Tax Time...Again

Photo Credit: Don DeBold

American is a "free" country, but it does not mean it is free to live here. Running the government, keeping us safe, and maintaining our vast infrastructure takes a lot of cold, hard cash from hard-working people. I don't mind paying my fair share of the costs of running the United States, but I do object when this money is wasted. Basically, many of us work four months a year just to pay our part.

I consider myself an astute shopper. I look around for the best deal, take advantages of bargains, and even use coupons. I closely watch the price of gas and will go a few extra miles to save a few cents per gallon. I turn down the thermostat, turn off lights when I am not in the room, and do all of my home maintenance - from painting the house to cleaning out the gutters (an iffy task for someone with vertigo). I mow my own grass, grow vegetables, and wash my own car. My computer is 7 years old and I bought it on sale. I go into a deep depression when I have to pay to fill up the fuel oil tank.

I would never pay $500 for a hammer, a half-million dollars for a Space Shuttle toilet, or a million plus for a cruise missile, but Uncle Sam does. I would buy the hammer at Sears, pee outside the Shuttle, and hold off on those missiles. We need to stop buying stupid, poisoned toys from China and start playing with our kids. Now that we are entering a recession and the stock market is plummeting, it is time for our government to tighten their belts, too. We need to stop borrowing money from the Saudis.

Thanks in part to our current administration, we are several trillion dollars in the hole. People are losing their jobs...their homes...and their patience. Our Interstate highways have potholes and bridges are falling down. I have considerably less money in my retirement account than I had last year, which is really ticking me off. I estimate that I will have to work several more years longer now. It seems that the government may be hoping I will work 'til I die so as to not use any Social Security. Man, I have a lot of stuff I want to do before I check out of this life. I sure do not want to die of old age while looking in someone's ear!

I keep careful tax records, especially my charitable donations. Every year I expect to be audited again by some ruthless, pencil-necked, thick-glassed, IRS agent. The last time I was audited about 15 years ago, I ended up paying about $60 more. Talk about squeezing a guy! Since that time, they have left me alone.

I gave up doing my own taxes years ago. They are much too complicated and I tend to add things up incorrectly. Of course, my tax accountant isn't that careful, either. He has made major mistakes three years in a row. Little does he know that last year was the last time he will see me. I am getting someone else - hopefully, someone less expensive and someone who does it right. Of course, when he informs me that I still owe even more money to the State and Feds, I am not going to be a happy taxpayer.

I have huge boxes of receipts that I will soon be sorting all over my spare bedroom. I use Quicken to keep track of checks and credit card payments, but I do not have the stomach to print out that 30 page, end-of-the-year report. It is just too heartbreaking to see where it all went. I am going to see that I ate thousands of dollars worth of groceries and spent thousands more on gasoline. I am going to see a grand total for all of the crap my wife buys (I have a sub-account with that title).

I would really vote for a GST (General Sales Tax) instead of having the IRS. Yes, things would cost more up front, but we would not have this April chaos. In New Zealand, you pay $3.00 for a widget, not $3.00 plus 24 cents tax. You pay the 24 cents, I am sure, but it is built in to that three bucks. Not only is that more simple, guys don't have to walk around with a pocket of loose change banging against our gonads. I could finally cash in my change jars. I bet I have a few hundred dollars in an old tongue depressor jar on my shelf.

With the GST, there would be no IRS agents and no tax forms to file every year. You won't have to pay someone else to tell you how much you have to pay. You would take more money home in your paycheck. And finally, because things will be more expensive up front, maybe you will think twice if you really want or need it.

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Technorati Tags: taxes, income tax, sales tax, economy, IRS

Getting To Know You

When you see your medical provider, there is usually a pre-determined reason. You may be sick or having a regular check-up for an ongoing medical problem. There is also a pre-determined time for your appointment. Typically, your medical provider will shoot in and shoot out in the blink of an eye, so there is rarely time to really get to know each other. You would think that two different people - people who have an intimate (albeit, professional) relationship - would really want to know each other better than they do.

Our practice has adopted EMRs - electronic medical records. We can no longer quickly scan through a thick paper chart to refresh our memories about you or your case. We must rely on a bland, superficial summary created in the computer that gives us mundane details such as your birthday or your allergies. The paper chart used to have a "profile" sheet on the left that had your address, occupation, marital status, place of employment, type of insurance, and your children's names. We would jot down your preferred name, too. No one really wants to be addressed as Rupert, if they preferred to be called Larry. That one sheet often gave us enough information to jog our strained memories and make connections. That sheet is no more.

