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'[OT]: Finding a doctor in the US'
2007\06\04@140350 by Vitaliy

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Hi List,

Is there a search engine, that lets one search for doctors based on their
rating (sort of like Froogle), or at least where one can read the ratings
left by other patients (a-la eBay or Amazon)?

There are several things that I HATE about the doctors that I had the
misfortune to have as my physicians.

1. Needless waiting. I make an appointment and come on time, then wait in
line for 30 minutes. A nurse weighs me, takes my blood pressure, and puts me
in a small room, where I wait for another 30 minutes, before I see the
doctor.

2. Lack of attention and personal care. The visit rarely lasts longer than 5
minutes. During this time, the doctor asks some questions (about symptoms,
etc), but I get the feeling that he's not really listening. And he's always
in a hurry.

3. Incompetence. On several occasions, doctors weren't able to correctly
identify the cause of the problem, much less suggest a solution. Recently, I
used WebMD to diagnose myself with a condition that affects one in four
people (so it's not uncommon), and has easily identifiable symptoms
(difficult to confuse with other diseases), something that two doctors
weren't able to do (and who suggested ridiculous solutions -- "shower less",
"drink more water"). Heck, if I could only spend 5 minutes per circuit on
troubleshooting, you bet I would misdiagnose problems -- and I humbly
consider myself a rather complicated circuit. ;)

I can go on with examples, but I am sure you get the point, and more likely
than not you have your own stories to share.

Having gone through a similar experience with dentists, I finally found one
that provides an excellent level of care, and I am sure the same is true of
doctors. There must be some good ones out there. I would prefer to vote with
more of my dollars for a good doctor, than to waste my money on bad ones.

Your comments are greatly appreciated.

Vitaliy


2007\06\04@161740 by alan smith

picon face
yes there are sites that rates doctors.  Cant remember off the top of my head, but I've run across when searching for a doc's phone number or address.  So they are there.
 
 You know....what you describe is alot like many other service oriented business.....take for example a auto repair shop.  You wait forever, get a diagnosis, spend little time with the mechanic yet pay alot.  Good thing I have my own personal mechanic :-) (a friend who does it for a living yet is willing to do work for me...and yes I pay him)

     
---------------------------------
Pinpoint customers who are looking for what you sell.

2007\06\04@163134 by David Euans

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Vitaliy,

Your best bet, as with most professional services, is to ask friends and
co-workers who they use and how satisfied they are.  Internet ratings
exist, but the responses found in them will, most likely, be heavily
weighted toward the negative.  Human nature being what it is, people
tend to voice their displeasure and say little about their good
experiences.  Unfortunately, some people just have an axe to grind
against physicians and other professionals.

A little disclosure on my part is appropriate at this point.  I am a
physician (Family Medicine).  I also train other Family Physicians. I
have seen very good and very bad doctors.  Some should have never been
allowed to graduate from medical school.  I have experienced
poor/incompetent medical care given to my family.  I have had bad
experiences with dentists, electronics repair techs and even a Microchip
certified consultant (no one active on this list).  

With that in mind, let me offer my $0.02 with regard to what happens in
a visit to a doctor.  Yes, waiting is an unfortunate part of going to a
medical visit. Why?  For one thing, patients are complicated.  The 80
year old patient that calls in for a cold and is given a brief
appointment time really has a heart problem and needs to be admitted to
a hospital.  Another patient comes in ten minutes late for an
appointment.  Other patients call in with urgent problems that must be
seen.  The end result: everybody waits and the doctor and his/her staff
go home late - again.  It is the end product of imperfect humans and
human interactions.  Do some docs get greedy and try to pack their
waiting rooms to maximize their income? Yes, but I'll bet a majority are
just trying to take care of those patients who need to be seen.  Our
medical system is imperfect.  Insurance providers and the government try
to run the average doc's practice in many ways.  They tell you they
won't pay for the service and give the disclaimer that "you will need to
do what is best for the patient".  We do that and our patients are irate
when they have to pay for the care out of their pocket.  I would get mad
too.  Responding to these issues will also ruin office schedules.  I
personally hate to be behind in my schedule and will profusely apologize
for long waits.

Too many doctors spend too little time in the exam room.  In fact,
research indicates that most physicians have come to a diagnosis within
30 seconds of beginning to hear the patient's history.  In some cases
this is appropriate (simple pattern-matching).  At other times it leads
to disaster.  Your doctor should LISTEN to you.  If not, go elsewhere.
The five minutes spent directly with you on a simple problem may be
adequate in some cases.  There is usually another five minutes spend by
the doc in behind-the-scenes activity such as prescription writing, test
ordering, consultation request, review of old lab tests as well as
information contained in your chart and completion of the documentation
of your current visit.  All of these activities may be necessary for
your visit and may not be apparent to you.

Let me suggest to you that you look for a physician certified by the
American Board of Family Medicine (http://www.theabfm.org). This may sound
self-serving, but family docs, in general, are people-people.  They may
be over-worked but most will take the time to listen to your problems.
The same can be said of general internists certified by the American
Board of Internal Medicine.  Sub-specialists, in my experience, are
usually excellent in their area of expertise.  However, they may have a
tendency to see every physical complaint as belonging to the organ
system of their specialty.  They may have trouble seeing the forest for
the trees.

I hope that this lengthy diatribe doesn't consume too much bandwidth,
but I felt I had to give an insider's view of this problem.  Frankly, I
wish curing people was as straight-forward as trouble-shooting my hobby
electronics and software issues.

Dave

2007\06\04@181249 by James Newtons Massmind

face picon face
David, that was an interesting read, and I really appreciate your taking the
time to write it.

I have a few questions if you don't mind thinking about them?

- What ever happened to MYCIN? I believe I have that spelled right. It was
an expert system which, given symptoms, returned a list of suggested tests
and possible diagnoses in order of likely hood. The test results further
tuned the diagnosis and requested tests. It learned from its mistakes. Given
that a lot of medicine is "pattern matching" as you put it, why don't we
have a system like that? I would PAY to not have to interact with a human.

- Why will doctors NEVER interact via email? Again, I would PAY to be able
to email symptoms, pictures, and questions. Has anyone ever asked their
doctor for their email address and gotten anything but a laugh? If you found
your doctors address and emailed a question, did you ever get anything other
than "make an appointment..." in return?

