Sometimes, I feel like the Mel Brooks character in Blazing Saddles --- "work work work, work work work, work work work." But, overall, it's been a good "general surgery" week:
parathyroidectomy, lap chole, removal of chest wall mass, melanoma excision with sentinel node biopsy, umbilical hernia repair, inguinal hernia repair, insert infusaport, remove infusaport......and that was just Wednesday! Two partners out of town, lots of call this week, and lots of typical summertime trauma, and call this weekend. Whoo-ah! How much fun can one man have?
Hopefully, it'll be slow enough this weekend for me to catch up on blogging.....time to pray for rain to keep the trauma types indoors!
Friday, July 29, 2005
Sometimes, I feel like the Mel Brooks character in Blazing Saddles --- "work work work, work work work, work work work." But, overall, it's been a good "general surgery" week:
Posted by Aggravated DocSurg at 3:30 PM
Tuesday, July 26, 2005
Saturday, July 23, 2005
In an update to my recent post on Medicare's Pay-for-Performance plan and its requirement for an electronic medical record system I found on Kevin's site a plan by Medicare to give, free of charge, an EMR system to physicians:
The program begins next month, and the software is a version of a well-proven electronic health record system, called Vista, that has been used for two decades by hospitals, doctors and clinics with the Department of Veterans Affairs. Medicare will also provide a list of companies that have been trained to install and maintain the system.I am unfamiliar with Vista, and would welcome any insight into how well it would work outside the VA system (where it apparently has been used for about two decades). Certainly this is quite a big step for Medicare, which has set an ambitious time schedule for mandating EMR usage in order to participate with Pay-for-Performance. Thoughts, anyone?
Posted by Aggravated DocSurg at 6:40 PM
Friday, July 22, 2005
One of the biggest challenges facing the future of medicine is how to train the physicians of the future. This is particularly problematic in specialties such as general surgery, given the 80 hour work week restrictions that have been in place the past few years and the coming onslaught of proficiency evaluations (see Dr. Bard Parker's thoughts here and a few of mine here).
Rising to the challenge, an old acquaintance of mine has published an interesting take on things in this month's Journal of the American College of Surgeons. Basically, he feels that surgical educators can learn quite a lot from the field of aviation --- we have been treated to the idea of comparing pilots and surgeons in the past, but this is sharply different. Specifically, Dr. McGreevy (a surgical program director) feels that we can adopt many of the techniques used to train fighter pilots to train surgeons:
The key elements in skills acquisition and maintenance in the operational squadron are pre- and postflight briefings, desired learning objectives (DLOs), levels of proficiency (wingman, flight lead, instructor, and evaluator), and currency tracking.While dealing with the human body involves a considerably larger number of variables than flying a plane, certainly we can improve our method of teaching and acquiring many of the skills involved with caring for patients. Dr. McGreevy in particular is keen on identifying desired learning objectives for each procedure taught to residents; this can vary depending on the case or the level of the resident.
In my opinion, the DLO can be the most powerful aviation training concept available for adoption by surgery. The DLO is useful in daily encounters, as explained previously, but in a more catholic way. For instance, once a resident has done 200 laparoscopic cholecystectomies, I suggest that the DLO has been met for that training square, and the resident should be spending time in some deficient area, such as outpatient anorectal problems. This requires a training office to monitor the resident's experience and proficiency.I was never specifically "assigned a DLO" for specific operations during training, and was simply expected to learn it -- and literallly everything about the operation, from indications to contraindications, from techniques to complications, etc. While I am not sure that a rigid method of instruction like this will work in every circumstance, it may take away some of the "BS time" and ensure that surgeons get the training they need with the new work hour restrictions. Dr. McGreevy summarizes his recommendations in this way:
- Applicants can be tested for innate dexterity and personality traits. The tools are available with skills trainers and psychologic tests that measure normal traits, like the NEO-PIR.12
- Teaching faculty can be encouraged to define a learning objective for each clinical encounter. This will require faculty to attend workshops in which the concept of the "desired learning objective" becomes a part of their collective consciousness, and pre- and postengagement briefings become a standard occurrence.
