Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

[Guest guest]

Grace,

Oh I totally agree that almost certainly that our well intended IMP friends usually run late for all the "Right" reasons and I know that my wife still feels it is rude to run late even by a few minutes like Musalini and the railroads my wife is I swear.... She too feels it is rude and disrespectful to do, which is great. And then as she gets too upset, I remind her what is going on down the road at all the other modern traditional broken model practices and that she is still probably one of the best "on time" performers in the county all while providing long appropriate length visits and appointment slots so that she is on time and has the time needed so both sides feel they had a good unhurried visit most of the time....

Anyway, I do not dispute the great reasons for running a modest amount late for all the Best and Right reasons.... I agree and support all of you and applaud all of you too. It is great well thought out personal belief systems and the better ethical practice of medicine with the patient's best interests at heart and in mind, who could ask for anything more....

But what I was saying was that I support most but not all stuck on the Hamster Wheel Docs too... They are like lost Matrix Souls, plugged in and lost in the false world created and perpetuated by those that parasitically suck them dry for their own self interests and selfish greed and needs... Hopefully, we can free these souls a few at a time with the "Red Pills" that promises only the truth and nothing more... But the reason these folks run late is the reasons I stated in those posts... They are like Matrix victims plugged in and not even aware many of them that there may even be another way of approaching the practice of medicine no less who their real Master and abusers are... I know who my enemy is and it is the carriers and the rest of Medical Industrialised Complex, including our colluded with those forces gov't and visa versa as well...

This women stated her intent and her intent was to run with the concept that doctors SUCK and we intentionally run late because we choose to run Meat Markets with take a number deli like churning and so we should all get used to paying our patients for their lost time while waiting too long, and instead of attempting to work and re-work with this women to properly reframe the thrust and negative stereotype implicit in this women's article and biases, instead Pam walked right into her lair with her guard down and the only thing she did was to Validate this women's slant on all of this by giving her more ideas along the same line, instead of telling the harder to do, NON-Sound bite journalism and press release.... IMP is not for those who want a slogan and a flag to follow, it is about patients and doctors together joining forces to press the envelope and start to create a new, different and better way and

place to practice medicine and good health together as partners.... And for folks to finally start to understand and empathise with us, we need to explain the present problem, well define it, give it form, substance and body, three dimesnsions, CONTEXT, and the other similar pay the patient ideas came without any IMP Context First, then and only then does the pay the patient idea even begin to support our way of working and practicing as partners and teams with our patients.... Instead it was just another example of why the first upset lady that billed her doc was correct and why we docs and practices stink and just milk our patients for our own selfish financial gains and it has nothing to do with care or quality and properly attending to the patients and their real human needs and health problems or issues...

It was not a blind sided attack, it was stated plainly enough to know better and to just walk away if she would not budge on her way of reporting the issue.... If she was willing to do our side and our perspective, then great and if not, sometimes even when it is NBC, CBS or CNN, you have to know when to pack it in and walk away, confident that doing it thier way would have simply been playing into the hands of those who want to maintain the present broken system and to keep defining us instead of the other real problem players as the problem... It was clear and stated and you, myself and others try to say, "Hey wait a minute, this one doesn't feel right, you are walking into a trap and even probably assisting in getting the wrong messege out, promoting the old blind messages about us and perhaps you should avoid this one this time...." that's all...

To: Sent: Friday, July 1, 2011 1:16 AMSubject: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

i tried my very best-est to follow paul's writings... way too long for my own good and i got tears in my eyes already half way down the cnn page. i follow paul's 'rants' closely because they are like mine but this time i wouldnt agree -- well, to be fair i really didnt read the entire way.i always run late. because i care. i stop. i listen. i answer questions. i ask how really my patients are. and i listen. todate the last two months (which is about as far as i can remember) only one rescheduled because of another appointment. my patients wait because i give them my undivided attention when im with them. and they value that. and i am not a real IMP with limited pts.i will start paying only if i can send a discharge-from-practice letter with my $5 bill. i spend too much time already with them to bear patients who have the gall to bill me.. these times i wouldnt care LESS where they go because they will NOT get the time i always give

them from anyone else around here...to see this CNN story and the IMP map attached to it... makes me want to say: you're on your own... but sadly so am i.(and yes Will, Pamela should have listened to you)grace

[Guest guest]

this is grace again.

i was going to tally how many doctors were writing comments on this CNN thread

and see how many public comments were for us and how many were against us. but

then as i was halfway down the comment list i saw as of this writing 1:03 am,

there were 4,871 likes on this CNN page.

and the more i thought and the more the clock ticked way into the night... my

face started to get red and my neck started to spasm... good intentions and

great doctors aside... i felt like i needed to send my ER bill to pamela and tim

should i get a heart or a neuroendocrine attack tonight.

i dont know how we can save ourselves from this one. in time for independence

day, im red black and blue.

but still... please please try to pull me out from under the bus.

[Guest guest]

Grace,Don’t despair. This article didn’t change anyone’s mind. It just gave all those people who were already angry at doctor’s for whatever reason a chance to vent about it. I agree with you about ,; you have a lot of great ideas and thoughts. You just need to condense it all to one paragraph that takes less than 3 minutes to read. I often do not have the time to read either. I understand that the intent was probably to promote IMP practices; which this did not. I understand that the hope was that this would be a conversation starter; it is not. Tim you are going to defend being in the article, fine, but you are having conversations with your patients who are already believers and the reader of your blog, who are already believers. This article really just has no redeeming qualities. If anyone thinks the comments are a “conversation” I have some nice land to sell you in a swamp. I do find it interesting though that Pamela is not mentioned at all. This was her gig? Why not mentioned in the article? Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of pricklyfinger2007Sent: Friday, July 01, 2011 3:11 AMTo: Subject: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant this is grace again.i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but then as i was halfway down the comment list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page.and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart or a neuroendocrine attack tonight.i dont know how we can save ourselves from this one. in time for independence day, im red black and blue.but still... please please try to pull me out from under the bus.

[Guest guest]

Kathy,I am not coming out in support of or defending the article. I think it is what it is and people will read into it whatever they want. A couple of points:1) Of course it is a conversation starter—even if none of my patients see it (and I don’t think any have), it has lit up the list serve. The question is whether we want the conversation to evolve into a discussion surrounding access and how to overcome the barriers that drive a wedge between us and our patients (which is kind of what IMP is all about) or whether we want to simply admit we have differing views of how we deliver patient care (where some of us believe we run behind because we give great care and others believe we cannot give great care if we are constantly running behind). The choice is up to the list serve, but I would vote for the former.2) Usually comments are written by people who are passionate about something and have free time on they’re hands. Also, due to the perceived anonymity of the internet, people post comments that they would never say to someone face to face. The combination allows some of the angriest and hurtful things to be typed. The comments always seem to increase my blood pressure and make me angry and upset. For that reason, I try to resist the urge to read them. To me, it is not worth it. From: [mailto: ] On Behalf Of Kathy SaradarianSent: Friday, July 01, 2011 8:13 AMTo: Subject: RE: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant Grace,Don’t despair. This article didn’t change anyone’s mind. It just gave all those people who were already angry at doctor’s for whatever reason a chance to vent about it. I agree with you about ,; you have a lot of great ideas and thoughts. You just need to condense it all to one paragraph that takes less than 3 minutes to read. I often do not have the time to read either. I understand that the intent was probably to promote IMP practices; which this did not. I understand that the hope was that this would be a conversation starter; it is not. Tim you are going to defend being in the article, fine, but you are having conversations with your patients who are already believers and the reader of your blog, who are already believers. This article really just has no redeeming qualities. If anyone thinks the comments are a “conversation” I have some nice land to sell you in a swamp. I do find it interesting though that Pamela is not mentioned at all. This was her gig? Why not mentioned in the article? Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of pricklyfinger2007Sent: Friday, July 01, 2011 3:11 AMTo: Subject: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant this is grace again.i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but then as i was halfway down the comment list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page.and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart or a neuroendocrine attack tonight.i dont know how we can save ourselves from this one. in time for independence day, im red black and blue.but still... please please try to pull me out from under the bus.

[Guest guest]

No, the conversations were with friends on Facebook who live far away, and other

parents at my son's soccer game, and a baseball coach who emailed me. The

discussion with my patients was a whole other story.

I do what I can in the part of the world I have some control over, most often

just the ten feet around me. The article notes something I do. The conversation

now is to further explain why I do that and what life is really like for docs --

including what I live now with stress, and how in my former office I was always

45-60 minutes behind.

You really don't think some folks aren't more likely to hear our real stories?

OK, we can agree to disagree. But then please help me understand how the public

will ever come to know our perspective and how we all need to work together,

doctors and patients, to make medical care as good as possible for everyone.

--Tim

Malia, MD

(phone / fax)

www.MaliaFamilyMedicine.com

www.SkinSenseLaser.com

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of the

intended recipient(s) and contains confidential information. Unauthorized use or

disclosure is prohibited. If you are not the intended recipient, you may not

use, disclose, copy or disseminate this information. If you are not the intended

recipient, please contact the sender immediately by reply email and destroy all

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Re: CNN story features Malia, Wible, Peikari and

IMP map --- MY own rant

this is grace again.

i was going to tally how many doctors were writing comments on this CNN thread

and see how many public comments were for us and how many were against us. but

then as i was halfway down the comment list i saw as of this writing 1:03 am,

there were 4,871 likes on this CNN page.

and the more i thought and the more the clock ticked way into the night... my

face started to get red and my neck started to spasm... good intentions and

great doctors aside... i felt like i needed to send my ER bill to pamela and tim

should i get a heart or a neuroendocrine attack tonight.

i dont know how we can save ourselves from this one. in time for independence

day, im red black and blue.

but still... please please try to pull me out from under the bus.

[Guest guest]

Grace,

I believe if any of us are going to go out on to the National Stage and start to claim to speak for the larger whole, with actually attaching IMP to the article or piece, that we need to start to consider some guidelines based upon a well thought out set of policies and or principles that include a certain amount of higher level Media understandings. Like I attempted to say, sure it is common knowledge that "grassroots" like and other smaller organizations can get a good amount of traction by attempting to make good use of press releases and free publicity by approaching the mainstream media. And in general it can be very useful and accomplish some of what you would hope that it would. But with all of that said, without some sort of editoral like understanding and filtering, just saying and doing "Anything" can be as dangerous and as

hurtful as it can be useful and helpful. And that is exactly my point here...

The small little videos and other snippets were very catchy and interesting, Creative. Clearly, Pam has a Nack for this kind of stuff and has cranked out some good stuff and I really like them and have praised them both publically as well as direct one on one emails back and forth as well... But that said, this last piece on the National Stage we both agree was a flop, a dud, and was ill-advised and we saw it coming, understood that this journalist (and I use that term very lightly here, such bias is the sign of a lack of journalistic integrity) was going to slant this in a fairly unfavorable way. And so the more Pam wouldn't speak to this, show that she saw and understood this, the more frustrated I got, going on and on attempting to hammer this point home. But something blinded her to this very common sense understanding that was all

too clear to the likes of you and me; et al....