Back in the late 1980's, one of the more popular books on the New York Times bestseller list was Swim with the Sharks by Harvey Mackay. One chapter in Mr. Mackay's book was entitled "The 66-Question Customer Profile" - basically 66 different things you should know about every customer so that you can make important personal connections. For instance, the other day, I noticed that a child was wearing a sweatshirt from Central Michigan University (CMU). Since I taught at CMU for a few years, we immediately had a connection. His father and grandfather were CMU alumni, and his grandmother still lives in that small university town. I made an important connection. Earlier in the week, I had an Egyptian family as patients. I informed them that one my good friends was Egyptian. They just happen to know him very, very well. We made a connection.

We have a very large staff of medical assistants, receptionists, nurses, patient service representatives, and clerical people. So many, in fact, that if it wasn't for name tags, I would not have a clue who the new ones are, even though I work with them every day. And, these people really do not know anything about the medical providers. To remedy that situation, we recently had a lunch mixer to socialize.

Sitting on our lunch table was a roll of toilet paper. We were told simply to pull off as many sheets as we wanted, but were not told why. Once everyone had their supply of toilet paper, we were told to tear it into individual squares. For each square that we have, we were to tell something about ourselves that no one really knew. This was an outstanding exercise for making human connections. There were people who were born in the Ukraine or Mexico; people that had Internet business on the side; people that sing in church choirs or play instruments; people who raise horses or chickens; people who have six kids at home, and so forth. I learned more about my coworkers, in that one hour lunch, than you can imagine. All of us made important human connections with each other.

It is a very sad state of affairs when your medical provider doesn't know your name, or remember that they just saw you yesterday. Yes, we are absolutely overloaded with daily details, but it important to remember...at each visit...that you are seeing a person. I absolutely hate it when my medical assistant tells me that I have a "cough in room one". I have to tell her over and over again that there is a PERSON in room one who happens to have a cough.

I must admit that my memory is not as good as it used to be. I need little hints and notes to jog my strained memory. I used to write little temporary "memory joggers" on the margins of my paper charts. For instance, if a little boy tells me that he just got a new golden retriever puppy, I would write (in pencil), "golden retriever puppy" in the margin of the chart. The very next time that I would see that little boy, I would ask him about his puppy. If a family was heading out to Disneyland, I would jot it down. At subsequent visit, I would ask them about their Disneyland trip. They thought I had a marvelous memory, but I really was finding and making human connections.

You can't possibly find out 66 things about a person on the first encounter, but over time, you can. Your medical provider needs to find out 66 things about you; and you need to find out 66 things about your medical provider. It only takes a minute to ask your doctor where he went to medical school or why he picked this particular profession. At first, he may be surprised that you are interested. At some future visit, ask him about his hobbies, and so forth. Soon, you will really know that person in the white coat. It will not take you long to find one or more of those important connections.

Humans really enjoy the company of other humans. We are social animals that desire these connections. Even though your doctor may act like a different species, he is human...just like you. Until these important human connections are established, you may be just a "cough in room one" and he may just be some arrogant guy in a white coat. How sad.

I will tell you a few things about myself that you do not know...

• I once received a letter from John F. Kennedy.
• I collect antique laxatives.
• I once launched a pregnant hamster in a homemade rocket (she and her offspring survived).
• I won grand prize in a state science fair
• I once sold flower seeds, salve, Grit newspapers, and Bibles door-to-door.
• I put myself through college.
• I shot a turkey (once) and did not enjoy the experience
• I survived near-drowning in a white water boating accident
• I once sang "The Star Spangled Banner" at an Oakland Raiders game (with a barbershop quartet)
• I rode Arnold Palmer's horse (Arnie)

If you post a comment on this blog, you must post at least one interesting thing about yourself that few people know...

