Tuesday, October 14, 2014

Questions to Ask to Reduce Diagnostic Disasters

Part Three of a Seven-Part series on Medical Care
Humans are incredibly adaptable. You can put us into the most bizarre situations, and we somehow learn to cope; eventually, we even begin to accept an untenable situation as almost normal. Unfortunately, this happens in medicine, too. Arrogance, ego, and hierarchy have become entrenched within the culture of medicine. This has led to what Dr. Peter Pronovost describes as “normalization of deviance.” . . . . To have an impact on the millions of misdiagnoses that occur each year physicians are going to have to overcome some ingrained behaviors.
Although some signs and symptoms are obvious indicators of a particular condition, many others are ambiguous and require sleuthing, intuition, testing, and modern technology to determine a correct diagnosis. . . . Ultimately, the most important component to successful diagnosis will be good communication and collaboration between patients, nurses, and physicians. That requires attentive listening by health professionals. Patients need to be able to tell their stories without being interrupted. Seemingly trivial details may provide the key to unlocking a mystery.
Top 10 Questions to Ask to Reduce Diagnostic Disasters
·         What are my primary concerns and symptoms?
Think about a conversation with your physician as if it were a noisy cell phone conversation with a friend. . . . Your doctor may be preoccupied or just not hearing everything you are saying clearly. . . . . The same thing is essential when you tell your story to your physician. Ask her to “teach back” to you what she heard. That way you will be sure she got all the key points.
·         How confident are you about this diagnosis?
Getting the diagnosis right requires a healthy degree of open-mindedness and the realization that something else might be going on. Encourage your doctor to share his level of uncertainty about your diagnosis.
·         What further tests might be helpful to improve your confidence?
This is a slippery slope. On the one hand, you want an accurate diagnosis. . . . Finding the balance between accuracy, affordability, and safety is critical to any decision to seek additional testing.
·         Will the test(s) you are proposing change the treatment plan in any way?
Most doctors are curious. That’s a good thing. They want to know what is causing your symptoms. But sometimes their curiosity can lead to expensive, invasive tests that hurt and may not change anything about your treatment.
·         Are there any findings or symptoms that don’t fit your diagnosis or that contradict it?
Once a doctor anchors onto a diagnosis, it can be hard for him to dismiss it, even if there is evidence that doesn’t quite fit the pattern.
·         What else could it be?
This is huge! If we had time to ask our doctor only one question, this is probably the Big Kahuna. Always ask this question regardless of how sure your physician is that he has your diagnosis nailed.
·         Can you facilitate a second opinion by providing me my medical records?
This is hard. Really hard! Even though patients have the legal right to review or obtain a copy of their medical records, it takes chutzpah to ask a doctor to provide a copy. Many people fear that they will antagonize their health care provider by requesting this document. Some doctors will be annoyed, but the growing movement toward electronic medical records is encouraging patient access.
·         When should I expect to see my test results?
Will you call with them, or will they come by mail or electronically? Doctors and doctors’ offices can be disorganized, just like the rest of us. They are human, after all. The trouble is that their disorganization can have life-threatening ramifications.
·         What resources can you recommend for me to learn more about my diagnosis?
When a doctor gives you a scary diagnosis, it can be overwhelming. Even something fairly common like diabetes or hypertension can seem overwhelming. When you get home and process the information, you may be tempted to turn to Dr. Google for more insight about your condition. . . . The Web has an amazing amount of helpful information if used skillfully, but people may also end up scaring themselves to death with inaccurate diagnoses. Patients can benefit from this incredible tool if they are selective and consult their doctor for interpretations and recommendations.
·         May I contact you by e-mail if my symptoms change or if I have an important question?
If so, what is your e-mail address? Be prepared for your doctor to say no. Most doctors reserve their e-mail for family, friends, and colleagues. Doctors seem to fear that they will be inundated by long messages and questions from patients that will take up significant amounts of their time. . . . Although there is not a lot of research on e-mail communication in medicine, the doctors’ fears appear to be unfounded.
In the world of Veterans Administration healthcare, the MyHealtheVet online system is intended to help with this aspect of your care and communication with your health care provider. However, having said that at this point it is a relatively new system and not fully mature, so don’t expect too much of it.
According to the web information (https://www.myhealth.va.gov),as a veteran or VA patient, in addition to accessing your records (at an authenticated Premium level) you may:
Use Secure Messaging to communicate online with your VA health care team. You may send messages to request or cancel VA appointments. Use it to ask about lab results or find out about a medication or health issue. Or simply to discuss other general health matters.