I think that we as an organization need to engage in a healthy debate and create some sort of basic understanding of what is good and appropriate use of the media and what is not, perhaps create a "Media Guide" for our members to bounce off of and to use as a basic foundation of how to use and approach the media, and how to watch out for the traps and hang-ups that they frequently tend to use, and therefore harm those that are supposedly working with them to get a message out and across. Many organizations have media policies and guides for just these kinds of purposes and as we can see, there is a good reason to try and stay ahead of these vultures.... Sure they can be of use and be helpful but you need to manage them, groom them, be careful and aware of their more common tatics and not so nice behaviors and their own motivations and

reasons... because as we have just seen here they Bite Back sometimes and it can quickly fall apart and even blow-up in your face if you are not careful. So, Then and only then can you start to tease out and plan a well thought out strategy to make good use of these very powerful mediums and resources while hopefully avoiding such hang-ups in the future.... Perhaps this is something we should have a serious talk about this fall at camp if not even sooner????

We're all of the same side attempting to communicate and accomplish similar things and with that as our guide I'm sure we can go very far. But when it comes to the creative process people get very "attached" to their creations and their works and sometimes they are the ones that are the least able to step back and review their own works critically. It's simply human nature and quite understandable but all the more reason to be aware of that too so there is someone like an editor or producer who keeps a more neutral objective eye on the process and the final products. and I used to be in a number of All Original Hard Rock bands together when we were much younger, and damn she was one really hot bass player holding up the bottom of our band... :-) But I know all too well as someone who was part of this kind of process for the

majority of my life that the artist, the creator sometimes is too attached to "their Baby" to be properly objective about how to tweak and polish it to finish it up right... They are too emotionally attached to their work... I was as guilty of it as anyone else and I'm sure had our band moved to the next level, somebody like a great record producer was going to have to be that objective third party, to add a little of this or that, and get rid of the meaingless guitar solos in some places, as attached to them as I the Lead Guitar Player and author of the song was... "Look what they've done to my song, Ma, look what they've done to my song...." And that is where great producers come in who have the creative vision thing but also know when and where to cut and leave some stuff on the cutting room floor... how to package it, how to tie it all up and make a great finished piece out of the thing. Does this last part that make sense to all of you???

To: Sent: Friday, July 1, 2011 3:11 AMSubject: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

this is grace again.i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but then as i was halfway down the comment list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page.and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart or a neuroendocrine attack tonight.i dont know how we can save ourselves from this one. in time for independence day, im red black and blue.but still... please please try to pull me out from under the bus.

[Guest guest]

Personally,  knowing Cohen's reporting I would not even

pick up the phone for her.  I really don't know what her issue

against Doc's is but it is prevalent in her work.  The other guy

just tends to push money making stuff for his friends (seems like

it).

As any other person I have children that get sick, cars that break

down, issues that need attention, public transportation gets

snarled, accidents at the bridge that stop traffic.  Last time I was

late (4 months ago) stuck on the subway for an hour, walk in the

office and patient pointed out I was late told, I him to call the

MTA and complain about it.

On the bigger picture, this is why I work in the Barrio, no issues

here, for the most part patients appreciate been seen, everyone is

late, half patients don't show, even after been called the prior

day, half just walk in.  Rule is simple appointment's are seen on

time, walk ins as I go, no one spends more that 20 minutes from

walking in to be seen.  I don't eat lunch and all calls are returned

after 4 pm. My waiting room is always empty or may have one person

sitting.  I see from 13 to 20 patients a day 4 to 5 new and have

only one staff, no nurse, do my own EKG,s, PFT's, injections,

vitals, document and bill as I go, patient reads my big computer

screen as I go (already one told me that he head only 2 or 3 drinks

a week not 203 drinks) and it seems to be ok for most.

On the other hand some of my patients don't like my system they seem

to like the system that several doc's have in the Barrio.  At these

practices patients show up at 8 o'clock the day of their

appointment, get a number and then wait to be seen, by number, when

the doc gets in (around 10 am), they spends hours in the waiting

room talking with their friends and believing that this doctor is so

good because all these patients are waiting for him or her.  Several

people have pointed out that I should do it that way.  Patients tend

to swap stories about how good you are and then tell their peers

that you are so good that everyone wants to see you.  Same 15 to 20

patients I see with my system, by the way.  Another hick up is that

patients seem to love that they call these other guys and are given

an appointment for 10 weeks, impression is that he is so busy

because he is so good.  I tell patients just come in at 2 o'clock,

empty waiting room, impression: he can't be that good because no one

is there.  Go figure that one.

On the even bigger picture people get what they pay for, they can

pay cash to someone that can afford to be  less busy, if they wish. 

They can vote and make sure the systems changes from the present

disease oriented one on into a health care one, another example. 

But they seem to want the cheapest "health plan" and then expect red

carpet treatment.

from the Barrio

 

No, the conversations were with friends on Facebook who

live far away, and other parents at my son's soccer game,

and a baseball coach who emailed me. The discussion with

my patients was a whole other story.

I do what I can in the part of the world I have some

control over, most often just the ten feet around me. The

article notes something I do. The conversation now is to

further explain why I do that and what life is really like

for docs -- including what I live now with stress, and how

in my former office I was always 45-60 minutes behind.

You really don't think some folks aren't more likely to

hear our real stories? OK, we can agree to disagree. But

then please help me understand how the public will ever

come to know our perspective and how we all need to work

together, doctors and patients, to make medical care as

good as possible for everyone.

--Tim

Malia, MD

(phone / fax)

www.MaliaFamilyMedicine.com

www.SkinSenseLaser.com

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

-- Confidentiality Notice --

This email message, including all the attachments, is for

the sole use of the intended recipient(s) and contains

confidential information. Unauthorized use or disclosure

is prohibited. If you are not the intended recipient, you

may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please

contact the sender immediately by reply email and destroy

all copies of the original message, including attachments.

Re: CNN story features

Malia, Wible, Peikari and IMP map --- MY own rant

this is grace again.

i was going to tally how many doctors were writing

comments on this CNN thread and see how many public

comments were for us and how many were against us. but

then as i was halfway down the comment list i saw as of

this writing 1:03 am, there were 4,871 likes on this CNN

page.

and the more i thought and the more the clock ticked way

into the night... my face started to get red and my neck

started to spasm... good intentions and great doctors

aside... i felt like i needed to send my ER bill to pamela

and tim should i get a heart or a neuroendocrine attack

tonight.

i dont know how we can save ourselves from this one. in

time for independence day, im red black and blue.

but still... please please try to pull me out from under

the bus.

[Guest guest]

Dear .

Where is your barrio?

what you described seems like Latino culture ideas.

I am Latino and I understand what you described below. It is frustrating to give quality and people have this misconception.

Adolfo

To: Sent: Friday, July 1, 2011 1:09 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

Personally, knowing Cohen's reporting I would not even pick up the phone for her. I really don't know what her issue against Doc's is but it is prevalent in her work. The other guy just tends to push money making stuff for his friends (seems like it).As any other person I have children that get sick, cars that break down, issues that need attention, public transportation gets snarled, accidents at the bridge that stop traffic. Last time I was late (4 months ago) stuck on the subway for an hour, walk in the office and patient pointed out I was late told, I him to call the MTA and complain about it.On the bigger picture, this is why I work in the Barrio, no issues here, for the most part patients appreciate been seen, everyone is late, half patients don't show, even after been called the prior day, half just walk in. Rule is simple appointment's are seen on

time, walk ins as I go, no one spends more that 20 minutes from walking in to be seen. I don't eat lunch and all calls are returned after 4 pm. My waiting room is always empty or may have one person sitting. I see from 13 to 20 patients a day 4 to 5 new and have only one staff, no nurse, do my own EKG,s, PFT's, injections, vitals, document and bill as I go, patient reads my big computer screen as I go (already one told me that he head only 2 or 3 drinks a week not 203 drinks) and it seems to be ok for most.On the other hand some of my patients don't like my system they seem to like the system that several doc's have in the Barrio. At these practices patients show up at 8 o'clock the day of their appointment, get a number and then wait to be seen, by number, when the doc gets in (around 10 am), they spends hours in the waiting room talking with their

friends and believing that this doctor is so good because all these patients are waiting for him or her. Several people have pointed out that I should do it that way. Patients tend to swap stories about how good you are and then tell their peers that you are so good that everyone wants to see you. Same 15 to 20 patients I see with my system, by the way. Another hick up is that patients seem to love that they call these other guys and are given an appointment for 10 weeks, impression is that he is so busy because he is so good. I tell patients just come in at 2 o'clock, empty waiting room, impression: he can't be that good because no one is there. Go figure that one.On the even bigger picture people get what they pay for, they can pay cash to someone that can afford to be less busy, if they wish. They can vote and make sure the systems changes from the present disease oriented one on into a health

care one, another example. But they seem to want the cheapest "health plan" and then expect red carpet treatment. from the Barrio

No, the conversations were with friends on Facebook who live far away, and other parents at my son's soccer game, and a baseball coach who emailed me. The discussion with my patients was a whole other story.I do what I can in the part of the world I have some control over, most often just the ten feet around me. The article notes something I do. The conversation now is to further explain why I do that and what life is really like for docs -- including what I live now with stress, and how in my former office I was always 45-60 minutes behind.You really don't think some folks aren't more likely to hear our real stories? OK, we can agree to disagree. But then please help me understand how the public will ever come to know our perspective and how we all need to work together, doctors and patients, to make medical care as good as possible for everyone.--Tim Malia,

MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original message, including attachments. Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant this is grace again. i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but then as i was halfway down the comment list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page. and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart

or a neuroendocrine attack tonight. i dont know how we can save ourselves from this one. in time for independence day, im red black and blue. but still... please please try to pull me out from under the bus.

[Guest guest]

Washington Heights.  Here we speak Spanish.

I am glad you get, believe me I talk about it at least once a month

on TV.

from the Barrio

 

Dear .

Where is your barrio?

what you described seems like Latino culture

ideas.

I am Latino and

I understand what you described below. It is frustrating to give

quality and people have this misconception.

Adolfo

From:

" Batlle,

MD"

To:

Sent:

Friday, July 1, 2011 1:09 PM

Subject:

Re: Re: CNN story features

Malia, Wible,

Peikari

and IMP map --- MY own rant

 

Personally,  knowing Cohen's

reporting I would not even pick up the phone for

her.  I really don't know what her issue against

Doc's is but it is prevalent in her work.  The

other guy just tends to push money making stuff

for his friends (seems like it).

As any other person I have children that get

sick, cars that break down, issues that need

attention, public transportation gets snarled,

accidents at the bridge that stop traffic.  Last

time I was late (4 months ago) stuck on the

subway for an hour, walk in the office and

patient pointed out I was late told, I him to

call the MTA

and complain about it.

On the bigger picture, this is why I work in the

Barrio, no issues here, for the most part

patients appreciate been seen, everyone is late,

half patients don't show, even after been called

the prior day, half just walk in.  Rule is

simple appointment's are seen on time, walk ins

as I go, no one spends more that 20 minutes from

walking in to be seen.  I don't eat lunch and

all calls are returned after 4 pm. My waiting

room is always empty or may have one person

sitting.  I see from 13 to 20 patients a day 4

to 5 new and have only one staff, no nurse, do

my own EKG,s, PFT's, injections, vitals,

document and bill as I go, patient reads my big

computer screen as I go (already one told me

that he head only 2 or 3 drinks a week not 203

drinks) and it seems to be ok for

most.

