest candidate, Republican or Democrat. Honestly, he is frankly brilliant.
2. He is  Negro and unlike our current “black-white Mulato” president, and so would very certainly start bringing a correction to race issues in the USA.
3. His integrity and morality are completely impeccable, regardless of accusations of his opponents and the press.
4. He stands first among all the candidates in being a gentleman and man of honor.

Marco Rubio
Con:
1. He would perpetuate and exacerbate the current immigration problem. He would do a terrible job with America’s borders.
2. He tends to be a “company man”, and would march to the beat of the Republicrat regime. It would mean politics as usual.
3. His policies are pseudo-conservative. This might garner liberal votes, but then, if one wishes to vote liberal, feel the Bern.
4. His public persona is awful. He looks like a little kid. He is nigh brain dead in his speeches. He will need a teleprompter just like the Bummer.
Pro:
1. This is a tough one, but he does have some conservative leanings regarding economic issues.
2. He has a reasonable morality. I find it odd that so many presidential candidates come to Jesus during the campaign year, making professions of faith that they could have said before hand but strangely did not.
3. He clearly sees that our current president is super-bad. I think he repeated that 4 times in a recent debate.

Ted Cruz
Con:
1. His public persona is horrible.
2. He doesn’t do the best job at selecting the people around him, a good example being his campaign manager
3. His policy stances regarding foreign wars, economics, domestic issues are weak.
4. If running against either of the democratic candidates, he will lose. The press will make mince meat of him.
5. He would make an absolutely superb Supreme court justice.
Pro:
1. He has good, solid policies on many issues, especially regarding immigration/border issues.
2. In spite of what the press and RNC tried to do to smear him, he is a man of integrity.
3. He is willing to stand up for what is right and speak out when there is a wrong or an injustice, even if it may mean political harm. His action of calling many of the lead Republicans liars was both truthful and proper.

Donald Trump
Con:
1. He is a novice in politics
2. He seems to be taking strong stances and expressing opinions which are often contrary to what he was saying just a few years ago. True, even President Reagan was originally a liberal, but Trump has not had the time to prove to the public that he really has mended his ways and thinking.
3. He has every reason to be self-serving as president.
4. He has a terrible grasp on the constitution. He will approach his job (similar to Obama) more as Führer than as a constitutional president.
5.  If elected president, there is a high chance that some liberal nitwit will assassinate him. (some people might put this in the “Pro” column).
Pro:
1. The press and established Republican Regime hate him, which means he is probably all right.
2. You usually don’t need to worry about him speaking his mind.
3. He seems to be the most outspoken about standing up for USA interests
4. He will not get us involved in crazy and expensive foreign wars without assuring ourselves a benefit from those wars.
5. He is the most clear about fixing the immigration issues. Above all, he understands that “illegal” in the phrase “illegal alien” does not mean anything but the plain reading of the words. It certainly does NOT mean undocumented workers.
6. He has some grasp of economics and would probably look out for the “little guy” in business.
7. He is VERY clear on other important issues, such as terminating ObamaCare as soon as he gets into office.
8. He’ll have Hillarious behind bars, where she belongs.
9. From his life in the business world, I suspect that he would be adept at recruiting competent men around him.
10. He generates very strong reactions from many of my friends about how dangerous he would be as president, accusing him of being a chameleon that will be a different color in office. I interpret those strong reactions (from even the friends that I trust) as all the more reason to vote for him. I find it intriguing that such notable characters as Pat Buchanan (whose opinions I always respect) and Ann Coulter (who I tend to agree with even though I detest her persona, and besides, she’s a damn lawyer), and Alex Jones (a very strange character but who usually gets it right) are all in favor of Trump (at least, at this time).
11. He is not a lawyer. We need a government with more people than just lawyers and political science majors. Lawyers and political scientists have the worst grasp on truth of anybody I know, and which I always count as a strike against them.

I’m sure this list will grow and change over the next few months. You might have noticed that I have not opted in favor of any candidate. Your notice is correct. You might have noticed that I also have some political leanings for this election. That is also correct. I remain moderately undecided at this point. If you wish to change my mind, don’t waste your time, as I’ll probably vote for somebody else just because you tried to persuade me otherwise.

Of course, some of my friends will bring up the question as to whether the candidate is a Christian. I would remind them that I have some very dear (but politically brain dead) friends who lauded Obama for being a Christian. I remember liking Jimmy Carter because he was “born-again”, and what a colossal mistake he was of a president. Our last great president that generally stood for Christian values was Reagan, but he came under attack for his lack of Christian faith. Meanwhile, the Bush clan were lauded as Christians, yet I have serious questions about their integrity and self-serving expectations while in office. I am reminded of the Cromwell regime in England, which stacked the parliament with Christians, but who were incompetent at running a country.