- My wife has wonderful bedside manner. Why can't she be my nurse and use
you as the doctor? Ok, I understand she doesn't have the time to become a
full on nurse, but couldn't there be a college level "Nurse Mom" program for
well educated women or men who are caring for their family? My wife has a
MSW and so has done lots of medical courses. If you took the most common
medical issues and the most basic methods for treatment and off-loaded them
into the hands of the people who are actually caring for your patients in
the first place...

If the problems with these are legal, I'll wave my rights. I will never sue
anyone anyway: I'll be damned if I'll put money in a lawyers pocket;
apologies to the few good lawyers who I know frequent this list.

If the problem is a need for poking and prodding, why not try pictures and
text first, and THEN say "I really need to poke and prod you to be sure of
what is going on in your body..." Of course, most of this could be farmed
out to labs. E.g. Please go to your nearest lab and give them a print out of
this email where I have requested a blood glucose test, etc...

How much good could we do if all the sick people didn't have to physically
go to the same office and sneeze all over each other?

Open an on-line office David... I'll sign up.

---
James.



> {Original Message removed}

2007\06\04@231434 by David Euans

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James,

MYCIN seems to be rattling a few of my old neurons.  I can't remember
why it never caught on - perhaps fear by doctors of "losing" to a what
is essentially a cookbook or general mistrust of what is new.  I'll have
to search for more about it.

Some docs do use email.  Personally, I would only use email to sort out
what probably could be treated by over-the-counter medications from
those that needed bona fide prescriptions.  I'm very old-school and
conservative and will not prescribe most meds over the phone unless I
personally know the patient very well.  The problem is - many diseases
sound and may even look alike and only a hands-on exam can distinguish
between them.  Tele-medicine is being used in some parts of the country.
The doc can see the patient, get close-up views of rashes and even hear
the heart and lungs through and electronic stethoscope.  Again, this
helps to sort out the serious from the not so serious problems but is no
replacement for hands-on care.  Perhaps trained lay people could augment
the remote doc and be his/her hands.

I think we are many years from this happening though.  There are
licensure issues when the doc is in a different state than the patient,
unless the doc is licensed in the other state too.  Third-party payors
will generally not cover this kind of care.  Of course, the potential
for litigation is high.  I can just hear a plaintiff attorney asking:
"Doctor, how could you make that diagnosis?  The patient was 500 hundred
miles away." Like it or not, that is the reality of medical practice (to
some degree deserved).  Waivers may or may not be any protection.

Long after I retire, I think your scenario will become reality.  In the
meantime, I think patients and doctors just need to be able to better
communicate and understand each other.

Dave

2007\06\05@004137 by Vitaliy

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David Euans wrote:
> Your best bet, as with most professional services, is to ask friends and
> co-workers who they use and how satisfied they are.

This road hasn't led me anywhere, unfortunately (maybe because I don't have
enough friends, LOL).

>  Internet ratings
> exist, but the responses found in them will, most likely, be heavily
> weighted toward the negative.  Human nature being what it is, people
> tend to voice their displeasure and say little about their good
> experiences.  Unfortunately, some people just have an axe to grind
> against physicians and other professionals.

While what you're saying is true, I believe am pretty good at determining
whether a complaint is legit or not (years of practice on eBay and Amazon).
I dismiss non-substantiated complaints, and some things that are big
negatives for some people, may not be such for me.

[snip]
> With that in mind, let me offer my $0.02 with regard to what happens in
> a visit to a doctor.  Yes, waiting is an unfortunate part of going to a
> medical visit. Why?  For one thing, patients are complicated.
[snip]

And yet there's no excuse to keep a patient waiting for an hour, and then
rush through the visit -- EVERY time. Statistics tells me it cannot be just
me, and I'm surprised at how accepting most patients are, of being treated
like this.

I had the same problem with my old dentists: they would keep me waiting in
the reception area, then put me in the seat, make me wait some more, then
work on me and two other patients at the same time (AND, it was a different
dentist every time). And then two months later I would be forced to come
back because I broke the new filling while flossing.

About a year ago a friend recommended his dentist. Nowadays, I never wait
longer than five minutes, the office has state-of-the-art equipment, the
doctor takes the time to explain what he's about to do, and what my options
are -- in  my mind, he is as close to the perfect dentist as one can get.
During my last visit, he even took the time to save the digital X-rays
(along with the viewer) to my thumb drive.

> Do some docs get greedy and try to pack their
> waiting rooms to maximize their income? Yes,

You nailed it. An aquaintance who has a dental practice said that's the only
way he can make money -- the insurance company pays him per patient visit.
It's obvious that the situation is the same with many doctors. Piece work.

> but I'll bet a majority are
> just trying to take care of those patients who need to be seen.  Our
> medical system is imperfect.  Insurance providers and the government try
> to run the average doc's practice in many ways.

Yes, I realize the system is broken. But there have to be good doctors out
there, who resist the McDonaldization of the medical establishment and
genuinely care about their patients. I want to find one REALLY-REALLY
BADLY!.. %-)

>  They tell you they
> won't pay for the service and give the disclaimer that "you will need to
> do what is best for the patient".  We do that and our patients are irate
> when they have to pay for the care out of their pocket.  I would get mad
> too.  Responding to these issues will also ruin office schedules.  I
> personally hate to be behind in my schedule and will profusely apologize
> for long waits.

I've read somewhere recently (About.com?) that some insurance companies
*forbid* their doctors from even mentioning certain procedures not covered
by the policy. That, if true, is completely insane.

I would much rather spend extra money out of pocket, and get some real care,
instead of wasting money on doctor's visits that bring me zero benefit.

> Too many doctors spend too little time in the exam room.  In fact,
> research indicates that most physicians have come to a diagnosis within
> 30 seconds of beginning to hear the patient's history.  In some cases
> this is appropriate (simple pattern-matching).  At other times it leads
> to disaster.  Your doctor should LISTEN to you.  If not, go elsewhere.

I'm TRYING TO! :-D

> The five minutes spent directly with you on a simple problem may be
> adequate in some cases.  There is usually another five minutes spend by
> the doc in behind-the-scenes activity such as prescription writing, test
> ordering, consultation request, review of old lab tests as well as
> information contained in your chart and completion of the documentation
> of your current visit.  All of these activities may be necessary for
> your visit and may not be apparent to you.

