I just received a text message from a recruiter for XYZ Healthcare, a locums company which failed me for over 8 months. I have set forth “new rules” about such companies and how physicians should manage locums companies. I will first present a discussion on pathologic physicians in medicine (and other healthcare providers). We need to detect this earlier and we can. I discuss that too.

I WANT TO ENCOURANGE EVERY PHYSICIAN WHO HAS  BEEN PREVIOUSLY BEEN NEGATIVELY AFFECTED IN ANY WAY BY THE LOCUMS SYSTEM TO READ WHAT I WRITE HERE AND PUT SOME OR ALL OF MY WORDS TO USE IN YOUR CONTRACTS.  It is time we take back medicine as physicians.  We are all fools as physicians if we continue to let middlemen and corporate America control medicine.  It is within our power to get back the respect we deserve and the opportunities afforded by mastering an MD/DO degree, a PA/NP degree.

I hope this image of water I painted on the ipad pro gives you some calm as you think about this issue:  HOWEVER BEFORE I WRITE ABOUT THE RULES I WANT TO GIVE YOU SOME INSIGHT AS TO WHY THESE LOCUMS GROUPS HAVE GONE HAYWIRE ABOUT CREDENTIALING.  THE ISSUE IS WE HAVE A LOT OF PATHOLOGIC PHYSICIANS AND NURSES AND NO AREA OF ANY PROFESSION NOR RANK IN SOCIETY CAN SAY IT DOES NOT HAVE “BAD APPLES”.  I AM GOING TO PRESENT THAT BEFORE I DISCUSS SOMETHINGS I WANT OR AT LEAST CONSIDERED IN MY CONTRACTS.  I NEGOTIATE EVERYTHING BECAUSE I AM NOT SOME KLUTZ IN LIFE BUMPING INTO WALLS.   THIS IMAGE IS TO HELP YOU FEEL THE CALM IT GAVE ME WHEN I PAINTED IT.  I FIND THIS SO RELAXING WHICH I KNOW I HAVE SAID OVER AND OVER BUT WATER IS SO AMAZING IN MANY WAYS TO ME.  I CHOSE A FILTER TO MAEK THIS GREEN TO DIVERGE FROM MY COMMON USE OF CERULEAN BLUE WHICH IS VIEWED BY MOST AS THE MOST PLEASING COLOR CATEGORY.

 

The thank you letter pictured below as a featured image was a kind letter for the work I completed as academic faculty for Midwestern University at one of their DO Emergency Medicine residencies.  The residents were much overworked and under-trained.  The director of the residency was also fired.  He made mistakes a medical student would likely not make.  He cited money as his primary reason for remaining in medicine.  He cursed like the ER director and made many clinical errors often from going too fast at work.  Missing data, not recording it and evaluating it’s importance.  Dismissing patient complaints that were obvious.  He was cursing because he was seeing the same people come back because of his own errors.  I listened to him teach; once was enough to know he had some skill and some feeling of pleasure from this, but I would not say it was his passion.

My career I keep reciting for recruiters:  Now over 400 hospitals whose physicians I have educated either in the classroom, or as in this situation working as full-time bedside instructor of residents with live patients and lots of medical students and scribes (a program I also started at this hospital)-all of these people, they were great.  The young are so positive and energetic and I enjoy helping them.  I have an extreme amount of experience and it started as a child reading medical books I would get at the public library on topics like endocrinology, hematology, physiology.  That was normal for me.  I also played like a normal child I just happened to like books on medicine and I could not tell you why.

OKAY back to why recruiters and those who credential are validated by how they collect all of your data to decide if you are worthy of employment or a hazard (yes there is some sarcasm in that statement-if they are collecting data to decide if someone is worthy…they need to step back and look at the whole career (they have tunnel vision on that last year of employment.  It might be relevant for a new doctor but not someone with extreme experience and a clean record.  Then it is so irrelevant…it means nothing…an entire career is a much more valid image of a person.

KINGMAN (working for Midwestern University)…I would have stayed but several of my key contractual features I had confirmed were written into my contract were not honored because of a pathological liar-my new partner.  That is the very person who hired me.  He did not complete simple paperwork for my CME programs.  So I could not advertise my programs or I would be in violation of the ACCME rules for teaching CME.  I think it is important that you understand that all you have in life is your reputation and even if it means giving up a position, it is better than trying to work with people who will do whatever they want no matter what they have signed and cause you harm.  This man proved to be bizarre in that he would say things in front of others like, “I feel like hurting you” but I can’t explain why.”  He actually made that statement and called me into his office to tell me in private.  He is menacing enough in appearance to believe him.  My experience with stalkers in the past has taught me to recognize such statements as truth until proven otherwise.  Here is a clue:  if someone says, “I want to hurt you…oh just kidding.”  The likely truth is that they mean what they say at least 50 percent of the time.  So they are not kidding.  Now this doctor actually stated he could not understand why and he blurted that out.  He clearly had thought about harming me and even wondered why.  His “confusion” may be contrived…people usually know why they want to hurt you…or love you.  He was on the hospitals and nursing staff’s “hit list” for expulsion which took years after I left before it happened…this is because the hospital feared it would be difficult to find a replacement group and they feared they would literally not have coverage for their ED.

