Sunrise. Loch Arbor, NJ. Paul Goldfinger photo. 10/23/21. ©  Click to enlarge.

THE WHITES    “Keep on the Sunny Side”  From the movie soundtrack  “O Brother Where Art Thou” (This movie is worth watching.)

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A love story. Naples, Florida. Paul Goldfinger photo.

THE ELGINS:

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The morning of a  Fort Hancock wedding day on Sandy Hook.  2015 © Paul Goldfinger. Click to enlarge.

SARAH VAUGHAN:

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Medscape  Oct 21, 2021:   By  Alok Patel MD:

“Patients want docs, not NP’s or PAs, leading their ER care:”

“Everyone has an opinion about the ED — the wait time, the workflow, the resources, whatever. As a hospitalist, I talk to ED staff and to patients about the ED on every single shift. Patients tell me everything. They tell me about their ED experience, how long they must wait, and worries about the cost. And recently, some of them told me that they couldn’t tell if they were being treated by a doctor or not.

“Nearly 80% of people said they most trusted a physician to lead their medical care, with 9% saying nurse practitioners, 7% saying physician assistants, and 5% saying nurses. This percentage increased as medical conditions became more severe, with more than 80% saying they preferred physician-led care for a heart attack, a stroke or after a car accident.”

Paul Goldfinger, MD:

When a close relative wound up in the Jersey Shore ER after a bad  car crash, his care was turned over to the Trauma Team. But during the early hours of his care no physician saw him.  He was fussed over by unidentified personnel who neglected to obtain xray reports.  They said that he might be discharged.

But they misdiagnosed the seriousness of his injury and they missed a pelvic fracture that required major surgery that day.  The diagnosis was finally made by a physician assistant to the trauma surgeon who showed up after too many hours and told us the truth, and still no physician saw him.

He was finally seen by an actual surgeon the next morning,  just before being wheeled into the OR.

I was hospitalized recently at Jersey Shore  and I couldn’t be sure who was coming into my room and what their qualifications were.  The attending physician never came in at all, and a couple of doctors came in who were residents and who were clueless about my problem. Most doctors or other personnel  who came in were in a hurry, and everyone ignored my request for a consultation with a specialist.   I know what a quality house-staff is like, and the residents whom I met  are not that.

On another occasion, at Monmouth Hospital, Eileen presented in the ER with a swollen knee.  A person in a white coat came in and began an assessment. He was doing a sloppy job and I asked for his credentials.  He said he was a physician assistant.

I told him that I wanted a physician to see her.  He pointed to another white coat down the hall and said, “He is a physician and he could see her, but he won’t add anything to my evaluation because I can do what a doctor can.”  He spent 5 minutes with her and ordered an xray.  But it turned out later that he was wrong—inadequate history taking and failure to consider the correct diagnosis. Later an ortho physician assistant showed up to make the correct diagnosis and provide appropriate care. He just happened to be in the ER. No physician ever saw her.

These mid-level practitioners make mistakes  and may overestimate their usefulness.  And they  cannot compare to a physician in quality.

When you visit a physician  (inpatient or outpatient) make sure that you know who is evaluating your care.  I have called a doctor’s office and found myself being questioned by some secretary who wanted to know why I wanted to see the doctor, what my symptoms were, etc.  This is inappropriate.

In my cardiology group practice, if a patient called with a medical issue, the phone was handed to an RN—CCU trained.  If she determined that a physician needed to get involved, she would make sure that we were apprised of the situation, put us on the phone with the patient, and she saw to it that one of our doctors saw the patient, either in the office that day or at the hospital where one our doctors was available as needed.  And that RN would followup the next day .

Much of the time  when I interact with the healthcare industry, I have something to complain about—-and not trivial complaints.  Technology these days is remarkable, but physicians are being forced to follow the guidelines of efficiency experts. As a result, quality is often compromised in ways that patients may not detect.   Patients don’t know how dangerous medical practice can be these days, and unfortunately, only 30% of physicians run their own practices.  A pulmonologist I know was ordered by management to limit his office visits to 10 minutes. He ignored the order and wound up 2 hours behind.

One of the biggest areas of trouble are failures of communication. And then there are shortages of healthcare workers including nurses and doctors.  Office staff is trained to prevent patients from actually speaking to or seeing a doctor.  Efficiency experts try to finesse the resultant problems, but they know little about medicine.  I don’t know why there isn’t a tsunami of malpractice suits across the country.

Maybe I will start a series of “medical  process complaints of the day” as seen thorough the eyes of a physician.

So be alert and ask questions of everyone you see.  Have an advocate with you if possible.

Paul Goldfinger, MD.

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Baseball fan. OG Boardwalk. Oct 21, 2021 Paul Goldfinger plhoto.

JOE BROWN   “That’s the Way It Goes.”  Concert for George.

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OG boardwalk. Oct 21, 2021. Paul Goldfinger. © Click to enlarge.

Paul Goldfinger, Photo Editor at  Blogfinger.net

I am on the OG boards today looking for some candid portraits or action shots.  I am glancing around trying to imagine a composition which would be revealing in some impressive way.

As this woman approaches from my left, she would reach me in about two minutes.   I  have already pre-set my Leica M-9 camera for focus, exposure, ASA, and  depth of field.  I sit on a bench looking towards the ocean and I aim my viewfinder straight ahead waiting for the magic moment when she would walk unaware into my field of vision.  But nothing happens.

So I lower  my camera and look left. 

She had stopped in her tracks when she noticed me.  She stands still.   So I motion for her to walk by as I aim my camera straight ahead.  I did not want her to know that she is my subject.    She walks briskly about 10 feet right past me.  I trip  the shutter without being sure what would result. Neither of us said a word.  She kept walking southward,

If you click on her portrait, you will see her face.  I love her dignified expression and her evident strength of character. And the way her hair flows behind.

I usually am unimpressed by portraits where critics think that one’s character can be shown.   But in this case we begin with  a photographic uncertainty yet  I believe the result reveals something about this person.

Too bad she won’t see the post.  I usually photograph anonymously. That is an inevitable component of street photography,

CHET BAKER  from his album My Funny Valentine:

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a.

The last scoop. Oct. 17, 2021. See ya next year. Blogfinger photo.

b.

From the OG flier.

Antisemitic  and anti-Israel two-sided fliers are being distributed around town and left on porches.  The content is too vile  and full of hate to reproduce.    Someone already contacted the police.

The crudely prepared fliers are produced anonymously, so the cowardly  perpetrators are unknown.

Here is a link to an incident this past summer:   Anti semitism July 2021

c.

The Chamber of Commercials is sponsoring this Halloween event.  But where is the word “Halloween? Is that now politically incorrect?

And why is the Township paying for this promotion using taxpayer money?  The Neptuners never do anything unselfish for the Grove.  What is their scheme?  Maybe the trick or treat will be found in your next tax bill.

d.    The gender wars haven’t arrived in the Grove yet, but looking back, here is Johnny Cash

e.  On October 19, Blogfinger had 977 hits.  We get many visits everyday from all over, due to Google searches.  Some people ask for links to articles we posted 10 years ago or more.  We also had visits from Norway, Moldova, Spain and Guatemala in addition to 8 other foreign countries.   By the way, guacamole was invented in Guacamala.

f     Root for the home team. Get a car magnet.

These  magnets are made in the USA from outdoor vinyl.  We are expecting another order next week.   They are $5.00.

Just send us an email with your OG address and we will provide  free delivery.  Drop off the $5.00 at 113 Mt. Hermon Way after you have received your OG mag.

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