The problem has little to do with time, per se. It's more about the
attitude. By the way, my last doc packed the first two activities you listed
into five minutes, and they never sent my swab sample to the lab -- so they
must be super-efficient. :)

I think the problem may be somewhat local in nature. A significant
percentage of population in Arizona is comprised of Mexican immigrants (many
of them illegal), who are the humblest bunch of folks I've ever met.

> Let me suggest to you that you look for a physician certified by the
> American Board of Family Medicine (http://www.theabfm.org). This may sound
> self-serving, but family docs, in general, are people-people.  They may
> be over-worked but most will take the time to listen to your problems.
> The same can be said of general internists certified by the American
> Board of Internal Medicine.

Thanks for the tip, I'll keep it in mind when I look through the listings).

> Sub-specialists, in my experience, are
> usually excellent in their area of expertise.

Based on my (albeit limited) experience, I would have to agree. They
probably aren't nearly as swamped, and thus can afford to spend more time
with each patient.

Vitaliy

2007\06\05@005151 by Vitaliy

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James Newtons Massmind wrote:
> - Why will doctors NEVER interact via email?
[snip]
> If the problems with these are legal, I'll wave my rights.

I think that is the biggest deterrent -- email leaves a document trail. It's
a much better piece of evidence than the chicken scratches.

> I will never sue
> anyone anyway: I'll be damned if I'll put money in a lawyers pocket;
> apologies to the few good lawyers who I know frequent this list.

Never say never. ;) With all its shortcomings, the legal system does have
its uses.

{Quote hidden}

Me too.

Vitaliy

2007\06\05@073908 by Gerhard Fiedler

picon face
Vitaliy wrote:

>> With that in mind, let me offer my $0.02 with regard to what happens in
>> a visit to a doctor.  Yes, waiting is an unfortunate part of going to a
>> medical visit. Why?  For one thing, patients are complicated.

> And yet there's no excuse to keep a patient waiting for an hour, and then
> rush through the visit -- EVERY time. Statistics tells me it cannot be
> just me, and I'm surprised at how accepting most patients are, of being
> treated like this.

Exactly. If a waiting room of a doctor is full /every/ day, after a week he
should get the message and schedule fewer visits, no? :)

> About a year ago a friend recommended his dentist. Nowadays, I never wait
> longer than five minutes, the office has state-of-the-art equipment, the
> doctor takes the time to explain what he's about to do, and what my
> options are -- in  my mind, he is as close to the perfect dentist as one
> can get.

Yes, I also can confirm from an experience like this that this is possible.
The downside, if you call it that, was in my case that if something was
going to take much longer than anticipated and didn't have to be done right
away, he wouldn't just go ahead and do it, but rather say "I've found this
and that which wasn't obvious before, and we need to schedule another
session." I rather come back for another session in this rare occurrence
than wait three session's worth of time each time I go there.

Gerhard

2007\06\05@115050 by Vasile Surducan

face picon face
On 6/4/07, Vitaliy <spam_OUTspamTakeThisOuTspammaksimov.org> wrote:
{Quote hidden}

I suggest you to be the happiest man in the world. Imagine you should
(still) live in a small village from Siberia. Or you should be an
illness person in Romania.
When I'm sick I've got an appointment to my "family doctor" which
usualy is one week delayed. Ok, in the mean time I'm dying or I'm
getting well. If I'm well  I'm going to see my doctor, it's a happy
reason. She send me to the analyses, and yes it takes two to three
weeks if I want to use my medical insurance or one to three day if I
choose to pay for this services (for which I've already payed once in
my medical insurance). Of course those analyses are not telliong
nothing, so I read them and never go beack to my doctor for
interpretation.

And of course, I'm the happiest man in the world. Do you know why ?
Because I'm glad that such nice people like Russel or Joe have the
best romanian doctors and nurses in New Zealand.
:)
Despite migration, romanian medical system is perfect, I could live in
Zimbabwe or Nigeria (so you, if you dislike any ex soviet union
country), where there is no doctor except the girafe caca used for
headache compress (don't forget to miix t with water if you're able to
find...).

Choose yourself  ten reasons why your medical system based on dollars
is better than others and you'll not complain anymore.

Vasile

2007\06\05@120622 by Aaron

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Vitaliy wrote:
>> at in mind, let me offer my $0.02 with regard to what happens in
>> a visit to a doctor.  Yes, waiting is an unfortunate part of going to a
>> medical visit. Why?  For one thing, patients are complicated.
>>    
> [snip]
>
> And yet there's no excuse to keep a patient waiting for an hour, and then
> rush through the visit -- EVERY time. Statistics tells me it cannot be just
> me, and I'm surprised at how accepting most patients are, of being treated
> like this.

Interesting thread.

I, too, hate waiting.  Two suggestions:
1. Schedule your appointment as early in the day as possible.  Less
things have had a chance to go wrong and wreck the schedule.
2. Call before you leave.  My dentist is a 5 minute drive from work.  I
routinely call 10 minutes before my scheduled appointment to ask if they
are on schedule.  The receptionist is really nice and will walk back to
check and let me know what to do.

Aaron


2007\06\05@125824 by Brooke Clarke

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Hi Vitality:

At my last house I had a neighbor that was a doctor.  So when I needed a doctor
I would consult him, not for my problem, but for a doctor's name.  So if  you
know someone who works in the medical field they may be a big help.  This
almost always was a specialist rather than a "family" doctor.  The specialists
work in hospitals and their mistakes are noted, the big mistakes become part of
their record.  A good hospital will kick out really bad doctors.  So just
knowing the names of doctors that practice at a high end hospital is a good
recomendation.  Sort of like the sport of going to your local court house and
watching the show in any court room and/or checking the names on the daily
calendar.

Lacking an "inside" source the next proiority would be to avoid the hacks.
Doctors in the U.S. are licenced by each state.  And it's a matter of public
rerord if they have had legal problems.  For example for California:
http://www.medbd.ca.gov/Lookup.htm

By the way you can lookup all the other licensed occupations from accounts to
vocational nurses:
http://www2.dca.ca.gov/pls/wllpub/wllquery$.startup

If you have medical insurance then you need to learn their rules.  But remember
you can always go outside your insurance system and I recommend you do that to
get a second opinion whenever you don't like the opinion/diagnosis you got.
Notice I said "don't like" not "don't trust".

