All Physical Exams are Not Created Equal

This speaks to why the Electronic Medical Record will NEVER save money as it was hoped to.I am sure Doctor Dinosaur is absolutely correct in his assessment.

Musings of a Dinosaur

Once again, I am in receipt of a letter from a specialist (a surgical subspecialty, of course) that has me alternately shaking my head in disbelief and trembling with fury.

The letter was clearly crafted with electronic medical record software to support billing as high a level office visit as possible. In addition to a complete specialty-specific organ system examination, a “Multi-System Physical Examination” was also documented:

• Constitutional: well-nourished, no physical deformities, normally developed, good grooming
• Neck: neck symmetrical, not swollen, normal tracheal position
• Respiratory: no labored breathing, no use of accessory muscles
• Cardiovascular: normal temperature, normal extremity pulses, no swelling, no varicosities
• Lymphatic: no enlargement of neck, axillae, groin
• Skin: no paleness, no jaundice, no cyanosis, no lesion, no ulcer, no rash
• Neurologic/Psychiatric: oriented to time, oriented to place, oriented to person, no depression, no anxiety, no agitation
• Gastrointestinal: no mass, no tenderness, no rigidity, non-obese abdomen
• Eyes: Normal…

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Healthcare Derivatives

Words from the wise.

Musings of a Dinosaur

I just realized what all these new insurance intermediaries and programs and organizations (all composed of people who don’t provide medical care to other people) remind me of: Derivatives! And we all remember how well that worked out for stocks a few years back.

Let me ‘splain.

A few years back, a bunch of Wall Street crooks financiers came up with a bunch of new ways to package various stocks and securities that were intended to be too convoluted for anyone to figure out that they were nothing more than a way to relieve gullible investors of their money. It worked. Really well. Well, until the housing market collapsed and the country plunged into near economic collapse. But hey; these things happen. Remember, it was all legal. It just wasn’t a very good idea. Take home message for investors: stick to owning pieces of real companies. Whatever else happens, there…

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Should the AAP Sleep Alone?

This is an excellent commentary on bedsharing.

Breastfeeding Medicine

Some public health messages everyone can agree with: Never drink and drive. Always put your infant in a car seat. Other public health messages seem to ask us to do the impossible: Teenagers must never have sex. Mothers must never share a bed with their infants.

Advice around the US urges parents never to bed share, reinforced by the official stance of the American Academy of Pediatrics. Scary ads abound. One ad shows a queen-sized bed with a headstone in place of headboard reading “For too many babies last year, this was their final resting place.” Another shows a baby in an adult bed with a meat cleaver, stating “Your baby sleeping with you can be just as dangerous,” and another ad says “Your baby belongs in a crib, not a casket.”

The fact is, across the United States and the world, across all social strata and all ethnic…

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The Power of “Reply All”

This was a very lovely story to wake up to this morning. I enjoy reading the blog posts of Notdeaddinosaur, a family physician with some years of experience and much wisdom.
Ann

Musings of a Dinosaur

The guy was a curmudgeon. That’s all you could say about him. His blood pressure and diabetes were dreadful, and he insisted there wasn’t anything he could do about it. The meds were too expensive; the diet was far too limiting; he had no pleasures in life other than food. He lived alone, hated his job, saw few people, had no friends; so he told me at every visit. His visits were unpleasant in other ways as well. He didn’t bathe often, nor did he appear to believe in doing laundry. 

He sent me emails from time to time. Funny pictures of cats; sentimental powerpoint presentations on the changing of the seasons; the usual. Sometimes I read them, sometimes not; depended on how busy I happened to be at the time. Mine was just one in a long list of names in the header.

Then one night, everything changed.

I…

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Yes, they are the best chocolate chip cookies ever.

The finished product.

My boyfriend sent me a link to this great article about one man’s quest to bake the perfect chocolate chip cookie.  Since I have baked every version of “the best chocolate chip cookie ever” for the last many years I do feel qualified to say that he has actually made a cookie that I personally will bake for the rest of my life. Every person I have given one to is in agreement. If you ever need to make an impression, bring a plate of these cookies. They are my ideal, crisp edges, chewy middle, fabulous depth of flavor.  I too have been experimenting with the difference between melted butter and room temperature and feel that this is the key to making these work.