- Resident rotations can be defined by a checklist of objectives, both operations to be mastered and disease processes to study.
- The most common operations can be dissected into essential steps to be drilled with "deliberate practice" in skills trainers and in the operating room.
- A checklist of essential skills, to include operations and other tasks, such as intubation, can track resident training and competency. These checklists will direct resident educational experience as we define the surgery rotations by skills acquired rather than time.
- With encouragement, the residents can acquire and use the DLO concept, so that their learning becomes active rather than passive.
Posted by Aggravated DocSurg at 1:55 PM
Thursday, July 21, 2005
I've been dealing with computers since my original IBM PC (wow, TWO floppy disk drives, and an expansion card with 64K of RAM!), and I know my way around Windows fairly well, but hey, as Bones would say, "Dammit Jim, I'm a doctor, not a tech support guru!" My brother, on the other hand, is a tech whiz, with all of his engineering degrees and computer know how (he's also a lot smarter than me). So, when my home network went on the fritz this weekend, out goes a call to my version of tech support!
But something interesting happened --- while we were on the phone, I happened to mention my little slice of the blogosphere.....and found out that he has a blog too! It's called Search '97 Information Server, but to be honest, given its content it should really be named Aggravated TechServ. I think he's mostly aggravated about having to drive my first car after I trashed it.
Posted by Aggravated DocSurg at 10:06 AM
Tuesday, July 19, 2005
Let the hosting of the postings begin -- so many posts, so little time! I'd like to group these into a few broad categories -- Trying to be a "Good" Doctor, Medical Business & Monkey Business, Being a Patient, and Extras....
Trying to be a "Good" Doctor
There are only two sorts of doctors: those who practice with their brains, and those who practice with their tongues. (William Osler)OK, I admit it, I’m a doctor …. so I’m a bit partial to posts that hit close to home. This post by Red State Moron hits all too close to for surgeons as he tries to make sense out of what can be unfathomable -- surgical complications. "You never remember the times when everything went perfectly. It is supposed to go perfectly.”
A discussion of Alternative Treatments is offered by Corpus Callosum, who notes that "I do not think that compassion is "alternative therapy." It is just part of being human." Compassion is a hard thing to come by when dealing with dementia, as Intueri illustrates. And while compassion is important, my esteemed surgical colleague to the East notes that it is important for patients to know a bit more about the folks who may be operating on them -- Inquiring Minds Want to Know.
Medical education is not completed at the medical school: it is only begun. (William H. Welch)Intueri also shows us how some interns have more to learn than others; the subject of this story sounds like an intern who will generate a goodly number of humorous posts in the next 12 months. And while Protodoctor Neils at The Haversian Canal will learn much in the next few years, he shows he has a good start to his education with I'm not a doctor, but.....
It is extremely difficult for a physician who puts too much trust in what he reads to form a proper decision from what he sees. (Andrew Boorde)As Orac points out, it’s important to read each published study with hefty dose of salt, as it is the rare study that provides a definitive answer to a clinical question. This is an excellent post, which should be read by physicians, lay people, and especially journal editors.
The politics of medicine are explored in this excellent post by Dr. Tony, who speaks out about the potential for poorly run peer review. Politics of a different sort are on GruntDoc’s mind, who is a bit peeved at the ACEP and it's political agenda.
Medical Business and Monkey Business
A drug is a substance that when injected into a guinea pig produces a scientific paper. (Anonymous)Starting off on the business side of medicine is a discussion on the Health Business Blog of an innovative pricing plan for a the new drug BiDil. But is this a truly a “new” drug, or simply an Ethnopharmacological phenomenon? Read the thoughts of a new medblogger, CardioBlog for an interesting perspective.
The forward march of technology in medicine is trumpeted in Sumer’s post regarding the practical application of that informatics in radiology practices. Hospital Impact tells us about robots in hospitals -- COOL! -- and Medical Connectivity lets us know about an innovative wireless technology that may be a simpler solution for many hospitals – even cooler!