--
Have Fun,

Brooke Clarke
http://www.PRC68.com
http://www.precisionclock.com

2007\06\05@155659 by James Newtons Massmind

face picon face
> > And yet there's no excuse to keep a patient waiting for an
> hour, and
> > then rush through the visit -- EVERY time. Statistics tells me it
> > cannot be just me, and I'm surprised at how accepting most patients
> > are, of being treated like this.
>
> Interesting thread.
>
> I, too, hate waiting.  Two suggestions:
> 1. Schedule your appointment as early in the day as possible.
>  Less things have had a chance to go wrong and wreck the schedule.

I have personally tried to do this. My experience (x3 doctors) is that the
doctor will then arrive late. It is INFURIATING to me that a doctor will
schedule patients and then not bother to show up on time.

> 2. Call before you leave.  My dentist is a 5 minute drive
> from work.  I routinely call 10 minutes before my scheduled
> appointment to ask if they are on schedule.  The receptionist
> is really nice and will walk back to check and let me know what to do.

That is an interesting idea... I'll have to give that a shot.

---
James.


2007\06\05@163103 by James Newtons Massmind

face picon face
> > I will never sue
> > anyone anyway: I'll be damned if I'll put money in a
> lawyers pocket;
> > apologies to the few good lawyers who I know frequent this list.
>
> Never say never. ;) With all its shortcomings, the legal
> system does have its uses.

Compared to the value of an education in con artistry, the value of the
legal system is minimal. I would much rather learn another way that I can be
tricked (and then learn how to stop that) than I would be paid back for
being stupid enough to have been tricked in the first place. Or should I say
"uneducated" to make it easier to swallow?

The current system, with consumer protections, malpractice and lawsuits
rewards idiots for being dumb. The world should be based on buyer beware,
know your vendor, and build relationships. A society of sheep must begat a
leadership of wolves and that is what it has done.

Indian gaming and the lottery do the country a great service by separating
fools from their money. Crap products and scams from no-name manufacturers
could be doing the same service and SHOULD be, not only allowed to, but
encouraged by all responsible adults. Yah sure, go ahead and buy that widget
from flibiknight.com at 1/10 what I charge. Let me know if you have enough
money left afterward to pay my rate and buy my reputation.

Why is my inbox filled with spam from drug vendors advertising meds at
1/10th the price? Because the real drugs are subject to lawsuits and so must
be priced to build that in, and because the public assumes the product is
good no matter the source.

Same for doctors in Mexico or charlatans or others who profess to cure
illness for rock bottom prices. They exist because the real doctors must pay
the "stupid patient tax" imposed by malpractice insurance and because the
patients do not take the time to get to know, and trust, (or switch) their
doctors. Due to the cost, they can't afford to.

If the doctors had to actually compete and develop reputations, earn
patients by word of mouth and stand on their record, and the shady ones
could no longer depend on the insurance to protect them... there would be a
difference.

Insurance and lawsuits are wrong. Period. They may help an individual, but
they damage the group.

---
James.


2007\06\05@182947 by Vitaliy

flavicon
face
Vasile Surducan wrote:
> Choose yourself  ten reasons why your medical system based on dollars
> is better than others and you'll not complain anymore.

Vasile, I appreciate the fact that the US medical system is better than dry
giraffe caca, but that's not going to stop me from trying to improve my
situation. :)

For example, I tend to get a kind of respiratory infection two or three
times a year, and it tends to last for weeks if left untreated (sore throat,
stuffed up nose, then ear infection). Lately even antibiotics aren't get rid
of it very well (during the last episode, I had to take three different
kinds for fifteen days), which is really scaring me. One type of harsh
antibiotics caused me to have acid reflux to the point where I could not
sleep at night, so the doctor prescribed two other kinds of antibiotics (to
be taken at different times), plus a pill to treat the acid reflux.

I was never told what type of infection it is, what steps I can take to
avoid it, and which drugs are the most effective. Last time I was there,
they lost my swab sample.

When I'm sick or in pain, I find it more difficult to work, and to enjoy
spending time with my family. So you bet I will complain and do whatever I
can to improve the situation. :-)

VItaliy

PS Then there's that genetic disease that Russell has tried to guess, which
doctors consider a chronic, uncurable condition. I've read a number of
encouraging reports on the internet, by people who have successfully cured
themselves of it using untraditional methods (luckily, nothing to do with
caca). I am currently conducting a controlled experiment to see whether they
actually work, and after only two weeks I'm starting to see noticeable
improvement (the treatment is supposed to take five months).

2007\06\05@184926 by James Newtons Massmind

face picon face
> For example, I tend to get a kind of respiratory infection
> two or three times a year, and it tends to last for weeks if
> left untreated (sore throat, stuffed up nose, then ear
> infection). Lately even antibiotics aren't get rid of it very
> well (during the last episode, I had to take three different
> kinds for fifteen days), which is really scaring me. One type
> of harsh antibiotics caused me to have acid reflux to the
> point where I could not sleep at night, so the doctor
> prescribed two other kinds of antibiotics (to be taken at
> different times), plus a pill to treat the acid reflux.

I have that. And I no longer take any medication for it.

1. I have a STACK of pillows of different types that raise the upper half of
my body when I sleep. So everything still drains nicely. This removes the
need for the acid reflux meds. If I have heartburn, I eat a little bit of
something dry, and easy to digest, like toast.

2. When I feel my nose start to stuff up or drip, I drink massive volumes of
water. Like the 8 sixteen ounce glasses they are always telling us we should
but we never do. Sometimes I drink more than that. I put a little bit of
something in it sometimes to keep it from tasting like nothing. A bit of
juice (like 1/2 apple 1/2 water) or tea (not caffeinated) or Lemon juice or
even some soda (1/4 soda, 3/4 water).

3. I take a nice hot shower with me not in the water... In other words, a
steam bath. And I breath the mist in through my nose. Sometimes I add a drop
or so of oils to the floor of the shower to help work the crap loose.

4. If that doesn't do it, I eat something very hot, like a pepper or hot
wings, etc... Eyes watering = no crud in my nose.

