Archive for December, 2015

Christmas Eve 1777

Tuesday, December 22nd, 2015

After the American victory at Saratoga, British General Howe struck back by driving the patriots out of Philadelphia. On Dec. 19, 1777, over 11,000 American soldiers set up camp at Valley Forge, just 25 miles outside Philadelphia. Meanwhile, another 11,000 Americans were dying on British starving ships.

Yale President Ezra Stiles recounted May 8, 1783: “‘O that my head were waters, and my eyes a fountain of tears,’ that I might weep the thousands of our brethren that have perished in prison ships – in one of which, the Jersey, then lying at New York, perished above eleven thousand the last three years – while others have been barbarously exiled to the East Indies for life.”

Soldiers at Valley Forge were from every state in the new union, some as young as 12 and others as old as 60. Though most were of European descent, some were African-American and American Indian. Among them were Marquis de Lafayette and the future Chief Justice John Marshall.

Lacking food and supplies, soldiers died at the rate of twelve per day. Over 2,500 froze to death in bitter cold, or perished from hunger, typhoid, jaundice, dysentery and pneumonia. In addition, hundreds of horses perished in the freezing weather.

A committee from Congress reported on the soldiers: “Feet and legs froze till they became black, and it was often necessary to amputate them.”

Of the wives and children who followed the army, mending clothes, doing laundry and scavenging for food, an estimated 500 died.

Two days before Christmas, George Washington wrote: “We have this day no less than 2,873 men in camp unfit for duty because they are barefooted and otherwise naked.”

Washington wrote “… that unless some great and capital change suddenly takes place … this Army must inevitably … starve, dissolve, or disperse, in order to obtain subsistence in the best manner they can.”

Hessian Major Carl Leopold Baurmeister noted the only thing that kept the American army from disintegrating was their “spirit of liberty.”

A farmer reportedly observed General Washington kneeling in prayer in the snow.

On Dec. 24, 1983, President Ronald Reagan stated in a radio address: “The image of George Washington kneeling in prayer in the snow is one of the most famous in American history.”

On April 21, 1778, Washington wrote to Lt. Col. John Banister: “No history … can furnish an instance of an army’s suffering such uncommon hardships as ours has done, and bearing them with the same patience and fortitude – To see men without clothes to cover their nakedness, without blankets to lay on, without shoes, by which their marches might be traced by the blood from their feet, and almost as often without provisions … marching through frost and snow, and at Christmas taking up their winter quarters within a day’s march of the enemy, without a house or hut to cover them … and submitting to it without a murmur, is a mark of patience and obedience which in my opinion can scarce be paralleled.”

Despite these conditions, soldiers prepared to fight.

A Christmas carol that lifted spirits at this time was “God Rest Ye Merry, Gentlemen,” first published in 1760 on a broadsheet in London as a “New Christmas carol.” It was called “the most common and generally popular of all carol tunes”:

God rest ye merry, gentlemen,
Let nothing you dismay.
For Jesus Christ our Savior,
Was born on Christmas Day;
To save us all from Satan’s power,
When we were gone astray.

O tidings of comfort and joy,
Comfort and joy,
O tidings of comfort and joy.

In February, 1778, there arrived in the camp a Prussian drill master, Baron Friedrich von Steuben, who had been a member of the elite general staff of Frederick the Great, king of Prussia. Baron von Steuben, who was sent with the recommendation of Ben Franklin, drilled the soldiers daily, transforming the American volunteers into an army.

Lutheran Pastor Henry Muhlenberg, whose sons Peter and Frederick served in the first U.S. Congress, wrote in “The Notebook of a Colonial Clergyman”: “I heard a fine example today, namely, that His Excellency General Washington rode around among his army yesterday and admonished each and every one to fear God, to put away the wickedness … and to practice the Christian virtues. … God has … marvelously, preserved him from harm in the midst of countless perils, ambuscades, fatigues.”

Washington successfully kept the army intact through the devastating winter, and gave the order at Valley Forge, April 12, 1778: “The Honorable Congress having thought proper to recommend to the United States of America to set apart Wednesday, the 22nd inst., to be observed as a day of Fasting, Humiliation and Prayer, that at one time, and with one voice, the righteous dispensations of Providence may be acknowledged, and His goodness and mercy towards our arms supplicated and implored: The General directs that the day shall be most religiously observed in the Army; that no work shall be done thereon, and that the several chaplains do prepare discourses.”

