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Tuesday, July 31, 2012

The Fading Art Of The Physical Exam

Internist Nesli Basgoz examines patient Barry Arcangeli who has a leaky heart valve. Basgoz discovered Arcangeli's heart condition during a routine physical examination.

"I sometimes joke that if you come to our hospital missing a finger, no one will believe you until we get a CAT scan, an MRI and an orthopedic consult. We just don't trust our senses." - Dr. Abraham Verghese

Would you prefer your doctor to take the time talk with you, give you a physical exam that includes touch, make judgements based on experience and physical touch? I do, that's why I go to 82 year old Dr. Pepe in Boulder City. But other physicians say that the time spent to practice the art of medicine takes away from the efficiency, documentation and physicall evidence of tests, scans and almost CSI or detective deductive evidence. After all we live in a modern world with modern things.

Insurance company demands that doctors spend less than fifteen minutes per patient  (in some cases ten) have taken from face time and physical touch. The family doctor is more likely a family clinic, where doctors who are contract employees come and go based on how much they are paid as much as how much they can help people.

Some med schools are never taught to "lay hands" or how to properly interview a patient, as their instructors come from the world of technology and large medical institutions.

NPR 's Morning Edition spent time yesterday morning looking at the "fading art of the physical exam."

It's not in the words...

Guide to London Olympics

Added to COMPROFESSOR.COM Actor Tabs

Olympics 2012: Olympic Stadium
Olympic Stadium. Credit: Wally Skalij / Los Angeles Times
Key date: July 27

Venue: Olympic Stadium

Big story: The ceremonies are scheduled to commence at 9 p.m. in London, which is eight hours ahead of the West Coast, and viewers here will have to wait. NBC is broadcasting the prerecorded Opening Ceremonies in Southern California beginning at 7:30 p.m. PDT.

What to expect: Queen Elizabeth II will officially open the games. Team members from more than 200 nations will participate in the parade. A cast of 15,000 people under the direction of Oscar-winner Danny Boyle, of “Slumdog Millionaire” fame, will perform.


1. The dog is not allowed in the house.

2. Okay, the dog is allowed in the house, but only in certain rooms.

3. Ok, fine, the dog is allowed in all rooms, but has to stay off the furniture.

4. The dog can get on the old furniture only.

5. Fine, the dog is allowed on all the furniture, but is not allowed to sleep with the humans on the bed.

6. Okay, the dog is allowed on the bed, but only by invitation.

7. The dog can sleep on the bed whenever he wants, but not under the covers.

8. The dog can sleep under the covers by invitation only!

9. The dog can sleep under the covers every night.

10. Humans must ask permission to sleep under the covers with the dog.

Make a Presentation Like Steve Jobs

Bye Bye Hotmail

Hotmail is going cold, at least as a brand.

Microsoft Corp. is phasing out the email service, a pioneer of electronic mail accessed on the Web, in favor of a new-but-old brand: Outlook.

The company said Tuesday it is converting Hotmail, which competes with Google Inc.'s Gmail and email services from Apple Inc. and Yahoo Inc., into a revamped Web-based email service called, mirroring the name of Microsoft's dominant line of workplace email software.

-Wall Street Journal

Big Bird and the death of journalism

I once read that the BBC worked long and hard to delay the introduction of “Sesame Street” on British Television because the program taught children that all you need to know you can learn in one or two minutes bites. The Sesame Street generation now includes most everyone under 40.

So, when it comes to laying blame for decreased attention span, a tendency to grab at the short and simple explanation for things, the way so many people grab onto sound bites or easy answers as true without questioning the source or the depth of the statement (Obama is a Muslim, Obama is not American, actors are not informed, celebrities should not be allowed to voice opinions, Global Warming is a myth and so on…), the only people we have to blame are ourselves, those in or who consume media.

We wanted short, fast, six minutes ratings increment driven news or entertainment. We wanted fast paced video and audio. We bought into anything worth saying can be said in 14 words or less, or thirty seconds or less, or on a simple billboard.