From InsureBlog comes a summary of several posts regarding HSAs and HRAs, warts and all. This is a good discussion, and the earlier posts are great background for those wading through insurance coverage changes (my group just switched to an HSA). The Health Care Blog wants us to be alerted to the coming of the Medicare Participating Prescription Drug Plans -- and potential associated scams.
As most of you know, Kevin, M.D. has started a new blog, Straightfromthedoc, and today he is shedding some needed light on the issue of hot flashes and HRT. Not to be outdone, Clinical Cases informs us about a novel effort by physicians at Johns Hopkins -- they're blogging! What a concept! Or is it simply clever marketing?
Being a Patient
The student is to collect and evaluate facts. The facts are locked up in the patient. (Abraham Flexner)Opinionated Bastard (who somehow got the title to his blog before I could claim it) reminds us that medical care isn't all that easy on some folks. Healthy Concerns weighs in with three posts this week -- you choose your favorite, but I enjoyed her discussion about what it is like to come home to the US after a few years and start searching for insurance. Finally, I found out that Beldar had a recent significant run-in with the medical system (hope he’s on the mend).
From the health care delivery side of things, GruntDoc lets us know that sometimes, you can have too much of a good (nor not so good) thing (a photo that must be seen to believed). Dr. Charles weighs in with a look at a tick and potential Lyme disease. Finally, Greg the neurologist blogger has a few "thoughts for food" as it relates to skin conditions.
On the lighter side, Interested Participant shows us what happens when interesting people participate in what we can euphemistically label “innovative” health care. And, despite what the Viagra/Cialis/Levitra crowd says, there apparently can be such a thing as too much sex, according to this report from Parallel Universes.
>> Sneezing Po has a few interesting thoughts about teamwork, and how it relates to medical care delivery.
>> What do Charlie and the Chocolate Factory, James and the Giant Peach, and The Twits have in common with shunts used for hydrocephalus? Read MedGadget for the whole story.
>> Finally, at Far From Perfect, we hear about one man's experience on his last night as a paramedic. Thanks to him for his service there and in his new position as a military medic!
Thanks to everyone who took the time to send a link. Next week's Grand Rounds will be hosted by Pharyngula.
Be happy while y'er leevin, for y'er a long time deid. (Scottish Proverb)
Posted by Aggravated DocSurg at 12:55 AM
Friday, July 15, 2005
Just a reminder --- FEED ME!
Send your submissions for Grand Rounds next week by Monday at 6 PM mountain time to aggravateddocsurg-at-yahoo-dot-com. Or, just leave me a note in the comments section.
Posted by Aggravated DocSurg at 5:35 PM
Wednesday, July 13, 2005
To borrow a line from Audrey II in Little Shop of Horrors, "Feed me Seymour!" Send your links for next week's Grand Rounds by 6PM Mountain time Monday (7/18) to "aggravateddocsurg at yahoo dot com." If you haven't been by there yet, spend some time on Shrinkette's couch and catch up on this week's medical blogging.
Posted by Aggravated DocSurg at 11:05 AM
Tuesday, July 12, 2005
With apologies to Orac, who spends the majority of his time to putting out respectable research, it often seems that the number of worthwhile papers published in surgical journals is infinitesimally small in comparison to the huge total number published each month. As my journals roll in to the inbox every several days, it is sometimes difficult to wade through them to eliminate the obvious ("surgery is good for appendicitis"), the ridiculous ("we can do this easy operation now with a robot!"), and the B.S. ("in our series of 2,000 patients, we have never had a complication").
Sometimes, when papers are presented at meetings, the journal will also publish the discussion that follows. Those papers are always interesting to me, as the discussants often air views about research that perhaps are not widely known. Frequently, the "big hitters" in a particular field will weigh in with their opinion, which may or may not be particularly relevant.