On the other hand some of my patients don't like

my system they seem to like the system that

several doc's have in the Barrio.  At these

practices patients show up at 8 o'clock the day

of their appointment, get a number and then wait

to be seen, by number, when the doc gets in

(around 10 am), they spends hours in the waiting

room talking with their friends and believing

that this doctor is so good because all these

patients are waiting for him or her.  Several

people have pointed out that I should do it that

way.  Patients tend to swap stories about how

good you are and then tell their peers that you

are so good that everyone wants to see you. 

Same 15 to 20 patients I see with my system, by

the way.  Another hick up is that patients seem

to love that they call these other guys and are

given an appointment for 10 weeks, impression is

that he is so busy because he is so good.  I

tell patients just come in at 2 o'clock, empty

waiting room, impression: he can't be that good

because no one is there.  Go figure that one.

On the even bigger picture people get what they

pay for, they can pay cash to someone that can

afford to be  less busy, if they wish.  They can

vote and make sure the systems changes from the

present disease oriented one on into a health

care one, another example.  But they seem to

want the cheapest "health plan" and then expect

red carpet treatment.

from the Barrio

 

No, the conversations were with friends

on Facebook

who live far away, and other parents at my

son's soccer game, and a baseball coach

who emailed me. The discussion with my

patients was a whole other story.

I do what I can in the part of the world I

have some control over, most often just

the ten feet around me. The article notes

something I do. The conversation now is to

further explain why I do that and what

life is really like for docs -- including

what I live now with stress, and how in my

former office I was always 45-60 minutes

behind.

You really don't think some folks aren't

more likely to hear our real stories? OK,

we can agree to disagree. But then please

help me understand how the public will

ever come to know our perspective and how

we all need to work together, doctors and

patients, to make medical care as good as

possible for everyone.

--Tim

Malia, MD

(phone / fax)

www.MaliaFamilyMedicine.com

www.SkinSenseLaser.com

Malia Family Medicine & Skin Sense

Laser

6720 Pittsford-Palmyra

Rd.

Perinton

Square Mall

Fairport,

NY 14450

-- Confidentiality Notice --

This email message, including all the

attachments, is for the sole use of the

intended recipient(s) and contains

confidential information. Unauthorized use

or disclosure is prohibited. If you are

not the intended recipient, you may not

use, disclose, copy or disseminate this

information. If you are not the intended

recipient, please contact the sender

immediately by reply email and destroy all

copies of the original message, including

attachments.

Re: CNN

story features Malia, Wible,

Peikari

and IMP map --- MY own rant

this is grace again.

i was going to tally how many doctors were

writing comments on this CNN thread and

see how many public comments were for us

and how many were against us. but then as

i was halfway down the comment list i saw

as of this writing 1:03 am, there were

4,871 likes on this CNN page.

and the more i thought and the more the

clock ticked way into the night... my face

started to get red and my neck started to

spasm... good intentions and great doctors

aside... i felt like i needed to send my

ER bill to pamela and tim

should i get a heart or a neuroendocrine

attack tonight.

i dont

know how we can save ourselves from this

one. in time for independence day, im

red black and blue.

but still... please please try to pull me

out from under the bus.

[Guest guest]

Dear .

I joke with my wife (she is from NY) about it.

when we drive by a newly open restaurant and see some cars. I always tell her that in Nicaragua, when you open a new restaurant the owners ask friends to park their cars in front of the restaurant. It gives the impression that they are full and the food is good.

This marketing technique make you think about how good is the food.

I notice here in America, when you see a restaurant that is pack you tend to walk away.

just my 1/2 cents, enjoy the barrio.

Adolfo

To: Sent: Friday, July 1, 2011 1:49 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

Washington Heights. Here we speak Spanish.I am glad you get, believe me I talk about it at least once a month on TV. from the Barrio

Dear .

Where is your barrio?

what you described seems like Latino culture ideas.

I am Latino and I understand what you described below. It is frustrating to give quality and people have this misconception.

Adolfo

To: Sent: Friday, July 1, 2011 1:09 PMSubject: Re: Re: CNN story features Malia, Wible,

Peikari and IMP map --- MY own rant

Personally, knowing Cohen's reporting I would not even pick up the phone for her. I really don't know what her issue against Doc's is but it is prevalent in her work. The other guy just tends to push money making stuff for his friends (seems like it).As any other person I have children that get sick, cars that break down, issues that need attention, public transportation gets snarled, accidents at the bridge that stop traffic. Last time I was late (4 months ago) stuck on the subway for an hour, walk in the office and patient pointed out I was late told, I him to call the MTA and complain about it.On the bigger picture, this is why I work in the Barrio, no issues here, for the most part patients appreciate been seen, everyone is late, half patients don't show, even after been called the prior day, half just walk in. Rule is simple

appointment's are seen on time, walk ins as I go, no one spends more that 20 minutes from walking in to be seen. I don't eat lunch and all calls are returned after 4 pm. My waiting room is always empty or may have one person sitting. I see from 13 to 20 patients a day 4 to 5 new and have only one staff, no nurse, do my own EKG,s, PFT's, injections, vitals, document and bill as I go, patient reads my big computer screen as I go (already one told me that he head only 2 or 3 drinks a week not 203 drinks) and it seems to be ok for most.On the other hand some of my patients don't like my system they seem to like the system that several doc's have in the Barrio. At these practices patients show up at 8 o'clock the day of their appointment, get a number and then wait to be seen, by number, when the doc gets

in (around 10 am), they spends hours in the waiting room talking with their friends and believing that this doctor is so good because all these patients are waiting for him or her. Several people have pointed out that I should do it that way. Patients tend to swap stories about how good you are and then tell their peers that you are so good that everyone wants to see you. Same 15 to 20 patients I see with my system, by the way. Another hick up is that patients seem to love that they call these other guys and are given an appointment for 10 weeks, impression is that he is so busy because he is so good. I tell patients just come in at 2 o'clock, empty waiting room, impression: he can't be that good because no one is there. Go figure that one.On the even bigger picture people get what they pay for, they can pay cash to someone that can afford to be less busy, if they wish. They can vote and make sure

the systems changes from the present disease oriented one on into a health care one, another example. But they seem to want the cheapest "health plan" and then expect red carpet treatment. from the Barrio

No, the conversations were with friends on Facebook who live far away, and other parents at my son's soccer game, and a baseball coach who emailed me. The discussion with my patients was a whole other story.I do what I can in the part of the world I have some control over, most often just the ten feet around me. The article notes something I do. The conversation now is to further explain why I do that and what life is really like for docs -- including what I live now with stress, and how in my former office I was always 45-60 minutes behind.You really don't think some folks aren't more likely to hear our real stories? OK, we can agree to disagree. But then please help me understand how the public will ever come to know our perspective and how we all need to work together, doctors and patients, to make medical care as good as possible for

everyone.--Tim Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you

may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant this is grace again. i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but then as i was halfway down the

comment list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page. and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart or a neuroendocrine attack tonight. i dont know how we can save ourselves from this one. in time for independence day, im red black and blue. but still... please please try to pull me out from under the bus.

[Guest guest]

I see 99% low income Latinos and the rest 1% low income others. We obviously speak Spanish too.  I have had the same situation (8 o’clock everyone shows up) but I find my patients are willing to work with me if I give them a good reason to do so. We spent some time working on our cycle time and we talked with them about coming around their scheduled time. We were somewhat successful however we found that for many of them this was a social event that got them out of their isolation and routine. So instead of insisting on them coming around their time we started offering educational sessions in the waiting room to make their time worth while (a lot of which were given by county staff wanting to reach difficult to reach populations and university students so no cost to us). I think that when we talk about patient centerdness this is the kind of thing we are talking about. I personally couldn’t care less what the person in CNN thinks about what my motivations to practice are. I just want to enjoy going to work every day and make a small tiny difference in someone’s life once in a while Izquierdo-Porrera MD PhDExecutive Director & Co-founderCare for Your Health, IncPhone From: [mailto: ] On Behalf Of Batlle, MDSent: Friday, July 01, 2011 1:50 PMTo: Subject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant Washington Heights. Here we speak Spanish.I am glad you get, believe me I talk about it at least once a month on TV. from the Barrio Dear .Where is your barrio?what you described seems like Latino culture ideas.I am Latino and I understand what you described below. It is frustrating to give quality and people have this misconception.Adolfo To: Sent: Friday, July 1, 2011 1:09 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant Personally, knowing Cohen's reporting I would not even pick up the phone for her. I really don't know what her issue against Doc's is but it is prevalent in her work. The other guy just tends to push money making stuff for his friends (seems like it).As any other person I have children that get sick, cars that break down, issues that need attention, public transportation gets snarled, accidents at the bridge that stop traffic. Last time I was late (4 months ago) stuck on the subway for an hour, walk in the office and patient pointed out I was late told, I him to call the MTA and complain about it.On the bigger picture, this is why I work in the Barrio, no issues here, for the most part patients appreciate been seen, everyone is late, half patients don't show, even after been called the prior day, half just walk in. Rule is simple appointment's are seen on time, walk ins as I go, no one spends more that 20 minutes from walking in to be seen. I don't eat lunch and all calls are returned after 4 pm. My waiting room is always empty or may have one person sitting. I see from 13 to 20 patients a day 4 to 5 new and have only one staff, no nurse, do my own EKG,s, PFT's, injections, vitals, document and bill as I go, patient reads my big computer screen as I go (already one told me that he head only 2 or 3 drinks a week not 203 drinks) and it seems to be ok for most.On the other hand some of my patients don't like my system they seem to like the system that several doc's have in the Barrio. At these practices patients show up at 8 o'clock the day of their appointment, get a number and then wait to be seen, by number, when the doc gets in (around 10 am), they spends hours in the waiting room talking with their friends and believing that this doctor is so good because all these patients are waiting for him or her. Several people have pointed out that I should do it that way. Patients tend to swap stories about how good you are and then tell their peers that you are so good that everyone wants to see you. Same 15 to 20 patients I see with my system, by the way. Another hick up is that patients seem to love that they call these other guys and are given an appointment for 10 weeks, impression is that he is so busy because he is so good. I tell patients just come in at 2 o'clock, empty waiting room, impression: he can't be that good because no one is there. Go figure that one.On the even bigger picture people get what they pay for, they can pay cash to someone that can afford to be less busy, if they wish. They can vote and make sure the systems changes from the present disease oriented one on into a health care one, another example. But they seem to want the cheapest " health plan " and then expect red carpet treatment. from the Barrio No, the conversations were with friends on Facebook who live far away, and other parents at my son's soccer game, and a baseball coach who emailed me. The discussion with my patients was a whole other story.I do what I can in the part of the world I have some control over, most often just the ten feet around me. The article notes something I do. The conversation now is to further explain why I do that and what life is really like for docs -- including what I live now with stress, and how in my former office I was always 45-60 minutes behind.You really don't think some folks aren't more likely to hear our real stories? OK, we can agree to disagree. But then please help me understand how the public will ever come to know our perspective and how we all need to work together, doctors and patients, to make medical care as good as possible for everyone.--Tim Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant this is grace again. i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but then as i was halfway down the comment list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page. and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart or a neuroendocrine attack tonight. i dont know how we can save ourselves from this one. in time for independence day, im red black and blue. but still... please please try to pull me out from under the bus.