Part Four will discuss Mistakes Doctors Make When Prescribing Medications

Top 10 Reasons Doctors Screw Up Diagnoses

Part Two of a Six-Part series on Medical Care
Joe and Teresa Graedon, authors of Top Screwups Doctors Make and How to Avoid Them reflected on the simple fact that doctors are humans with limits:
Doctors have an impossible job. They have to learn way more information than any human is capable of retaining during their medical school education and residency training. Then they have to keep up with the latest developments in research and treatment despite grueling hours seeing patients. They frequently have to wrestle with insurance companies and all sorts of other bureaucratic bottlenecks. Finally, they are under enormous time pressure to see as many patients as possible. We have talked with many doctors who complain about having to practice “assembly line medicine.” It’s no wonder that sometimes doctors make mistakes.
Note: quoted passages are excerpts from Top Screwups Doctors Make and How to Avoid Them.
Because medical school and residency training promote the idea that doctors must come up with the correct diagnosis based on their own memories, physicians are destined to miss many diagnoses.
Lawrence Weed, MD, who has spent a lifetime studying these issues, has said:
The physicians’ unaided minds are incapable of recalling all the necessary knowledge from the literature and processing it with data from the unique patient. An epidemic of errors and waste is occurring as we persist in trying to do the impossible.
Dr. Weed and others who have recognized this problem suggest that physicians need to harness the power of information technology to avoid the high rate of missed or delayed diagnoses.
Overconfidence
Mark Twain is reported to have said: “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” Based on an analysis of available data, it is pretty clear that physician overconfidence is a major factor contributing to diagnostic disasters. . . . The problem with overconfidence is that doctors may not take the time or be willing to consider alternative possibilities for a patient’s symptoms. One reason for the epidemic of overconfidence is that doctors rarely get feedback about diagnostic screwups.
Information overload
If you’ve ever had to clear away a stack of magazines you’ve been meaning to get to, but just couldn’t keep up with, you may have an inkling of what your doctor faces. There are thousands of medical journals spewing out the latest research in a never-ending tidal wave. A busy clinician who comes home exhausted cannot possibly read all the medical journals in her area of expertise. Throw in the Journal of the American Medical Association, the New England Journal of Medicine, and several other general medical publications , and there is just no way to keep up. Even if your doctor could read half of the relevant research in his field, remembering it, especially at just the right moment to help with a difficult diagnosis, is impossible.
Going it alone
Asking for help doesn’t come easily to many physicians. To get into medical school you have to be a superb student and very competitive. One doctor described such people as “top guns.” They are smart, bold, and driven. They are not necessarily people who instinctively know how to work well with others. Medical school and residency training don’t usually teach teamwork or ego-free collaborative problem solving. When faced with a diagnostic dilemma, such people are likely to try to solve the puzzle themselves. The trouble with this approach, however, is that if they get in over their heads, the patient may drown.
Tunnel vision
In How Doctors Think, Dr. Jerome Groopman talks about something called anchoring: “a shortcut in thinking where a person doesn’t consider multiple possibilities but quickly and firmly latches on to a single one, sure that he has thrown his anchor down just where he needs to be. You look at your map but your mind plays tricks on you — confirmation bias — because you see only the landmarks you expect to see and neglect those that should tell you that in fact you’re still at sea. Your skewed reading of the map ‘confirms’ your mistaken assumption that you have reached your destination.”
Time pressure
One of the reasons that so many doctors end up jumping to conclusions is a lack of time to stop and think clearly. They’re in a hurry all day long, dashing from one patient to the next. . . . Cutbacks in payments from insurance companies and the federal government have led many clinics and hospitals to encourage physicians to see more patients in less time. Some doctors have called this trend “hamster treadmill medicine ” or “assembly-line medicine.” Is it any wonder that physicians feel compelled to interrupt patients within twelve to twenty seconds after they start talking?
Missing test results
“Ordering and following up on outpatient laboratory and imaging tests consumes large amounts of physician time and is important in the diagnostic process. Diagnostic errors are the most frequent cause of malpractice claims in the United States; testing-related mistakes can lead to serious diagnostic errors. There are many steps in the testing process, which extends from ordering a test to providing appropriate follow-up; an error in any one of these steps can have lethal consequences.” Lawrence P. Casalino, M D, et al., in Archives of internal Medicine, June 22, 2009
Ignoring drug side effects
Just about every drug known to man has the potential to cause some side effects in some people. So how does a doctor who wants to do the best for his patient justify prescribing a medicine that could cause heart attacks, strokes, life-threatening liver failure, or kidney disease, to name just a few drug-induced side effects? . . . . When doctors fail to take patient accounts of side effects seriously, they are not likely to report the problems, either to the Food and Drug Administration or as a case report in the medical literature. As a result, other physicians also have more trouble making a connection.
Follow-up failure
One of the reasons that doctors sometimes don’t realize how frequently their diagnoses miss the mark is that they rarely get feedback on how the story ends. Under normal circumstances, the emergency department doctor won’t hear back from the physicians upstairs in the hospital . The specialist and the primary care physician may communicate, but perhaps not as much as one might hope. The patient with a puzzling constellation of symptoms may get passed from one doctor to another to a third or even a fourth before a diagnosis can be reached. At that point, the patient is generally so relieved to finally understand what is going on that she may not inform all the doctors she saw along this torturous path.
Hurried hand-offs
When patients go from one doctor to another, there is no organized system for hand-offs. This is often true even within the same hospital. Many diagnostic mistakes take place in the emergency department (ER). If you have ever had to go to the emergency room, you know what a bizarre setting it has become. There is almost always a waiting room full of people, and the wait time is interminable. Unless you are bleeding on the floor or having a heart attack or a stroke, you could easily be there for many hours before you are seen. The people who work in the ED are harried and often have to make snap decisions under pressure. In one study of malpractice claims, “approximately half of the missed diagnoses (52 percent ) involved emergency physicians.”

Communication breakdown
Whether during a hand-off or at some other time, communication failures cause problems. When patients don’t get to tell their whole story, important clues are missed. When doctors don’t communicate all relevant details to colleagues, the diagnosis and treatment can go horribly wrong. . . . Patients sometimes complain about having to repeat their whole history and all their symptoms to each health care provider they see, but instead of feeling miffed, they should take advantage of the opportunity.
As one can easily see, the fault can be shared by both the patient and the doctor. We must become a partner in our health care. Don’t assume that the doctor “knows best,” because only you know how you feel and are reacting to the medications you are prescribed.

Part Three will discuss Mistakes Doctors Make When Prescribing Medications.