However, what I love to find in a journal is an "invited critique" of a paper, which gives a respected academic physician the ability to summarize the results of the paper and put it into some perspective. No one, and I mean absolutely no one, does this better than Jack Pickleman, the now retired general surgeon from Loyola University in Chicago. He is concise, incisive, and has a deadly command of the weapons of wit and sarcasm. Most importantly, he wastes no time in declaring something B.S. that is clearly B.S. For example, in this month's Archives of Surgery (subscription required, so no link available) he critiques a paper describing yet another incarnation of scoring systems for cirrhotics:
In prior times, the surgeon on rounds would stand at the bedside and observe a lemon-yellow patient awaiting an urgent operation and proclaim, "He's gonna die." Although this judgement was wholly subjective, it was rarely incorrect. Subsequently, systems such as the Child and CTP classifications appeared, but these also suffered from subjectivity. The problem with all such predictors of death was that they did exactly that but provided the surgeon with little guidance in the way of therapeutic interventions by which to thwart the anticipated outcome.....The present study makes a strong case to use the MELD classification to categorize risk in these patients. Until, however, such classifications cannot only assess risk but provide therapeutic recommendations to decrease that risk, I fear that surgeons will now stand at the bedside and proclaim, "His MELD score is ___; he's gonna die."Dr. Pickleman is basically stating what the vast majority of physicians would say --- judgement matters more than scoring systems for disease processes --- but somehow makes this point so sharply that it is more memorable than the paper he is critiquing.
Posted by Aggravated DocSurg at 3:42 PM
Winds of Change has a great visual presentation that illustrates for us the Al Quaeda attacks that have occurred since the creation of the International Islamic Front and their subsequent declaration of war in February of 1998 --- including the casualty numbers.
The purpose of the presentation is to graphically demonstrate al Qaeda's ability to conduct mass casualty assaults on a global scale. This presentation by no means documents every single al Qaeda attack. For example, the murders of journalist Daniel Pearl in Pakistan and USAID executive Lawrence Foley in Jordan were excluded, as have smaller impact suicide attacks and beheadings by al Qaeda in Iraq and elsewhere. al Qaeda's butchery in Iraq can fill a presentation of its own. Also, planned or foiled chemical attacks against Jordan, France and England, the assassination attempts on President Musharraf of Pakistan and numerous other incidents throughout the world have not been documented.Click on the link to view the presentation -- requires Macromedia Flash Player. It's worth a few minutes of time to view.
Posted by Aggravated DocSurg at 1:35 PM
Monday, July 11, 2005
I was at a meeting on Friday, picking up a few CME hours, and was able to hear a presentation by a CMS regional chief medical officer on the Medicare "pay for performance" proposal. The program is now to be called "Value-Based Purchasing," perhaps in response to some of the criticism of the previous nomenclature. Basically, the whole idea is to decrease costs (no surprise there), and rewards for performance are to be budget-neutral ---- in other words, if hospitals and physicians are to be paid more based upon meeting certain performance goals, the money will come out of somebody else's revenue (either hospitals or less-well-performing physicians). It is clear that CMS does not feel it is getting an appropriate "bang" for its bucks:
"Our medical system has progressed tremendously over the past 20 years. People are living longer and better. But there are still lots of examples of where we are paying more than we need to for complications, medical errors and duplicative procedures." (CMS chief Mark McClellan, M.D.)So, what is on the table for physicians and hospitals under the P for P system?
"Today, Medicare pays the same amount regardless of quality of care. Some people would argue that in fact, the current Medicare payment system rewards poor quality. This situation just doesn't make sense to me, nor should it to beneficiaries." (Sen. Charles Grassley, introducing the Medicare Value Purchasing Act of 2005)
The Secretary would be given the authority to select measures of quality to be used for each program for the different providers. The selected measurements, in consultation with provider input, would be based on a range of criteria established in the legislation and could be varied according to the size and scope of hospitals and to physician specialty and practice size. Such measures would be weighted for clinical effectiveness and risk-adjusted.