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Men are Bad Pill-Takers

Men are often targets of generalizations. Because I am a man, I feel that it is okay to take some liberties on this issue of medication noncompliance. In my professional experience, men cannot be trusted with complying with medication. Men who are taking antibiotics for infection tend to "forget" doses much more often than women. They also are more likely to stop their treatment early if they are feeling better. It is no wonder that men die sooner than our female counterparts. When men are the primary caregivers for their children, they also forget to give prescribed medicine to them, too. If men are questioned by their medical providers about compliance, they will lie. Men are not shy about asking for shots for their children instead of taking the responsibility for giving oral medications. The children are not pleased.

There has been research for years developing a male birth control pill. If that every happened, I would caution women not to trust them. Not only will they forget to take their pill, they would lie about it if it meant not having sex. If man cannot complete a ten day course of antibiotics, how can they be trusted to take a daily pill to prevent pregnancy? There is an old joke about a male birth control pill that is not swallowed, but goes in your shoe. The shoe? Yes, they put the pill in their shoe and it makes them limp.

Women seem to be better with certain details. Guys, on the other hand, forget things that they determine are unimportant, like pulling up their zippers. Women will not go out with their dresses unzipped. Men forget to comb their hair, brush their teeth, and do requested chores. Women leave the curling iron on and forget to lock the car.

One of my priorities in life is to conserve energy. When I am not in a room, I turn off the lights. My wife does not understand that light switches have an off position. She will turn on every light in the house and then leave for work. I turn down the thermostat and put on a sweater. She turns up the thermostat to 80, thinking it will heat up the house faster than if she puts it on 72. However, my wife does remember to take her medications, and she reminds me to take mine.

After over three decades in medicine, you would think that I would be more compliant with my own medications, but I was a man long before I was a medical professional. I only take a few "real pills"; the rest are vitamins, fish oil, minerals, etc. that my wife throws in the mix. She could be slowly poisoning me; I wouldn't know. Some of those capsules are the size of rectal suppositories; I don't know whether to swallow them or insert them. Even though it has been proven that vitamin C does not prevent colds (Sorry, Mr. Pauling), she still makes me take vitamin C. I have gotten many colds. I have not gotten scurvy. Yes, I do believe in the benefits of antioxidants, but come on, I do not want to take a handful of pills and capsules. Psychologically, this is not a man-thing.

I think women like taking pills. They must. My wife takes twice as many as I will tolerate. The other day, I saw my 31-year-old daughter swallow a dozen or so vitamins(?) at the sushi restaurant. Personally, I would rather get my fish oil from sushi. As she downed that fistful of vitamins, my son told of his experience spilling an entire bottle of some horrible-smelling fish oil that was prescribed by his doctor. He wiped it up with some towels and threw it in the laundry with his wife's good clothes - not a good idea. I suspect he wouldn't have taken that bad-tasting fish oil anyway.

My late friend and mentor, Bob, took more nutritional supplements than any human I had ever met. He was an exception to the "men are bad pill-takers" generalization. When Bob passed away in his eighties, I volunteered to help his family dispose of his extensive home pharmacy. As a physician and former pharmacist himself, Bob was big on self-medication that promoted longevity. He was always his own doctor; perhaps, in retrospect, not his wisest choice. He literally had thousands (I am not exaggerating) of various nutritional supplements, herbal concoctions, homeopathics, etc. Nutritional supplements or not, we will all eventually die. Until his sudden demise, I felt that Bob was a very healthy man, but I am not convinced it was due to his use of these multiple supplements.

If men have to take pills, they want to keep it simple: once a day (maybe) is about the best they can do. If any medication is prescribed more than once per day, it will be forgotten at least half of the time. Giving a man an injection in the office is just about the only way to assure full compliance. If the pills cause ANY side effects, even side effects not associated with the medication, it will be promptly stopped. If men do not have insurance and have to pay for the medication, they will not buy it. Women think nothing of paying a hundred bucks for a prescription. For men, twenty bucks - tops. If it costs more than twenty bucks, they will just take their chances.

If the pills taste funny, or cause them to burp with an odd taste/smell, they will not take them. If the pills are too big or scary-looking, they will not take them. If the capsules are red or black, men will most likely think they cause side effects. If the pills are pink, they will not be strong enough to cure their ailment.

Men are not easy patients to treat; even the little men (boys). Men do provide valuable services to society, like killing spiders, hanging shelves, changing tires, or providing chromosomes. True, men do not like to take pills...or see doctors for that matter. If you have one of these men in your life; please help him.