5. If all else fails, I exercise. I HATE exercise.

But all of that has to be done at the first sign, or it wont work.

And that is for me.

I am not a doctor.

---
James.


2007\06\05@191927 by Gerhard Fiedler

picon face
Vitaliy wrote:

> For example, I tend to get a kind of respiratory infection two or three
> times a year, and it tends to last for weeks if left untreated (sore
> throat, stuffed up nose, then ear infection). Lately even antibiotics
> aren't get rid of it very well (during the last episode, I had to take
> three different kinds for fifteen days), which is really scaring me.

And it should. I don't think you'll easily find an MD that will treat this
successfully -- their normal education doesn't handle this, as you already
found out. There are the exceptions that go beyond what the pharma industry
promotes, but they are probably hard to find. And the pharma industry does
by definition have no interest in curing you: they'd lose a customer.

Anyway, I've been there for a long time. Let me know offlist if you're
interested in an exchange about this. No guaranteed or simple solutions,
but decades of experience :)

Gerhard

2007\06\05@193757 by Rich

picon face
Have you tried an ENT medical group or clinic?  Sometimes it is good to have
a group of providers.

Finding a doctor is easy anywhere but finding a good doctor that you can
trust is difficult everywhere.  I started with the referral agency.  Then I
called a few and spoke to them on the phone.  I chose a talked who did not
seem to listen to me and I was not happy with their practice.  On the fourth
try I found a good doctor who is on top of the latest developments, middle
aged, his father was a doctor with a reputation and so far he has resolved
some things that could have been easily missed.  He is adamant about
preventive medicine which includes a good routine of exercise and careful
diet, quality and quantity.  He is not against herbal medicines but he says
most of them are unnecessary if you follow a good diet at any age.



{Original Message removed}

2007\06\05@195419 by Jinx

face picon face
> Because I'm glad that such nice people like Russel or Joe have
> the best romanian doctors and nurses in New Zealand.

Haha, those Romanian/Indian/Czech/pick-a-country MDs make
pretty passable taxi drivers too ;-)

Shouldn't really ;-), every country needs all its doctors doing what
they trained for

2007\06\05@233829 by Jake Anderson

flavicon
face

>
> For example, I tend to get a kind of respiratory infection two or three
> times a year, and it tends to last for weeks if left untreated (sore throat,
> stuffed up nose, then ear infection). Lately even antibiotics aren't get rid
> of it very well (during the last episode, I had to take three different
> kinds for fifteen days), which is really scaring me. One type of harsh
> antibiotics caused me to have acid reflux to the point where I could not
> sleep at night, so the doctor prescribed two other kinds of antibiotics (to
> be taken at different times), plus a pill to treat the acid reflux.
>  

My method of "checking out" a doctor is to see if they try to give you
antibiotics for a virus. I think any doctor that gives antibiotics when
there is no indication of a bacterial infection should have their
license revoked and possibly look at jail time. The only thing its going
to do is make you sick and make the bugs immune to the antibiotic. My
question is are you/they sure that it is actually a bacterial infection?
If its not then all the pills are doing is making you sick. The only
thing i have found (with at least some medical backing) that actually
helps a virus (ie the common cold) is zinc. I use the "ease-a-cold" zinc
based capsule's. They have a whole bunch of herbal gumph in them as well
but you cant win them all.
Take one at the first signs and I haven't had anything more than a bit
of a sniffle in a year or more.

2007\06\06@001415 by Nate Duehr

face
flavicon
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On Jun 4, 2007, at 4:12 PM, James Newtons Massmind wrote:

> - My wife has wonderful bedside manner. Why can't she be my nurse  
> and use
> you as the doctor? Ok, I understand she doesn't have the time to  
> become a
> full on nurse, but couldn't there be a college level "Nurse Mom"  
> program for
> well educated women or men who are caring for their family? My wife  
> has a
> MSW and so has done lots of medical courses. If you took the most  
> common
> medical issues and the most basic methods for treatment and off-
> loaded them
> into the hands of the people who are actually caring for your  
> patients in
> the first place...

If you're in a situation where home nursing care is wanted/required/
available, my wife does that for a living, and I've never seen her  
complain when a family member actually WANTS to help in the long-term  
care of a loved one.

Hospice care is another area where loved ones can be VERY involved  
(and should be, really).

In a hospital environment, your untrained wife really is just in the  
way, no matter how you slice it... things can go wrong and do, and  
real nurses have appropriate training and experience to handle lots  
of crazy stuff.

(Stuff I would never do... nursing is a definite NO THANK YOU as a  
job for ME!  My wife's a saint.  5 years of college for THAT  
salary... and the disdain of Doctors throughout their entire lives?  
Right... no way.)

> If the problem is a need for poking and prodding, why not try  
> pictures and
> text first, and THEN say "I really need to poke and prod you to be  
> sure of
> what is going on in your body..." Of course, most of this could be  
> farmed
> out to labs. E.g. Please go to your nearest lab and give them a  
> print out of
> this email where I have requested a blood glucose test, etc...

Most doctors I've worked on computer systems for can barely find the  
Start button in Windows.

You really don't want them dealing with e-mail... they're so  
specialized, in many cases, they're completely computer illiterate.  
They also will not make enough time to properly learn it.

--
Nate Duehr
.....nateKILLspamspam@spam@natetech.com



2007\06\06@003804 by Nate Duehr

face
flavicon
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On Jun 5, 2007, at 5:38 AM, Gerhard Fiedler wrote:

> Vitaliy wrote:
>
>>> With that in mind, let me offer my $0.02 with regard to what  
>>> happens in
>>> a visit to a doctor.  Yes, waiting is an unfortunate part of  
>>> going to a
>>> medical visit. Why?  For one thing, patients are complicated.
>
>> And yet there's no excuse to keep a patient waiting for an hour,  
>> and then
>> rush through the visit -- EVERY time. Statistics tells me it  
>> cannot be
>> just me, and I'm surprised at how accepting most patients are, of  
>> being
>> treated like this.
>
> Exactly. If a waiting room of a doctor is full /every/ day, after a  
> week he
> should get the message and schedule fewer visits, no? :)

My wife worked in a private Doctor's office years ago.  He was being  
stretched thin by insurance companies, not of his own accord, and  
slowly being run out of business.  In order to accept certain  
insurance, he had to sign contracts that would put limitations on him.