I am telling you to never let people take advantage of you and use the system of privacy for reporting a disruptive physician or “disruptive anyone”…every state has a private confidential reporting system.  There are so many pathologic people that now many states when I re-license I have notice the questions states ask us imply how seriously damaged physicians can be.  For example, the state of ILLINOIS and I love this state and Chicago, and I have enjoyed the culture there and many physicians who were trained there were excellent so I always think of it in a positive way but…when I last relicensed the state requested I fly up and interview for a view minutes for a new protocol.  The protocol is a series of questions asked of physicians to confirm they have no background that should keep them from clinical practice.  I was asked if I had ever molested an elder patient at work or abused an elderly patient ever in any clinical setting.  Such a question I answered “no” immediately and that is a true answer.  However, that state has such sick people in it that a state licensing board now asks these questions.  Surely you would think the system would assess people so well that when they become medical students the system knows they have chosen people of the highest character.  This is simply not the case.  I must also stand by a concept I have believed in and repeated many, many times:  a person is who they are from birth (mostly) but they are greatly who they will be by age 8 at the very oldest.  I mean your genetics (which can determine if you are born a psychopath or not-1 in 100 people are born that way), and your environmental influences by age 8 have largely formed your personality and character and that will remain the rest of your life.  Cruel children often grow up to be cruel adults.

Naive children often grow up to be naive adults.  Wisdom is much more developed (or not)  in you in childhood.  It is your knowledge base that grows and your character and wisdom will control your use of knowledge for the rest of your life.  Now for every concept or rule there are exceptions or variations sometimes on a grand scale.  When it comes to personality, traumatic events like war, other violence (rape), when it occurs in the formative or even adult years it can affect permanently alter your judgement and your beliefs.  It may have an effect on your personality or make a personality disorder appear.  That is true when you read the literature, in particular, on borderline personality disorder.  These are the people who, when you leave the exam room you will like feel disturbed, even angry.  You sense it.  As a professional it is your job to realize where those feelings are coming from and to never let them interfere with your medical judgement.

If you are a person with a personality disorder and the director I mention who was saying he wanted to injure me is a person with Post traumatic stress syndrome.  He has that diagnosis.  His wife is a physician and advised me of that in his presence.  She and he presented themselves that it was not something I had to be concerned about.  Again, if someone mentions something like that to you, and you get a feeling of the hair standing up on the back of your neck, you should view that as a real concern.  I did not get any sense that anything seriously wrong would be an issue with this man when I met him…but in a few weeks working with him it was so obvious.  I felt quite foolish that I accepted an offer to work and become a partner with this man.  So the questions states ask are being asked so late, they should administer the MMPI II or use a similar instrument to assess all who plan to go into healthcare before they are accepted into medical school or any job of authority or power over other people.  You may ask why or not know much about this test.  The Minnesota Personality Inventory is a computer evaluated test of  ~567 questions.  Many of the questions are the same question written in a different way to get a response that is consistent.  So if you answer this questions with the same response although it was asked in many ways it does imply you have the tendency (pathology) that the question poses.  This test should be scored by the computer not a person; a board certified experienced psychologist in the area of the pathology is best to evaluate what it portends and possibly contribute (in my mind to determine if a person should be allowed to enter the medical profession.  I include all providers.  Nurses are a huge group and the larger the group the more you will find.  The classic answer as to why someone wants to become a nurse is often born out to be so true…it is a way to find financial security…nurses definitely have and I dislike this phrase but will use it, “they have spilled the beans.”  Once married hundreds of thousands leave the profession because they do not want to be a nurse…they just wanted a nice lifestyle.  Now again please don’t think I for one moment think this is true of them as a whole or any specific number nor am I categorizing them…many who become doctors view it first as a job with a lifestyle.  They quickly learn after performing a few rectal exams as a medical student, “This is not the job for me.”  If you see “rectal deferred” on the chart over and over on the same doctor…it is highly suggestive that they simply should not be a physician.  It is not a joke; missing cancer does harm patients.  So my goal is to expose every detail on how we can see the problem is real.

The MMPII, if it has anything to say about you, [I view these positives like “blips on a pathology oscilloscope”]  …it is always pathology the test is detecting.  It is well proven and used by psychiatrists and psychologists world-wide; it has been used for decades and has been proven to be accurate enough to determine evaluations like competency, capacity and others in the courtroom.  I don’t know why such an intelligent organization as a hospital that trains medical students does not require this as a part of the testing for entry into medical school.  If the test says you are a pathologic person someone with expertise needs to decide if that would impair you as a physician before you and likely the citizens who pay taxes to educate physicians pay to make another pathologic brain with now more authority to harm people.  You might think this is overhanded, but I don’t.  I have seen in my work just too many of them.  It is like “leaky gut syndrome”.  The universities/medical schools are the immune system (the gut-yes it play a huge role in immunity, not just absorption of nutrition), and the people who enter and become healthcare providers are some of the most pathologic people I have ever met-like the particles that upset your immune system once they pass into your circulation from “leaky gut”.  Perhaps you think this about me but I have at least a record of performance that speaks otherwise.  I have to include myself this way so as to make you understand I have allowed people to test me for so many things because people sometimes find it hard to believe a person can be just gifted in a good way and it does not mean they have some disability.  We all have strengths and weaknesses but there is a boundary that clearly defines what is moral for behavior that makes a great physician.  Now some people i have met have done some pretty crazy things, but they are aware of there behaviors when they are healthier types and they know they were doing something like rebellion.  I never had such an urge.  I like conformity; I like boundaries.

Yet I have done things like dive deep into a cave which is very dangerous.  I did it in a very controlled environment with experts.  So I don’t view that as reckless.  I wanted to survive that wonderful experience and I knew the entire plan before doing that dive.  While in Hawaii in the open ocean where waves can curl and pull you to the surface and cause a sudden and deadly air embolism that can be dangerous and reckless because it is totally uncontrollable.  Each of us decides what is “OK” for us.  There are other hazards in the open ocean that are not the same as a calm cavern (although it is a decompression dive) I have enough experience with open ocean diving that I would say it is more unpredictable and thus more dangerous than that cave dive.   People with claustrophobia should not dive in caves because it is very tight in places).  I have never had claustrophobia and I can fall asleep in an MRI machine.  Especially if I am listening to music.  So knowing oneself is very important but others knowing you before you enter medical school is vitally important and I think we need to adjust how we choose not based purely on academics but on ability to keep the values expected of every healthcare provider.

