Paul Goldfinger from the streaming film:   Truffle Hunters. Italy.  Click to enlarge.

RINA KETTY    “J’Attendrai”

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Deal Lake. Asbury Park. Paul Goldfinger photo and silver gelatin darkroom print. ©   Click to enlarge.

NATHANIEL ROSEN string quartet.  “O Sanctissima”

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Polka dots and moonbeams. Ft.Myers, Fla. Paul Goldfinger photo ©

JOE TEMPERLEY (baritone sax)    “Polka Dots and Moonbeams” from his album  A Portrait

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Ft. Myers, Fla. 2020.  Paul Goldfinger photograph.

Preservation Hall Jazz Band:

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Oakhurst begins development of a large property on Monmouth Road.  It will be a “community” of 18 single family homes. Paul Goldfinger photo. 1/22/22.

Sample design of Country Day Estates in Oakhurst.

By Paul Goldfinger MD    Editor   Blogfinger.net

Work has begun on a large property in Oakhurst (Ocean Township. ) This development is taking place on Monmouth Road, a mixed use area where there are private homes, shops, professional offices, small food stores, churches, day camp, and a municipal building.   There is nothing along that road that is higher than two stories.  Originally there was a school and a camp there.

The developers of this space did not strive to build condominiums, or a hotel, or more strip malls.  Instead the project is called “Country Day Estates” and will consist of 18 homes making up a  “community”.  The zoning is respectful of the surroundings, and there is no sign of a “redevelopment zone.” It will be a fine place for families to live.

Here is part of the Ocean Planning Board’s  discussion  (minutes) as this property was on the agenda in 2010:

You will see how local government is supposed to focus on representing we the people:

“Councilman William Garofalo gave the Board a brief history of the applicant’s
proposal. Mr. Epstein first came to the Town with a proposal for a more highly dense
development of 24 homes and 17 three-story townhouses on Monmouth Road. He was
told that his proposal was not in the best interest of the area. He changed his proposal
to what the Board was shown this evening.

Mr. Epstein met with the neighbors and showed them the plan and they felt that the second plan is preferable over the first.

Chairman Thomas Means said that he did not think the proposed plan is
consistent with the neighborhood and it is not consistent with the Master Plan. He felt
that if the subject site is developed as proposed, then it will be opening a door for other
tracts of land to be developed similarly.”

The CMA and Neptune Township should have insisted on a historic single family home layout for our North End.

The OG North End will have a 5 story hotel,  condominiums, limited parking and stores.  There will be 12 single family homes.

There is little in that North End re-development plan which can be considered to be a “community” or consistent with the historic precedent of OG.   The OG nomenclature of “historic district and master plan ” is  just a smokescreen for Neptune’s real agendas for the Grove.

And, as the Oakhurst “community”  starts construction, the OG North End remains stuck, but the public is clueless as to what is going on behind the scenes even though a re-development zone is the responsibility of the  Township, ie we the people.

It’s ironic that over 120 years ago a hymn was sung in the Great Auditorium called “Beautiful City of God.”  What design at the North End would have been preferred by the founders of Ocean Grove?

Ira Sankey  from Waxing the Gospel recorded in the Great Auditorium:

” Beautiful City of God,
Beautiful City of Light,
Where naught that defileth may enter,
Where none see the shadow of night.

Refrain:
Beautiful City of God,
Beautiful City of Praise,
Where the songs of the blest shall be ringing,
Through eternity’s endless days.

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By Moe Demby. He’s a snowman from Blogfinger.

Fierce snowfall fades,
the rising moon fills the sky--
fallen flakes glisten




Charles Gounod with the London Philharmonic:

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QUOTE OF THE DAY:

“There are absolutely no credible scientific studies that support the safety and efficacy of non-physicians practicing without physician supervision.  None.”

This quote is from a new book by Niran Al-Agba,  MD and Rebekah Bernard, MD. It is called “Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare”

By Paul Goldfinger,  MD, FACC

I was a young doctor in the 1970’s when “physician extenders”   (nurse practitioners and physician assistants) appeared on the scene.  It was a great idea, but I was certain that it could only succeed if these healthcare professionals would work under the supervision of physicians.

Over the years, these “mid-levels” began to push for the right to open their own practices without supervision by physicians.

They have been growing in numbers and they have gotten permission in an increasing number of states to cast aside physician oversight.

These battles have been won due to politics and not medical wisdom or (see above) scientific proof.

Running parallel to these new mid-level rights to practice alone there is a new revolution which will change the practice of medicine forever.