While the program would be voluntary, providers not participating in the program would receive a reduction to their updates. Specifically, in FY 2007 and thereafter, hospitals not participating in the program would see their payment updates be reduced by 2 percentage points. Those hospitals participating in the program would receive a full update, as well as be eligible to receive payments from a quality pool financed through a reduction in Medicare inpatient payments of the reporting hospitals. The quality payments would then be redistributed to those hospitals based on certain thresholds of quality performance or quality improvement, as determined by the Secretary.
For physicians, beginning in 2006, a comparative utilization system to measure resource use would be established based on claims data and shared confidentially with physicians in 2006 and 2007. Beginning in FY 2007, physicians not reporting on quality measures as determined by the Secretary would receive an update reduced by 2 percentage points. Physicians reporting quality data would receive a full update to the Medicare payment according to current law. Beginning in 2008, physicians would be eligible to receive payments from a quality pool financed through reductions from the conversion factor of physicians reporting the quality measures. The quality payments would then be redistributed to those physicians based on certain thresholds of quality performance or quality improvement as determined by the Secretary and efficiency of care provided according to the comparative utilization system. In addition, the Secretary shall establish procedures for making the data submitted by physicians available to the public. (AAMC Washington Highlights, July 8, 2005)
In essence, this means several things:
- Those that participate will potentially see a 2% increase in reimbursement, based upon a pool of money that is shared.
- Those that don't participate will definitely be paid 2% less than standard Medicare rates.
- Participation is not described above, but requires that physicians and hospitals have electronic medical record systems. CMS recognizes that there are no standards in this arena, and states it will be working to establish those standards.
- In order for the system to work, gainsharing between physicians and hospitals must be allowed to take place; that will require legislative changes.
- All of the data generated will be readily accessible to the public.
I worry about the solo or small group of internists who have yet to give away their patients to hospitalists; facing a significant cost to participate with this program, with the prospect of very little increase in reimbursement, will they simply opt out of Medicare? A 2% increase in revenue may mean a significant amount of money to a large hospital system, but may be far too little to ensure the full participation of many small groups of physicians.
Perhaps the most vexing problem facing CMS is how, and exactly what, to measure in terms of quality? There are any number of programs currently being utilized across the country to measure outcomes, and they work well within certain parameters with measurable data. Picking what data to collect, and what to toss, will be a challenge for CMS. This will be an interesting process to watch.
Posted by Aggravated DocSurg at 1:38 PM
Saturday, July 09, 2005
It's hard to do any medblogging with the London bombings fresh in one's mind. Sadly, many with access to a microphone and TV camera are in total denial of what has happened, and why. Once again, nitwits seem to be taking center stage ---- enter Ron Reagan! As I was driving home from a meeting yesterday afternoon, Hugh Hewitt was playing an interview from MSNBC, with Ron Reagan trying to go toe to toe with Christopher Hitchens. Fortunately for Mr. Reagan, Mr. Hitchens was armed with sharp words rather than sharp instruments:
CH: Do you know nothing about the subject at all? Do you wonder how Mr. Zarqawi got there under the rule of Saddam Hussein? Have you ever heard of Abu Nidal?
RR: Well, I'm following the lead of the 9/11 Commission, which...
CH: Have you ever heard of Abu Nidal, the most wanted man in the world, who was sheltered in Baghdad? The man who pushed Leon Klinghoffer off the boat, was sheltered by Saddam Hussein. The man who blew up the World Trade Center in 1993 was sheltered by Saddam Hussein, and you have the nerve to say that terrorism is caused by resisting it? And by deposing governments that endorse it? ... At this state, after what happened in London yesterday?...
RR: Zarqawi is not an envoy of Saddam Hussein, either.
CH: Excuse me. When I went to interview Abu Nidal, then the most wanted terrorist in the world, in Baghdad, he was operating out of an Iraqi government office. He was an arm of the Iraqi State, while being the most wanted man in the world. The same is true of the shelter and safe house offered by the Iraqi government, to the murderers of Leon Klinghoffer, and to Mr. Yassin, who mixed the chemicals for the World Trade Center bombing in 1993. How can you know so little about this, and be occupying a chair at the time that you do?