In some states when it is to be decided who should be the primary custodial parent, the MMPI II examination is part of the evaluation a parent will experience so a judge makes a proper determination what is best for the children.  That is just one example of how the test is used; it is a standard test for screening for psychopathology.  I think this is a serious issue and there are also many other positions of authority that should be addressed with this type of testing as opposed to just interviews.  I was interviewed and accepted into medical school in the same week; sure it was a great feeling.  However, it was not a pleasant interview.  I was interviewed by a family practitioner and a psychiatrist, and because of  my young age, they had valid concerns that I might waste everyone’s time and just decide after three years of medical school that I needed to live life more and that I simply did not have enough fun before medical school.  I have to agree this is logical.  I was also married three weeks before I entered medical school.  Sound like a lot of stress to me.  When looking back on all of it.  It was a wonderful experience for me because I had great people always teaching me and I had a great life.  People whose names are still on the cover of major texts who happen to be at the University of Utah. I won’t list their names but I can say that medicine for me is not a job but like my art it is my passion.  I knew from childhood it was what I was supposed to do as I mentioned.  No one ever told me this is what you should do with your life.  I was always fascinated initially by two people who I read about in an encyclopedia: DaVinci and Michelangelo.  Now, I am not comparing myself with them nor do I think I am them…i just liked them.  I still study them. Perhaps that formed the ideas in me that lead to why I chose art and medicine and I definitely chose both.

Today and for at least all the time I have been working in education (at least as far back as 1989 and I chose to do that too), I can say I have met thousands of physicians who I can tell you came to my programs because they had failed their board exams and it was seriously affecting their lives.  Many had failed two or three attempts and four exam failure attempts was not rare.  I did rarely see a person who had tried for their entire career…10 part I board exam failures (yes the same doctor) and they were not happy, their lives which they reveal to me are often like an exposed nerve, and they had so many issues it did not surprise me that they could not pass.  So does passing an examination mean you will be a great doctor.  NO I don’t even believe that.  We are, by nature, good test-takers.  What I mean is that once you get to the level of a doctorate in any field, you are likely a good test-taker.  So why all the test failures?  You have likely always been a good student.  We don’t test morality and this has cultural and other biases so that some people think it cannot be tested.  I think the kind of pathology that is concerning can be tested and established…what I am looking for is pathology that is serious.  Serious enough that it harms patients and others.

So the system is now asking questions of people who may be pathologic and they are in the system and have been for a long time.  Their record shows lots of hits in areas of malpractice, claims and other issues.  We have to be careful though, just because someone is sued does not mean that they are pathologic.  This is an oversimplification for sure.  It definitely means someone greatly disagreed with what you did for them and that you harmed them.  Under-reporting by healthcare providers of each other is no different than any other culture of people who tend to protect their own.  I have observed this too.  So my point is early testing before medical school, perhaps even before college will help better improve the system of tools we have to detect those who will go on to success versus those who will go on to cause problems because they are, in fact, a problem person.

My belief is anyone who will have such authority over others should be held to the highest standards and thus to the highest scrutiny.  When I entered medical school there was a trend to accept students who studied culture more than science.  Do they make better physicians?  Not in my experience.  They are not even more polite, more able to discuss something serious with a patient and family.  I think it is like the basics in grammar school, you must first master life rules and they start in Kindergarten (K).  If people could just do what is taught in K the world would be a much calmer place.

So I do not think a sociology or French Major will make a better doctor.  Each person is unique and the qualities of honor, morality, and ability to understand human nature is very important and that is not determined by the major you choose in college nor the specialty you choose.  However, many pathologic people choose a career to try and solve the very problems that plague them.  Yes, the crazies study psychology, someone with cancer will likely want to be a doctor and do if they survive.  I know one who had that life scenario and he is both a fine physician and police officer-the best.

So I believe in testing and that the letters after your name do not mean anything about how well you will care for you or others.  The first hurdle in medical school is  you have to be able to study and memorize a lot of material.  It can be as much as forty pages a night for the first two years.  It is a fact that most people simply do not have the desire, ability, or personality to do this.  That does not include even the people with pathology.  One does not exclude the other, brilliant people can be very pathologic and vice versa.  It does not mean they always are; there is a great distinction to be made.  Plenty of brilliant people are happy nice folks.

Several text books I illustrated and wrote, and speaking and teaching for 80 hours at a time, sometimes 4 programs in a row-well that is ok for me.   I taught every resident in that program in Kingman, Arizona that is what the letter is about, i.e., why they are thanking me, and I have yet a second letter dated in the fall of 2016 and it is for over 500 hours of CME for teaching over 500 hours of procedures and clinical bedside emergency medicine.

This includes teaching the chief resident how to insert his first transvenous pacemaker, he was thrilled.  I was concerned.  The problem I see at this program is how can this physician confidently practice and know one day when he will need to perform this procedure when he has only done it once under close supervision.  He was that the chief resident and a fine doctor no doubt in my mind.  But he has not been given the experience I had in my training even prior to a residency.  One example is that as a second year medical student starting the Summer months I was given what they then called a “fellowship” to key students and I had 4 months of nonstop training to intubate in one operating theater every patient at one hospital…and yes I mean every patient.  Many of the cases for four months were open heart surgeries so I had much to monitor while my mentor a brilliant man would spend hours with me after work teaching me even more.  This I just don’t see anywhere anymore.  So I know I intubated hundreds of patients and often several a day.  They were long but great days.  So no I did not just intubate once and get set out to practice.  It is why I was able to be a director of an ED right out of my internship without any difficulty.    I had a much better education.  I never had a computerized device with me I had to study, memorize and use my brain.  This is a true problem in medical education and now we have raised a generation of doctors who are dependent on their phones to get the right information on what to do…it does not even mean they have done much in clinical practice.  So a patient will experience a wide variety of level of care due to this issue.  Some will get great care from a great clinically oriented program with hands on.  That is what I had.  This is reform we need to make in all areas of medicine again.  Doctors will not just be replaced by AI (artificial intelligence)…it is a tool for now.