On May 2, 1778, Washington ordered: “The Commander-in-Chief directs that Divine service be performed every Sunday. … To the distinguished character of Patriot, it should be our highest Glory to laud the more distinguished Character of Christian.”


US Primary Care System Under Strain

Saturday, December 12th, 2015

US physicians are under a greater strain, said Robin Osborn author V Pres. of Health Policy and Practice.

US physicians also voiced major concerns about gaps in care coordination and administrative hassles, which they said were interfering with patient time; 43% of those surveyed said their job was very or extremely stressful, and 34% said they were somewhat or very dissatisfied about practicing medicine.

“We need a strong primary care infrastructure, and we don’t have it, and we haven’t had it for a long time, and it’s actually getting worse,” said Dr Blumenthal. As evidence, he pointed to the proliferation of walk-in clinics. They are on the rise “because the primary care system in the US is failing”.

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Socialism: America’s Chilling Prediction

Wednesday, December 9th, 2015

Ben Kinchlow warns, ‘Socialism has failed everywhere it has been tried’

A little over two centuries ago, a historian named Alexander Tyler made a chilling prediction that could easily be applied to America today. While he spoke of the ancient Athenians, the principles apply to modern-day America.
He wrote,
“The average age of the world’s greatest civilizations from the beginning of history has been about 200 years. During those 200 years, these nations always progressed through the following sequence: from bondage to spiritual faith; from spiritual faith to great courage; from courage to liberty; from liberty to abundance; from abundance to complacency; from complacency to apathy; from apathy to dependence; from dependence back into bondage.”

A most chilling observation in this “prophecy” is that civilizations rise and fall in 200-year cycles. Based upon this observation, could America already be three decades beyond the deadline? Could it be that the signs of “dependency and bondage” that Tyler spoke of have manifested and, though unnoticed, are all around us today?


1944 Norman Thomas America’s leading Socialist

Wednesday, December 9th, 2015

Norman Thomas was the Socialist Party’s six time presidential candidate and never won an election. He did not have to be elected to win, 90% of his platform is now in place in America.

From a 1944 Norman Thomas speech:
“The American people will never knowingly adopt socialism. But, under the name of “liberalism”, they will adopt every fragment of the socialist program, until one day America will be a socialist nation, without knowing how it happened. I no longer need to run as a Presidential Candidate for the Socialist Party. The Democratic Party has adopted our platform.”

In 1964 Norman Thomas spoke at Washington & Jefferson College.
He said that all planks of the Socialist Party were adopted except for Socialized Medicine.

Thomas said Socialized Medicine will soon be accepted by America.

Physician Burnout: A Personal Story

Tuesday, December 8th, 2015

Editor’s Note: Dr. Thomas Murphy December 03, 2015
The following commentary is authored by Thomas Murphy, a rheumatologist living in Boise, Idaho, and practicing medicine in nearby Emmett, Idaho. He recently published a book about physician burnout: Physician Burnout: A Guide to Recognition and Recovery. He also has a website dedicated to the issue of physician burnout. The following article is the first in a series about physician burnout in which Dr Murphy and Medscape seek to bring knowledge and awareness to this topic.

Time is baffling. It seemed like just yesterday that I sat in a posh auditorium in Chicago, an enthusiastic young adult on my first day of medical school orientation at Northwestern University in 1995. Eighteen years later, I was a 43-year-old burned out physician, practicing in Boise, Idaho, searching Google for the most effective way to end my life. During my time of maximum burnout, I was the type of physician that I never wanted to be: impatient, sarcastic, and occasionally dismissive of my patients. I made caustic jokes about some patients in the lunchroom. In short: I was not happy.

As I learned about the problem of physician burnout, I came to recognize that I was not alone. While researching the subject of burnout for a book I recently wrote on the subject, I learned that burnout is not some psychological abnormality too embarrassing to speak about in public. Quite the contrary. For example, a 2011 survey of over 2000 US physicians found that 87% reported feeling moderately to severely stressed or burned out on an average day.[1] On the extreme spectrum, female physicians have a successful suicide rate of 250%-400% higher than their counterparts in the general population.[2] Something very alarming is going on in the American healthcare system nowadays. Doctors aren’t happy, and neither are patients. The proverbial admonition, “Happy doctors make for happy patients” comes to mind with the caveat that the reverse is also true.