So, I now offer a serious question. Does America deserve a good president? Perhaps not. I see no candidate that will make king Hezekiah or king Josiah style reforms to correct public sins and evil, and foster a more righteous nation. Ultimately, is this not the ONLY thing that matters? Making America great is a matter of making America Christianly moral. But, returning to a biblical foundation will not happen because not even most Christians have a clue as to what that is. Why do so many Christians (like the current Pope Francis) view socialism as a form of Christianity by doing good to the poor? Are they so foolish as to imagine that goodness can be forced and delegated by an evil government? Judgement on our nation looms, and Christians need to get off their Pollyannish pie-in-the-sky-in-the-sweet-by-and-by mentality that God still loves America, and that other countries might be bad, but at least we are not as evil as Russia or China. Just see what Habakkuk says… (You who are of purer eyes than to see evil and cannot look at wrong, why do you idly look at traitors and remain silent when the wicked swallows up the man more righteous than he? Hab 1:13)

Perhaps Christians wish for more social justice. God’s law specifically forbids judgements in favor of “the poor” just because they are poor (“You shall not fall in with the many to do evil, nor shall you bear witness in a lawsuit, siding with the many, so as to pervert justice, nor shall you be partial to a poor man in his lawsuit” Exo 23:2,3). A strong sense regarding personal ownership of property and goods must not be viewed as being evil, but the wish to re-distribute the goods of “the rich” as being very evil (You shall not covet-10th commandment, Exo 20:17).

Our current president has accelerated the process of wickedness in our nation. We are far worse now in being racially divided. We no longer grasp that having a penis means that you are male, regardless of your feelings on the subject. The gay/lesbian/trans-sexual/confused-sexuality agenda has flourished under our current Nobel peace prize gay bath-house visiting “Christian” president. Social programs have removed any moral responsibility from people, so that any sexual, economic, or behavioral issue might get you time behind bars or in the Krankenhaus, but will not result in you suffering the full impact of your inappropriate behaviors. We no longer fear the influx of foreign gods, including Buddhism, the Muslim “god”, Satanism in its various forms, and the god of mammon. The Scriptures are not silent on this. (Beware lest you say in your heart, ‘My power and the might of my hand have gotten me this wealth.  You shall remember the Lord your God, for it is he who gives you power to get wealth, that he may confirm his covenant that he swore to your fathers, as it is this day. And if you forget the Lord your God and go after other gods and serve them and worship them, I solemnly warn you today that you shall surely perish. Like the nations that the Lord makes to perish before you, so shall you perish, because you would not obey the voice of the Lord your God Deut 8:17).

So, my action items are as follows.
1. Pray. God is in ultimate control of everything. Remember that Obama was ordained by God (it doesn’t mean that God loves Obama! Contrary, God truly hates Obama!).
2. Stand up for what is right. Work for a crisis pregnancy center that offers alternatives to abortion. Refuse to patronize businesses that cater to the gay/lesbian/trans agenda (including the YMCA). Speak your mind for truth. Don’t be ashamed that you are a Christian. Go to a real church. Not a feel good, “Jesus loves you, come as you are” “Get in touch with the real-you”, self-empowerment church, but a real church.
3. Quit thinking that God loves America. He doesn’t. Quit thinking that America is a Christian country. It might have been at one time, but it sure is not now. Quit thinking that most Americans that say they are Christian are Christian. Do they truly understand God’s laws, and seek to live by them? (As a father shows compassion to his children, so the Lord shows compassion to those who fear him. But the steadfast love of the Lord is from everlasting to everlasting on those who fear him, and his righteousness to children’s children, to those who keep his covenant and remember to do his commandments Ps 103:13, 17,18). Do you erroneously consider the Older Testament as obsolete and replaced by “grace” under Jesus? Are we all Marcionites now? Are there two different gods in the bible, the old testament and new testament gods? Or did God announce through Jesus that he was just kidding, and really will not be imposing a harsh moral law on mankind from Jesus on out? Do you realize that all of America is enemy territory, the worst being many “conservative” American Christian churches?
4. Pay close attention to practicing a personal morality. It really does matter. Don’t complain when God’s judgement hits, if you are not personally walking with God, and remembering to keep His covenant. Do you encourage your neighbor to seek a biblical faith.
5. Let Scripture alone rule as your moral guide. Memorize it. Start with Ps. 1 and Ps. 2. Psalm 1 is a summary for the entire Scripture regarding the need for personal morality. Psalm 2 is a summary for the entire Scripture regarding God’s ideas regarding politics. They are eternal inviolate truths.
6. Refuse to vote for the status quo. If you do vote, trust that God will establish the perfect person for America. It will probably NOT be the person you wanted to be president.
7. Remember that over ½ of Americans voted for Obama twice over. If you think that our country truly wants what is right and good, you are living under a massive delusion.