I taught residents to perform every emergency medicine procedure including bedside ultrasound.  Unfortunately they had the worst ultrasound machine I have ever had to use and it had a dead battery and those in charge would not purchase a new one so it caused numerous failures during procedures when it was accidentally unplugged.  It would not hold any charge.  The residents should not have to work like this and the patients should not have to be exposed to this danger.  So sure I pointed this out and yes it is why I offered them my CME dollars so they could have funds to purchase equipment.  But they did not follow through after they signed a specific contract saying they would complete all the elements of my contract.   Likewise in a similar way I declined a job because they want me to be a secretary and make all the arrangements.  In locums it is standard for the company to do that work.  I am not interested in doing more than provide my cv and documents and it with references should be enough…my job is  patient care.  I minimize travel by staying at a sight for a long time.  Then I go home to a mountain of mail and handle my life from the internet (things like automated payments).  But as soon as I find a permanent job all of this locums life ends.  It is not possible to get married and do locums and expect a spouse to be dragged around the country.  Yes I am getting married.

So here is the second thank you letter and what follows are the NEW RULES…something like those new rules you see on televisions by that comedian Im sure you all know but I wont name him.  Here is a nice thank you letter I posted on another page to remind you I have plenty of documents to show you its all true…and here is a great letter but what they did not do is follow up with me to know that the director of both the residency and the ER were constantly in trouble and constantly a threat to staff, patients and, yes me.  So no I would not stay no matter how much I wanted to.  Now in 2017 they are all gone so perhaps I could reconsider that location.

Midwestern University 2016 letter for clinical teaching of EM residents

IN RUSSIAN THE WORD FOR ZERO IS PRONOUNCED “NULL”  YOU MIGHT BE SURPRISED TO KNOW THAT THIS LETTER IS SO IMPORTANT WE ARE GOING TO CALL IT THE NULL LETTER.  FOR WITHOUT IT…YOU ARE DOING NOTHING AS A RECRUITER FOR ME.  YOU NEED TO TAKE THIS LETTER AND READ IT SLOWLY AND CLEARLY AND THEN AGAIN THE FIRST LETTER.  ANY DIRECTOR OR ADMINISTRATOR WHO INTERRUPTS YOU SHOULD CAUSE YOU TO STOP AND STARE AT THEM.  YOU WILL NEED A SITE VISIT FOR THIS TO BE THE MOST EFFECTIVE.  THE FIRST THING YOU SAY WHEN YOU STOP THEM AND STARE IS  SAY PLEASE STOP FOR A MOMENT.  I WANT YOU TO IMAGINE THE MOST DESOLATE COUNTY YOU  KNOW OF IN THE US.  AND ASK THEM TO NAME IT.  MOHAVE COUNTY IS HUGE AND DESOLATE AND SERVICED BY JUST ONE OVERLOADED ED THAT IS CARING FOR MORE THAN TWICE THE NUMBER OF PATIENT’S IT WAS DESIGNED FOR.  IT IS CALLED “THE ED FROM HELL” AND NO EPs WHO WORK THERE LAST BUT A FEW SHIFTS UNLESS THEY HIGHLY EDUCATED AND KNOW THEIR MEDICINE.  I HAD NO REAL DIFFICULTY THERE JUST A CRAZY BUNCH OF FACULTY WHO ALL HATED THEIR JOBS, THEIR LIVES, THEIR SPOUSES.  THE RESIDENTS WERE GREAT.

WHAT WAS IT LIKE TO TEACH THERE?  I WORKED WITH CRAZY PEOPLE WHO HAD NO IDEA WHAT THEY WERE DOING AND MANY EXHIBITED BEHAVIORS OF WHAT IS DEFINED AS A “DISRUPTIVE PHYSICIAN”.  THAT ENTIRE GROUP HAS BEEN SUBSEQUENTLY REMOVED FROM THAT SITE FOREVER.

HERE ARE SOME EXAMPLES OF THE CRAZINESS:   THE DIRECTOR OF A FAST PACED ED MAKES A DOSING ERROR AND THE NURSE WAS WILLING TO DO IT AND NOT ADVISE HIM OF THE MISTAKE (HE GAVE 1/10 THE DOSE OF VECURONIUM FOR RSI AND COULD NOT FIGURE OUT WHY THE PATIENT WAS STILL MOVING)….IT WAS NOT HIS ONLY DRUG DOSING ERROR THAT NEARLY KILLED A PATIENT.  THE NURSE SO DISLIKED HIM THAT SHE WAS KNOWINGLY GAVE THE WRONG DOSE AND DID NOT WARN THE PHYSICIAN AND NURSES DO FUNCTION AS A CHECK AND BALANCE SYSTEM IN MEDICINE.  THEY ARE OBLIGATED TO STOP WRONG DECISIONS.  IN MANY PLACES I FIND THAT THIS IS AUTHORITY IS ALSO OUT OF CONTROL.  THIS DOSING ERROR ISSUE WAS A REPETITIVE THING WITH THE DIRECTOR DOCTOR.  HE IS THE MOST EVIL, NARCISSITIC PHYSICIAN I HAVE EVER COME ACROSS.  HE ACTUALLY STATED IT IS PROPER TO USE THE “F”  WORD IN THE ED, EVEN YELLING IT SO ALL THE PATIENTS CAN HEAR IT…AND THE REASON HE WANTS TO HURT OR KILL ME WELL (HE SAYS THAT IT EVADES HIM WHY HE SAID HE WANTED TO HURT ME). HE SAID, “I HAVE NO IDEA WHY I FEEL THIS WAY,” BUT THAT IT WAS AN OVERWHELMING FEELING HE JUST TOLD ME WHEN HE ASKED ME AND ANOTHER PHYSICIAN TO COME INTO IS OFFICE.  HE SAID THIS IN FRONT OF A LONG-TERM ASSOCIATE WHO SHOWED NO EMOTIONAL RESPONSE AS IF THIS IS A NORMAL STATEMENT.  SHE IS EQUALLY AWFUL IN HER FAILURES AS AN EP.  HER LIST IS SO LONG I WILL PRESENT HER AS A SINGLE BLOG CASE STUDY.  THE POINT IS I DO CHECK EACH SITE FOR WHO IS WORKING AT A SITE BEFORE I WILL GO THERE..IT IS CLEAR TO ME THIS IS A PROBLEM ALL OVER THE US…IT IS LIKE A CANCER.  WE HAVE A LOT OF SELF “CLEANING” TO DO.  CALL IT WHAT YOU WANT.

