Wednesday, December 17, 2014


Until after the New Year there is little reader interest in blogs except for sensationalism. With that in mind my postings will be sporadic at best, but please do a quick check by noon daily since I will blog if I have the time and the subject is noteworthy.
In this era of “racial equality” The following should be a must read and an eye opener to those who believe that black targeting is limited only to the poor urban youths.
The protective bubble that comes with the presidency – the armored limo, the Secret Service detail, the White House – shields Barack and Michelle Obama from a lot of unpleasantness. But their encounters with racial prejudice aren't as far in the past as one might expect. And they obviously still sting.

"I think people forget that we've lived in the White House for six years," the first lady told PEOPLE, laughing wryly, along with her husband, at the assumption that the first family has been largely insulated from coming face-to-face with racism.” 

"Before that, Barack Obama was a black man that lived on the South Side of Chicago, who had his share of troubles catching cabs," Mrs. Obama said in the Dec. 10 interview appearing in the new issue of PEOPLE out Friday (19th) this week'
Once again there is going to be another dilution in the quality of Health Care. This is especially pertinent in the “Primary Care” field which too many physicians are shunning in favor of higher paying specialties.
Additionally Primary Care or the “Family Physician “has become an entrepreneurial enterprise with hospitals controlling practices and commercial sponsored ambulatory care facilities. In some states pharmacies have gone big into “walk in care” provided by “Nurse Practioners”. In NJ at this time all the pharmacy chains offer various immunizations administered by the “druggist”.
The Senate Health Committee passed S1184 (Vitale), which would expand the scope of practice for physician assistants.
The bill would authorize a physician assistant to make pronouncements of death, and to undertake any other duties and responsibilities beyond those in the statute that a supervising physician elects to delegate, pursuant to a written delegation agreement. The duties and responsibilities delegated to a physician assistant would be limited to those procedures that are customary to the supervising physician’s specialty, and that are within the supervising physician’s competence and training.
The bill provides parameters for a delegation agreement, including a requirement that, in the case of a multi-specialty physician practice, a written delegation agreement must be executed for each physician specialty within the practice.
“The bill requires a physician assistant who is working in either in or outpatient settings to be under the continuous supervision of a physician; supervision may mean only maintaining contact through electronic communication”. ( Yep, the doctor could and will be miles away dependent only on what information he receives by phone or email/fax )
This does not apply in an emergency.
The bill would authorize a physician assistant to order, prescribe, dispense, and administer medications and medical devices to the extent delegated by a supervising physician. Now a physician must countersign all prescriptions.


  1. I recently had the experience of being told "Dr. XXXX" would see me in the absence of my general practitioner. The "doctor" turned out to be a physician assistant. My doctor was out on leave and I saw no evidence of any other doctors in the office that day. While the PA was very professional, I was a bit surprised at this turn of events. She stated she could do anything a doctor would do. I had a very long wait for service and the PA seemed to be overloaded with patients. She wrote a prescription for me, which I decided not to take after reading the "common side effects" which included "altering brain function and/or structure." The condition quickly cleared up on its own without the antibiotic. I came away from this experience wondering what to expect the next time.

    1. Benice, hanks for the incident report. Yours will be only one of thousands in which under Obama and managed care patients have become a commodity and the provider of the care althogh may be competent will have limited training. On the plus side their use means more "encounters" in a time period equating to more money to the operators of the facility, and less cost per visit tp the third party payerr be it Medicare, Medicaid or insurance carriers.

    2. Health care became a "commodity" long ago--about the same time doctors became "providers" and health insurance became a for-profit "free enterprise." I remember one of my doctors saying to me, "I'm not a 'provider,' I'm a doctor, dammit!." And health care itself has become an "industry." Well, as the old song says, "God bless free enterprise!"...

    3. Yes Dottie as you know I have b een writing about the impact of the HMOs and the theinsurance carriers on health care since the 70s. First with letters to the editor and then through the blog. Thee HMOs pushed by the Republicans set artificial reimbursement, need of services approved by somebody a clerk? at the carrier, and of course cook book medicine with get you out of the hospital yesterday.

  2. Thanks for the insight, Doc. And Happy Hanukkah.

  3. Race relations in this county, imo, have worsened since he became President. It's race 24/7 with them and I'm tired of it. I don't believe anything the O's say. Both of them are proven liars. Can't wait until 2016.

    I travel the Parkway up to Exit 145. Take a look at some of the apartments which has

    1. HAS WHAT? And what have they to do with race relations?