I always bake a new recipe exactly as written. I will change things after I fully understand the initial recipe. The only thing I did differently with this recipe is that I used mini semi-sweet chocolate chips instead of chopped chocolate. They were in the cupboard and I have been enjoying the way they disperse more evenly through the cookie dough. I feel that the small chips also give a nicer proportion of chocolate and cookie dough per bite. The next time I make the cookies I will use some nice chopped chocolate and see what I think.

If you want to make them for yourself, here is the recipe separate from the original article.

A few helpful hints: I weighed all the ingredients as recommended.

Weighing the ingredients

This is how the eggs, sugar and vanilla appear after whipping for 4 minutes. There was a nice thick ribbon that fell from the beater.

Eggs, white sugar and vanilla after beating for 4 minutes

It is important to let the dough rest overnight as the author suggests. This the tastiest cookie dough imaginable. Try not to eat too much!

Refrigerated Cookie Dough

I weighed my dough balls. If I made each cookie 1.3 -1.4 ounces I was able to get 28 -30 cookies. I find that weighing is a better method as you are more consistent with cookie size. I made all the dough balls before I started baking the first pan so I could pay close attention to the baking process.

Weighing the dough balls.

I found it was very important to rotate the pans as stated and also to remove the cookies from the oven when the edges were golden brown. Most of the centers will still be puffed a bit when removed. I let them cool on the sheets for 2-3 minutes even when I wasn’t adding the salt. I found that the sprinkled sea salt was interesting but you might like to make half without for those who are more traditional in their tastes.

The snowmen approve.

Gratitude to J. Kenji Lopez-Alt for this amazing cookie recipe.

Ann Friedmann: The Importance of Women’s Shelters

As a member of the Board of Directors for Ruth’s House of Hope, Dr. Ann Friedmann was instrumental in the founding of this women’s shelter that serves the city of Faribault, Minnesota. Women’s shelters are vital for a number of reasons.

1. Shelters offer a safe haven for women who are the victims of physical or sexual abuse. For some women, a shelter may be the only viable means of escaping a violent situation.

2. Shelters can provide women with access to a variety of support services that can provide food, clothing, and child care, as well as job-hunting services if they need to find employment.

3. For women who need protection against future violent attacks, shelters can assist them in obtaining the necessary legal services to pursue appropriate civil or criminal actions.

4. Shelters can offer a variety of counseling services to help them cope with the emotional trauma that often results from domestic violence. Counseling may be available on an individual basis or through participation in support groups.

Pork Sauerkraut Goulash with Sour Cream

So, I finally found this recipe. Long ago I thought I might cook for a living and so I saved many recipes. This was one of my favorites. Recently I found my three handwritten notebooks which included this recipe. I …

Beef Barley Soup

This is simple, savory and it gets better the next day. I love barley. It has this great toothsomeness.

Ingredients

Olive oil

3 pounds beef stew meat cut into small cubes ( No more then one inch square)

1 onion, chopped (any sort but I have never used a red onion

3 carrots, chopped

2 celery stalks, chopped ( I often leave this out because I find celery tedious)

2 tablespoons fresh thyme, finely chopped ( I have used half thyme and half rosemary)

2 quarts beef broth- 8 cups

1 large can diced tomatoes with juice1 cup pearled barley

Salt &  coarse ground black pepper to taste

I have also added green beans and/or potatoes.See note below.

1. Look at your stew meat. I always cut it into smaller pieces and remove excess fat etc… Toss it with a nice amount of kosher salt (if you have it)  otherwise any salt will do. I always add a generous amount of coarse ground black pepper because I am a pepper freak.
2. Heat ~ 2 tablespoons olive oil in a large dutch oven. I heat to medium high.
3. Brown the meat in small batches. If you dump it all in at one time it will just braise and release moisture.Small batch searing will get you a nice amount of meaty glaze on the bottom of the pan. This is key to a good broth.
4. Transfer the browned meat to a bowl. You may have to add a bit more olive oil if the pan gets very dry.
   