Some docs can't see less than a certain number of patients.

They have a quota of patients to see in order to keep their status  
with certain insurance companies.  The insurance companies put a low-
end cap on a base pay-out and all the patients below and up to that  
number are covered at a monthly flat rate, but you need to regularly  
see at least that many patients.

The doctor doesn't get paid any real money until they see MORE than  
the average number of patients.

Don't like it, ask the Doc which insurance companies do this and then  
convince your employer not to use that nice cheap HMO/PPO insurance.  
(Sure... right... uh-huh.)

Their name for it is "capitation"... usually.  The root of the word  
"decapitation"... which is funny, in and of itself... or sad,  
depending on how you look at it.

This particular doc also saw low-income and many people without  
insurance and genuinely cared about patients, recycling his endless  
supply of "samples" from various pharmaceutical companies as free  
drugs for those who truly couldn't afford them.

The big pharma people came in weekly, if not more than once a week,  
and used outright bribery of buying the entire office lunches,  
bringing handouts (bags, tools, other schwag) constantly trying to  
get him to prescribe their drugs more than their competitors... like  
a bunch of strange mobsters...

It's an insanely corrupt business.  This doc was about three years  
from retirement when my wife left his office, and he admitted that  
he'd been operating the office in the red for about two years prior  
to her deciding to switch to home healthcare nursing.  He was trading  
away his money saved for retirement for the betterment of his low-
income and financially challenged patients while still trying to hire  
quality (read: more expensive) office staff, nurses, etc.

He was slowly going "broke".  No, he'd never truly be personally  
bankrupt, his practice had done well for years, but it was eating up  
a large chunk of his retirement nest egg to continue to retirement age.

And losing money was a tax write-off for him, of course, so there was  
a minor upside... but there were many months in the six or seven  
years my wife was there, that the insurance companies were three to  
six months in arrears in payment, and he had to pay the payroll out  
of his own pocket.

This is why you don't see single "family practitioner" offices with  
one or two docs in them much anymore.  They have to gang together  
into "groups" and hire a bunch of physician's assistants or nurse  
practitioners (my favorite - they listen, they've had virtually the  
same level of schooling and training as a family doc, and they're  
damn good people usually too -- having usually worked their way up  
from "regular" nursing jobs) to crank through the people there with  
minor afflictions (to keep up their insurance quotas, which they can  
collectively bargain in a large office with the insurance companies  
to some extent), so they can free themselves up for the REALLY sick  
folks.

But the chaos and high numbers of people in the offices that run like  
that, lead to pretty impersonal interactions that are too fast, and  
generally poor quality.

Again, I like seeing the nurse practitioners within such over-run  
offices.  They take a bit more time, and can always call the doc in  
for a consultation if you look like you're really going to drop dead  
in the next few minutes... or need advanced tests, etc.  I trust my  
nurse practitioner to tell me the straight story more than I trust  
the doc too... the practitioner is not a named partner in the "firm"  
and has no need to hide anything or make things sound better than  
they are.  They're just an employee, and usually really good ones, at  
that.

With that said, in the office I go to, the doc himself is a great  
guy, and the couple of times I had some bad numbers on tests, he came  
in personally to ask a bit more history and being that he's a  
completely no-nonsense guy, he laid out what I was doing wrong and  
that it was completely up to me to fix it... no time to screw around,  
and no mincing words or worried I wouldn't come back, he knows I see  
the NP and if he's in the room he knows that I know (heh) that he  
came in to say something important.

His office is a "crank them through the mill" type busywork place  
with 8 doctors sharing an internal medicine practice, but they do  
have a "system" worked out that works.  They'd NEVER have time to add  
e-mail to that chaos, though... I can see that wouldn't work at all.

I *did* send a fax once (doctor's offices live or die by their fax  
machines to insurance companies) that had the symptoms I had been  
experiencing on something and stuck a note on it to the desk staff to  
please stick it in my visit folder ahead of time (I also brought a  
copy) so the NP and the doc could READ the symptoms, since the list  
was long (and mostly unrelated, but I wanted them to see all of them).

--
Nate Duehr
natespamKILLspamnatetech.com



2007\06\06@033717 by Dario Greggio

face picon face
James Newtons Massmind wrote:

> 2. When I feel my nose start to stuff up or drip, I drink massive volumes of
> water. Like the 8 sixteen ounce glasses they are always telling us we should
> but we never do. Sometimes I drink more than that. I put a little bit of
> something in it sometimes to keep it from tasting like nothing. A bit of
> juice (like 1/2 apple 1/2 water) or tea (not caffeinated) or Lemon juice or
> even some soda (1/4 soda, 3/4 water).

Something similar: I almost never take any kind of pills (make them
anti-biothycs or else) and just put myself in bed, with one more cover
and then get a very hot cup of tea filled with lot of lemon.
One or 2 nights like these are usually enough for me to make it go. And
I hardly get 2 of them in one year.


--
Ciao, Dario

2007\06\06@035820 by Nate Duehr

face
flavicon
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On Jun 6, 2007, at 1:37 AM, Dario Greggio wrote:

{Quote hidden}

This is probably what most people crowding the average Doctor's  
office really need to go do, also.

The Docs tend to over-prescribe antibiotics so the people feel like  
they "got something" out of the hassle of the visit.

But really -- if you have a cold and a headache, and no major  
symptoms other than the usual ones that go along with such virii --  
there's nothing the doc can do for you anyway.  Drink some water,  
call in sick to work, and go back to bed.

It's sometimes a wonder we have any natural immunity left if our  
bodies aren't left alone to process and deal with the milder  
pathogens that won't seriously hurt us, just inconvenience us.

Too many people rush off to the doc every time they sneeze.

--
Nate Duehr
.....nateKILLspamspam.....natetech.com



2007\06\06@064553 by Bob Axtell

face picon face
Nate Duehr wrote:
{Quote hidden}

I enjoyed reading this. Your assessment is very accurate. My wife is an
RN who is director
of nurses at a nursing home here in Tucson. She has seen everything.