CNN shifted from national international news gathering and long form reporting organization to increased personality and bias, hot spot rhetoric and ratings driven after FOX replace them in the ratings by presenting opinion and feel good reinforcement of one point of view, with shouting heads instead of dedicated news resources and balance reporting. CNBC followed, gaining ratings with the opposite political presentation to FOX. Ratings, fast paced headline coverage, personality news are all the result of our shift from long-term thinkers to instant gratification and short attention spans. Broadcast news has been “the bubble headed blond” smiling and doing small talk for years. Gone are Cronkite, Brokaw, Murrow or any attempt at balance and presentation to fit the seriousness of what is being presented.

Americans do not feel a need for a better journalism than they have. This was written in response to another Open Salon posting and was not penned by me.

Because it is not true, but a generalization with mixed values revealing the view of the common man from an elite perspective. By Americans do we mean the masses? If so, realize that serious reporting has always appealed to the minority and the decision makers. Newspapers dying out has little to do with content and more to do with economics of publishing and the ability of the comic readers, the sports box score fanatic, the Wall Street ticker-tape watcher to get real time information over other media. Except for those who have slashed reporters instead of fat, newspapers still offer long form and insightful journalism that cannot be found in other areas, at least not easily or for the passive mass audience.

Of course economics includes bad management, not shifting quickly enough to a multi-media integration of revenue and resources, and not keeping their fingers on the actual daily habits of time use by the general population they relied on to attract advertisers, sell subscriptions and maintain their reputations.

As a teacher I have to disagree on the low view of Americans. Knowledge, learning and education have shifted from the Eastern Elite definition held so dear by so many who think they represent business and political norms. Americans are learning more, reading more and thinking more than ever before. The difference is it may not be balanced, as broad in focus or as in depth as in the past. Fast, quick form Internet and sound bite media have taken their toll on our attention span.

People are basically good. People may be learning more than ever before through experience, experimentation, and object lessons as they seek more than book or traditional knowledge. We are not dumbing down, but the evolution from long form attention spans to “the fast and furious” will change and is changing how we think, our perceptions of reality and our ability to communicate on complex levels.

What if anything can be done?

Hats off the New York Times for resisting the trend to cut reporting and editorial staff during hard times, and to keep printing national and international daily editions.

So this entry rants, wanders and touches on probably too many areas. I would like response, elaboration and discussion in any direction these thoughts may lead.

Thank you in advance.


March, 12, 2009 first posted, repost 1/20/10

Olympic ranting. Disney Channel's crossover hit. Comcast begins appeals process in FCC Tennis Channel ruling. Rebourne.

After the coffee. Before learning how to score gymnastics.

The Skinny: Lots of gripes about how NBC is covering the Olympics (see below). My favorite complaint is that NBC has a "monopoly" on the games. Well, they outbid Fox and ESPN for that "monopoly." No one handed them the Games and said "go to town." Tuesday's headlines include the above-mentioned Olympic coverage complaints, a look at how much money Warner Bros. pumps into the local economy and a new Disney Channel cartoon is a hit with African Americans.

Daily Dose: Fox Business Network continues to make gains on CNBC. In July, FBN's "Lou Dobbs Tonight" beat CNBC's "The Kudlow Report" in the key 25-54 demographic. It's the first time "Lou Dobbs Tonight" has scored a monthly win since it premiered in March 2011. In total viewers, Dobbs still trailed Kudlow by about 10,000.
Bill Macatee and Martina Navratilova interview Ana Ivanovic for the Tennis Channel
Comcast began its appeal of last week's FCC ruling on the Tennis Channel. The Tennis Channel's Bill Macatee and tennis great Martina Navratilova, center, interview Ana Ivanovic, in 2009 at Wimbledon. (Fred Mullane / July 30, 2012)

Comcast Corp. has asked the Federal Communications Commission to stay its decision that the Philadelphia-based cable television giant discriminated against the independently owned Tennis Channel.

Monday's filing by Comcast Corp. is expected to be the first step in a lengthy appeals process in the dispute over distribution that began three years ago.

Last week, in a 3-2 vote, the FCC found that Comcast had discriminated against the Santa Monica-based Tennis Channel by placing it in a more expensive sports package that limited the channel's exposure and revenue prospects.