Coming to a town near you, big corporations such as CVS, Walgreens and Walmart will be opening in-store clinics which will be staffed by nurse practitioners or physician assistants who will be on their own without physician oversight.

They will act  like primary care doctors and will mostly see simple everyday disorders such as sore throats, rashes, and musculoskeletal complaints. And they will do well with such complaints, but what happens if a difficult diagnostic problem shows up?  They may miss the problem and leave the patient with the risk of dangerous delayed or absent care.

A related phenomenon is the explosive growth of urgicenters which are usually staffed by doctors, but now, more often, are staffed by PA’s and NP’s.

None of these facilities will accept the responsibility of following someone for chronic conditions as doctors’ offices do.  One shot diagnosis and treatment is a recipe for trouble.

And in some states mid-levels  can open their own offices to diagnose, treat, and prescribe. These “doctors”  are sometimes allowed to do and interpret  xrays, ecg’s and other critical procedures such as ultrasounds.  The PA’s want to jettison the “assistant” name in their title.

I took a relative  to a local ER for a painful knee. A  young man with a white coat and no name tag came into the room, and I watched him carefully. He did a terrible job of taking a history, ignoring her medications and failing to ask necessary questions.

He barely conducted a physical exam and he quickly ordered an xray.  I asked him who he was, and he admitted to be an NP.  I asked if a doctor would see her, and he said that he “can do what a doctor does!”    His approach was amateurish and he was about to miss a serious and unusual diagnosis and waste time with an unnecessary test until I intervened.   An ER doctor came in and corrected the situation.

These mid-levels tend to be delusional over what they are capable of.  Their  training cannot compare to the years and hours spent becoming a physician, where the depth of inquiry into a situation can only be achieved though years of experience   (medical school and residency.)

In some states, mid-levels can get licensed without ever examining a patient—all teaching being done on-line.

Yes they can treat a cold and order a blood test on their own, and they can even order a prescription drug.  But they are more likely to make a mistake and threaten a patient’s life than with a physician in charge.

Lately even doctors offices are having mid-levels take their place in certain situations. I have seen that in action including failure to take a blood pressure properly or obtain  an appropriately in-depth history.

You will hear more about these issues very soon.  We all need to be aware. And these new and unsavory ways to practice medicine will force some primary care doctors out of business.

As a physician, I am horrified. We will soon need more malpractice lawyers.

It used to be said that “doctors bury their mistakes” but there is a great deal of oversight of doctors especially in hospitals. I have long complained about lack of oversight in doctors’ offices, but if I needed an office visit, I will take an appt. with an MD any day over one with a PA or NP.

But turning healthcare over to unsupervised mid-levels will be dangerous to all.  Try to obtain your care from physicians. For example if you want an urgicare visit, call ahead and make sure that your care will be supervised by and provided by physicians.

The two physicians who wrote this book open with this:

Patients at Risk: The Rise of the Nurse Practitioner and Physician Assistant in Healthcare “exposes a vast conspiracy of political maneuvering and corporate greed that has led to the replacement of qualified medical professionals by lesser trained practitioners. As corporations seek to save money and government agencies aim to increase constituent access, minimum qualifications for the guardians of our nation’s healthcare continue to decline—with deadly consequences. This is a story that has not yet been told, and one that has dangerous repercussions for all Americans.”

So, here’s a truth for those mid-levels in their white coats who want to provide unsupervised care:  You can’t be a beacon if your light don’t shine!

THE BLIND BOYS OF ALABAMA:  (From the Imus Ranch Record II)

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Paul Goldfinger still photographs  from the movie “A Chorus Line.”

PRISCILLA LOPEZ   Original Broadway Cast Album.  She sings “What I Did For Love” here, but the photo is of another Chorus Line performer years later.

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Actually, in this case, it is the gulls:

Ocean Grove beach: hunger games with hungry birds. Photo by Jean Bredin 1/20/22

Jean looking for “action”at the beach says, “The only action by the ocean today was this swarm of seagulls looking for something to eat.”

Lovely photo.   Any sand in your shoes?

Jean: You should be like the ladies in Central Park who sit on a bench with a paper bag of bread crumbs for the pigeons and the squirrels.

Here’s a link from the Blogfinger New York collection; click on the title:

Central Park conversation.

Or you can go to Paris and bring some wine for the kids who hang around Jim Morrison’s grave. Or bring them some croissants.

THE HOT SARDINES    “La Petite Fleur”

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