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Physician Burnout Climbs 10% in 3 Years, Hits 55%

Saturday, December 5th, 2015

Diana Swift December 01, 2015
• Medical Resident Burnout Reaches Epidemic Levels
• Impact of Burnout: Clinicians Speak Out
• Burnout Rates Soar Among Family Physicians

Professional burnout among US physicians has reached a dangerous level, with more than half of physicians affected, according to the results of a 2014 national survey across various medical specialties and practice settings. Compared with responses from a similar survey in 2011, burnout and satisfaction with work–life balance have worsened dramatically, even though work hours have not increased overall.

“American medicine is at a tipping point,” lead author Tait D. Shanafelt, MD, from the Mayo Clinic’s Department of Internal Medicine in Rochester, Minnesota, told Medscape Medical News. “If a research study identified a system-based problem that potentially decreased patient safety for 50% of medical encounters, we would swiftly move to address the problem. That is precisely the circumstance we are in, and we need an appropriate system level response.”
Dr Shanafelt and colleagues published the survey results in the December issue of the Mayo Clinic Proceedings. Changes must come in the practice environment, overcome inefficiencies, decrease administrative burden, and inflexibility.

The researchers invited 35,922 physicians to respond to their questionnaire. Of these, 6880 (19.2%; 67.5% men; median age, 56 years) completed the survey between August 2104 and October 2014. Dr Shanafelt and colleagues compared the results with those from the 2011 survey and with those for a probability-based sample of working adults in the general population surveyed during the same period.

Burnout rates, depressive symptoms, suicidal ideation in the last 12 months, and satisfaction with work–life balance were among the measured characteristics. Evaluated with the Maslach Burnout Inventory, 54.4% of physicians reported at least one symptom of burnout in 2014 compared with 45.5% in 2011 (P < .001). Satisfaction with work–life balance also declined during the 3 years, to 40.9% vs 48.5% in 2011 (P < .001). Differences emerged by physician specialty, however: compared with 2011, burnout was higher in 2014 across all disciplines, with many climbing more than 10% in the 3-year interval.

Family med______51.3%___63.0%
General Surg____42.4%___52.7%

Factors independently associated with both burnout and satisfaction with work–life balance included age, sex, specialty, hours worked per week, and practice setting. Women physicians had a higher burnout risk than their male colleagues (odds ratio, 1.29; P < .001), perhaps because of their overall younger age, Dr Shanafelt told Medscape Medical News.

On the measure of work–life balance, satisfaction declined in 2014 for all specialty disciplines except obstetrics/gynecology and general surgery. In contrast, working adults in the general population experienced only minimal changes in burnout or work–life balance satisfaction between 2014 and 2011 (28.4% vs 28.6%; P = .85). After multivariate adjustment for age, sex, marital/partnership status, and workweek, physicians faced an almost twofold greater risk for burnout (odds ratio, 1.97; 95% confidence interval, 1.80 – 2.16; P < .001) compared with nonphysician working adults.

In addition, 46.9% of physicians had a high score for emotional exhaustion, 34.6% had a high score for depersonalization, and 16.3% had a low score for personal accomplishment. Just 40.9% of practitioners said their schedules left sufficient time for personal and family life. Only minimal differences were noted between 2011 and 2014 in respondents reporting symptoms of depression (39.8% vs 38.2%; P = .04). There was no difference in the rates of suicidal ideation, which held at 6.4% for both years (P = .98).

Dr Shanafelt and colleagues note that although students begin medical school with superior mental health profiles relative to graduates entering other fields, 1 or 2 years' medical study reverses this psychological situation, and once they begin to practice, "physicians have generally high degrees of satisfaction with their career choice but experience high degrees of burnout and dissatisfaction with work-life integration."

The work was financially supported by the Mayo Clinic Program on Physician Well-being. Dr. Shanafelt is coinventor of the Physician Well-being Index. The authors have disclosed no relevant financial relationships.
Mayo Clin Proc. 2015;90:1600-1613. Abstract