The Tennis Channel is available in about 3 million homes that receive Comcast Cable service.
At the same time, Comcast provided two sports channels it owns, the Golf Channel and NBC Sports Network (previously called Versus) to nearly all of its 22 million subscribers. The FCC ordered Comcast to provide the Tennis Channel with distribution comparable to the two sports channels, which would effectively increase its coverage by about 18 million homes, and force Comcast to pay Tennis Channel millions of dollars more each year in programming fees.

It was the first time that a major cable operator has been found in violation of federal anti-discrimination program carriage rules that were established in 1993.

To continue reading in the LA Times click on  More...

Two Broke Girls
A Warner Bros. product like "Two Broke Girls" pumps a lot of money into the local economy. (CBS / July 31, 2012)

 Big spender! How important in Warner Bros. to Los Angeles County? Well, in 2010 the studio spent about $1.6 billion on local businesses and paid $2.5 billion in wages and residuals to residents. While studios typically guard such numbers, Warner Bros. is in a talking mood in an effort to enlighten local communities and civic leaders about the value of having it in the backyard. Details on the local spending habits of Warner Bros. from the Los Angeles Times.

No pleasing everyone. NBC's Olympics are scoring big ratings for the network. It is also streaming events live online (I snuck a peak at women's volleyball on Monday). But there will also be people who can find things to complain about and now thanks to Twitter they have a platform for their rants against NBC. If the network could make as much money by playing the Olympics live on TV all day with no tape delay and no worries about a prime-time audience, it would. But until that day comes, tape delay in prime time for TV will remain as it has for decades. Since I actually work during the day and am definitely in the casual viewer camp, it's not a big deal to me. There are worse things in the world I can find to complain about. Talking heads covering competent event announcers who are talking in English, comments made on what viewers can obviously see and not showing some of the most poignant moments of the overall events to highlight content less interviews with US athletes. More on the backlash against NBC from the Baltimore Sun and Los Angeles Times.

Can I get a show? Google's YouTube is determined to make its video platform a showcase for professional entertainment (as opposed to clips of cats doing silly things). Having already spent $150 million to launch dozens of channels, it is now pumping another $200 million into the effort. Lots of producers and stars are also giving YouTube a shot. Side deals with Facebook and other distributors for cross promotion and distrubution increase YouTubes odds at becoming a true programming challenger. Details from the Wall Street Journal.

Building bridges. The New York Times notes that Walt Disney Co. has at times had a hard time connecting with African Americans. But now, thanks to a new Disney Channel cartoon called "Doc McStuffins," the company has hit pay dirt. “For Disney to make a cartoon that stars a little brown girl as an aspiring intellectual professional, that’s coming a long way,” one mother said of the show.
Get out the vote! The Academy of Motion Picture Arts & Sciences will elect a new president Tuesday night. There are at least five people jockeying for the job including studio executive Rob Friedman and producer Gale Anne Hurd. Variety with a preview of the race.

Reborn! When Matt Damon decided to stop playing Jason Bourne, many bet that the franchise would end. But Universal is banking on Jeremy Renner keeping it alive. The Hollywood Reporter talks with producer Frank Marshall and coproducer Jonathan Crowley about their efforts to show that Bourne is more than Matt Damon.

Inside the Los Angeles Times: Spanish-language TV stations and networks are poised to make big bucks from political spots.

Follow me on Twitter and pick fights with me.


Close to one in five Nevadans are unemployed or working under the table...nearly one in three are 'under employed', working part time not by choice or in temporary work that requires periods of time without working. Nevada leads the nation in these negative statistics. California is a close second.

Public Speaking and Leadership

The best speaker I have ever seen/heard was a Colonel in the United States Airforce. I say "was" because he is now a Brigadier General at the Pentagon. It is amazing what great speakers many of the Higher ranked officers are and I guess they have to be. Speaking in front of a sea of Soldiers/Marines/Airman, they have to find ways to keep all of their troops stimulated. Especially since they are leaders of people all ages, gender, and educational level. This is really great advice and goes along with my motto; you get out what you put into something. If you are passionate and excited what you are speaking about, then your audience will be as well; as long as you are able to relate your message to many different groups in your audience. Being able to relate to individuals of all ages, gender, and sociological backgrounds is what makes leaders great, and what makes people want to follow. - Jess Kobayashi on Public Speaking Advice