Wednesday, October 8, 2014

Top 10 Screwups Doctors Make

Part One of a Six-Part series on Medical Care
In times past, we were taught that “Doctor knows best” and “Do what the doctor tells you.” Not being medically trained, we accepted that as conventional wisdom — even more so if the doctor visit was made in a military context where service men and women are taught to obey unquestionably the orders of officers set over them.
Conventional wisdom is, unhappily, often wrong, particularly when it comes to our health. The wise consumer will ask pertinent questions and become a participant in their personal health issues.
Mistakes are most commonly made when complete communication is lacking in a clinical situation.
Joe and Teresa Graedon, authors of Top Screwups Doctors Make and How to Avoid Them reflected on the simple fact that doctors are humans with limits:
Doctors have an impossible job. They have to learn way more information than any human is capable of retaining during their medical school education and residency training. Then they have to keep up with the latest developments in research and treatment despite grueling hours seeing patients. They frequently have to wrestle with insurance companies and all sorts of other bureaucratic bottlenecks. Finally, they are under enormous time pressure to see as many patients as possible. We have talked with many doctors who complain about having to practice “assembly line medicine.” It’s no wonder that sometimes doctors make mistakes.
Note: quoted passages are excerpts from Top Screwups Doctors Make and How to Avoid Them.
If we are to receive the best medical care, we must become collaborating partners with our medical providers to help them help us. Doctors must be like detectives to ferret out the true facts of the situation we present them with.
In the same way detectives must listen carefully and question involved individuals to arrive at the truth of a crime, so a doctor must carefully question his patient to grasp the presenting health problem.
Not listening to patients
Studies repeatedly show that many doctors have a habit of interrupting patients within twelve to twenty seconds of the beginning of an office visit. This frequently means that the patient never gets to tell the whole story. When sidetracked by an interruption, she may not ever get to finish telling the doctor about her chief concerns. Because a proper diagnosis depends so much on the patient’s story, interruptions interfere with the ability to make the right diagnosis and determine the best course of treatment.
Misdiagnosing
One of the primary reasons to visit a physician or go to a hospital is to find out what’s wrong. We assume that all those arduous years of training have prepared doctors to figure out exactly why we are having symptoms . It turns out that misdiagnosis is far more common than most patients ever imagine. . . “an estimated 40,000 to 80,000 US hospital deaths result from misdiagnosis annually.”
Providing too little information
Physicians are placed in an untenable position. On the one hand, they are told to follow the tenets of the Hippocratic [O]ath, which includes the admonition to “do no harm.” On the other hand, every medicine they prescribe has the potential to cause side effects, at least in some people. This double bind often results in doctors’ glossing over possible side effects for fear that mentioning them will bring them on by the power of suggestion. . . . in one study of emergency room doctors , researchers found that “information on diagnosis, expected course of illness, self -care, use of medications, time-specified follow-up, and symptoms that should prompt return to the ER [emergency department] were each discussed less than 65 percent of the time.

Not dealing with side effects
You would think that if patients reported side effects from a medicine, most physicians would respond promptly to try to solve the problem. But at least one study showed that doctors failed to address one out of four patient-reported symptoms.
Undertreating or ignoring the evidence
Doctors have adopted a mantra called “evidence-based medicine.” The idea behind it is to use treatments that have been proved effective. [One doctor] has suggested that far too many patients die because their physicians failed to implement the best treatment for their condition. One of the most obvious examples is a failure to prescribe an inexpensive generic drug called spironolactone (Aldactone) for patients with congestive heart failure (CHF), a common and very dangerous condition in which the heart has trouble pumping blood efficiently. Nearly 6 million Americans suffer from congestive heart failure, and one out of five dies within the first year after diagnosis.
Overreacting or being seduced by numbers
Doctors who don’t understand how to evaluate statistics regarding drug effectiveness may easily fall prey to drug company advertising. These ads often lead them to overestimate benefits and underestimate risks. Many doctors believe that more is better. We [the Graedons] have another phrase for this idea, the “lottle” principle: if a little is good, then a lottle will be better.
Overlooking drug interactions
We have been writing about the dangers of drug interactions for more than thirty-five years. This is truly one of the colossal screwups that doctors make on a regular basis, and it accounts for an astonishing amount of disability and death. . . . Americans take an astonishing number of medications, and not all of them get along. Researchers have found that 81 percent of older adults took prescribed drugs. More than half “used 5 or more prescription medications , over-the-counter medications, or dietary supplements.” A surprising number of people swallow dozens of pills daily. . . . A fascinating study was conducted to test prescribers’ knowledge of potential drug-drug interactions. Questionnaires were mailed to 12,500 physicians, nurse practitioners, and physician assistants. These prescribers were asked to determine the safety of fourteen drug pairings. Of the 950 who responded, fewer than half correctly identified all the unsafe combinations.
Failing to revise the plan
A popular definition of insanity is “doing the same thing over and over again and expecting different results.” We frequently hear from patients who have experienced severe muscle pain and weakness as a side effect of a statin-type cholesterol-lowering drug. The doctor responds by prescribing another statin. Although this occasionally works, more often than not the patient has the same symptoms all over again, only to be prescribed yet a different statin.
Overlooking lab results
In a busy practice, a doctor orders a lot of lab tests for diagnosis or monitoring. Unless she has a well-organized system in place for tracking the results when they come back, important information may fall through the cracks. This is far more common than most people realize. . . . Researchers reviewed medical records of over 5,000 patients in twenty-three different medical practices. The investigators discovered more than 1,800 abnormal test results. Of these, 135 patients had never been told the results of their test. That means 1 out of 14 patients with abnormal results did not hear about them. Practices varied enormously in their failure rates. In some cases, as many as one-quarter of abnormal test results were not communicated to the patient.
In other practices, every worrisome lab finding was relayed to the patient. Not communicating test results to a patient can be life threatening.

Not addressing lifestyle issues
Doctors know that healthy habits could replace a lot of medication . Researchers have proved this beyond a shadow of a doubt. One study from Britain followed almost 5,000 adults for about twenty years. People with poor health habits (smoking , drinking too much, not exercising, and eating badly) were likely to die twelve years earlier on average. Even though physicians frequently tell their patients to lose weight , stop smoking, and exercise more, everyone gets frustrated at the lack of progress. Most doctors don’t know how to help patients change their behavior; teaching those skills is not a priority in medical school.

Part Two will discuss Why doctors screw up diagnoses.