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Technorati Tags: mens health, medications, pills

The Real Holiday Breaks (Bones, That Is)

I am not referring to a "break" from work or school, but rather all of the broken bones that I see the week or so after the holidays. Starting on December 26th, children started limping into my office, or came in favoring their arms - thanks to those new scooters, skateboards, and bicycles. Parents have been good about making kids wear helmets, but it is very difficult to protect those arms and legs from injury; especially when "ramps" are involved.

Children tend to be risk-takers; especially boys. They will happily ride around on the driveway on a new skateboard for about twenty minutes or so; then their male brains start thinking about ramps. In their mind, they see themselves flying through the air, landing safely to the cheers of their friends. Quickly, they find an old milk crate, some fence boards, or a broken piece of plywood, and make a launching ramp. The next sound that you hear is often a broken bone. Yes, sticks and stones do break their bones, but so do many other things.

Winter is also the time for skiing, snowboarding, and ice skating. One bone that is commonly broken with these activities is the coccyx - the tail bone. This is one fracture that does NOT require a cast (thank goodness). We couldn't have people going around in some weird butt cast, but you would be surprised at the number of parents that wonder why I don't cast a coccyx fracture.

We raised five children. Three of them shared seven broken bones (so far). Alex was the first to bite the dust, breaking his left arm when he tripped over a parking lot speed bump. He was a six year old left-hander and thumb-sucker. Hoping to kill two birds with one stone, I elected to put on a full, long arm cast (he only needed a below the elbow cast). The long arm cast prevented him from sucking his thumb! Six weeks later, his arm was healed and he no longer sucked this thumb - a true success story.

At age ten or so, Benjamin was the next to break. He broke BOTH of his arms (like this other child to the left) at school when he tripped on a tree root. Having a cast on both arms creates a hygiene dilemma since it is not possible to wipe your own butt. That boy owes us big time for that extra service. Ben broke his leg in high school football, and just two years ago, he broke his arm again showing off his fancy dance moves at a wedding. There is nothing more impressive to the ladies as breaking your arm while dancing. No, it wasn't break dancing!

Kristin waited until her adult years to break bones. She broke her elbow from falling out of a loft in her apartment, and more recently, broke her clavicle (collar bone) when she fall off her bike. Alcohol may have been involved in this last one.

The other kids were just lucky. Based on their behavior, they should have broken bones, but they somehow escaped. We have three grandchildren now. So far, they have not broken any bones.

The most common fracture that I see in children occurs at the distal radius - the main forearm bone near the thumb side of the wrist. When we fall forward, we instinctually put our arms out in front to protect our face. This sudden force often breaks this bone, either completely through or just cracked/dented. In most cases, this requires a cast.

Kids love casts...for the first few days. Parents are not as enthusiastic. Like scars, a cast is a sign of achievement and a validation that they are tough. Depending on the fracture, upper extremities casts must remain on for four to six weeks. As soon as the kids know that they cannot play soccer or basketball while in a cast, they are very upset. Some parents are even puzzled why they can't play football. Most casts cannot get wet, so showers are other challenges when it comes to bathing and showers. Newer fiberglass casts do not itch like the old plaster casts, but they can still be miserable.

We have casting material in different colors, including glow-in-the-dark. Glow-in-the-dark casts are popular around Halloween. Personally, I would find a lit-up arm quite annoying when trying to sleep, but the kids love them. At Christmas, I make a few striped candy cane casts. If they bring a teddy bear or appropriate doll, I will make sure they get a cast, too.

Like visiting relatives, casts begin to stink after a few days. By the time we remove them six weeks later, you can actually see "stink waves" coming off some of them. I have found a variety of toys, food, and other debris inside casts when I remove them.

Even with all of the parental warnings/guidance and safety equipment, I firmly believe that children can break bones playing with marshmallows. Kids are not only serious risk-takers and clumsy, they like to create their own hazards. Children need to play on monkey bars and climb trees. They need to feel the thrill of a rope swing and that momentary feeling of weightlessness just before they hit the ground. It is not always their fault. Blame it on gravity.

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Technorati Tags: broken bones, children, safety

Please...STOP Smoking!

It's another New Year. If you are a smoker, perhaps you have entertained stopping once again. I hope you do it this time. Smoking cessation, like controlling any chemical addiction, is not easy.

