P4P- that means 'pay for performance', and it has your docs in an uproar, or in denial. And I think that it will be bad for your health as well.

If you work hard to control your own disease, we get the credit (and a bit of cash as well). And if you need some help-- you need support to control your diabetes, your weight, your heart failure, your cholesterol-- you have compliance issues, or just need a big kick in the seat-- well, now you're costing us money. It is way too easy to cut you loose. I believe that the patients with lowest health literacy and the most needs will be jettisoned. Read more about it at http://www.revolutionhealth.com/blogs/valjonesmd/pay-for-performance--3298

Had you heard about P4P? Are you in favore, or appalled?

And here I thought Yoga was as slow and 'paint-dry' boring an exercise that you could find, but safe, safe, safe. I didn't think that 'hot-yoga' sounded too safe, but that's because I drip as I exercise.

However, here's some news about the 5000 yoga related injuries of 2005, and how, if this is your exercise of choice, you might stay well: http://www.revolutionhealth.com/blogs/jamesherndonmd/common-yoga-injuries-8188

This weekend I spent some time at a Sam Horn seminar www.SamHorn.com ; if you don't know her I can only say that this woman has a brilliant mind. She cuts through the fog, the mustard, and the sh*t.

One of my big insights during the conference is that I don't know what it is you're looking for. What your beliefs are for good health.  Sam came up with a series of questions, but lets talk about the first of them: What does 'good health' mean to you?

Now don't go rolling your eyes, its not as simple as all that. In our group, and answers included: good sex, pain-free, not short of breath, looking good. None of us had the same answer.  My answer: It's when your physical being does not limit the things that you want to accomplish.

Have you wanted to take a hike or go to an outdoor art show, only to hesitate as you're not sure that you can keep up with your friends, or if the weather might be too warm for you? Have you had to consider if you want to take an exotic vacation, as it might be too rigorous? The young don't consider these things, they throw themselves into these activities. I find that I'm no longer young, and if I want to do all the things that life has to offer me, I need to reclaim my health.

So, how about you? Is your health holding you back? What does 'good health' mean to you? Email me at This email address is being protected from spam bots, you need Javascript enabled to view it .

Hmmm. I'm all in favor good health, but it always perterbs me a bit when the government steps in.  I hope that universal health care coverage does occur, as I'm tired of big insurance getting big profits, and the docs & nurses who provide the care and expertise getting les & less each year. We're not business people, most of us never will be, and we're being taken advantage of.

But there's a new bit of legislation in the works to shift discussion to prevention of illness in the workplace, as the workplace can't seem to afford health insurance. The bill, the Healthy Workforce Act at http://www.healthpromotionjournal.com/publications/journal/en2007-07.htm, is a 50% tax credit  of the cost of a qualified employer health promotion program, up to $200/employee for the first 200 employees and $100/employee for remaining employees for ten years.

The Secretary of Health and Human Services, in conjunction with the Centers for Disease Control and Prevention (CDC), will certify which programs qualify, but all programs must have the following specific features: 1) Include at least three of the following four components: health awareness, behavior change, employee engagement, and supportive environments. 2) Use practices that are consistent with evidence-based research and best-practices strategies. 3) Focus on employee populations with disproportionate health burdens, be culturally competent, and meet employees’ health literacy needs. 4) Offer all programs to all employees who work at least 25 hours per week.

They say that enhanced productivity and attendance at work will cause this tax break to be income neutral to the feds, and it will cost 50 cents per dollar spent to your employer.  So is this going to be a good deal for all of us? Or an effort to justify lack of health nsurance due to company investment in a health program?  Let me know what you think.

Katherine Heigl, the gorgeous blond of Grey's Anatomy, is debuting a new line of scrubs for female docs and nurses who "want to look stylish on the job". She is working with Peaches Uniforms to design the Katherine Heigl Collection (http://www.peachesuniforms.com/).

Arrg. In a 'normal', non-Hollywooded hospital, scrubs are worn by docs in the OR and ED, but nurses, technicians, housekeeping and dietary also wear scrubs. And what's missing in medicine is the proper respect and attention given to the nurses as collegues in care. This respect will not be accorded in "pop colors, chic city grey and black, and custom floral prints".

Nurses need not return to those stached gull-like hats perched atop their noggins, but need to choose a uniform style (not scrubs) that designates the rank and status in a medical team that they have earned.  Heigl missed an opportunity to work with nurses on developing professional attire, and elevating the profession. Read more about it in an article with image consultant Sandy Dumont at http://www.endonurse.com/articles/endoscopes/592_481scope.html

You probably don't know how doctors choose their speciality. Sometimes it's because of contact early in life with a physician role model, sometimes due to a disease ravaging a loved one. For many of us in medicine, our speciality is chosen based on what we find fascinating, and avoiding those things that are distasteful.

We're talking body discharges. I determined early on that I don't like toe jam and scaly long toenails (so Podiatry is out), have no interest in 'wee' (so no Urology), hated the ladies who came to the ED at 0300 for their vaginal discharges (no Gyn  on my list), and am grossed out entirely by phlegm (Pumonary docs love it!) Obviously I have no issues with poo or vomit; and no, I'm ok with your thought that this in itself is pathologic.

 However, I really believed that the ENT specialists were out of the great body fluid debate, at east until I saw this site detailing the joys and sorrows of ear wax http://www.tchain.com/otoneurology/disorders/hearing/wax2.html. If you're like me, the service the photo will provide is to quell your appetite for a bit today-- and snuff any notions of wanting to be an Otolaryngologist when you grow up!

So, have you asked your doc why s/he chose their profession? Very illuminating!

We have an obesity epidemic in America, but we also pride ourselves on our fredom of choice. So for you freedom lovers a recent gift from Burger King is the BK Stacker.

I've not seen nor eaten one of these, and have seen no data on how many Burger King is selling. In fact, I can but wonder if it only serves as a publicity stunt, like the 72 oz  (that's 4 1/2 pounds!)steak you can get for free at the Big Texan in Amarillo Texas if you eat it all within an hour http://www.roadsideamerica.com/attract/TXAMAsteak.html.

The four pattie choice on the Stacker (you can get from one to four patties on your Stacker) comes with 8 (yes, thats EIGHT) slices on bacon. It features 1000 calories, 620 of them from FAT! There's 30 grams of saturated fat and 1800 mg of sodium here. http://en.wikipedia.org/wiki/BK_Stacker

But the question remains-- real menu choice or publicity ploy? The official Burger King site www.bk.com  only offers nutritional information on the double. And prominantly on the index page, they proclaim: "Hey parents! To learn more about our commitment to promote well-balanced meals and active lifestyles in children, click here." This click takes you to a press release, insisting that their child directed ads will promote health. http://www.bk.com/companyinfo/newsreleases.aspx

So is this a Barnumesque pubilicity stunt,  or a pandering to the masses (who are becoming ever more massive?)? Is it resonsible and responsive restauranteering to give us what we shouldn't have? You decide.

New York Post on toxic food

Quick & Simple Magazine on motion sickness and hangover nausea