[Guest guest]

,This reminds me of a story I read once (maybe one of JAMA's "Piece of my Mind" articles?) about the different perceptions patients have of doctors. A patient was telling her doctor about the specialists that came to see her while she was hospitalized. One specialist spent a long time asking all sorts of questions and doing a thorough physical examination, but she said she didn't like that doctor. When her doctor asked her why, she said it was because he asked too many questions and spent so much time looking at her that he didn't seem as if he knew what was going on. She liked another specialist better. When her doctor asked her why, she said it was because he just took one look at her and didn't even have to touch her and he knew exactly what was wrong with her. I've learned over the years that no matter how good a doctor you are, there will be a patient who hates you. And no matter how bad of a doctor you may think someone is, there are patients who love him/her. SetoSouth Pasadena, CAAnother hick up is that patients seem to love that they call these other guys and are given an appointment for 10 weeks, impression is that he is so busy because he is so good. I tell patients just come in at 2 o'clock, empty waiting room, impression: he can't be that good because no one is there. Go figure that one.

[Guest guest]

You and Adolfo are right.

Because of this quirk we tend to have all the old folks in the AM,

they all tend to show early and then the younger crowd comes in the

afternoon, usually after work or before work depending on their

schedule.  They all learned that they can show up and would be seen

no questions asked so they just come in and ask to be seen.

On the other hand, they don't call after hours or weekends.  If you

call my office and press 5 it goes to my cell, google published my

cell and I have had maybe 8 calls since I opened 23 months ago.  The

younger demographics emails and I have had maybe 5 after hours or

weekends.  My patients are very respectful to the point of annoying

me some times when they wait until the morning to come in or call

with an issue that should have been dealt on before.

The other day I had a patient stop me in on the street, on the way

to the subway, show me the canker sore in his mouth.  I remote

access my server, wrote a note from my G2 and sent an e-script to

the pharmacy and the patient thought I was the best guy in the

world.

By the way, my patients want the NOVELA running on TV, no

educational videos.

from the Barrio

 

I see 99% low income Latinos and

the rest 1% low income others. We obviously speak

Spanish too.  I have had the same situation (8 o’clock

everyone shows up) but I find my patients are willing

to work with me if I give them a good reason to do so.

We spent some time working on our cycle time and we

talked with them about coming around their scheduled

time. We were somewhat successful however we found

that for many of them this was a social event that got

them out of their isolation and routine. So instead of

insisting on them coming around their time we started

offering educational sessions in the waiting room to

make their time worth while (a lot of which were given

by county staff wanting to reach difficult to reach

populations and university students so no cost to us).

 

I think that when we talk about

patient centerdness this is the kind of thing we are

talking about. I personally couldn’t care less what

the person in CNN thinks about what my motivations to

practice are. I just want to enjoy going to work every

day and make a small tiny difference in someone’s life

once in a while

 

Izquierdo-Porrera MD PhD

Executive Director &

Co-founder

Care for Your Health, Inc

Phone

 

From:

[mailto: ] On

Behalf Of Batlle, MD

Sent: Friday, July 01, 2011 1:50 PM

To:

Subject: Re: Re: CNN

story features Malia, Wible, Peikari and IMP map

--- MY own rant

 

 

Washington Heights.  Here we speak Spanish.

I am glad you get, believe me I talk about it at

least once a month on TV.

from the Barrio

 

Dear .

Where is your barrio?

what you described seems like

Latino culture ideas.

I am Latino and I understand

what you described below. It is

frustrating to give quality and people

have this misconception.

Adolfo

 

From:

" Batlle,

MD"

To:

Sent: Friday, July 1, 2011 1:09

PM

Subject: Re:

Re: CNN story

features Malia, Wible,

Peikari and

IMP map --- MY own rant

 

Personally, 

knowing Cohen's

reporting I would not even pick

up the phone for her.  I really

don't know what her issue

against Doc's is but it is

prevalent in her work.  The

other guy just tends to push

money making stuff for his

friends (seems like it).

As any other person I have

children that get sick, cars

that break down, issues that

need attention, public

transportation gets snarled,

accidents at the bridge that

stop traffic.  Last time I was

late (4 months ago) stuck on the

subway for an hour, walk in the

office and patient pointed out I

was late told, I him to call the

MTA

and complain about it.

On the bigger picture, this is

why I work in the Barrio, no

issues here, for the most part

patients appreciate been seen,

everyone is late, half patients

don't show, even after been

called the prior day, half just

walk in.  Rule is simple

appointment's are seen on time,

walk ins as I go, no one spends

more that 20 minutes from

walking in to be seen.  I don't

eat lunch and all calls are

returned after 4 pm. My waiting

room is always empty or may have

one person sitting.  I see from

13 to 20 patients a day 4 to 5

new and have only one staff, no

nurse, do my own EKG,s, PFT's,

injections, vitals, document and

bill as I go, patient reads my

big computer screen as I go

(already one told me that he

head only 2 or 3 drinks a week

not 203 drinks) and it seems to

be ok

for most.

On the other hand some of my

patients don't like my system

they seem to like the system

that several doc's have in the

Barrio.  At these practices

patients show up at 8 o'clock

the day of their appointment,

get a number and then wait to be

seen, by number, when the doc

gets in (around 10 am), they

spends hours in the waiting room

talking with their friends and

believing that this doctor is so

good because all these patients

are waiting for him or her. 

Several people have pointed out

that I should do it that way. 

Patients tend to swap stories

about how good you are and then

tell their peers that you are so

good that everyone wants to see

you.  Same 15 to 20 patients I

see with my system, by the way. 

Another hick up is that patients

seem to love that they call

these other guys and are given

an appointment for 10 weeks,

impression is that he is so busy

because he is so good.  I tell

patients just come in at 2

o'clock, empty waiting room,

impression: he can't be that

good because no one is there. 

Go figure that one.

On the even bigger picture

people get what they pay for,

they can pay cash to someone

that can afford to be  less

busy, if they wish.  They can

vote and make sure the systems

changes from the present disease

oriented one on into a health

care one, another example.  But

they seem to want the cheapest

"health plan" and then expect

red carpet treatment.

from the Barrio

On 7/1/2011 9:20 AM,

Malia wrote:

 

No,

the conversations were with

friends on Facebook

who live far away, and other

parents at my son's soccer

game, and a baseball coach

who emailed me. The

discussion with my patients

was a whole other story.

I do what I can in the part

of the world I have some

control over, most often

just the ten feet around me.

The article notes something

I do. The conversation now

is to further explain why I

do that and what life is

really like for docs --

including what I live now

with stress, and how in my

former office I was always

45-60 minutes behind.

You really don't think some

folks aren't more likely to

hear our real stories? OK,

we can agree to disagree.

But then please help me

understand how the public

will ever come to know our

perspective and how we all

need to work together,

doctors and patients, to

make medical care as good as

possible for everyone.

--Tim

Malia, MD

(phone / fax)

www.MaliaFamilyMedicine.com

www.SkinSenseLaser.com

Malia Family Medicine &

Skin Sense Laser

6720 Pittsford-Palmyra

Rd.

Perinton

Square Mall

Fairport,

NY 14450

-- Confidentiality Notice --

This email message,

including all the

attachments, is for the sole

use of the intended

recipient(s) and contains

confidential information.

Unauthorized use or

disclosure is prohibited. If

you are not the intended

recipient, you may not use,

disclose, copy or

disseminate this

information. If you are not

the intended recipient,

please contact the sender

immediately by reply email

and destroy all copies of

the original message,

including attachments.

Re:

CNN story features Malia, Wible,

Peikari

and IMP map --- MY own rant

this is grace again.

i was going to tally how

many doctors were writing

comments on this CNN thread

and see how many public

comments were for us and how

many were against us. but

then as i was halfway down

the comment list i saw as of

this writing 1:03 am, there

were 4,871 likes on this CNN

page.

and the more i thought and

the more the clock ticked

way into the night... my

face started to get red and

my neck started to spasm...

good intentions and great

doctors aside... i felt like

i needed to send my ER bill

to pamela

and tim

should i get a heart or a neuroendocrine

attack tonight.

i dont

know how we can save

ourselves from this one. in

time for independence day, im red

black and blue.

but still... please please

try to pull me out from

under the bus.

 

 

 

[Guest guest]

You are right about that one.

It is all a matter of perception.

from the Barrio

,

This reminds me of a story I read once (maybe one of

JAMA's "Piece of my Mind" articles?) about the different

perceptions patients have of doctors. A patient was

telling her doctor about the specialists that came to see

her while she was hospitalized. One specialist spent a

long time asking all sorts of questions and doing a

thorough physical examination, but she said she didn't

like that doctor. When her doctor asked her why, she said

it was because he asked too many questions and spent so

much time looking at her that he didn't seem as if he knew

what was going on. She liked another specialist better.

When her doctor asked her why, she said it was because he

just took one look at her and didn't even have to touch

her and he knew exactly what was wrong with her.

I've learned over the years that no matter how good a

doctor you are, there will be a patient who hates you. And

no matter how bad of a doctor you may think someone is,

there are patients who love him/her.

Seto

South Pasadena, CA

Another hick up is that

patients seem to love that they call these other

guys and are given an appointment for 10 weeks,

impression is that he is so busy because he is so

good. I tell patients just come in at 2 o'clock,

empty waiting room, impression: he can't be that

good because no one is there. Go figure that one.

[Guest guest]

Same in Dominican Republic.

Believe me, the only reason I am still in practice is because I am

in the Barrio.  Like I enjoy arriving at the office.  At least

twice a month I find out that one of my patients used to be my grand

father's patient in Santiago, Dominican Republic and the guy died in

1975 and I use his black bag.  Really makes my day.

from the Barrio

 

Dear .

I joke with my wife (she is from NY) about it.

when we drive by a newly open restaurant and

see some cars. I always tell her that in Nicaragua,

when you open a new restaurant the owners ask friends

to park their cars in front of the restaurant. It

gives the impression that they are full and the food

is good.

This marketing technique make you think about

how good is the food.

I notice here in America, when you see a

restaurant that is pack you tend to walk away.

just my 1/2 cents, enjoy the barrio.

Adolfo

From:

" Batlle, MD"

To:

Sent:

Friday, July 1, 2011 1:49 PM

Subject:

Re: Re: CNN story features

Malia, Wible, Peikari and IMP map --- MY own rant

 

Washington Heights.  Here we speak Spanish.

I am glad you get, believe me I talk about it at

least once a month on TV.

from the Barrio

 

Dear .

Where is your barrio?

what you described seems like Latino

culture ideas.

I am Latino and

I understand what you described below.

It is frustrating

to give quality and people have this

misconception.

Adolfo

From:

" Batlle,

MD"

To:

Sent:

Friday, July 1, 2011 1:09 PM

Subject:

Re: Re: CNN

story features Malia, Wible,

Peikari

and IMP map --- MY own rant

 

Personally,  knowing

Cohen's reporting I

would not even pick up the phone

for her.  I really don't know

what her issue against Doc's is

but it is prevalent in her

work.  The other guy just tends

to push money making stuff for

his friends (seems like it).

As any other person I have

children that get sick, cars

that break down, issues that

need attention, public

transportation gets snarled,

accidents at the bridge that

stop traffic.  Last time I was

late (4 months ago) stuck on the

subway for an hour, walk in the

office and patient pointed out I

was late told, I him to call the

MTA

and complain about it.

