Electronic Medical Record

My first day in Mercy's outpatient Endocrine Office, saved by no-shows which enabled me to struggle with their electronic medical record, a system called Nextgen.  Our financial institutions and travel systems have taken full advantage of computerization, though our medical systems have been laggards.  While I think there is much to be gained, the systems that I have encountered do not seem to be able to template a complex present illness such as diabetes particularly well.  One worthy project might be to compare dictated History of Present Illnesses with those templated.

Mens Club Discussion

AKSE has both a Mens Club and a Sisterhood, each productive in its own way.  The Sisterhood raises money and makes sure food is on the table for kiddush and other events.  The Mens Club meets monthly with some type of program.  I attended today's meeting, one that I had looked forward to, where a U of Delaware professor of Jewish Studies would present on how he transformed from a good ol' boy of non-Jewish ancestry to a Jewish scholar, who definitely did not attend Rabbinical Junior College.  Despite my anticipation, and the obvious knowledge of the professor, the morning was a great disappointment, so much so that I looked at my watch and bentsched early as the Rabbi watched. 

The talk just wasn't focused.  To make it more arduous, the organizers invited the Jewish War Veterans to present.  And furthermore, the food fell short of its usual attractiveness.  I probably won't go back to any more of these, no matter who is scheduled for the presentation.

High Holy Day Sermons

Survived another Rosh Hashana and Yom Kippur, not quite knowing where I am sealed.  Didn't do so great on "latznu" from the viduy, and not about to take the Rabbi's advice to work on where I personally fit in on my transgressions, at least that one.

I do not recall what the Rosh Hashana sermons were.  Something about binding Yitzchak the first day, even though they didn't actually do it until the second day.  For the second day, my daughter commented something about Dr. Phil on the pulpit.  I do not recall anything of the sermon only the paucity of Jewish content, decent theme probably but without the substance that would enable me to recall the content a week later.  Yom Kippur went better, with the Kol Nidre message including a decent review of several passages of Al Chait and a poignant message introducing Yizkor based on his feelings following his experience with a stillborn child.

Last night at AKSE's Board Meeting we had a High Holiday review.  To my great surprise the sermons were well received by most of the Board Members.  None of them required attendance at Rabbi School, the Jewish content was paltry in all, though compensated by other things in the YK messages.

Patient Repairman

My new job has commenced.  While I learn the lay of the land, I started seeing consults and visiting the primary care settings from which my patient originate.  Thus far, the consults have challenged me, which energizes me more than I have been in some time.  Not that I want anyone to be unnecessarily ill or ignore prevention but working as a repairman brings a type of thrill that had been dormant.  Most of the people that I've seen had little medical thought given to them by those who had been treating them.  A few easily correctable insulin revisions make all the difference the first 24 hours, though I ask each of these folks to bear with me for about six months to reconstruct their diabetes from insulin to end organs.  Some of the people seem a little surprised to learn that with some alterations of treatment, they could be doing better.  People had been experiencing marginal diabetic care for more than a decade, yet I was the first endocrinologist they had seen.

Can Obamacare really improve the medical outcome of these individuals?  Unlikely, as absence of insurance does not seem at first glance to be the barrier to lower glucoses or protection of body parts in the diabetics that have come my way the first week.  I think there needs to be somebody accountable for optimal medical decisions.  As I visit the primary offices in a three mile radius, I do not perceive a lot of attentive goal focused medical care, with a few exceptions that bring me a measure of optimism.

For now, I like getting up early to go to work.

New Year 5771

Rosh Hashana eases in and eases out.  The day clearly demarcates one calendar year from another but it really occurs at about the midpoint of a season.  At the start of Elul the parochet and Torah mantles switch over to white, Avinu Malkeinu, LDavid Hashem Ori and Shofar begin and continue through Yom Kippur, with an extension for Psalm 27 through Shmini Atzeret.   Unlike the American New Year which tends to function as the anticlimax to the more widely celebrated Christmas, the Rosh Hashana goes in the other direction beginning an upward swing to Yom Kippur with sukkot as the anticlimax, though preserved by the comeraderie of socializing in different people's sukkahs.

At AKSE the first day appeared well attended, the second day less so.  I located the No Chatter Section for the first time, staying in the designated Men's Section the first day.  Unimpressed with sermons which had vallid topics but paltry Jewish related development.  Went to in-laws afternoon of first day, followed by tashlich at nearby stream that still supports minnows who enjoyed the bread fragments.  After yontiff, shabbos, appropriately restful, then some light chores Sunday, then new job Monday.

Definitely a transition of one time to another.

Erev Rosh Hashana 5771

My greetings have been pretty much sent.  This morning I arose at 5:30, my last full day in my medical office, to prepare dinner for yontiff.  Irene made her annual rice kugel last night.  I made the chicken today.  I was going to make honey cake and had all the ingredients out but took advantage of my New Year's intent of cutting down on procrastination by postponing this until tomorrow, to take to my in-laws.  I made Kojel for dessert instead.  It goes much faster but never gels as well as trafe Jell-o, though I am told that there is now a reasonably competitive Kosher product.

Rozzy plans to be with us for the holiday so we purchased a worship ticket for her.  I picked out a Round Challah, initially getting an Ace product from Safeway but returning it to the shelf when the self-register rang up $9.59.  Procrastinate next year, try not to.  Cheap next year, you betcha.  Got a smaller and less inviting one at Shop-Rite for less than half that.  Tablecloth looks grungy and I could not find the other fleishig one, so probably stop off at Boscov's on the way home for a new one.  Then make a vegetable, make the soup and heat up the pre-made stuff for a good start to the New Year. 

Son's birthday tomorrow.  Same birthday as the world, at least this year.

AKSE Ad Book

Some background: Adas Kodesch Shel Emeth, my congregation since 1997, needs to raise money or to spend less. About every five years they sponsor an event to celebrate something, this time the congregation's 125th anniversary. While it may be a social bonding success, though a very transient one, it rarely makes a lot of money as up-front costs of dinner and publicity are high. The Board and organizers always seem very ambivalent as to whether the purpose of the effort is social or financial. The dinner breaks even, though if they replaced the live band with a DJ they might come out ahead. I'd expect people old enough to have hosted some family simchas to possess the saichel to realize this. In any case, the real fundraising comes from an ad book, for which Irene and I wrote a check for $118 for a half page to announce a message. I could not help be a laytz, extracting the four types of students from Pirke Avot [5:15].

There are four types among those who sit before the sages: the sponge, the funnel, the strainer and the sieve.

The sponge absorbs all

The funnel takes in at one end and lets it out the other

The strainer rejects the wine and retains the sediment.

The sieve rejects the coarse flour and retains the fine flour