----

I have stopped using American dentists. I go to Nogales, Mexico, and see
a dentist who is
within easy walking distance of the border. He is considerate, does a
great job, and charges
25% of what American dentists charge. How can he do that? he doesn't
carry huge liability
insurance. An American dentist has to cover a $100,000 insurance payment
every year, just
to stay in business, and that is BEFORE paying the office space rent, or
the salary of the cute
girl with the short skirt that greets the patients when they come into
the office.

I would drop my American medical insurance (costs $400/month) and use a
Mexican
medicine doctor instead, if I had a good recommendation. Anybody know one?

--Bob

----


2007\06\06@072542 by Alan B. Pearce

face picon face
> His office is a "crank them through the mill" type busywork place
> with 8 doctors sharing an internal medicine practice, but they do
> have a "system" worked out that works.  They'd NEVER have time to add
> e-mail to that chaos, though... I can see that wouldn't work at all.

Sounds like a UK GP surgery I use. The UK health system has been tending to
drive surgerys into this sort of operation by the way they are funded.
However I do have to say that the doctors are very good and do tend to
squeeze a lot into their 10 minute slots.

And to get a repeat script it is a case of ring up, and wait 48 hrs before
picking it up - but I can do this by ringing the pharmacy I use who deal
with the doctor for the script, and then they fill out the script so all I
need to do is pick up the items from them.

2007\06\06@105819 by Gacrowell

flavicon
face


> -----Original Message-----
> From: piclist-bouncesspamspam_OUTmit.edu
> [@spam@piclist-bouncesKILLspamspammit.edu] On Behalf Of James Newtons Massmind
> Sent: Tuesday, June 05, 2007 4:49 PM
> To: 'Microcontroller discussion list - Public.'
> Subject: RE: [OT]: Finding a doctor in the US
>
...
> > of harsh antibiotics caused me to have acid reflux to the
...

> I have that. And I no longer take any medication for it.
>
> 1. I have a STACK of pillows of different types that raise
> the upper half of
> my body when I sleep. So everything still drains nicely. This
> removes the
> need for the acid reflux meds. If I have heartburn, I eat a
> little bit of
> something dry, and easy to digest, like toast.

I used to have reflux, pretty bad, as in aspirating acid in my sleep.
Handfuls of antacids daily, angled bed, this was before the current acid
control drugs became common.  Nexium, et al.  Normally you'd think a
surgical option would be a last resort, maybe it was, but I had a
Nissan's Fundopulation.  One night stay in the hospital, just a few days
off work, and it turned it off like a switch.  I haven't had a single
antacid or the least bit of discomfort for over 15 years.

> 2. When I feel my nose start to stuff up or drip, I drink
> massive volumes of
> water. Like the 8 sixteen ounce glasses they are always
> telling us we should
> but we never do.

Interesting about water.  I used to have kidney stones.  A couple dozen
over a twenty-five year period.  Nothing to be done about it...  About
ten years ago I just decided to drink heavily, water mostly, but about
two liters a day of whatever sloshes (avoiding too much soda).  And the
kidney stones,... stopped.  So easy, and, I seldom seem to have a
problem with colds.

Gary

2007\06\23@201734 by Vitaliy

flavicon
face
Nate Duehr wrote:
> But really -- if you have a cold and a headache, and no major
> symptoms other than the usual ones that go along with such virii --
> there's nothing the doc can do for you anyway.  Drink some water,
> call in sick to work, and go back to bed.
>
> It's sometimes a wonder we have any natural immunity left if our
> bodies aren't left alone to process and deal with the milder
> pathogens that won't seriously hurt us, just inconvenience us.
>
> Too many people rush off to the doc every time they sneeze.

I used to wait until I became very miserable (2+ weeks), and my sore throat
is followed stuffy nose and a painful ear infection. The thing I'm talking
about is definitely caused by bacteria, the mucus is green (sorry for the
details), and believe me I've tried every home remedy mentioned in this
thread. I came to the conclusion *must* take antibiotics to get rid of the
bacteria, and not just any kind of antibiotics (some of them have no
effect), and I have to use them in conjunction with decongestants.

Too many people mis-using antibiotics, and breeding the super-bugs...



2007\06\23@202454 by Vitaliy

flavicon
face
Jake Anderson wrote:
> My method of "checking out" a doctor is to see if they try to give you
> antibiotics for a virus. I think any doctor that gives antibiotics when
> there is no indication of a bacterial infection should have their
> license revoked and possibly look at jail time.

Amen.

> My
> question is are you/they sure that it is actually a bacterial infection?

Yes.

> If its not then all the pills are doing is making you sick. The only
> thing i have found (with at least some medical backing) that actually
> helps a virus (ie the common cold) is zinc. I use the "ease-a-cold" zinc
> based capsule's. They have a whole bunch of herbal gumph in them as well
> but you cant win them all.
> Take one at the first signs and I haven't had anything more than a bit
> of a sniffle in a year or more.

I'm curious, what is the mechanism? And does it work against *any* virus?

2007\06\23@204055 by Vitaliy

flavicon
face
Bob Axtell wrote:
> I have stopped using American dentists. I go to Nogales, Mexico, and see
> a dentist who is
> within easy walking distance of the border. He is considerate, does a
> great job, and charges
> 25% of what American dentists charge. How can he do that? he doesn't
> carry huge liability
> insurance. An American dentist has to cover a $100,000 insurance payment
> every year, just
> to stay in business, and that is BEFORE paying the office space rent, or
> the salary of the cute

$100k/year insurance payment? Are you sure?

How much insurance can you buy with $100k/year?!

2007\06\23@221406 by Vitaliy

flavicon
face
James Newtons Massmind wrote:
{Quote hidden}

I must respectfully disagree. Both the legal system and insurance are
beneficial to the group, when implemented properly.

I believe we've touched on the subject of "wolves" in a lawless society.
Dishonest crooks and ruthless sadists are the only people who benefit from
anarchy. Even if we talk just about consumer protection (forgetting about
murder, rape, and robbery for a moment) society as a whole suffers, because
lack of consumer protection increases the cost of each transaction,
translating into higher cost for the buyer, and lost sales for the seller.

Insurance has a sound statistical basis. It's a way to manage risk -- a loss
that is devastating to an individual, can be easily bourne by the group.