On the bigger picture, this is

why I work in the Barrio, no

issues here, for the most part

patients appreciate been seen,

everyone is late, half patients

don't show, even after been

called the prior day, half just

walk in.  Rule is simple

appointment's are seen on time,

walk ins as I go, no one spends

more that 20 minutes from

walking in to be seen.  I don't

eat lunch and all calls are

returned after 4 pm. My waiting

room is always empty or may have

one person sitting.  I see from

13 to 20 patients a day 4 to 5

new and have only one staff, no

nurse, do my own EKG,s, PFT's,

injections, vitals, document and

bill as I go, patient reads my

big computer screen as I go

(already one told me that he

head only 2 or 3 drinks a week

not 203 drinks) and it seems to

be ok

for most.

On the other hand some of my

patients don't like my system

they seem to like the system

that several doc's have in the

Barrio.  At these practices

patients show up at 8 o'clock

the day of their appointment,

get a number and then wait to be

seen, by number, when the doc

gets in (around 10 am), they

spends hours in the waiting room

talking with their friends and

believing that this doctor is so

good because all these patients

are waiting for him or her. 

Several people have pointed out

that I should do it that way. 

Patients tend to swap stories

about how good you are and then

tell their peers that you are so

good that everyone wants to see

you.  Same 15 to 20 patients I

see with my system, by the way. 

Another hick up is that patients

seem to love that they call

these other guys and are given

an appointment for 10 weeks,

impression is that he is so busy

because he is so good.  I tell

patients just come in at 2

o'clock, empty waiting room,

impression: he can't be that

good because no one is there. 

Go figure that one.

On the even bigger picture

people get what they pay for,

they can pay cash to someone

that can afford to be  less

busy, if they wish.  They can

vote and make sure the systems

changes from the present disease

oriented one on into a health

care one, another example.  But

they seem to want the cheapest

"health plan" and then expect

red carpet treatment.

from the Barrio

On 7/1/2011 9:20 AM,

Malia wrote:

 

No, the conversations

were with friends on Facebook

who live far away, and

other parents at my son's

soccer game, and a

baseball coach who emailed

me. The discussion with my

patients was a whole other

story.

I do what I can in the

part of the world I have

some control over, most

often just the ten feet

around me. The article

notes something I do. The

conversation now is to

further explain why I do

that and what life is

really like for docs --

including what I live now

with stress, and how in my

former office I was always

45-60 minutes behind.

You really don't think

some folks aren't more

likely to hear our real

stories? OK, we can agree

to disagree. But then

please help me understand

how the public will ever

come to know our

perspective and how we all

need to work together,

doctors and patients, to

make medical care as good

as possible for everyone.

--Tim

Malia, MD

(phone / fax)

www.MaliaFamilyMedicine.com

www.SkinSenseLaser.com

Malia Family Medicine

& Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

-- Confidentiality Notice

--

This email message,

including all the

attachments, is for the

sole use of the intended

recipient(s) and contains

confidential information.

Unauthorized use or

disclosure is prohibited.

If you are not the

intended recipient, you

may not use, disclose,

copy or disseminate this

information. If you are

not the intended

recipient, please contact

the sender immediately by

reply email and destroy

all copies of the original

message, including

attachments.

Re:

CNN story features Malia,

Wible, Peikari and IMP map --- MY own rant

this is grace again.

i was going to tally how

many doctors were writing

comments on this CNN

thread and see how many

public comments were for

us and how many were

against us. but then as i

was halfway down the

comment list i saw as of

this writing 1:03 am,

there were 4,871 likes on

this CNN page.

and the more i thought and

the more the clock ticked

way into the night... my

face started to get red

and my neck started to

spasm... good intentions

and great doctors aside...

i felt like i needed to

send my ER bill to pamela

and tim should i get a heart or a neuroendocrine attack tonight.

i dont know how we can save ourselves

from this one. in time for

independence day, im red black and blue.

but still... please please

try to pull me out from

under the bus.

[Guest guest]

I am with you Doctora Izquierdo, the question that I ask myself is: is this still my passion? are you happy helping others? are you happy touching other peoples lives?

My wife make fun of me all the time. she is introverted person and I am extroverted.

We could be making a line at the supermarket and I find people that approach me and start telling me their business.

I learned about stuff from people that I do not even know. I guess they feel OK with me.

Adolfo

To: Sent: Friday, July 1, 2011 2:00 PMSubject: RE: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

I see 99% low income Latinos and the rest 1% low income others. We obviously speak Spanish too. I have had the same situation (8 o’clock everyone shows up) but I find my patients are willing to work with me if I give them a good reason to do so. We spent some time working on our cycle time and we talked with them about coming around their scheduled time. We were somewhat successful however we found that for many of them this was a social event that got them out of their isolation and routine. So instead of insisting on them coming around their time we started offering educational sessions in the waiting room to make their time worth while (a lot of which were given by county staff wanting to reach difficult to reach populations and university students so no cost to us).

I think that when we talk about patient centerdness this is the kind of thing we are talking about. I personally couldn’t care less what the person in CNN thinks about what my motivations to practice are. I just want to enjoy going to work every day and make a small tiny difference in someone’s life once in a while

Izquierdo-Porrera MD PhD

Executive Director & Co-founder

Care for Your Health, Inc

Phone

From: [mailto: ] On Behalf Of Batlle, MDSent: Friday, July 01, 2011 1:50 PMTo: Subject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

Washington Heights. Here we speak Spanish.I am glad you get, believe me I talk about it at least once a month on TV. from the Barrio

Dear .

Where is your barrio?

what you described seems like Latino culture ideas.

I am Latino and I understand what you described below. It is frustrating to give quality and people have this misconception.

Adolfo

To: Sent: Friday, July 1, 2011 1:09 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

Personally, knowing Cohen's reporting I would not even pick up the phone for her. I really don't know what her issue against Doc's is but it is prevalent in her work. The other guy just tends to push money making stuff for his friends (seems like it).As any other person I have children that get sick, cars that break down, issues that need attention, public transportation gets snarled, accidents at the bridge that stop traffic. Last time I was late (4 months ago) stuck on the subway for an hour, walk in the office and patient pointed out I was late told, I him to call the MTA and complain about it.On the bigger picture, this is why I work in the Barrio, no issues here, for the most part patients appreciate been seen, everyone is late, half patients don't show, even after

been called the prior day, half just walk in. Rule is simple appointment's are seen on time, walk ins as I go, no one spends more that 20 minutes from walking in to be seen. I don't eat lunch and all calls are returned after 4 pm. My waiting room is always empty or may have one person sitting. I see from 13 to 20 patients a day 4 to 5 new and have only one staff, no nurse, do my own EKG,s, PFT's, injections, vitals, document and bill as I go, patient reads my big computer screen as I go (already one told me that he head only 2 or 3 drinks a week not 203 drinks) and it seems to be ok for most.On the other hand some of my patients don't like my system they seem to like the system that several doc's have in the Barrio. At these practices patients show up at 8 o'clock the day of

their appointment, get a number and then wait to be seen, by number, when the doc gets in (around 10 am), they spends hours in the waiting room talking with their friends and believing that this doctor is so good because all these patients are waiting for him or her. Several people have pointed out that I should do it that way. Patients tend to swap stories about how good you are and then tell their peers that you are so good that everyone wants to see you. Same 15 to 20 patients I see with my system, by the way. Another hick up is that patients seem to love that they call these other guys and are given an appointment for 10 weeks, impression is that he is so busy because he is so good. I tell patients just come in at 2 o'clock, empty waiting room, impression: he can't be that good because no one is there. Go figure that one.On the even bigger picture people get what they pay for, they can pay cash to someone

that can afford to be less busy, if they wish. They can vote and make sure the systems changes from the present disease oriented one on into a health care one, another example. But they seem to want the cheapest "health plan" and then expect red carpet treatment. from the Barrio

No, the conversations were with friends on Facebook who live far away, and other parents at my son's soccer game, and a baseball coach who emailed me. The discussion with my patients was a whole other story.I do what I can in the part of the world I have some control over, most often just the ten feet around me. The article notes something I do. The conversation now is to further explain why I do that and what life is really like for docs -- including what I live now with stress, and how in my former office I was always 45-60 minutes behind.You really don't think some folks aren't more likely to hear our real stories? OK, we can agree to disagree. But then please help me understand how the public will ever come to know our perspective and how we all need to work together, doctors and patients, to make

medical care as good as possible for everyone.--Tim Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose,

copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant this is grace again. i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but

then as i was halfway down the comment list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page. and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart or a neuroendocrine attack tonight. i dont know how we can save ourselves from this one. in time for independence day, im red black and blue. but still... please please try to pull me out from

under the bus.

[Guest guest]

Dear .

you made me laugh about the Novela =soap opera.

I used to live in Miami and my uncle and I used to watch brazilean soap operas every night.

I enjoyed so much, one my favorites was Terra nostra , it talks about the italian imigration to brazil.

when my wife (girlfriend) used to stop by she laught to see guys watching soap opera.

Adolfo

To: Sent: Friday, July 1, 2011 2:13 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

You and Adolfo are right.Because of this quirk we tend to have all the old folks in the AM, they all tend to show early and then the younger crowd comes in the afternoon, usually after work or before work depending on their schedule. They all learned that they can show up and would be seen no questions asked so they just come in and ask to be seen.On the other hand, they don't call after hours or weekends. If you call my office and press 5 it goes to my cell, google published my cell and I have had maybe 8 calls since I opened 23 months ago. The younger demographics emails and I have had maybe 5 after hours or weekends. My patients are very respectful to the point of annoying me some times when they wait until the morning to come in or call with an issue that should have been dealt on before.The other day I had a patient stop me in on the street, on the way to the subway, show me the canker sore in his

mouth. I remote access my server, wrote a note from my G2 and sent an e-script to the pharmacy and the patient thought I was the best guy in the world.By the way, my patients want the NOVELA running on TV, no educational videos. from the Barrio

I see 99% low income Latinos and the rest 1% low income others. We obviously speak Spanish too. I have had the same situation (8 o’clock everyone shows up) but I find my patients are willing to work with me if I give them a good reason to do so. We spent some time working on our cycle time and we talked with them about coming around their scheduled time. We were somewhat successful however we found that for many of them this was a social event that got them out of their isolation and routine. So instead of insisting on them coming around their time we started offering educational sessions in the waiting room to make their time worth while (a lot of which were given by county staff wanting to reach difficult to reach populations and university students so no cost to us).

I think that when we talk about patient centerdness this is the kind of thing we are talking about. I personally couldn’t care less what the person in CNN thinks about what my motivations to practice are. I just want to enjoy going to work every day and make a small tiny difference in someone’s life once in a while

Izquierdo-Porrera MD PhD

Executive Director & Co-founder

Care for Your Health, Inc

Phone

From: [mailto: ] On Behalf Of Batlle, MDSent: Friday, July 01, 2011 1:50 PMTo: Subject: Re: Re: CNN story features Malia, Wible, Peikari

and IMP map --- MY own rant

Washington Heights. Here we speak Spanish.I am glad you get, believe me I talk about it at least once a month on TV. from the Barrio

Dear .

Where is your barrio?

what you described seems like Latino culture ideas.

I am Latino and I understand what you described below. It is frustrating to give quality and people have this misconception.

