I will stay in Podunk and make a living wage if you will take it to a blog. sm

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Outsourcing simply means that big corporations show bigger profits and the CEOs get bigger bonuses. They claim that it's good for the economy because the companies and CEOs have more money to spend, gag me with their trickle down economics theory, but they refuse to see what it does to the working class people. It's going to be interesting to see what happens in this country down the road as more and more working class people lose their jobs to offshoring. What, are we all going to sign up for unemployment and welfare? Will crime go up as we all start stealing just to put food on the table? I wonder what's going to happen.

If there is anyone out there new and still considered a mentoree and able to work full time and make rent please tell me because I need some encouragement. I want to quit the day job to be able to do this fulltime but when I do the math it just doesn't add up to the rent:-)

I just looked at your transcription blog. I love it! I had added to my favorites. What a great idea.

or do you have one? It would be a place for you to write like you have here. Just wondering.

I mentioned this a few messages below, but the blog has its first post. I am NOT supporting any Ad things on there and will not be making anything off this.

If you have a link that would be useful to others to write their gov't reps, companies, news sources, etc, feel free to post them or e-mail me so i can get them up there. I am also looking for any news stories or any information we can get. One way or the other, we might be able to make a difference.

who says what he REALLY thinks about the JCAHO. Funny, I found it on Google when I typed in JCAHO and q.i.d. since I wasn't sure what to do about q.i.d. ........

The Death Star of American Medicine

I wish I had written this (JCAHO Unplugged; registration required), because it gives voice to the feelings that I (and probably 99% of the physicians in this country) have about the Death Star of American medicine -- JCAHO. A few excerpts (emphasis is mine):

That is why it really upsets me to watch the JCAHO people walk through my hospital like they were navigating a toxic waste dump. What upsets me even more is the utter paralysis of normal activity that occurs months before their visit and the huge sums of money spent on mock drills and consultants to prepare for the JCAHO invasion. JCAHO (the Joint Commission on Accreditation of Healthcare Organization) arouses more fear in hospitals than MRSA gone wild, and their "visit" has a greater institutional paralytic effect than circulating a neuromuscular depolarizing agent through the ventilation system.

A few unsigned verbal orders, or an anesthesiologist carrying a syringe of Anectine in his or her scrubs, or not locking up I.V. bottles of normal saline will result in conditional or provisional approval, and failure to take remedial action within 30 days may result in the death penalty, which for the hospital means bad PR, and more significantly, loss of all federal money. That's right, you can get the chair for parking tickets in the JCAHO world.

It doesn't matter that the hospital admits 50,000 patients a year, saves countless lives and performs daily miracles. Write q.i.d. twice and you can get your liver transplant someplace else.

A response by Russell Massaro, MD, FACP, Executive Vice President Accreditation and Certification Operations, JCAHO, follows Dr. Cossman's screed. The only thing I can say about it is that he makes clear that unannounced surveys will be forthcoming in 2006. Oh, joy!

A lot of the press in the past few days has been discussing issues such as oversight, accountability, and clearly expressed legal authority. JCAHO operates without any real semblence of these niceties, and does so with all the subtlety of a bureaucracy run by Darth Vader. Watching hospital administrators lose bowel and bladder control the minute a JCAHO inspection is brought up has always reminded me of Vader's underlings wilting in his presence --- and for good reason. Without the JCAHO seal of approval, they cannot operate an otherwise well-run, caring facility. The organization, as it was originally intended, was designed to ensure a basic level of safety for all hospitals. It has now become yet another "certifying" agency which must come up with new "critical" problems to fix in order to ensure its ongoing existence (those of you who have gone through the most recent mental masturbatory experience of banning QD and QID in orders know what I mean). What is most galling to me, however, is that hospitals must fork over a hefty sum for these frequent torture sessions, and the inspections are done not by practicing physicians or nurses, but by folks who long ago gave up the difficulties of actually caring for patients for the safety of a clipboard to hide behind.

Maybe I have my metaphors mixed up --- JCAHO comes in like the Death Star, but leaves no room for different institutions to solve problems in their own way. The JCAHO mantra can really be translated as "Resistance is futile. You will be assimilated!" As a result, I suppose JCAHO is really The Borg.