   
5. Add another pour of olive oil if the pan is very dry. Continue at medium-high heat and add the onions with the accumulated beef juice.The “accumulated beef juice” is the liquid released by the cooked beef. It is under the pieces of beef that have been seared.  Cook and stir until the onions are quite soft and all the nice browned bits from the bottom of the pan are dissolved.
6. Add the carrots and celery. Saute until the carrots are barely tender.

   

7. Add the thyme and cook for one minute.
8. Pat the dog who is waiting patiently for his walk (more realistically …to lick the bowl)
   
9. Add the tomatoes, broth and the barley. Bring to a simmer.
10. Simmer the soup for 1 hour (or until the meat is nicely tender). Season to taste with salt & pepper.

Other Additions
One or two cups of 1/4-1/2 inch diagonally cut fresh green beans added to simmer for only 15 minutes or so, diced potatoes added for the last 30 -45 minutes of cooking.

Well, I hope you like this. I just had it for lunch with an obscene number of buttered saltines. This is OK as I have walked Ernie the Dog twice ( two miles each go around) and blasted the new elliptical at the YMCA for 50 minutes.

My Spotify playlist for Beef Barley Soup will be published shortly.

Hello everyone and welcome to my blog!

Well here goes! This is my first post and I am a wee bit nervous. This, despite the fact that I have been recipe testing for over 30 years. I am just not as confident in my ability to write well.

My interest in cooking started when I was 16 or so. Mom, Kathy, was newly divorced with 7 children on her hands. In order, Myself, John, Jane, Tom, Frank,Jimbo and Tootsie (Clare). It must have been overwhelming. But my mom really had been in charge of almost everything for quite a while. She kept us in line, made sure we did our homework, cooked, cleaned, organized and was a member of the South St. Paul school board for 25 years, 10 years or so as president. She had even attempted to run for political office as a republican candidate ( a story for another day).   She also realistically understood that she would likely be supporting the family. So she learned to drive and she enrolled in the School of Architecture at the University of Minnesota. It was then that we all had to pitch in and help out. My job was meal planning and cooking.

I remember opening Mom’s Betty Crocker cookbook for the first time. So many recipes, so many possibilities! She also had the French Larousse Gastronomique hidden way back in the cupboard above the oven. I believe it was a wedding present. This too was fascinating.Snails! Strange cheese, liver pate, eels! My siblings were my test audience and my clean-up crew. they can go on and on about that. Ask them about the 7 course chinese menu where Ann used EVERY POT AND PAN IN THE KITCHEN!!! It took 15 years before they stopped bringing that up.

To backtrack a bit, I am primarily German with just a hint of Irish. My cooks growing up were Mom, Grandma Frieda  and my Great Aunt Rose. Aunt Rose lived across the street from Grandma Frieda. Saturday was her baking morning. She had a little bungalow with a breakfast nook (which explains why I adore bungalows). The bakery would cool on the breakfast nook table. I remember the warm kitchen smelling of cinnamon and baked bread. My Mom says that Aunt Rose’s baking wasn’t all that stellar but I remember thinking it was just wonderful. It might have just been the smell.

My family believes that we make the best German potato Salad in the world. Potatoes, bacon,onion,vinegar, salt and pepper. AND THAT IS ALL. Sugar is NOT allowed.I will show you one day. Our piecrust is also really good. I know now that is because it is a 50/50 mix of fat to flour, the handling of which is very delicate. Now having read many piecrust recipes I understand that the best of them are similar. I recently made the best apple crumb pie ever and my pecan pie is legendary. Again, I will share later.

Besides loving food I am also an OB/Gyn physician and  a mom. I love to exercise and I love music. Over the years I have acquired a little cookbook of wonderful things. Those who know me will be happy that I am finally going to give you the recipes. All the great nurses I have known, the clinic staff, my friends, these recipes are for you. I love you all.