Adolfo

To: Sent: Friday, July 1, 2011 1:09 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

Personally, knowing Cohen's reporting I would not even pick up the phone for her. I really don't know what her issue against Doc's is but it is prevalent in her work. The other guy just tends to push money making stuff for his friends (seems like it).As any other person I have children that get sick, cars that break down, issues that need attention, public transportation gets snarled, accidents at the bridge that stop traffic. Last time I was late (4 months ago) stuck on the subway for an hour, walk in the office and patient pointed out I was late told, I him to call the MTA and complain about it.On the bigger picture, this is why I work in the Barrio, no issues here, for the most part patients appreciate been seen, everyone is late, half patients don't show, even after been called the prior day, half just

walk in. Rule is simple appointment's are seen on time, walk ins as I go, no one spends more that 20 minutes from walking in to be seen. I don't eat lunch and all calls are returned after 4 pm. My waiting room is always empty or may have one person sitting. I see from 13 to 20 patients a day 4 to 5 new and have only one staff, no nurse, do my own EKG,s, PFT's, injections, vitals, document and bill as I go, patient reads my big computer screen as I go (already one told me that he head only 2 or 3 drinks a week not 203 drinks) and it seems to be ok for most.On the other hand some of my patients don't like my system they seem to like the system that several doc's have in the Barrio. At these practices patients show up at 8 o'clock the day of their appointment, get a number and then wait to be seen, by number, when the doc gets in (around 10 am), they

spends hours in the waiting room talking with their friends and believing that this doctor is so good because all these patients are waiting for him or her. Several people have pointed out that I should do it that way. Patients tend to swap stories about how good you are and then tell their peers that you are so good that everyone wants to see you. Same 15 to 20 patients I see with my system, by the way. Another hick up is that patients seem to love that they call these other guys and are given an appointment for 10 weeks, impression is that he is so busy because he is so good. I tell patients just come in at 2 o'clock, empty waiting room, impression: he can't be that good because no one is there. Go figure that one.On the even bigger picture people get what they pay for, they can pay cash to someone that can afford to be less busy, if they wish. They can vote and make sure the systems changes from

the present disease oriented one on into a health care one, another example. But they seem to want the cheapest "health plan" and then expect red carpet treatment. from the Barrio

No, the conversations were with friends on Facebook who live far away, and other parents at my son's soccer game, and a baseball coach who emailed me. The discussion with my patients was a whole other story.I do what I can in the part of the world I have some control over, most often just the ten feet around me. The article notes something I do. The conversation now is to further explain why I do that and what life is really like for docs -- including what I live now with stress, and how in my former office I was always 45-60 minutes behind.You really don't think some folks aren't more likely to hear our real stories? OK, we can agree to disagree. But then please help me understand how the public will ever come to know our perspective and how we all need to work together, doctors and patients, to make medical care as good as possible for

everyone.--Tim Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all

copies of the original message, including attachments. Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant this is grace again. i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but then as i was halfway down the comment list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page. and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart or a neuroendocrine attack tonight. i dont know how we can save ourselves from this one. in time for independence day, im red black and blue. but still... please please try to pull me out from under the bus.

[Guest guest]

As an old Bronxite myself with tons of friends and the like from all parts of the city and walks of life, I am splitting a gut and smiling ear to ear ease dropping in on your back and forth about all of this cultural differences in perceptions. It is absolutely the truth about the crowded busy place, and the more laid back actually wanting to hang out and spend time chatting and catching up with others... And to some extent because all of us NY'ers grew up with one another's stuff leaking into our own lives and lifestyles I feel to a good extent I have this ecclectic weird mix of so many different cultural things that at some point are just, "He's a New Yorker", or "I'm from Da Bronx" and between the various stuff blending together you guys have some of my Jewish Culture in you and you

don't even know it and I too have some of our hispanic stuff in me I'm sure, and to some extent some of these various places and cultures that got all mixed up in NY sort of were more similar to begin with than either side understands or would openly admit to.... I find it so interesting and when I am not in a NY City Rush, I love to sit back and people watch in eateries and parks and the like.... It's so cool to watch it blend and clash and then become something uniquely NYC like where we just have to sort of adapt and make it work.... Yes I know 's part of town all too well just south of the Inwood area at the top on Mannhatten with the # 1 and # 9 and the famous "A" train....

Happy holidays guys....

To: " " < >Sent: Friday, July 1, 2011 2:50 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

Dear .

you made me laugh about the Novela =soap opera.

I used to live in Miami and my uncle and I used to watch brazilean soap operas every night.

I enjoyed so much, one my favorites was Terra nostra , it talks about the italian imigration to brazil.

when my wife (girlfriend) used to stop by she laught to see guys watching soap opera.

Adolfo

To: Sent: Friday, July 1, 2011 2:13 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

You and Adolfo are right.Because of this quirk we tend to have all the old folks in the AM, they all tend to show early and then the younger crowd comes in the afternoon, usually after work or before work depending on their schedule. They all learned that they can show up and would be seen no questions asked so they just come in and ask to be seen.On the other hand, they don't call after hours or weekends. If you call my office and press 5 it goes to my cell, google published my cell and I have had maybe 8 calls since I opened 23 months ago. The younger demographics emails and I have had maybe 5 after hours or weekends. My patients are very respectful to the point of annoying me some times when they wait until the morning to come in or call with an issue that should have been dealt on before.The other day I had a patient stop me in on the street, on the way to the subway, show me the canker sore in his

mouth. I remote access my server, wrote a note from my G2 and sent an e-script to the pharmacy and the patient thought I was the best guy in the world.By the way, my patients want the NOVELA running on TV, no educational videos. from the Barrio

I see 99% low income Latinos and the rest 1% low income others. We obviously speak Spanish too. I have had the same situation (8 o’clock everyone shows up) but I find my patients are willing to work with me if I give them a good reason to do so. We spent some time working on our cycle time and we talked with them about coming around their scheduled time. We were somewhat successful however we found that for many of them this was a social event that got them out of their isolation and routine. So instead of insisting on them coming around their time we started offering educational sessions in the waiting room to make their time worth while (a lot of which were given by county staff wanting to reach difficult to reach populations and university students so no cost to us).

I think that when we talk about patient centerdness this is the kind of thing we are talking about. I personally couldn’t care less what the person in CNN thinks about what my motivations to practice are. I just want to enjoy going to work every day and make a small tiny difference in someone’s life once in a while

Izquierdo-Porrera MD PhD

Executive Director & Co-founder

Care for Your Health, Inc

Phone

From: [mailto: ] On Behalf Of Batlle, MDSent: Friday, July 01, 2011 1:50 PMTo: Subject: Re: Re: CNN story features Malia, Wible, Peikari

and IMP map --- MY own rant

Washington Heights. Here we speak Spanish.I am glad you get, believe me I talk about it at least once a month on TV. from the Barrio

Dear .

Where is your barrio?

what you described seems like Latino culture ideas.

I am Latino and I understand what you described below. It is frustrating to give quality and people have this misconception.

Adolfo

To: Sent: Friday, July 1, 2011 1:09 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

Personally, knowing Cohen's reporting I would not even pick up the phone for her. I really don't know what her issue against Doc's is but it is prevalent in her work. The other guy just tends to push money making stuff for his friends (seems like it).As any other person I have children that get sick, cars that break down, issues that need attention, public transportation gets snarled, accidents at the bridge that stop traffic. Last time I was late (4 months ago) stuck on the subway for an hour, walk in the office and patient pointed out I was late told, I him to call the MTA and complain about it.On the bigger picture, this is why I work in the Barrio, no issues here, for the most part patients appreciate been seen, everyone is late, half patients don't show, even after been called the prior day, half just

walk in. Rule is simple appointment's are seen on time, walk ins as I go, no one spends more that 20 minutes from walking in to be seen. I don't eat lunch and all calls are returned after 4 pm. My waiting room is always empty or may have one person sitting. I see from 13 to 20 patients a day 4 to 5 new and have only one staff, no nurse, do my own EKG,s, PFT's, injections, vitals, document and bill as I go, patient reads my big computer screen as I go (already one told me that he head only 2 or 3 drinks a week not 203 drinks) and it seems to be ok for most.On the other hand some of my patients don't like my system they seem to like the system that several doc's have in the Barrio. At these practices patients show up at 8 o'clock the day of their appointment, get a number and then wait to be seen, by number, when the doc gets in (around 10 am), they

spends hours in the waiting room talking with their friends and believing that this doctor is so good because all these patients are waiting for him or her. Several people have pointed out that I should do it that way. Patients tend to swap stories about how good you are and then tell their peers that you are so good that everyone wants to see you. Same 15 to 20 patients I see with my system, by the way. Another hick up is that patients seem to love that they call these other guys and are given an appointment for 10 weeks, impression is that he is so busy because he is so good. I tell patients just come in at 2 o'clock, empty waiting room, impression: he can't be that good because no one is there. Go figure that one.On the even bigger picture people get what they pay for, they can pay cash to someone that can afford to be less busy, if they wish. They can vote and make sure the systems changes from

the present disease oriented one on into a health care one, another example. But they seem to want the cheapest "health plan" and then expect red carpet treatment. from the Barrio

No, the conversations were with friends on Facebook who live far away, and other parents at my son's soccer game, and a baseball coach who emailed me. The discussion with my patients was a whole other story.I do what I can in the part of the world I have some control over, most often just the ten feet around me. The article notes something I do. The conversation now is to further explain why I do that and what life is really like for docs -- including what I live now with stress, and how in my former office I was always 45-60 minutes behind.You really don't think some folks aren't more likely to hear our real stories? OK, we can agree to disagree. But then please help me understand how the public will ever come to know our perspective and how we all need to work together, doctors and patients, to make medical care as good as possible for

everyone.--Tim Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all

copies of the original message, including attachments. Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant this is grace again. i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but then as i was halfway down the comment list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page. and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart or a neuroendocrine attack tonight. i dont know how we can save ourselves from this one. in time for independence day, im red black and blue. but still... please please try to pull me out from under the bus.

[Guest guest]

,

We have had a few patients walk in our reception area only to find themselves alone. One lady, from nearby upscale town, left our practice because no one was waiting.

You can please some of the people some of the time, but you cannot please all of the people all of the time.

Another patient just left our practice, he has COPD end stage, when he called he noted he had been a new hospital built clinic which had 100 foot shorter route and an elevator to the doctors office. I didn't even bother to tell him I make house calls. The tone in his voice showed he had found his nirvana. I wished him well.

Making an impact on patients who will let me.

To: Sent: Fri, July 1, 2011 12:49:57 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

Washington Heights. Here we speak Spanish.I am glad you get, believe me I talk about it at least once a month on TV. from the Barrio

Dear .

Where is your barrio?

what you described seems like Latino culture ideas.

I am Latino and I understand what you described below. It is frustrating to give quality and people have this misconception.