I have never been a voluntary smoker. Both of my parents, and eventually, my step-parent, were heavy smokers. I can remember lying on the floor watching television, looking up at a cloud of blue smoke hanging just above me. As a non-smoker, I suspect that my secondary exposure was significant. I worry about that exposure even now. In the 1950's, everyone smoked. People smoked in movie theaters as we watched people on the screen smoking. Ronald Reagan appeared in smoking advertisements. The "cool kids" all smoked.

Cigarettes used to be about fifty cents a pack. When I did my medical and surgical rotations at the Veterans Administration hospital in the 1970's, the patients could buy cigarettes for 25 cents a pack in the commissary. Many were hospitalized for emphysema and various forms of cancer. I remember assisting a surgery to remove a huge cancerous tumor from a man's throat and create a tracheostomy (a portal in the neck so he could breathe). A few weeks later, I saw him actively smoking through his tracheostomy.

Yes, I did try one cigarette when I was about ten. I didn't care for it. I even tried making my OWN tobacco one time using a variety of leaves, including a large proportion of poison oak. If that didn't cure an urge to smoke, nothing would. You have not experienced discomfort until you have poison oak over 100% of your body. I cannot tell you how much I hate cigarettes and or how much they have affected my life.

When I was in kindergarten, my father died of lung cancer. Within a more few years, two of my uncles and my grandfather died of lung cancer. Some were coal miners and my father worked with asbestos in the shipyards during World War II - exposed to an incredible amount of cancer-causing chemicals. Not too many years ago, the Marlboro man died of lung cancer, too. They were all smokers. A lung cancer link to cigarettes was suspected at that time, but not proven. Decades later when it was proven and warnings appeared on cigarette packages, people continued to smoke. Within a short time, the lung cancer rate for smoking women soared to first place. Yes, you've come a long way, Baby.

No longer do Americans have to tolerate smoking in a crowed movie theater, or in restaurants. Smoking is banned in most public places. Some communities have even banned smoking outside! Several years ago, we had the opportunity to travel to Great Britain. The smoking was so prolific, especially in pubs where I wanted to try the food, that we had to eat outside most of the time. I heard that Ireland has not banned smoking in the pubs. This is something that I never thought I would read in my lifetime. No longer are cigarettes 50 cents a pack. Now, they are $5.00 a pack; taxed heavily by the government to help pay for a variety of things. In California, the cigarette tax money even helps pay for birth control pills, immunizations, and health care for the poor. Some of that tax money goes for anti-smoking educational programs, cancer research, and so forth. I am sure that a lot of that money also ends up in thousands of undeserving pockets.

Do people have the right to smoke? Perhaps, as long as I don't have to pay for their medical care. Unfortunately, we ALL non-smokers pay in one form or another for tobacco abuse. Non-smokers typically pay the same health insurance premiums.

One of my best friends is a pharmacist. While he is no longer a smoker himself, his wife and adult sons continue to smoke. I was shocked the other day when he told me that he gives cigarette money to his still-living-at-home, non-working sons. His wife has terrible varicosities in her legs - a visible example of the condition of her other "hidden" blood vessels. She has also had skin and colon cancer so far. She continues to smoke.

My 32-year-old daughter smokes, but promises to stop after New Year's using some of the new medications for this purpose. I pray that she (and her boyfriend) finally give up cigarettes for good. I remind my daughter that that grandfather she never met died when he was just five years older than she is now. In the past, she just told me to butt-out (so to speak).

Threats of disability or death have not significantly slowed down the toll of tobacco use. High cigarette taxes have helped (a little), but not enough. If cigarettes were ten dollars a pack, people would still buy them. There are people that give up food and other necessities for cigarettes. Restricting where people can smoke is certainly a deterrent, but people will find a place; like right in the doorway to your workplace. It is their right. They like it. And they are going to smoke no matter what.

Parents will continue to die. Teens will start to smoke. Old geezers will walk around (slowly) pulling their little oxygen generators. Medical providers will lose sleep knowing they have to tell another person that they have cancer tomorrow.

Everyone has the ability to stop smoking; they first must make that decision. Some smokers will need medications; nearly all will need encouragement from family or friends. Some will need the psychological support from health care professionals. Some will take smoking cessation classes, or get hypnotized, or use anti-smoking devices. It really doesn't matter how you chose to stop. As far as cigarettes are concerned, Gone is Good - Gone for Good.

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