Tuesday, September 27, 2011

Dirty Sidewalks, Teaching Hospitals and Afghanistan

This blog is looked at by many people who live in the same gated community in Palm Beach County (Florida) as I do, but it is also looked at by many who reside elsewhere.  For example, last week we had four viewers from Romania who checked us out.  Therefore, I am reluctant to include postings which relate specifically to my community.  I am overcoming that reluctance at this time however, to tell you about

Our Dirty Sidewalks

When they laid the sidewalks in my community, and this process took place over the almost two years it took for all of the homes to be built, different types of cement were apparently used to lay them. Some are clean and bright and some have a darker hue to them.  Some are smooth and some have tiny ridges in them.  Some take longer than others to dry after a rainstorm or watering.  And some get dirty more readily than others do.  Our governing board has a contractor come in to power wash and clean all of our sidewalks.  For many sidewalks, this is fine.  For many others, however, more frequent cleaning than the community has contracted for is obviously needed.

Recently our Property Manager, having received a good number of requests from residents asking that their sidewalks be cleaned, asked the Board if the contractor could be called in for additional cleaning.  The Board declined to approve this, feeling that the budget provided for a sufficient amount of sidewalk cleaning.

I am one of the residents with a very filthy sidewalk and I have Emailed our Board about the problem.  I pointed out that although it is not the homeowners’ responsibility to clean the grime from the sidewalk in front of their house, many do.  In fact, only this afternoon, I told them, I took a brush and a bottle of Clorox and started the job.  I am hoping that they will finish the job.  You can see from this picture, what I left for them to do.


It would make me very happy if other residents of my community with filthy sidewalks who happen to be reading this do the same thing as I have done.  If they contact me, I will even help them with the brush and the Clorox.

Jack Lippman


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Teaching Hospitals

It has been said that the best hospitals are “teaching” hospitals, that is, hospitals affiliated with a medical school or hospitals at which newly graduated physicians serve residencies as a continuation of their learning process.  Such institutions are at the forefront of medicine, aware of the latest advances and often heavily involved in the research that produces them.

My experience with teaching hospitals, however, has made me aware of a significant disadvantage they present.  If your doctor hospitalizes you in a teaching hospital , even if he or she is on the staff there, you may not see very much of them once admitted.  

For example, assume you have a gastrointestinal problem.  You will be assigned to a bed in the section of the hospital reserved for those being treated for gastrointestinal problems.   Each week, one of the attending physicians on the hospital’s staff who specializes in such problems (and who may or may not also teach it in the associated medical school) will be in charge of the section.  Each day he or she will check on every patient in the section, accompanied by an entourage of resident physicians who are learning more about gastroenterology than they learned in medical school.  One or two of these residents will remain in the section, supervising  the care that patients receive there.  But they may not be the same one each day.

Your own doctor may or may not be such an attending physician, but if he or she is, you will get to see them only during the times that he is the gastroenterological attending physician assigned to the section.  If he is not, as is the case with many internists, you may never see him in the hospital.

In such a setting, you will receive the latest in care, but you will receive it from attending physicians and residents who may change from week to week or day to day.  A doctor-patient relationship will not exist since an attending physician and a resident who are caring for you may have never seen you before, and only know what the computer screen reflecting your records tells them.

In a non-teaching hospital, however, your personal physician and the gastroenterologist to whom he referred you, and who will be taking care of you, may come to check on you frequently, perhaps daily.  They will take good care of you, but you may not be getting the benefit of the cutting edge of medical science which is available in a teaching hospital.  More often than not, you may not even need it.

I am not an expert in this field, but what I write comes from personal experience.  I welcome  comments from readers, particularly if they are in the healthcare professions, to supplement what I have written, to criticize it or to agree with it.  

JL
 


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Afghanistan and Pakistan

Four postings ago, on September 16, I suggested that we get out of Afghanistan 
immediately.  I said we should put all of our troops on planes without delay, even if commercial airliners had to be comandeered and taken off of domestic flights for a few days to accomplish this, and get them back to this country.  What equipment we couldn't take with us would be destroyed.


More recent headlines have validated this proposal.  There is no reason to remain a single day longer in a country that will never, ever, be able to defend itself against those referred to as insurgents and who will be shortly ruling the place.  


As for Pakistan, they must learn that they have to be with us or against us.  Lately, they have been behaving like they are against us.  They hid Osama Bin Laden for years and they cooperate with those we have been fighting in Afghanistan.  I would cut off every penny of aid we send to them.  Today!

The spread of nuclear weapons to terrorists is far more likely to come from Pakistan than from Russia, China, India or North Korea.  One of the aims of our foreign policy, therefore, should be to courageously confront this threat and work toward the destruction of their nuclear arsenal.

JL

  
                      
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