NEW RULE #1: if a hospital hires me to work locums and then seeks a permanent physician they must give me 90 days to decline the position with the right of first refusal so I don’t lose time working.  MY TIME IS THAT VALUABLE.  SO YOU CANNOT HIRE ME AND MESS WITH MY LIFE ANYMORE.  YOU HAVE TO ACCEPT MY TERMS OR FIND SOMEONE ELSE AT THE START.  MAKE SURE YOU PUT IT IN MY CONTRACT.  I WILL BE ADDING MORE TO THIS.  THIS IS AS OF DEC 3 2017.

NEW RULE #2:  if a hospital hires me on a permanent basis I expect a sign-on bonus commensurate with my 37+ years of excellences with a completely clean record of superior healthcare.  That includes a moving allowance, paid malpractice, paid 1 week of CME and a retirement package.  Sounds like I feel entitled.  I am asking for what all other perms get nothing more.   Three weeks to 1 month a year I need to teach my CME programs for which I will have a permanent teaching title of “Director of Medical Education, Dept. of Emergency Medicine.”  I need that in my contract locums or perm.

NEW RULE#3: the hospital is welcome to receive income from my cme programs by sponsoring them for CME and CEUs both since all hospitals have such a department and will be paid according to standard rates for this accreditation.  I will further the name and reputation of the hospital by providing only the finest CME/CEU academic teaching just as I have always presented as I have constantly updated all of my programs to keep them current with the “Core Content” as defined by both ACEP and ABEM and is well-documented all over the world now since 1989 in all of my publications, recordings and videos.  “CT Scanning for the Emergency Physician.”  is a live presentation I had professionally recorded in front of a green screen by my primary producer-director who is also my life-long friend Clayton Pereira.  This was so it could also be professionally edited.  All of this and new programming will be available on this site in our store.  I can’t give you an exact date yet for this yet but it will be back as will a separate online store for the art and much more.

A radiologist from Virginia called me years after I made the CT video later to tell me he uses that video to train his radiology residents because I go into all of the science of how a CT machine works before I go through the entire body scans with a detailed discussion.  I discuss all the major causes of artifacts, details that a radiologist must know.  Why so much detail?  To raise the quality of assessments by emergency physicians who get very little training even today in these studies is why.  Even today emergency physicians when well trained can find a pulmonary embolism, or mediastinal gas missed by a tired radiologist.  It happens and we all need this cross system of checks and balances to prevent medical errors.  The information in that video will be reproduced here because it is all still clinically relevant.  My goal in making a production is to produce the classic information that never changes.

NEW RULE #4:  KNOW YOUR PHYSICIAN before you speak to him/her….because you likely do not have a concept of who you are speaking to .  You speak to us without the respect we are due.  Not that we deserve more respect than others but we are not mr or sir we are Doctor and you don’t call us by our first name.  That is something I allow my colleagues to do but they wont for they want to show me the respect.  They want my augtograph.  I am not saying this to brag, but to tell you how embarrassed I feel all the time that they ask me for somehting like my autograph which means to me that they place me above them.  I put my pants on the same way as the rest of you do…so if you think I think I am better than you…you are just plain wrong.

RULE #4 NO COMPANY OR PERSON WHO DOES NOT HAVE THE EQUAL MEDICAL DEGREE SHALL OVERSEE ANY OF US; it is way out of hand.  Unless that happens the rest of you are to treat us like we are.  WE ARE YOUR DOCTORS.  WE SAVE YOUR LIVES.  WE HEAL YOUR WOUNDS.  WE TAKE PRIDE IN WHAT WE DO.  If you find a doctor  who is not living up to this standard call me and tell me and I will handle the rest.  I will go, if needed to that person and I will get at the truth, but do not think any of you who do not have years of experience as well as MD or DO after your name have any authority over me or the others who have achieved this accomplishment.

NEW RULE #4:  Any recruiter and his/her agency must look for a permanent position for me.  I am licensed in IL, IN, AL, AZ and FL.

Sorry:  some more digression:  I studied every form of surgery since my teens because I designed and built the first ECMO machine (extracorporeal [outside the body] silicone membrane oxygenator).  So before I even entered college I was solved this huge problem for premature infants with immature lungs and won many awards.  By the time I was two years into college I had it working and the whole world published me as one of the brightest minds of my childhood.  For a teen is still a child.  I was not old enough ugh to vote!   I had to know a lot of medicine as a teen interviewing numerous cardio-thoracic surgeons reading every book on medicine and surgery for many years that related to pediatric physiology and what is used in the operating room.  I found there was nothing I lacked and I had everyone giving me what I needed because they saw the good in what I was doing.  I started to prove my concept with simple saline and a baffle of a membrane I designed to be organized to increase surface area for maximum effect and I used gas chromatography to prove both oxygen and carbon dioxide traverse the membrane down small pressure gradients…just like in the alveoli of the human lung.   Then I moved on to using real blood and a blood gas analyzer.  I was 16 when I switched to blood and measuring blood gases.