Adolfo

To: Sent: Friday, July 1, 2011 1:09 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

Personally, knowing Cohen's reporting I would not even pick up the phone for her. I really don't know what her issue against Doc's is but it is prevalent in her work. The other guy just tends to push money making stuff for his friends (seems like it).As any other person I have children that get sick, cars that break down, issues that need attention, public transportation gets snarled, accidents at the bridge that stop traffic. Last time I was late (4 months ago) stuck on the subway for an hour, walk in the office and patient pointed out I was late told, I him to call the MTA and complain about it.On the bigger picture, this is why I work in the Barrio, no issues here, for the most part patients appreciate been seen, everyone is late, half patients don't show, even after been called the prior day, half just walk in. Rule is simple appointment's are seen on time, walk ins as I go, no one spends

more that 20 minutes from walking in to be seen. I don't eat lunch and all calls are returned after 4 pm. My waiting room is always empty or may have one person sitting. I see from 13 to 20 patients a day 4 to 5 new and have only one staff, no nurse, do my own EKG,s, PFT's, injections, vitals, document and bill as I go, patient reads my big computer screen as I go (already one told me that he head only 2 or 3 drinks a week not 203 drinks) and it seems to be ok for most.On the other hand some of my patients don't like my system they seem to like the system that several doc's have in the Barrio. At these practices patients show up at 8 o'clock the day of their appointment, get a number and then wait to be seen, by number, when the doc gets in (around 10 am), they spends hours in the waiting room talking with their friends and believing that this doctor is so good because all these patients are waiting for him or her.

Several people have pointed out that I should do it that way. Patients tend to swap stories about how good you are and then tell their peers that you are so good that everyone wants to see you. Same 15 to 20 patients I see with my system, by the way. Another hick up is that patients seem to love that they call these other guys and are given an appointment for 10 weeks, impression is that he is so busy because he is so good. I tell patients just come in at 2 o'clock, empty waiting room, impression: he can't be that good because no one is there. Go figure that one.On the even bigger picture people get what they pay for, they can pay cash to someone that can afford to be less busy, if they wish. They can vote and make sure the systems changes from the present disease oriented one on into a health care one, another example. But they seem to want the cheapest "health plan" and then expect red carpet

treatment. from the Barrio

No, the conversations were with friends on Facebook who live far away, and other parents at my son's soccer game, and a baseball coach who emailed me. The discussion with my patients was a whole other story.I do what I can in the part of the world I have some control over, most often just the ten feet around me. The article notes something I do. The conversation now is to further explain why I do that and what life is really like for docs -- including what I live now with stress, and how in my former office I was always 45-60 minutes behind.You really don't think some folks aren't more likely to hear our real stories? OK, we can agree to disagree. But then please help me understand how the public will ever come to know our perspective and how we all need to work together, doctors and patients, to make medical care as good as possible for everyone.--Tim Malia, MD (phone / fax)www.MaliaFamilyMedicine.comwww.SkinSenseLaser.comMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments. Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant this is grace again. i was going to tally how many doctors were writing comments on this CNN thread and see how many public comments were for us and how many were against us. but then as i was halfway down the comment

list i saw as of this writing 1:03 am, there were 4,871 likes on this CNN page. and the more i thought and the more the clock ticked way into the night... my face started to get red and my neck started to spasm... good intentions and great doctors aside... i felt like i needed to send my ER bill to pamela and tim should i get a heart or a neuroendocrine attack tonight. i dont know how we can save ourselves from this one. in time for independence day, im red black and blue. but still... please please try to pull me out from under the bus.

[Guest guest]

,

I do understand what you mean.

By the way,

Slow day at the Barrio office, after a Holiday most patients won't

show even if they were called Friday because of all sorts of holiday

issues.

So far:  out of 12 scheduled appointments 6 no shows, 4 walk ins, 3

late, 1 very early (woke up early and decided to come early), 2 on

time, 2 came in because of forms that needed completed.  Very early

one did not get her blood work done but came anyways.  1 patient

brought me a bag of Dominican mints (mentas) to prove that she keeps

me in her mind when traveling to Dominican Republic and another

asked "why I am loosing weight?" (middle of cycling season makes me

trimmer) and told me I should be eating lunch every day because I

look better (buenmozo) with more weight.  Another informed me that

she and her prayer group were praying for me (did not ask what for

or why?, neither told her that I am an atheist) so I thanked her.

Novela not running on the TV at this time because patients ask for

Dra. Polo at this time slot (TV Judge show).  I even know what time

it is depending of the background TV noise by know.

from the Barrio

 

,

 

We have had a few patients walk in our reception area

only to find themselves alone.  One lady, from nearby

upscale town, left our practice because no one was

waiting.

 

You can please some of the people some of the time,

but you cannot please all of the people all of the time.

 

Another patient just left our practice, he has COPD

end stage, when he called he noted he had been a new

hospital built clinic which had 100 foot shorter route

and an elevator to the doctors office.  I didn't even

bother to tell him I make house calls.  The tone in his

voice showed he had found his nirvana.  I wished him

well.

 

Making an impact on patients who will let me.

 

From:

" Batlle, MD"

To:

Sent:

Fri, July 1, 2011 12:49:57 PM

Subject:

Re: Re: CNN story features

Malia, Wible, Peikari and IMP map --- MY own rant

 

Washington Heights.  Here we speak Spanish.

I am glad you get, believe me I talk about it at

least once a month on TV.

from the Barrio

 

Dear .

Where is your barrio?

what you described seems like

Latino culture ideas.

I am Latino and I understand what

you described below. It is frustrating to

give quality and people have this

misconception.

Adolfo

From:

" Batlle, MD"

To:

Sent:

Friday, July 1, 2011 1:09 PM

Subject:

Re: Re: CNN story

features Malia, Wible, Peikari and IMP

map --- MY own rant

 

Personally,  knowing

Cohen's reporting I would not even

pick up the phone for her.  I really

don't know what her issue against

Doc's is but it is prevalent in her

work.  The other guy just tends to

push money making stuff for his

friends (seems like it).

As any other person I have children

that get sick, cars that break down,

issues that need attention, public

transportation gets snarled,

accidents at the bridge that stop

traffic.  Last time I was late (4

months ago) stuck on the subway for

an hour, walk in the office and

patient pointed out I was late told,

I him to call the MTA and complain

about it.

On the bigger picture, this is why I

work in the Barrio, no issues here,

for the most part patients

appreciate been seen, everyone is

late, half patients don't show, even

after been called the prior day,

half just walk in.  Rule is simple

appointment's are seen on time, walk

ins as I go, no one spends more that

20 minutes from walking in to be

seen.  I don't eat lunch and all

calls are returned after 4 pm. My

waiting room is always empty or may

have one person sitting.  I see from

13 to 20 patients a day 4 to 5 new

and have only one staff, no nurse,

do my own EKG,s, PFT's, injections,

vitals, document and bill as I go,

patient reads my big computer screen

as I go (already one told me that he

head only 2 or 3 drinks a week not

203 drinks) and it seems to be ok

for most.

On the other hand some of my

patients don't like my system they

seem to like the system that several

doc's have in the Barrio.  At these

practices patients show up at 8

o'clock the day of their

appointment, get a number and then

wait to be seen, by number, when the

doc gets in (around 10 am), they

spends hours in the waiting room

talking with their friends and

believing that this doctor is so

good because all these patients are

waiting for him or her.  Several

people have pointed out that I

should do it that way.  Patients

tend to swap stories about how good

you are and then tell their peers

that you are so good that everyone

wants to see you.  Same 15 to 20

patients I see with my system, by

the way.  Another hick up is that

patients seem to love that they call

these other guys and are given an

appointment for 10 weeks, impression

is that he is so busy because he is

so good.  I tell patients just come

in at 2 o'clock, empty waiting room,

impression: he can't be that good

because no one is there.  Go figure

that one.

On the even bigger picture people

get what they pay for, they can pay

cash to someone that can afford to

be  less busy, if they wish.  They

can vote and make sure the systems

changes from the present disease

oriented one on into a health care

one, another example.  But they seem

to want the cheapest "health plan"

and then expect red carpet

treatment.

from the Barrio

On 7/1/2011 9:20 AM, Malia

wrote:

 

No, the conversations were

with friends on Facebook who

live far away, and other

parents at my son's soccer

game, and a baseball coach who

emailed me. The discussion

with my patients was a whole

other story.

I do what I can in the part of

the world I have some control

over, most often just the ten

feet around me. The article

notes something I do. The

conversation now is to further

explain why I do that and what

life is really like for docs

-- including what I live now

with stress, and how in my

former office I was always

45-60 minutes behind.

You really don't think some

folks aren't more likely to

hear our real stories? OK, we

can agree to disagree. But

then please help me understand

how the public will ever come

to know our perspective and

how we all need to work

together, doctors and

patients, to make medical care

as good as possible for

everyone.

--Tim

Malia, MD

(phone / fax)

www.MaliaFamilyMedicine.com

www.SkinSenseLaser.com

Malia Family Medicine &

Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

-- Confidentiality Notice --

This email message, including

all the attachments, is for

the sole use of the intended

recipient(s) and contains

confidential information.

Unauthorized use or disclosure

is prohibited. If you are not

the intended recipient, you

may not use, disclose, copy or

disseminate this information.

If you are not the intended

recipient, please contact the

sender immediately by reply

email and destroy all copies

of the original message,

including attachments.

Re: CNN

story features Malia, Wible,

Peikari and IMP map --- MY own

rant

this is grace again.

i was going to tally how many

doctors were writing comments

on this CNN thread and see how

many public comments were for

us and how many were against

us. but then as i was halfway

down the comment list i saw as

of this writing 1:03 am, there

were 4,871 likes on this CNN

page.

and the more i thought and the

more the clock ticked way into

the night... my face started

to get red and my neck started

to spasm... good intentions

and great doctors aside... i

felt like i needed to send my

ER bill to pamela and tim

should i get a heart or a

neuroendocrine attack tonight.

i dont know how we can save

ourselves from this one. in

time for independence day, im

red black and blue.

but still... please please try

to pull me out from under the

bus.

[Guest guest]

What an amazing life. You should be in a documentary !

> >>> No, the conversations were with friends on Facebook who live far

> >>> away, and other parents at my son's soccer game, and a baseball

> >>> coach who emailed me. The discussion with my patients was a whole

> >>> other story.

> >>>

> >>> I do what I can in the part of the world I have some control over,

> >>> most often just the ten feet around me. The article notes something

> >>> I do. The conversation now is to further explain why I do that and

> >>> what life is really like for docs -- including what I live now with

> >>> stress, and how in my former office I was always 45-60 minutes behind.

> >>>

> >>> You really don't think some folks aren't more likely to hear our

> >>> real stories? OK, we can agree to disagree. But then please help me

> >>> understand how the public will ever come to know our perspective and

> >>> how we all need to work together, doctors and patients, to make

> >>> medical care as good as possible for everyone.

> >>>

> >>> --Tim

> >>>

> >>> Malia, MD

> >>>

> >>> (phone / fax)

> >>> www.MaliaFamilyMedicine.com <http://www.maliafamilymedicine.com/>

> >>> www.SkinSenseLaser.com <http://www.skinsenselaser.com/>

> >>>

> >>> Malia Family Medicine & Skin Sense Laser

> >>> 6720 Pittsford-Palmyra Rd.

> >>> Perinton Square Mall

> >>> Fairport, NY 14450

> >>>

> >>> -- Confidentiality Notice --

> >>> This email message, including all the attachments, is for the sole

> >>> use of the intended recipient(s) and contains confidential

> >>> information. Unauthorized use or disclosure is prohibited. If you

> >>> are not the intended recipient, you may not use, disclose, copy or

> >>> disseminate this information. If you are not the intended recipient,

> >>> please contact the sender immediately by reply email and destroy all

> >>> copies of the original message, including attachments.