Thanks for hearing out my rant.

Though the fig tree should not blossom,
nor fruit be on the vines,
the produce of the olive fail
and the fields yield no food,
the flock be cut off from the fold
and there be no herd in the stalls,
yet I will rejoice in the Lord;
I will take joy in the God of my salvation.
God, the Lord, is my strength;
he makes my feet like the deer’s;
he makes me tread on my high places. Hab. 3:17-19

All Bible quotes in this blog were taken from the English Standard Version, complements to some of my friends who participated in this translation.

 

ADDENDUM: 28FEB2016

You might have noticed that I did not review Kasich. The simple reason is that I have nothing to say about him. I won’t move out of the USA if he becomes president, but I view him as a weak liberal.

I am feeling that Trump is shooting himself with his mouth. I am becoming increasingly concerned about him being president. He will be a better alternative that Col. Sanders or Hillarious, but feel that it would be very risky voting for him as president. I’ve also appreciated Ted Cruz more as time goes on. He’s a sharp cookie, even though he is a lawyer. If I had to vote tomorrow, it would probably be for Cruz. Who knows who my next addendum will prefer? I’ll be glad when the Republican and Democratic conventions are over with. Who knows if there will be a third party candidate? We wait in prayer that God will show at least a modicum of his steadfast love on the USA as a country, that his wrath not be too severe.

 

ADDENNDUM: 12MAR2016

I’m seeing why it was a good reason not to cast my vote firmly. Events of the past few weeks have changed my mind. Issues that have developed with Cruz.

  1. He selected Neal Bush to be on his financial staff. Why in the Sam Hill did he do this? Is he trying to get in good through the back door with the established politicians that we have learned to so thoroughly despise? Wasn’t it Neal that was involved criminally in the Savings and Loan disruption many years ago?
  2. Cruz is throwing unnecessary mud at other candidates, suggesting that he is desperate; not a good trait for a president. He now accuses Trump of stirring up the crowds. But, the crowds stirred up are the worthless chronic parasitic students, Negros, of Chicago. Get out the Kleenex. Like spoiled children, it’s time somebody told them off. Cruz cannot let go of his establishment mentality.
  3. Cruz has some very strange “magical” concepts of Christianity. The Lord told him that he would be King in America, according to his father. I don’t mind Pentecostalism, but they sometimes have the worst approach to truth.
  4. Cruz would make a good attorney general, but an awful president.

What about Trump?

  1. He has shown that he can behave and be presidential.
  2. He pisses off the liberals. Good. Hopefully, he’ll put some of those sorry asses back to real work. Hopefully, he’ll terminate half the funding to colleges, so that we don’t produce yet another generation of totally useless BS’s and BA’s, trained in gender studies, political science, environmental studies, racial studies, or law.
  3. He pisses off neocon conservatives. Good. They can keep their little playacting at party meetings, but they are just as criminal at bringing collapse to America as the liberals. The neocon arguments are ridiculous, and without substance. His hair. He looks haughty (like Hillary, Rubio, and others don’t???). He’ll get us into war (really now, are you so deaf that you can’t hear what Trump has said a million times—if we go to war (ever), THEY will pay!!!)
  4. He is acquiring more and more people that like him. My favorite candidate (above) in terms or morality and wisdom and personality was Carson, and Carson threw his towel in with Trump. The liberal neocon right simply can’t bear that, and are now coming down hard on Carson for stupidity. They lack a mirror. Phyllis Schafly has supported Trump. There are many others that are coming out.
  5. I actually ventured onto Trump’s website, prompted by the baby-ass crying neocons. I reviewed his policy statements. I agree with nearly every one of them, such as his foreign policy (except for his involvement in the South China Sea – we don’t belong there), economic issues, education (he’s listening to Carson! on that one), healthcare reform (abolish ObamaCare), immigration reform, tax reform, eliminating the death tax, and second amendment rights. I love his idea to make concealed carry permits applicable across state lines, like driver’s licenses. There’s almost nothing that I disagree with. Plus, and most importantly, he promised to put Hillary in prison. I hope that he also tries Obama for treason, makes illegitimate all of his actions as president, puts half the Supreme Court before the firing squad for treason, hangs Loretta Lynch for treason, and fires half of everybody in government.