So first I had to understand the problem of bubble oxygenators in adults and come up with a solution for pediatrics because they are not even closely related problems.  Bubble oxygenators cause hemolysis and that won’t work long term to help a premature baby.  So bubble oxygenators are ok for short term use in the OR…They are used for entirely different purposes (coronary artery bypass surgery).  Now my device is used all over the world.  It has for decades.

I was scooped up one week after I sent in my packet to the university where I then had an interview for medical school and my acceptance letter to medical school came to me all in the same week.  I was the youngest in my medical school class and some of my classmates enjoyed trying to torment me, but I followed my plan I have discussed on another page to ignore those kinds of negative stressors (you only hurt yourself if you react).

RULE #5 I am looking for people who work to get permanent positions.  That is my first goal now.  I will only accept locums if I have no source of income.

I studied with a world-renown trauma surgeon and met with him each morning (Donald Trunkey MD) at San Francisco General Hospital where I spent time as I did for nearly all of my second two years of medical school participating in ICU and surgical care of pediatrics, adults, in every type of situation. So to walk into an ED and practice medicine was easy and remains easy and pleasant for me. I made this choice to…because I need to control my schedule so I can also be a workng artist.

YES YOU MAY HAVE READ I HAVE WHAT I BELIEVE IS A CURE FOR CENTRAL AND ANTERIOR SPINAL CORD SYNDROMES.

I have a cure for central [ccs] and anterior cord syndrome [acs] and it works for other nerve injuries I have cured.  These were full dense lesions clinically and if you have ever seen the pain of central cord syndrome [ccs] you would be equally amazed to see the pain disappear overnight and the patient to stand up and begin walking in a few days.  The first patient was 75 years old.  He was an insulin-dependent, diabetic with a 4 vessel CABG 1-year prior and still smoking one to two packs per day.  He was told he would never recover-never get out of the wheel chair by a board certified neurousurgeon and board certified neurologist.  I cured all of his symptoms in 8 days, but I treated him with over 8 weeks to complete the regimen I designed.

This patient and his son a minister who I know very well, well they did a the litmus test I would never do…he stopped the medicine thinking his cure was an act of God…in 2 days he was back in the wheelchair paralyzed as before with the burning in his hands which again were more like flippers with no extensor function.  All he could do is moan and rub his hands just like when I first saw him 4 days after his symptoms began after nonstop coughing  caused the bleed in the center of his spinal cord (proven on MRI-an acute bleed just hours old).  He had been in the ICU with a tracheostomy for 4 weeks for bilateral lung contusions and all of his ribs were fractured bilaterally but rib one on both sides.  Note as I will mention again: his son waited 4 days to call me to cure this CCS!  This man stood up in 8 days.  His son is still alive; He was so happy I helped his dad…but each time through the years for some reason he waits to call.  There are many more patients and two are physicians!

This 75- year old gentleman, he was a kind mechanic and at the State Fair in So Florida under a Cadillac when someone pushed on the car causing the jack to fail and the full weight of the car to fall on him.  I don’t know why he got under the car his English is so poor and so is my Portuguese but he was repairing a flat tire on a grassy surface [this is not a stable place to use a jack].  When the car fell on him, this is not what caused his central cord syndrome.  He had bilateral lung contusions, bilateral rib fractures and classic signs of traumatic asphyxia.  He had no neurologic deficit for the month in the hospital.

After he was in the ICU for a month he was sent home and was walking on the beach and coughing and coughing until suddenly he lost use of his legs and his arms in the pattern classic for central cord syndrome  [ccs].  The arms were weaker than the legs but his legs had no useful motor power for even standing.   He was for all his specialists could see, a patient who would likely remain in a wheelchair due to a hemorrhage in the center of his cord from severe coughing and a lot of co-morbidities.  He had not smoked in weeks and that wakes up the mucociliary elevator mechanism and with all this sputum coming up he was nonstop coughing.  He lesion was so dense he was told there was no hope and no treatment (and then the family called me).

There is nothing to do for this lesion surgically it is a hemorrhage in the center of the spinal cord…so if you tried to evacuate the hematoma if it was causing pressure all you would do is cut motor neurons on your way to the center of the cord and the laterally placed spinothalamic nerves which convey temperature and pain on the opposite side a few levels adjacent to the injured area.

My friend calls me days after his dad is sent home and after he was seen for the CCS and told this is permanent and discharged with nothing except a new wheelchair.  Not even a pill for his burning dysthesias in his hands.  Pathetic.  My friend (his son) said Dwight, I know I am asking for a lot.  He said “You must cure my father.”  I said I have postulated for a time a cure but never had a chance to use it and no hospital where I work will allow it (it would be experimenting).  He was surprised I came with the medicine and I had an agreement with them that this is unproven and he is the first patient to ever received it for this injury.  The word of his recovery spread like wild fire-hence more patients.