> >>>

> >>> Re: CNN story features Malia, Wible,

> >>> Peikari and IMP map --- MY own rant

> >>>

> >>> this is grace again.

> >>>

> >>> i was going to tally how many doctors were writing comments on this

> >>> CNN thread and see how many public comments were for us and how many

> >>> were against us. but then as i was halfway down the comment list i

> >>> saw as of this writing 1:03 am, there were 4,871 likes on this CNN

> >>> page.

> >>>

> >>> and the more i thought and the more the clock ticked way into the

> >>> night... my face started to get red and my neck started to spasm...

> >>> good intentions and great doctors aside... i felt like i needed to

> >>> send my ER bill to pamela and tim should i get a heart or a

> >>> neuroendocrine attack tonight.

> >>>

> >>> i dont know how we can save ourselves from this one. in time for

> >>> independence day, im red black and blue.

> >>> but still... please please try to pull me out from under the bus.

> >>>

> >>

> >>

> >>

> >

> >

>

[Guest guest]

you make me laugh all the time, I will have to visit your barrio whenever I go back to NY.You remind me about Nicaraguan culture about been thin or skinny.I practiced rural medicine and sometimes mothers give maizena instead of breasfeeding (type of corn beverage), very high in carbs.If you are thin you may be sick or dying of cancer.My Grandma when she saw me, after my delivery ( I was long and weighted 7 pounds and 7 onz) she told my mom that I was not gonna make it.she was used to see my female cousins

around 11 and 12 pounds at the moment of delivery ( my aunt is 4'11).Of course Doctora Ana Polo, cuban-american lawyer with a people's court TV program.If you are close to rural area in your barrio, I would not be surprise to get some chicken eggs or chickens as gifts.I did my rural area social service in a community of las Salinas ( they make salt and it is near the ocean). I had a lot rain and the communication with the city was cut off.we had a collera epidemic because of wells talking to the outside letrines.I had to go to another small village deeper in the area, 4x4 toyota ambulance got stuck. I had to ride a horse to get to the community.I got the small center and they patients with IV lines waiting for me. I took care of them for a week and no casualties. I work 24 hours a day with 2 RNs.the point that I was trying to make is: the owner of the horse forgot to unleash the horse and the horse got tangle and strangulate himself.You know there are always jokers in the barrio, they were saying that the horse committed suicide after carrying me. The horse preferred to kill himself before carrying me outside the community.I found another horse 7 days later and left the place. I had to cross a river on foot with my backpack on my arms .I can tell you , I miss that small community and the RNs and their families.

They took care of me,fed and shelter me.you see people in the barrio making a fit and touching their chest and pointing at you, meaning I got u Doc. I had that relationship with them.I have not have the chance to go back that small community (called Canas de ). I was station at las salinas 4 days a week and went to Canas once a week.I was thinking to go back and talk to the nurse and see what their needs are.they did not have a doctor every day, I was thinking to talk to a OB/GYN and pay him to go and provide services once a week or biweekly and maybe get a used US.I can tell you , we as latinos are a

complex group. we are not the same in our beliefs. I noticed every country and region have different way to say things. Also we have so many similarities. I will stop there, thinking about my favorite novela ( El bien Amado = the good love).take care .To: Sent: Tuesday, July 5, 2011

3:51 PMSubject: Re: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

,

I do understand what you mean.

By the way,

Slow day at the Barrio office, after a Holiday most patients won't

show even if they were called Friday because of all sorts of holiday

issues.

So far: out of 12 scheduled appointments 6 no shows, 4 walk ins, 3

late, 1 very early (woke up early and decided to come early), 2 on

time, 2 came in because of forms that needed completed. Very early

one did not get her blood work done but came anyways. 1 patient

brought me a bag of Dominican mints (mentas) to prove that she keeps

me in her mind when traveling to Dominican Republic and another

asked "why I am loosing weight?" (middle of cycling season makes me

trimmer) and told me I should be eating lunch every day because I

look better (buenmozo) with more weight. Another informed me that

she and her prayer group were praying for me (did not ask what for

or why?, neither told her that I am an atheist) so I thanked her.

Novela not running on the TV at this time because patients ask for

Dra. Polo at this time slot (TV Judge show). I even know what time

it is depending of the background TV noise by know.

from the Barrio

,

We have had a few patients walk in our reception area

only to find themselves alone. One lady, from nearby

upscale town, left our practice because no one was

waiting.

You can please some of the people some of the time,

but you cannot please all of the people all of the time.

Another patient just left our practice, he has COPD

end stage, when he called he noted he had been a new

hospital built clinic which had 100 foot shorter route

and an elevator to the doctors office. I didn't even

bother to tell him I make house calls. The tone in his

voice showed he had found his nirvana. I wished him

well.

Making an impact on patients who will let me.

From:

" Batlle, MD"

To:

Sent:

Fri, July 1, 2011 12:49:57 PM

Subject:

Re: Re: CNN story features

Malia, Wible, Peikari and IMP map --- MY own rant

Washington Heights. Here we speak Spanish.

I am glad you get, believe me I talk about it at

least once a month on TV.

from the Barrio

Dear .

Where is your barrio?

what you described seems like

Latino culture ideas.

I am Latino and I understand what

you described below. It is frustrating to

give quality and people have this

misconception.

Adolfo

From:

" Batlle, MD"

To:

Sent:

Friday, July 1, 2011 1:09 PM

Subject:

Re: Re: CNN story

features Malia, Wible, Peikari and IMP

map --- MY own rant

Personally, knowing

Cohen's reporting I would not even

pick up the phone for her. I really

don't know what her issue against

Doc's is but it is prevalent in her

work. The other guy just tends to

push money making stuff for his

friends (seems like it).

As any other person I have children

that get sick, cars that break down,

issues that need attention, public

transportation gets snarled,

accidents at the bridge that stop

traffic. Last time I was late (4

months ago) stuck on the subway for

an hour, walk in the office and

patient pointed out I was late told,

I him to call the MTA and complain

about it.

On the bigger picture, this is why I

work in the Barrio, no issues here,

for the most part patients

appreciate been seen, everyone is

late, half patients don't show, even

after been called the prior day,

half just walk in. Rule is simple

appointment's are seen on time, walk

ins as I go, no one spends more that

20 minutes from walking in to be

seen. I don't eat lunch and all

calls are returned after 4 pm. My

waiting room is always empty or may

have one person sitting. I see from

13 to 20 patients a day 4 to 5 new

and have only one staff, no nurse,

do my own EKG,s, PFT's, injections,

vitals, document and bill as I go,

patient reads my big computer screen

as I go (already one told me that he

head only 2 or 3 drinks a week not

203 drinks) and it seems to be ok

for most.

On the other hand some of my

patients don't like my system they

seem to like the system that several

doc's have in the Barrio. At these

practices patients show up at 8

o'clock the day of their

appointment, get a number and then

wait to be seen, by number, when the

doc gets in (around 10 am), they

spends hours in the waiting room

talking with their friends and

believing that this doctor is so

good because all these patients are

waiting for him or her. Several

people have pointed out that I

should do it that way. Patients

tend to swap stories about how good

you are and then tell their peers

that you are so good that everyone

wants to see you. Same 15 to 20

patients I see with my system, by

the way. Another hick up is that

patients seem to love that they call

these other guys and are given an

appointment for 10 weeks, impression

is that he is so busy because he is

so good. I tell patients just come

in at 2 o'clock, empty waiting room,

impression: he can't be that good

because no one is there. Go figure

that one.

On the even bigger picture people

get what they pay for, they can pay

cash to someone that can afford to

be less busy, if they wish. They

can vote and make sure the systems

changes from the present disease

oriented one on into a health care

one, another example. But they seem

to want the cheapest "health plan"

and then expect red carpet

treatment.

from the Barrio

On 7/1/2011 9:20 AM, Malia

wrote:

No, the conversations were

with friends on Facebook who

live far away, and other

parents at my son's soccer

game, and a baseball coach who

emailed me. The discussion

with my patients was a whole

other story.

I do what I can in the part of

the world I have some control

over, most often just the ten

feet around me. The article

notes something I do. The

conversation now is to further

explain why I do that and what

life is really like for docs

-- including what I live now

with stress, and how in my

former office I was always

45-60 minutes behind.

You really don't think some

folks aren't more likely to

hear our real stories? OK, we

can agree to disagree. But

then please help me understand

how the public will ever come

to know our perspective and

how we all need to work

together, doctors and

patients, to make medical care

as good as possible for

everyone.

--Tim

Malia, MD

(phone / fax)

www.MaliaFamilyMedicine.com

www.SkinSenseLaser.com

Malia Family Medicine &

Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

-- Confidentiality Notice --

This email message, including

all the attachments, is for

the sole use of the intended

recipient(s) and contains

confidential information.

Unauthorized use or disclosure

is prohibited. If you are not

the intended recipient, you

may not use, disclose, copy or

disseminate this information.

If you are not the intended

recipient, please contact the

sender immediately by reply

email and destroy all copies

of the original message,

including attachments.

Re: CNN

story features Malia, Wible,

Peikari and IMP map --- MY own

rant

this is grace again.

i was going to tally how many

doctors were writing comments

on this CNN thread and see how

many public comments were for

us and how many were against

us. but then as i was halfway

down the comment list i saw as

of this writing 1:03 am, there

were 4,871 likes on this CNN

page.

and the more i thought and the

more the clock ticked way into

the night... my face started

to get red and my neck started

to spasm... good intentions

and great doctors aside... i

felt like i needed to send my

ER bill to pamela and tim

should i get a heart or a

neuroendocrine attack tonight.

i dont know how we can save

ourselves from this one. in

time for independence day, im

red black and blue.

but still... please please try

to pull me out from under the

bus.

[Guest guest]

dearest jose and adolfo,

thanks for your stories.

my best time (well one of the better ones)was when i did medicine off of a

donkey. I was travelling on a donkey with a guide since i dont know where (guide

(not the donkey) pointing with his snout) the next house on the itinerary was.

well, it was corn harvest so i was fed at EACH house corn on the cob, corn soup,

fresh(!) chicken corn soup and corn dumplings and corn cake with " kape barako " -

ground burnt rice coffee.

i was the most beautifulest, kindest doctor there ever was.. (considering they

hadnt seen one the past 5 years)

i think the only complaint i got was from the donkey... i had to stop for

multitudes of breaks (winks) on the way home.

LOL

grace

[Guest guest]

Dear Grace.I was called the Horse Killer Doctor, the whole community was having fun on me.I bet the donkey was noisy making a lot of stops.Sorry about my stories, 's story gave me flash backs while laughing. AdolfoTo: Sent: Tuesday, July 5,

2011 6:01 PMSubject: Re: CNN story features Malia, Wible, Peikari and IMP map --- MY own rant

dearest jose and adolfo,

thanks for your stories.

my best time (well one of the better ones)was when i did medicine off of a donkey. I was travelling on a donkey with a guide since i dont know where (guide (not the donkey) pointing with his snout) the next house on the itinerary was.

well, it was corn harvest so i was fed at EACH house corn on the cob, corn soup, fresh(!) chicken corn soup and corn dumplings and corn cake with "kape barako" - ground burnt rice coffee.

i was the most beautifulest, kindest doctor there ever was.. (considering they hadnt seen one the past 5 years)

i think the only complaint i got was from the donkey... i had to stop for multitudes of breaks (winks) on the way home.

LOL

grace