Sunday, September 21, 2014

Safe Patient Checklist

Many of us just accept uncritically what our doctors tell us—if we even hear what they tell us. That can result in disability or death. In their book, Top Screwups Doctors Make and How to Avoid Them, Joe and Teresa Graedon provide techiques for preventing the screwups.
The death toll from health care screwups adds up to at least 500,000 Americans annually. I don’t currently have access to specific statistics for VA doctors, but, given that they receive the same training, it is not unreasonable to believe that our experiences with VA medical doctors will likely be much the same.
Here are the Graedon’s recommended key strategies for safer health care:
  • Take a prioritized list of your top health concerns/ symptoms.
  • Ask the doctor for a recap to make sure you have been heard.
  • Take notes or record the conversation: you won’t remember everything you have heard.
  • Take a friend or family member to be your advocate and record keeper.
  • Get a list of all your medications and supplements so that interactions can be prevented.
  • Find out about the most common and serious side effects your medications may cause.
  • Ask the doctor how confident he or she is about your diagnosis.
  • Find out what else could cause your symptoms.
  • When in doubt, seek a second opinion.
  • Always ask your providers to wash their hands before they examine you.
  • Get [and keep a file of] your medical records and test results.
  • Keep track of your progress: maintain a diary of relevant measurements such as weight, blood pressure, and blood sugar readings.
  • Be especially vigilant when moving from one health care setting to another. Mistakes and oversights are especially common during transitions.
  • Ask how to get in touch with your providers. Get phone numbers or e-mail addresses, and learn when to report problems.
  • Inquire about resources to learn more about your diagnosis or treatment.





Friday, June 27, 2014

Perception as Reality

During the Lincoln-Douglas debates in the summer of 1858, Abraham Lincoln was debating Stephen A. Douglas on the subject of slavery. Lincoln felt that Douglas was presenting spurious arguments in favor of allowing States to decide for themselves whether to be slave-owning or disallowing slave ownership.
Douglas maintained that any State, anywhere, at any time, had a right to have slavery if the majority of its citizens voted for it. And he didn’t care whether they voted it up or down. His celebrated slogan was this: “Let each State mind its own business and let its neighbors alone.”
Lincoln replied, “In Judge Douglas’s thinking slavery is right and my thinking is wrong is the precise fact upon which depends the whole controversy. He contends that whatever community wants slaves has a right to have them. So they have, IF it is not a wrong. But if it IS a wrong, he cannot say people have a right to do wrong.”
His arguments, Lincoln said had got down to the point where they were as thin as “soup made by boiling the shadow of a pigeon that had starved to death.” He [Douglas] was using specious and fantastic arguments of word, by which a man can prove a horse-chestnut to be a chestnut horse.”
If Lincoln were alive today, he could clearly make the same arguments against the LGBT community and other morally–challenged individuals who advocate for allowing homosexuals in society and the military. Their arguments of alleged “rights” are degrading society and are no more rights than the so-called rights of slave-owners to hold slaves.
We are cast adrift into a sea of raging immorality and will likely flounder if we remain no longer tied to eternal values as reflected in the Judeo-Christian scriptures upon which our nation was founded.
In his debates with Douglas, Lincoln stated, “If a man will stand up and assert, and repeat and assert and reassert, that two and two do not make four, I know nothing that will stop him. I cannot work and argument into the consistency of a mental gag and actually close his mouth with it.”
Lincoln’s remarks remind us of the passage in the book or Proverbs where it says, “Do not answer a fool according to his folly, or you will be like him yourself. Answer a fool according to his folly, or he will be wise in his own eyes.” (Proverbs 26:4-5 NIV)
I often say, “You can’t fix stupid!”
Too many in positions of leadership live by the clichĂ©, “Perception is reality,” and through false assumptions inherit in Common Core are teaching our youth and our society that two and two does not necessarily make four. Morally-challenged leaders continually assert that if they say something often enough it becomes reality, because they say so.
For individuals to continually reassert that marriage is not limited to relationships between a man and a woman or to say that restrooms and locker rooms must be jointly used by both genders based upon nothing more than an assertion that a person “feels” they are of a gender other than the one they were born with is ludicrous. God calls it sin and warns mankind of the eternal danger they are placing themselves in!

Such arguments fall into the very categories cited by Lincoln in his debates with Douglas; “using specious and fantastic arguments of word, by which a man can prove a horse-chestnut to be a chestnut horse.”

Friday, May 30, 2014

Topping Dandelions Doesn’t Work

Last year I was lax in attending to an infestation of dandelions in my grass. I started too late and failed to consistently keep up with their removal. Sometimes in my haste to move on to recreation or other more urgent projects, I wasn't careful to ensure the total removal of the weeds. The tops would detach themselves easily, leaving the main plant stem and the roots intact only to regrow within days.
If the lawnmower cut off the flower or fuzzy seedpod and the roots stayed in the ground. God allowed another flower to appear shortly. The secret was to apply a weed and feed product while the grass was wet.
Having Eric Shinseki resign as head of the Veterans Administration is like cutting off the flower of a dandelion. Unless we root out the whole plant, the weed will regrow. Don’t get me wrong, removing the head is a good thing; just insufficient in itself to ultimately solve the problem of VA weeds!

What has been allowed by this administration and previous administrations in regard to veteran medical care is an abomination! The source of the malfeasance and malpractice must be rooted out. Impeachment and criminal prosecution of the head of this federal administration and his complicent sycophants is needed urgently. 
The lies and misdirection must stop! Veterans have given of their lives and health to serve this country. We owe them!

Monday, March 31, 2014

Why go for second best?