So…to continue once again he had no ability to use his legs again when he stopped the medicine.  I restarted it and told him he must not stop it for 8 weeks.  I also mitigated his coughing but only minimally.  He was left on his baby aspirin too.  He was back to work repairing automobiles as a mechanic and driving his car in 2 weeks.  He lived another decade without any spinal cord symptoms.  He had a massive mechanism of injury you would have thought caused the CCS (the huge cadillac falling on his chest and it took many people to lift it to get him out and he had all the signs of traumatic asphyxia as well) but until the walking after discharge weeks later no CCS until one big cough and he felt his motor function disappear in minutes and the burning in his hands appeared.  He was so happy back to work and I paid for the medication as this man could not afford that and I paid for all of the patients I have treated but one physician who is also a student of mine who had a surgical accident that damaged his peritoneal nerve (a neuropraxia) which is a contusion to the nerve that never recovered for 4 months.  I saw him and he was back to normal function in less than a month.  The longest case was a cervical radiculopathy on the right affecting the right radial nerve and the patient refused surgery for nerve root compression from an HNP (herniated disc).  He was 6 months out from his injury when he returned to me with full function.  The next is a patient with a T6-7 severe anterior cord syndrome causing near full paraplegia of both lower extremities and in 7 days days he was cured with the same protocol.  I have over 20 cases now in 15 years I have treated and not one failure.  One is deceased due to his age, diabetes and continued smoking but his spinal cord syndrome remained cured for the decade he lived after I treated him for 8 weeks.

I felt mortified when I could not treat a patient with a CCS that occurred in front of me in an ED because the director told me it is his ED and I am not allowed to use off label use of any medication in his ED-yet we do this with many many medicines.  Sadly it was a 24 year old mom of two who hit her chin with full hyperextension when she fell over the handle bars of her bike striking her chin.   I examined her and she had the classic mechanism of injury for CCS (cervical [neck] hyperextension).  She was not treated and he made sure I had none of her information too so I could not follow up with her and help her.  Another stupid evil doctor.  Why?  The treatment is safe for use in children for decades and approved in adults for another condition.  It was that condition that told me it would work…AIDS.  HIV-wasting syndrome.  It gave me the information I needed to know what to do for cord syndromes.  IF YOU HAVE ANY  PATIENT WITH NEW or OLD CCS I would still try this treatment.  Why?  I treated patients who presented late.  It did not seem to affect the outcome.  None had cord transections but there is another reason those cases would benefit from this treatment and it is to keep and improve all of their functional muscle mass.

I supplied the medication and as long as I saw the patient as soon as the diagnosis was made by MRI or suspected clinically (since the treatment is harmless) and you can’t be allergic to it since it is a substance already in your body…you make it.

I would like to do some research BECAUSE OF HOW this agent AFFECTS METABOLISM.  IT IS THIS EFFECT THAT I BELIEVE IS DOING THE TRICK TO NEURONS THAT HAVE MUCH MORE RECOVERY THAN WE THOUGH POSSIBLE.  SOME OF THESE CASES ARE MONTHS OLD WHEN I SEE THEM.  THE LITERATURE STATES:   IN MOST CASES THE CORD IS CONCUSSED BY THE LIGAMENTUM FLAVUM.  THAT DOES NOT MEAN NERVES ARE SEVERED AND CERTAINLY NOT ALL…I AM BEGINNING TO WONDER IF THIS IS NOT AN ANSWER TO DAI, DIFFUSE AXONAL INJURY NO MATTER HOW SERIOUS BECAUSE THE PATIENT MAY REGAIN SOME FUNCTION IN THE NERVES THAT ARE NOT FULLY TORN.  STRETCHED IS NOT TORN NOR LACERATED.

AT THIS POINT I NEED TO GET ENOUGH CASES AND THE ONLY WAY I CAN DO THIS IS TO TELL THE WORLD AS I AM DOING HERE. CALL ME IF YOU HAVE CENTRAL CORD SYNDROME., WEAKNESS OF ANY CAUSE, ASTHENTIA, WEIGHT LOSS PROVEN NOT TO BE DUE TO CANCER, ADVANCED CANCER WITH NO APPETITE WHO WOULD LIKE RETURN OF APPETITE (YOU DONT HAVE TO DIE STARVING AND MY DAD WAS GLAD I DID THIS FOR HIM).  IT WILL NOT CAUSE YOUR CANCER TO PROGRESS OR SPEED UP.  IT ALLOWED MY DAD TO IMPROVE HIS NUTRITION TO THE POINT HE COULD STAND AFTER BEING BED RIDDEN FOR 2 MONTHS.  HE ATE HUGE FEASTS AND HE PLAYED CARDS, THEN ONE NIGHT HE HAD A MASSIVE STROKE BECAUSE OF HIS HYPERCOAGUABILITY AND DIED.  BUT HE DID NOT DIE HUNGRY.

I WOULK LIKE TO PUBLISH THE FIRST 100 CASES IN MY FUTURE RESEARCH TO CONVINCE THE MEDICAL COMMUNITY THIS IS A VIABLE TREATMENT THAT WORKS AND IS SAFE. (FOR SPINAL CORD SYNDROMES).

THOSE OF YOU WITH TERMINAL CANCER

YOU WILL NEVER REGRET THIS I CAN PROMISE YOU.  MY FATHER HAD TERMINAL CANCER AND HE ATE SO WELL AFTER I BEGAN HIS TREATMENT.  HE THEN GOT OUT OF BED AS I SAID.  HE PLAYED GAMES AND GOT SO ME ENJOYMENT BACK IN HIS LIFE.  EVEN IF YOUR CANCER IS NOT TERMINAL I WOULD TAKE THIS TREAMENT IF YOU ARE MALNORISHED.

THOSE OF YOU IN WHEECHAIRS FROM CCS ACS AND OTHER NERVE, SPINAL CORD AND BRAIN INJURIES INCLUDING STROKES OF ANY KIND.