Ouch! A smackdown worthy of a heavyweight title bout. Other media idiots seem to be preoccupied with the idea that the London bombings represent abject failure of our intelligence and security measures -- without taking into consideration that we have had numerous intelligence successes in the past few years which are public knowledge, and likely many others that are unknown to the general public. These need to be recounted, and celebrated, by the press to put the London atrocities into the broader perspective of the fight against Islamofascist terrorism.
Mr. Hitchens has a great perspective here:
We shall track down those responsible. States that shelter them will know no peace. Communities that shelter them do not take forever to discover their mistake. And their sordid love of death is as nothing compared to our love of London, which we will defend as always, and which will survive this with ease.
Although not as stirring, it echoes the sentiments of one of the greatest men to live in the 20th century, Sir Winston Churchill:
We shall not flag or fail. We shall go on to the end, we shall fight in France, we shall fight on the seas and oceans, we shall fight with growing confidence and growing strength in the air, we shall defend our Island, whatever the cost may be, we shall fight on the beaches, we shall fight on the landing grounds, we shall fight in the fields and in the streets, we shall fight in the hills; we shall never surrender, and even if, which I do not for a moment believe, this Island or a large part of it were subjugated and starving, then our Empire beyond the seas, armed and guarded by the British Fleet, would carry on the struggle, until, in God's good time, the New World, with all its power and might, steps forth to the rescue and the liberation of the old.
Posted by Aggravated DocSurg at 9:28 AM
The object of terrorism is, well, to terrorize. Try telling that to the folks who have posted on this site. While the language is colorful, the message is loud and clear -- we are not afraid! Bully, I say!
Hat tip to Hugh Hewitt.
Posted by Aggravated DocSurg at 9:22 AM
Thursday, July 07, 2005
Tuesday, July 05, 2005
Sunday, July 03, 2005
One of the bits of medical lingo that confuses patients is the expression "free air," or pneumoperitoneum (isn't all air, by definition, free?). It refers to the idea that air normally contained within the confines of the GI tract has been liberated, and is "free" within the abdominal cavity. It can generally be seen on plain x-rays as air below the diaphragm, and may be due to perforated ulcer, perforated diverticulitis, and obviously after abdominal surgery. In the unoperated patient, it generally will require a trip to the room with no windows.
Patients, being people, sometimes don't make it easy on us to figure out what's going on (why can't they just read the textbooks?). Such is the case with a 30ish-year-old man I met the other evening. He had terrible abdominal pain, a fever, and an elevated white blood cell count. He also had chronic terrible abdominal pain, end stage renal failure requiring peritoneal dialysis, a history of pulmonary emboli, and was admitted to the hospital a week earlier with an upper GI hemorrhage and over-anticoagulation. His vascular options for dialysis are pretty much shot, so all the stops were pulled out to avoid an operation (which would eliminate peritoneal dialysis as an option) ---- lots of vitamin K and FFP as well as very aggressive endoscopic therapy for his bleeding....which, mercifully, stopped.
None too healthy, he was still here with pneumonia and a few other problems when his pain worsened, he developed fevers and chills, and his abdomen became suddenly much more tender; his dialysate is quite cloudy. Now, a CT in this gentleman can be confusing --- some free air and a lot of fluid will be expected due to peritoneal dialysis.
What we see initially is a striking amount of air(arrows) surrounding the pancreas and splenic hilum in the lesser sac, outside the "free" abdominal cavity. The stomach (square mark) and spleen (circle mark) can be seen in this view.
Another view shows how the stomach abuts the free air, concerning for a perforation of the posterior wall of the stomach.
However, the colon also abuts the free air near the tail of the pancreas (arrow; colon has white contrast within it) --- and could also be a source for the process.
Finally, a large amount of fluid is present within the abdomen due to peritoneal dialysis (arrows), and the result of renal failure can be seen in the shrunken kidneys (circles). There is no free air outside the confines of the lesser sac.