If the Lord is the very best, why accept less than the very best.
When I was growing up money was very tight. It was a time of economic recession in the 1950s.
As a young Boy Scout when most other kids could afford to buy sponsored scout gear, I was reduced to making my own gear. My back pack frame was made from the ladder back of a wooden chair that hard been ready or its terminal trip to the refuse heap at our community trash dump. Don’t be mistaken, it got the job done because it allowed me to transport my canvas pack and support the gear it contained for hiking and camping. My camping gear was the remaining World War Two equipment my dad had brought home from the war: shelter halves and mess kit.
As I got older, this mindset stayed with me. Without affirmation from an often absent father, I lacked the confidence to believe that I was worthy of having quality material things.
I was always willing to accept second best.
In my senior year in high school, I had the opportunity on Career Day to visit California Institute of Technology in Pasadena. After hearing a lecture by Dr. Linus Pauling, I wanted to attend CalTech, but thought that my grades were probably not good enough, so I didn’t even try. Don’t get me wrong, I was not a bad student, pulling down Bs and a few As. Besides that, my parents could not afford to pay the tuition for me to go to CalTech.
I was a member of an Explorer aviation squadron during high school and loved to fly the sailplanes we had. I thought maybe I could try one of the service academies and get a college degree paid for by the government. I applied for an appointment to the Naval Academy and was only able to secure an alternate appointment, so I decided to register for Junior College. San Bernardino Junior College had an excellent aviation program, so I signed up for that. It was the best of times and my aviation instructor put me up for a scholarship competition just at the time I was ready to graduate with an Associate of Arts degree in Aeronautical Technology.
I was one of two people selected in the competition and won a full-ride scholarship to Northrop Institute of Technology to take a degree in Electronic Engineering. Now I had to make a decision. Did I want to take the scholarship and give up on my dream of becoming a Naval Aviator or did I want to take the Electronics degree? After some discussion with my fiancé, I decided to give up the Navy goal and go into Electronics; a booming career field at that time.
The Navy did not allow midshipmen to be married, so going to the Academy would have meant postponing our marriage for four years.
Most of my fellow classmates at Northrop took jobs in the electronics industry at some very good salaries. I decided to take the safe route and went to work for a telephone company in the small desert town where I had graduated from high school at far less salary than my fellow NIT graduates. I avoided taking the necessary written test to work at Pacific Bell because I didn’t have the confidence that I could pass it. Don’t get me wrong, the phone company job allowed us to move back to a familiar environment near where we had met and had gone to high school. It wasn’t the best, but it worked for me and my family.
I was not yet a Christian, although my wife and I attended church regularly.
After a couple of years at the phone company, they were bought out by another phone company and I began to look around for other work. My job in the Building Engineering department was not very exciting or overly challenging, despite the tremendous personal growth I experienced learning electrical engineering. I had really wanted to work with microwave engineering, but no jobs were available after I completed six-months as a Management Trainee. The local cement manufacturing company placed an advertisement for an electrical engineer. I interviewed for the job and got it.
After a few years working in the plant, I had moved around through several jobs: Electrical Engineer, Packing Foreman, Production Foreman and then Electrical and Instrument Foreman. While working as Electrical and Instrument Foreman the Plant Manager decided that I needed to gain more personal confidence and speaking ability and I signed up for a Dale Carnegie course entitled “Human Relations and Public Speaking.” During the fourteen week course I was able to find the confidence that has served me well to this day. Later I was promoted to Maintenance Management Supervisor in charge of all plant maintenance planning.
Just after the Dale Carnegie course, I accepted Jesus Christ as my Savior and made Him Lord of my life.
I quickly learned that accepting a personal relationship with and serving God was moving me toward eschewing second best and going for the very best: God’s will!
As I look back to that time, I reflected on the fact that had I gone to the Naval Academy, I would likely have been sent to Vietnam and possibly have given my life there. God was watching out for me even when I did not know it!
In 1972, I was selected to move to the office of the Vice President of Operations as his assistant. While working at the local company headquarters I sensed a call to full time ministry and began to prepare myself with courses to qualify for the necessary church credentials to ultimately become a pastor of a church.
After being credentialed as a Christian Worker, the first level of credentials, I had changed jobs and was hired as a part-time Associate Pastor at a church in the new town we moved to. While serving that church, I was called to prepare to be a Navy Chaplain. Finally, the Lord had me where He wanted me in the Navy, not as a pilot but rather as a “sky pilot” (what some call a chaplain).
God’s plans are always the very best!
He always prepares us for the destination He intends for us and it is always the best. The pathway to the best takes us through second best at times, but always ends up with His best!
Don’t let anyone tell you to do what you can and then let God finish it for you. That is second best because you are the weak link in that chain.
The very best is experienced by doing what the Lord wants you to from the very beginning!
The world will try to draw you in to the second best. Scripture tells us that, “Your enemy the devil prowls around like a roaring lion looking for someone to devour” (1Pet. 5:8 KJV). So there is a being or force working to divert us from positive endeavors. This being or force is identified as God’s enemy, the devil.

Don’t accept second best!

Sunday, February 23, 2014

A Shock to NBC!!!

If you read this and agree that "under God" should be left in the pledge, then just LIKE or SHARE it and forward your thoughts to those you have voted for it to be left in.
If you ignore it and don't LIKE or SHARE it you are voting no to "under God".  Easy huh!!!
Official versions (changes in bold italics)
1892                       "I pledge allegiance to my flag and the republic for which it stands: one nation indivisible with liberty and justice for all."
1892 to 1923           "I pledge allegiance to my flag and to the republic for which it stands: one nation indivisible with liberty and justice for all."
1923 to 1924           "I pledge allegiance to the flag of the United States and to the republic for which it stands: one nation indivisible with liberty and justice for all."
1924 to 1954           "I pledge allegiance to the flag of the United States of America, and to the republic for which it stands; one nation indivisible with liberty and justice for all."
1954 to Present       "I pledge allegiance to the flag of the United States of America, and to the republic for which it stands, one nation under God, indivisible, with liberty and justice for all."
This is not posted for discussion. If you agree, LIKE and SHARE...  I don't want to know one way or the other.  By my posting it, you know how I feel.
Do you believe that the word God should stay in American culture?
NBC had a poll on this question. They had the highest number of responses that they have ever had for one of their polls, and the percentage was this:
86% to keep the words, In God We Trust on our currency and God in the Pledge of Allegiance
14% against
That is a pretty 'commanding' public response in the “For’ category!.
86% of Americans responding said that believe the word God should stay... 
Therefore, I have a very hard time understanding why there is such a mess about having 'In God We Trust' on our money and having God in the Pledge of Allegiance. 
Why are we catering to this 14%? Is it out of some false sense of tolerance? Is it just because we have accepted the brainwashing foisted upon us? Say NO to the usurpers!
In God We Trust!
Many of our fathers, sons, brothers and sisters served to protect and defend this nation in wars against tyranny and many also paid the ultimate price for our freedom, speaking the word God at the end. We dishonor their memories when we yield to the small number of ignorant, manipulative people who would deny us our heritage.
It’s time for real Americans to stand up and defend the values upon which our country was founded!