PS: I HAVE ONE PATIENT WITH AN EARLY MALIGNANT MELANOMA WHO HAD A SPINAL INJURY YEARS LATER (3 YEARS LATER).  HIS DERMATOLOGIST SAID IT WAS NO PROBLEM AND IT HAS BEEN SINCE 911 AND HE HAS NO RECURRENCE OF HIS MELANOMA BUT TOOK MY TREATMENT FOR A EXTENDED PERIOD.  HE IS THE PATIENT I TREATED THE LONGEST BECAUSE OF MUSCLE ATROPHY.  HE TAKES THE MEDICATION ON A PERIODIC BASIS BECAUSE OF THE COST.  BUT IT HAS KEPT HIM EMPLOYED BECAUSE HE IS AMBULATORY AND CAN LIFT AND I HAVE SEEN HIM LIFT 50 LBS WHEN HE COULD DO NOTING BEFORE.  THE ONCOLOGIC DERMATOLOGIST SAID IT WAS NOT A CONCERN AND, IN FACT, THE DRUG I AM USING COULD BE IMPROVING T CELL KILLER FUNCTION WHICH FIGHTS CANCER CELLS.  I HAVE NOT FOUND A CASE LITERATURE IN WHICH CANCER WAS REPORTED TO HAVE DEVELOPED IN THE 15 YEARS SINCE I BEGAN THE TREATMENT OF BOTH SHORT (8 WEEK) AND LONG (YEARS) OF INTERMITTENT TREATMENT (INCLUDING ONE PATIENT WITH MELANOMA).

THE LOW DOSE I USE HAS A LOT TO DO WITH THE SAFTEY YET THE DRUG HAS BEEN USED IN 20X HIGHER DOSES IN PEDIATRICS FOR AN ENTIRELY DIFFERENT CONDITION.   I HAVE ONLY TREATED ADULT CASES, TWO OF THEM ARE PHYSICIANS.

IT IS INTERESTING TO NOTE:  HUMAN CHILDREN ARE NOT TYPICALLY USED IN ANY STUDIES FOR THE POTENTIAL POSSIBILITY OF DEVELOPING CANCER OR OTHER COMPLICATIONS IN THE DEVELOPMENT OF MOST MEDICATIONS APPROVED FOR USE IN CHILDREN.  SO WE DON’T USE THE SAME RULES IN CHILDREN…YET WE USE THE SAME DRUGS EXCEPT FOR A FEW NOT USED IN CERTAIN AGE GROUPS WHEN PROBLEMS WITH A DRUG ARE LATER IDENTIFIED.

 

SWITCHING GEARS: THIS WILL BE MOVED TO ANOTHER PAGE:

The program I teach for oral exams is alive and well (MY ORAL BOARD TUTORIAL!)

I AM TEACHING THE CRITICAL TOPICS CLEARLY DEFINED BY THE USE OF SUPERLATIVES: WORDS LIKE THE MOST IMPORTANT, THE MOST LIKELY…

IT IS A SET OF CASES THAT ABEM TESTS AND MUCH MORE.  They test only 11 cases.  I created the most 100 cases (BUT I PRESENT 52 OVER 6 DAYS…IT IS ENOUGH TO GET EVERYONE INTO THE CONCEPT OF USING THIS FORM OF EDUCATION AND THEY CAN FINISH THE REST ON THEIR OWN).   If you know these cases there should be nothing in emergency medicine in which you make an error.  EVER.  EVERY ONE, EVERY SINGLE PHYSICIAN WHO EVER ATTENDED THAT PROGRAM WOULD ATTEST TO THAT.  Some came back year after year for up to a decade. It shocked me.  I asked why and it was always the same answer…each year I am learning more and more…which means it is so deep many cannot learn it all in the time allotted but they have no requirement to learn it in the 6 days.  I give them a huge number of cases to go home and keep learning.

READ PEARLS OF WISDOM IN EMERGENCY MEDICINE ed 5 and when I release it the 7th ed which will be an electronic version which I will provide at a nominal cost so it is affordable to all.  Including all the color images.  Part of that rule means that every agency that approves physicians must know that each has completed the text and I have signed off on their exam.  I am not charging much for this…i am taking a loss.  I am doing it so you will all do better.  I WILL GIVE YOU 2 YEARS ALL TO DO THIS THEN THE PRICE WILL BE THE STANDARD PRICE FOR MY WORK.  It will be $995.00 plus shipping of the USB drive when we open a store on this site.  

 

NEW GOALS…it includes all physicians and APPs must complete the ORAL BOARD TUTORIAL as a live simulation program JUST LIKE it has always been.  The schedule for the program will be a 6 day program as always with category 1 ACEP CREDIT I HOPE…I HAVE TO TALK TO NATIONAL ACEP.  I WILL BE THE SOLE INSTRUCTOR AS USUAL.  I HAVE RUN THIS PROGRAM FOR ¼ A CENTURY.  I KNOW HOW TO DO IT.  I KNOW HOW AND WHY IT WORKS.  I WILL LIST ALL OF THAT ON ANOTHER BLOG CALLED THE ORAL BOARD TUTORIAL.  YOU CAN READ THE ARTICAL IN THE 2006 EDITION OF ANNALS OF EMERGENCY MEDICINE (THE EMERGENCY MEDICINE ORAL EXAMINATION) THAT SHOWS MY METHODOLOGY BUT IT HAS NONE OF MY CASES…CASES THAT ABEM HAS REVIEWED.

ONE OF THE BOARDS HAD ME WRITE 17 CASES FOR THEM AFTER THEY SAW MY WORK BECAUSE AS ONE EXAMINER SPOKE IN A DISCUSSION GROUP…IT IS ABSOLUTELY TRUE…MY CASES GO BEYOND WHAT THE BOARD HAS DONE AND THEY WANTED IT TO BE PUBLISHED FOR THEIR USE AND IT WAS…THAT WAS IN THE MID 1990s.  SO THEY USED THOSE CASES AND OVE 750 TEST ITEMS I WROTE FOR THEM.  I HAVE ALSO WRITTEN TEST ITEMS FOR THE AOBEM.

 

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