Vitaliy

2007\06\24@000214 by Gokoko -

face picon face
>
On Jun 23, 2007, at 8:13 PM, Vitaliy wrote:

James Newtons Massmind wrote:
{Quote hidden}

The phrase "implemented properly" begs the question.  Any scheme is
beneficial if "implemented properly".  What is your scheme for making  
lawyers
and insurance against lawsuits beneficial ?
>
> I believe we've touched on the subject of "wolves" in a lawless  
> society.
> Dishonest crooks and ruthless sadists are the only people who  
> benefit from
> anarchy. Even if we talk just about consumer protection (forgetting  
> about
My idea of a wolf is a U.S. Senator.  The Alpha wolf is GW Bush.  
People who
denigrate anarchy must explain to me ( please ) how decision making  
in the
whitehouse is functionally different than anarchy.
> murder, rape, and robbery for a moment) society as a whole suffers,  
> because
most murder, rape, and robbery is conducted by the state and given a  
charming
label like " saving the village", "bringing democracy" , defending  
freedom.  The
folks who are raped, robbed and murdered don't usually appreciate the  
irony.
> lack of consumer protection increases the cost of each transaction,
> translating into higher cost for the buyer, and lost sales for the  
> seller.
The best consumer protection comes by way of the consumer being  
vigilant.
Because who but the consumer will know what is important in a  
transaction ?
Price, warranty, reliability, selection, ....... ?
>
> Insurance has a sound statistical basis. It's a way to manage risk  
> -- a loss
> that is devastating to an individual, can be easily bourne by the  
> group.

Insurance is great to protect income streams or hedge against natural  
disaster.
If it is merely a way to transfer large amounts of money into a  
shyster piggy bank,
it is not insurance, it is the same as a "protection  
payment" [ called " the krysha" in Russia ].

Best Cedric

>
> Vitaliy
>
> --

2007\06\24@000542 by Gokoko -

face picon face
{Quote hidden}

It is all part of the darwinian process.  We must eliminate the weak.  
heh heh
Best    Cedric

2007\06\24@040117 by Tony Smith

picon face
> > (sorry for the details), and believe me I've tried every
> home remedy
> > mentioned in this thread. I came to the conclusion *must* take
> > antibiotics to get rid of the bacteria, and not just any kind of
> > antibiotics (some of them have no effect), and I have to
> use them in
> > conjunction with decongestants.
> >
> > Too many people mis-using antibiotics, and breeding the
> super-bugs...
>
> It is all part of the darwinian process.  We must eliminate
> the weak.  
> heh heh


Bugs 1, humans 0.  Yep, sounds like Darwin to me.

Tony

2007\06\24@180058 by William Chops Westfield

face picon face
On Jun 23, 2007, at 7:13 PM, Vitaliy wrote:

> Insurance has a sound statistical basis.

But "Health Insurance" has been replaced with "Health Care"; you're no
longer paying based on a statistical likelyhood that you'll incur major
medical expenses, you're paying to support regular Dr visits, and
procedure X every year, and procedure Y every 2 years, because someone
has been convinced that it's cheaper to prevent major illnesss, and/or
catch them early, than to wait.

I submit that it is clearly NOT cheaper.  Perhaps it should be, but
there doesn't seem to be a lot of effort going into making the
COMMON aspects of "health care" less expensive.  Perhaps there is
too much entrenched interests in collecting big bucks; on the part
of Doctors for providing services, and/or on the part of Insurance
companies just for filtering the money, on the part of drug companies
for providing overpriced medication.  Perhaps it's just laziness and
inertia.  The fact that the people most likely to influence directions
ARE covered by "insurance" de-motivates them from paying too much
attention to WHY things are expensive enough to require insurance.

I'm of an age where I sorta expected medical insurance to cover things
like unexpected injuries (car accidents, broken bones, etc), and
hospital
stays due to nasty but relatively unlikely diseases (cancer,
pnemonia...)
Now it covers preemptive healthcare as well, but little of those
statistical expenses become less likely.

And...  The inefficiency!  So for a regular physical, why do I see a
Dr at all unless lower paid medical personnel see something they're
worried about?  Why do the blood tests happen after the visit instead
of beforehand do they can be related to observations?  As computing
power has encroached into diagnostic tools, how come costs haven't
gone down with the cost of computing power?  If I say "hayfever", why
does that result in an automatic "Allegra" for which SOMEONE pays
about $100/month?  (and no, it ISN'T OK just because my insurance
reduced my co-pay to only $x/month.  A few sniffles are not worth
anyone paying $3/day...)  And meanwhile the insurance companies
"negotiate" rates much lower than the normal billing rate "cause
we're sending lots of patients your way" so the Drs have to raise
their apparent standard rates and I'm pretty sure WAY too much time
is spent micro-optimizing cost structures ("90472 administration of
additional vaccines when more than one is administered"?!) instead
of optimizing the health care itself.    Grrr...

BillW

2007\06\24@181427 by Chris Smolinski

flavicon
face
>On Jun 23, 2007, at 7:13 PM, Vitaliy wrote:
>
>>  Insurance has a sound statistical basis.
>
>But "Health Insurance" has been replaced with "Health Care"; you're no
>longer paying based on a statistical likelyhood that you'll incur major
>medical expenses, you're paying to support regular Dr visits, and
>procedure X every year, and procedure Y every 2 years, because someone
>has been convinced that it's cheaper to prevent major illnesss, and/or
>catch them early, than to wait.
>
>I submit that it is clearly NOT cheaper.  Perhaps it should be, but
>there doesn't seem to be a lot of effort going into making the
>COMMON aspects of "health care" less expensive.  Perhaps there is

You're now paying for all the added overhead of the insurance
companies. Adding more layers of bureaucracy makes things more
expensive, not less.

--

---
Chris Smolinski
Black Cat Systems
http://www.blackcatsystems.com

2007\06\24@185751 by Bob Barr

flavicon
face
On Sun, 24 Jun 2007 18:12:25 -0400, Chris Smolinski wrote:

>
>You're now paying for all the added overhead of the insurance
>companies. Adding more layers of bureaucracy makes things more
>expensive, not less.
>

If you think health care is expensive now, just watch what it costs
when it's free. (P.J. O'Rourke)


Regards, Bob

2007\06\26@212757 by Vitaliy

flavicon
face
Gokoko -wrote:
> It is all part of the darwinian process.  We must eliminate the weak.  
> heh heh
> Best    Cedric

You're not very nice. ;-(


;-)

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