Monday, February 3, 2014

Does this sound like anyone you know?

. . . [He] is arrogant and never at rest. Because he is as greedy as the grave and like death is never satisfied, he gathers to himself all the nations and takes captive all the peoples. "Will not all of them taunt him with ridicule and scorn, saying, 'Woe to him who piles up stolen goods and makes himself wealthy by extortion! How long must this go on?'”  (Habakkuk 2:5-6 NIV)
A certain national leader, who has risen far above his ability to lead, can be described by these ancient words of the prophet Habakkuk. This unnamed, but prominent leader (if one can be generous and call him that) must be warned that he is in the spotlight and will be called to answer for his arrogance, greed, lies and thievery.
Taking multiple million dollar vacations at government expense, smoothing the way for generous gifts to nations who are our enemies, overtly removing protection from Israel, and decimating our military—reducing its ability to protect us—are all, or should be, considered treasonous, impeachable and prosecutable offenses.
His sycophants in Congress as well should take note and bring their behavior in line with good practices of morality and ethics. Continuing to serve the present leader reveals their true immorality and ethical behavior.
A question commonly asked of our fellow citizens is, “Are you behaving yourself?” It is usually answered in the affirmative. The true answer is, “Of course I am behaving myself.” The differentiator is the quality of the behavior.

Failure to constantly evaluate ones behavior has eternal consequences. Take note, Obama, Pelosi, et al!

Wednesday, January 29, 2014

A Prophetic Word for Our Nation’s Leadership

As recorded in scripture, the Prophet Micah warned the leaders of Israel:
. . . "Listen, you leaders of Jacob, you rulers of the house of Israel. Should you not know justice, you who hate good and love evil; who tear the skin from my people and the flesh from their bones; who eat my people's flesh, strip off their skin and break their bones in pieces; who chop them up like meat for the pan, like flesh for the pot?" Then they will cry out to the LORD, but he will not answer them. At that time he will hide his face from them because of the evil they have done. This is what the LORD says: "As for the prophets who lead my people astray, if one feeds them, they proclaim 'peace'; if he does not, they prepare to wage war against him. Therefore night will come over you, without visions, and darkness, without divination. The sun will set for the prophets, and the day will go dark for them. The seers will be ashamed and the diviners disgraced. They will all cover their faces because there is no answer from God." (Micah 3:1-7 NIV)
 Micah’s prophetic warning to the leaders of Israel is equally applicable to the leaders of the United States of America which was founded on the same Judeo-Christian values. Our founding fathers espoused high standards of behavior, morality and integrity. While not always living up to all of those standards, at least they strove to do so.
When devising our Constitution as a new nation state, they recognized the disvalue of allowing tyrants and the resulting tyrannical government to rule over it.
Concepts embodied in the Bill of Rights appended to the Constitution served to limit the extent to which the federal government could oppress and intimidate its citizens:
  • Recognizing that speech must be freely allowed in a free country.
  • Providing for self-defense and the defense of the country through a non-government-controlled and armed civilian militia.
  • Quartering of soldiers in private homes prohibited without consent of the owner.
  • Right to a speedy trial and favorable witnesses.
  • Unreasonable search and seizure prohibited. Liberty was ensured through prevention of government intrusion into the private lives of the people without due process of law.
  • Rights of non-self-incrimination.
  • Right to a jury trial in civil cases.
  • Prevention of cruel and unusual punishments.
  • People’s rights not denied or disparaged when not enumerated in Constitution.
  • States right protected as rights of the people.
  • Prohibition of slavery or involuntary servitude.

Yet our national leaders tend to ignore those clear founding ideas and assert the rule of law set down in the Constitution is outdated. Clearly, when leaders are honored, they presume to declare certain rightness to their actions, but when castigated for inappropriate behavior such as proffering liberal or progressive initiatives opposed to the consensus of the citizenry, leaders mock, label with unkind labels, and belittle those opposed to them.
When leaders such as those in Washington D.C. openly lie to the citizens of this nation they demonstrate to us that they consider it right to do so and thus mentor those with patterns of uncritical thinking to emulate them. Deception is endemic at this time in history! When one branch of government adopts a stance of if you oppose me I will use Executive Orders to go around you, that branch usurps the boundaries designed by the founding fathers and creates a culture of tyranny. When the Judicial branch makes law instead of performing its role of assessing law in light of constitutional provisions, tyranny is further encouraged. When the legislative branch fails to keep in check the two other branches, tyranny is authorized.
Unrighteous liberal and progressive leaders wage war against their opponents. Epithets such as “Racist” or “Bigot” or “Ultra-Conservative” are applied to the persons opposing the immoral behavior or speech or liberal and progressive agenda leadership.
Micah referred to leaders who lead God’s people astray. Leaders who dissimulate or obfuscate ideas and intentions with the goal of subverting the population to adopt, tolerate, and accept unrighteous results are positioning themselves to be ashamed and disgraced; maybe not immediately, but certainly in the final judgment at God’s docket.
Such leaders are warned that the day will come that sees the sun set on their initiatives and darkness descend like night.
Be not deceived America! God has placed a choice before us — to obey His commandments or to die spiritually because of our disobedience.  Lee Greenwood, singer, songwriter, and American patriot in his new book, Does God Still Bless the USA? asks the title question.
His answer may surprise you. Greenwood says that God doesn't bless countries as much as the people in those countries where they set and live out their values as the Lord designed them.
Making the choice to abort children has taken us below what population experts have identified as the optimal level of reproduction for a thriving nation.

Accepting and tolerating sexual sins has put us in the position of becoming recipients of God’s judgment.
America! It is time to cast out and remove from power by impeachment those abusing the power granted them!