Once again, the abdomen is like a box of chocolates; you never know what you're going to get. By all rights, this patient should have a perforated posterior gastric wall in the area of known ulceration, where aggressive endoscopic therapy had been delivered. Instead, the splenic flexure of the colon was perforated, and I got to "deal with poop," as one of the surglings is fond of saying. This was likely an ischemic process at a watershed area, but could also be related to NSAIDs (which also contributed mightily to his ulcers) or diverticular disease. Unfortunately, his peritoneal dialysis access is gone for now, and we'll have to find another way to get his blood spun.
Posted by Aggravated DocSurg at 6:56 PM
It's nice to see that people still get a lot for their money at our institutions of higher learning. For example, this year's tuition increase at the University of Colorado will only be 20%! With that increase, your kids will be able to enjoy these educational opportunities at the "flagship" university in the heart of Beijing in the Rockies:
- Ethnic Studies (Afro-American, American Indian, Asian American, and Chicano Studies) -- Ward Churchill's bailiwick -- 'nuff said
- Lesbian, Gay, Bisexual, and Transgender Studies ("LGBT Studies involves the academic investigation of sexuality in established fields such as literature, history, theatre, law, medicine, economics, sociology, anthropology and political science. With its interdisciplinary approach, LGBT Studies interweaves complex theories and analysis into the study of sexuality." Includes such courses as Queer Theory, Queer Film, and Queer Modernism)
- Peace and Conflict Studies ("It's a simple and effective way to learn more about peace and conflict, and to gain skills to make the world a more peaceful place." Includes courses such as Prison Writing and Literacy and the ever popular Nonviolence for Everyday)
- Women's Studies (Includes courses such as Chicana Feminism and Knowledge, Workplace Diversity, and Queer Theory)
Look, I don't care if college kids want to waste their time gazing at their navels; their brains can rot on this Colorado Kool Aid as far as I'm concerned. However, should taxpayers not ask that their tax dollars be spent a bit more wisely? If one looks at the list of academic departments and programs at CU, it is easy to find any number of educational opportunities that will produce thinking, educated, working (i.e., tax-paying) graduates.....and that is what we need in a functioning society. Perhaps the taxpayers of Colorado would be better served if the above type of departments were eliminated and encouraged to reconstitute at private colleges. That would diminish to some degree the animosity folks have towards idiots like this, and still allow the navel gazers access to their lint. I know that some will want to throw college sports into this argument, and that's fine; I don't have the data to tell whether or not sports are a net winner or loser for most institutions.
In the long run, the world of academia will have to come to the realization that there is no bottomless pit of money available to kids who need a college degree ---- and without some changes, they may be put into the same situation as newspapers and magazines are in today due to the explosion of the internet.
Posted by Aggravated DocSurg at 3:41 PM
A while back I posted about a friend's new BMW, a car I have seriously lusted after in the parking lot (the drool marks are starting to show; I think I owe her a car wash). To be honest, however, this is a manifestation of a long term BMW infatuation. My first car was a 1968 BMW 1600-2, bought for $850 when it had over 100,000 miles on the odometer. Squatty, square, and the possessor of the world's largest steering wheel, it took me everywhere in my teens and early 20s.
My father, ever patient with machines, was able to help me rebuild the engine, replace the water pump (twice), replace the radiator, install a stereo, replace the rear end differential, and replace the frequently worn out constant velocity joint boots over the years. It was so square that my brothers and I dubbed it "the box;" its trunk was large enough to hide a few extra riders when entering a drive in theater. What it lacked in looks, it also lacked in power, generating a mind-numbing 83 hp.
I grew to love the way that car drove. Ever since, I have only felt comfortable driving a car that has minimal power assistance, especially for steering. As I grew older, I would dream about owning another BMW -- first the 2002, then the 3.0 CSi (still my favorite style), then the 320i....and then my interest petered out (until now). As much as I enjoy the reliability of my Toyota, I'd still like to take a spin in a Bimmer -- even my old 1600.
Posted by Aggravated DocSurg at 10:48 AM