So, I’m not totally committed but would vote for Trump if the ballot was given to me today. This has not been a good election cycle. The worst thing is not who the candidates are, but how the professional politicians of all stripes are responding to the election that isn’t going their way. They are working too hard to protect their own comfortable turf. Because of that, I dearly hope that whoever gets into office removes any retirement benefits for congress and presidents. They don’t deserve it. They get enough already in other royalties. I dearly hope that a law is passed that makes that forces congress and executive office members to live by the same laws that we have to live by. We are not supposed to have a class of royalty. Let’s get rid of them!

 

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Jan 03

Christmas2014-624

Weihnachten 2014

Many of you readers are wondering why I took so long to post a Christmas report. Why didn’t it come on late Christmas? Or, at least, on 26DEC. Well, if you are asking, go suck on green persimmons. My top priority in life is NOT to provide the world instantaneous reports of what I just happened to do in the last hour, or what one of my children/grandchildren/nephew-niece or other relative just said that was cute. I will enjoy their cuteness in a hedonistic fashion, realizing to the rest of the world, my child/grandchild/whatever will be viewed as a solipsistic spoiled brat. No, I’m also not going to tell you what I just happened to cook, or what I am currently eating (I just happen to be taking my Abendmedikamente geschluckt mit Bier und eine Dose Rosarote Lachs für Eiweis Anhang); and if you can’t read German, you really don’t need to know what I eat/ate/will eat.

So, today, I went for a short bicycle ride (41 miles) with Russ Anderson and had an inspiration to write this post. The ride was at freezing point, and we returned quite cold. It took about 2 hours to thaw out. I don’t mind those sort of experiences. I get more annoyed when it is too hot, and I am borderline on a heat stroke. But, thinking about Christmas, Christmas tends to be melodramatic. We spend a lot for presents which don’t seem to be appreciated commensurate with the money spent or the time taken to select and purchase those items. This year, we avoided the mall altogether (Betsy and I went once just to visit the Apple Store several days after Christmas-we didn’t buy anything). We had the Hastings over, and sang Christmas carols, which we all really enjoyed.

Christmas Evening – Jon and I attended the 11 pm Gottesdienst. Bei Mitternacht gibt es Kerzenanzundung mit dem Raumlicht aus und das Stille Nacht Lied singen. Und dann, zu Hause. Every year, I make up cinnamon rolls from scratch, make about 8-12 platters of them, and then freeze them, giving them to friends, fiends, and family as gifts (aber, nicht giftig!). You simply set them out the evening before, and they unthaw, and then rise by morning, allowing you to stick them in the oven and have fresh cinnamon rolls in the morning. I made up a prime rib on the Trager grill and we had all the kids over (except for our dearest Rachel and Alex and kids). We had just installed an outdoor fireplace, into which we got a fire going, while the older kids played with the bb gun. Then, dinner.

 

Patrick as marksman on the bb rifle.

Patrick as marksman on the bb rifle.

Sammy as competitive marksman.

Sammy as competitive marksman.

Dean smirking at Patrick and Sammy, knowing that some day he will whip their Arsch on the firing range.

Dean smirking at Patrick and Sammy, knowing that some day he will whip their Arsch on the firing range.

Me cutting up the prime rib.

Me cutting up the prime rib.

Die Kinder devouring the Christmas Dinner.

Die Kinder devouring the Christmas Dinner.

Dean wanted prime rib but enjoying what he got.

Dean wanted prime rib but enjoying what he got.

The adult table.

The adult table.

Then, it was time for the kids to open up presents.

Elizabeth showing off her doll.

Elizabeth showing off her doll.

Elizabeth with mutant Frozen character themes.

Elizabeth with mutant Frozen character themes.

Sammy loves rocks.

Sammy loves rocks.

Dean wasn't sure at first what to do with the presents, but soon figured things out.

Dean wasn’t sure at first what to do with the presents, but soon figured things out.

Afterwards, we decided on S’Mores for dessert. The outdoor fireplace was the perfect place for that.

Roasting marshmallows on the campfire.

Roasting marshmallows on the campfire.

Roasting buttocks on the campfire. Left to right, Doug, Diane, Sarah, Andrew

Roasting buttocks on the campfire. Left to right, Doug, Diane, Sarah, Andrew

It was a wonderful Christmas, with a focus on God and family. Hopefully, each Christmas could be all the more so. By the way, I got the shirt in the first photo from my favorite German patient. It seems to sum up matters in few words.

The Feucht family wishes you all a Merry Christmas and a Happy New Year.

 

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