Tuesday, January 14, 2014

Protection from a Cyber-Economic Attack

We are to be the recipients of cyber-economic attacks
Actually, we already have been and can expect to be again. This is not if, but when!
Kevin Freeman in his book Game Plan discusses the problem in depth and suggests some solutions urgently needed. 
This book is an important read. I highly recommend you read it and take note. Here are some excerpts from the book:
There Is Hope
The amazing thing about the current global economic war is that the United States of America is still ideally positioned to win. If we act properly, it’s not too late to usher in a period of global peace and prosperity. It’s not too late, even though we have accumulated the largest budget deficits and national debt in history. Even though we have over-shackled our people with crippling rules and regulations. Even though we have nearly abandoned all the things that made America great in the first place. It’s still not too late. But it is close.
There are dozens of reasons to believe that the American experiment will end in failure. We have plenty of internal problems— out-of-control spending, paralyzing political agendas, a government that operates more like a confidence game, an apathetic population, and a system that rewards failure and punishes success. In many ways, we are our own worst enemies.
Externally, we have enemies who want to see America go away. Some of them are parasites on our prosperity and intend to bleed us dry over the long term. Others hate us ideologically. Some simply resent our success. Whatever their motivation, they are intent on our destruction.
There are eight steps we must take to restore our greatness. The first is to admit we have a problem.
Step One: Recognize the Global War Under Way
Officials in defense and intelligence have little training in economics. Even those who appreciate our economic problems don’t understand that our enemies could use economic weapons to damage us.
Step Two: Take Reasonable Precautions
The United States should take a few reasonable precautions to protect its financial system and infrastructure. These measures are not costly, but they will provoke opposition from some powerful interests that benefit from the status quo, so they will require political will.
First, we should prohibit naked short selling and naked credit-default swaps.
Second, we should also look into ways to strengthen the cybergrid. The military has developed a Cyber Command, and that is a start.  But we have little in the way of private-sector defense.
Third, we should reinstitute the civil defense measures that were maintained during the Cold War. There was a time when every school-child in America had an action plan in case of an attack. 18
Finally, there is promising legislation aimed at preventing disaster from an electromagnetic pulse— either natural, from solar flares, or from a deliberate missile attack— that should be adopted.
The key is to take sensible steps in response to the reality that we face a global economic war. Now is the time to prepare— before disaster strikes.
Step Three: Get Money Moving without Money Printing
Since 2009 the Federal Reserve has conducted three rounds of “quantitative easing.” It has pumped trillions of dollars into the system, and yet the economy remains stagnant. Just before the 2008 crash, the Federal Reserve’s balance sheet was around $ 800 billion. Five years later it was in the range of $3.6 trillion. The unemployment rate has barely dipped, and that minimal decrease is attributable to workers’ getting discouraged and giving up the search for a job. So why isn’t all this new money from the Fed making the economy strong? The answer from economists is that the “velocity of money” is too low. In plain English, that means that individuals and businesses have been hoarding cash. Consumers have been reluctant to spend, and companies have been slow to expand.
So where has all the money gone? Corporations now hold a record amount of cash, and they have kept almost $2 trillion of that overseas. 26 A mere eighty-three companies hold almost $1.5 trillion among them. The reason that American companies hold so much cash in offshore accounts is our tax code. The United States has the highest official corporate tax rate in the world. Even accounting for various deductions and manipulations that allow companies to pay less than the stated rate, we are ranked ninety-fourth out of one hundred nations in tax competitiveness. . . .
Corporate leaders have made it clear that if the U.S. tax system didn’t penalize them, they would invest and spend at home.
Step Four: Achieve Energy Independence
One of the areas in which we could let American companies invest that overseas cash is energy. The same government that wants to tax corporations’ overseas cash at 35 percent set aside $80 billion of the $800 billion stimulus for green energy. While not all of that money was spent, at least thirty-four of the recipients of this federal subsidy have already gone bankrupt, taking billions of taxpayer dollars with them. Were these projects chosen solely because of their economic merit? Not according to the Hoover Institution’s Peter Schweizer. In Throw Them All Out, he writes that 71 percent of the Obama Energy Department’s grants and loans were given to “individuals who were bundlers, members of Obama’s National Finance Committee, or large donors to the Democratic Party. . . .” Politico reported in late 2011, “The Energy Department’s inspector general has launched more than 100 criminal investigations related to 2009 economic stimulus spending.” Everyone knows about Solyndra’s bankruptcy (costing taxpayers a half billion) and should understand that the government isn’t the ideal venture capitalist.
There is an understandable interest in developing new forms of energy with the hope that they will create jobs and strengthen our economy. But when you contrast the government failures with private-enterprise successes, you begin to see why we should promote the free-market approach to energy development. . .
Alternative energy is only one step toward American energy independence. What if we allowed some of that corporate cash to accelerate fossil fuel development as well? . . .
What if American corporations were allowed to repatriate foreign cash if they invested to promote energy independence? . . .
Lifting the ban on offshore drilling could result in a million new American jobs, according to some estimates, and reduce our reliance on foreign oil. Our energy future is bright— if we don’t foolishly spoil it. . . .
Developing our domestic energy resources is essential to our fight in the global economic war.
Step Five: Reduce Regulation
A couple of years after President Ronald Reagan left office, [the author]  had the privilege of presenting him with the Adam Smith Award for Individual Excellence in Free Enterprise. Reagan’s modest response was: “Really, all I did was get the government the hell out of the way so good people like you could grow the economy.”
Since the end of Reagan’s presidency, however, the regulatory burden has grown uncontrollably. Back in 1974, Reagan, then the governor of California, complained about forty-five thousand pages of new federal regulations. Today there are about 175,000 pages of new regulations.
Step Six: A Workable Tax Code
Reform of the tax code should go hand in hand with a reduction of regulation. Nearly everyone agrees that the current tax system is a convoluted mess. It does not maximize revenues, and it hampers economic growth.
So how do we fix it? There are four basic options:
1.      Simplify the system by stripping it of numerous breaks, leaving only those which help grow the economy or make the tax code fairer.
2.      Implement a flat tax, which would give people more incentive to work and invest their earnings back into the economy.
3.      The so-called fair tax would eliminate the payroll tax and impose a national sales tax on purchases of new goods and services, excluding necessities. The fair-tax rate after necessities would be 23 percent, which equals the lowest current income-tax bracket (15 percent) plus the employee’s share of payroll taxes (7.65 percent).
4.      A combination of the flat tax and the fair tax might ameliorate the problems with each. The flat tax does not eliminate the payroll tax, while the fair tax, depending on one’s state sales tax, could leave someone with a tax burden of close to 40 percent of his income. One proposal is to combine a flat income tax of about 16 percent (eliminating altogether the tax liability of the poorest) with a national sales tax or VAT of roughly 10 percent.
Each idea has merit, and each has its proponents. Regardless of what we do, we have to fix the tax code. Such a fix would dramatically enhance our ability to fight in the global economic war.
Step Seven: Teach What America Is All About
Immigration is a serious problem. Some argue that because our native population is declining, we need more immigrants to fuel growth and allow America to compete in the global market. Others argue that uncontrolled immigration will destroy the fabric of society. Richard Lamm, as governor of Colorado, “saw how employers were using illegal immigration for cheap labor and in some cases firing Americans so they could hire illegals who they could pay less and work harder. I saw the incredible flow of illegal aliens who crowded out American workers in construction, packing plants, the service industry, etc, many of whom were paid ‘off-books’ so we got no state income taxes from them.”
Others worry that our lax immigration policies will allow terrorists to infiltrate our nation. . . .
Immigrants built our nation, and immigration is an essential part of the American story. What’s different, however, is that immigrants are no longer taught the uniqueness and greatness of America. It used to be that we were a cultural melting pot. Now political correctness teaches us to maintain and celebrate our differences rather than coming together. Our educational institutions seem intent on developing disdain for America by highlighting failure rather than celebrating success. . . .
Our own government is in on the act— often leading the way. The air force teaches that the Founders of the United States were extremists: “In U.S. history, there are many examples of extremist ideologies and movements. The colonists who sought to free themselves from British rule and the Confederate states who sought to secede from the Northern states are just two examples.”
This is a nation that has lost its moral compass and so has lost its way. The corrosion of Americans’ self-understanding has seriously weakened us. But there is a solution. We can begin celebrating the Founders and their principles. We have to return to old-fashioned patriotism. And, we have to make such teaching a part of any immigration solution.
Step Eight: Return to Our Spiritual Roots
 Of the eight steps, this one is the most important. American was founded on the Judeo-Christian principles of Western civilization. As George Washington affirmed, “It is the duty of all nations to acknowledge the providence of Almighty God, to obey His will, to be grateful for His benefits, and humbly to implore His protection and favor.” He also said, “Of all the dispositions and habits which lead to political prosperity, religion and morality are indispensable supports.”
President Reagan warned us not to forget our national dependence on divine Providence: “If we ever forget that we are One Nation Under God, then we will be one nation gone under.” . . .
[The author agrees] with President Reagan. Remembering our spiritual heritage is the most important step we can take in defending America, because our problem isn’t really economic or even political. Our real problem is spiritual. “Blessed is the nation whose God is the Lord,” writes the psalmist (Psalms 33:12). The Bible promises blessings to the obedient: “The Lord shall open unto thee his good treasure, the heaven to give the rain unto thy land in his season, and to bless all the work of thine hand: and thou shalt lend to many nations, and thou shalt not borrow. And the Lord shall make thee the head, and not the tail; and thou shalt be above only, and thou shalt not be beneath; if that thou hearken unto the commandments of the Lord thy God, which I command thee this day, to observe and to do them” (Deuteronomy 28:12– 13).
To the disobedient, in contrast, God promises a curse: “thou shalt not prosper in thy ways: and thou shalt be only oppressed and spoiled evermore, and no man shall save thee” (Deuteronomy 28:29). “The fruit of thy land and all thy labors, shall a nation which thou knowest not eat up” (Deuteronomy 28:33). “The stranger that is within thee shall get up above thee very high; and thou shalt come down very low. He shall lend to thee, and thou shalt not lend to him: he shall be the head, and thou shalt be the tail” (Deuteronomy 28:43–44). By these verses, America today sounds more like a nation under a curse than a nation under blessing.
The Bible also warns that “the borrower is servant to the lender” (Proverbs 22:7). The decline of American influence has been rapid and has coincided with the rise in our federal debt. The Canadian newspaper publisher and biographer Conrad Black has observed, “Not since the disintegration of the Soviet Union in 1991, and prior to that the fall of France in 1940, has there been so swift an erosion of the world influence of a Great Power as we are witnessing with the United States.”
Now, if the problem is spiritual, the solution will be spiritual as well. America needs wise economic and security policies, but those policies alone will not restore our greatness. America needs a spiritual revival: “If my people, which are called by my name, shall humble themselves, and pray, and seek my face, and turn from their wicked ways; then will I hear from heaven, and will forgive their sin, and will heal their land” (2 Chronicles 7:14).
Conclusion
After in-depth research on behalf of the Pentagon, it became obvious to me that America suffered a financial terror attack in 2008. . . .  Make no mistake; we are in a global economic war.
The bad news is that we are fighting blindly. Too few in our nation’s leadership have grasped what we are facing. Call it ignorance or arrogance. Either way, we are not prepared to defend the dollar in world trade, protect trade secrets from corporate espionage, or safeguard our financial systems from cyber attack. There are even more serious risks, like the EMP that could send us back to a pre-industrial age. Our $17 trillion debt creates a whole host of vulnerabilities. Yet we go on as if American supremacy will endure forever.

Excerpt from Chapter Twelve of Game Plan: How to Protect Yourself from the Coming Cyber-Economic Attack by Kevin D. Freeman. Available from Amazon.com in either hard-cover or Kindle versions.