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It is time for us [Americans] to take action to keep our children safe [and thus reduce the rate that our children die]. An opinion piece in the February 18, 2028 New York Times by David Leonhardt reports that the United States is now "the most dangerous of affluent nations for a child to be born into."  This reflects that in the United States we mourn the death of our children from guns but then do nothing to protect our children from future gunfire. The United States now has the highest number of children [up to age 19] dying per one million children [6,500] compared to other affluent countries with Canada having 5,200 children dying and Britain has 4,600 dying. The average of the 20 high income [affluent] countries is 3,800 children dying. So, why are we the worst?  Well, besides the number of children dying from guns, the other two areas that kill our children are vehicle crashes and infant mortality.  If we compare the deaths of our children to the average number for high income countries, this represents 21,000 excessive deaths per year. 

What are some things that we can do to save more of our children's lives?  We can make background checks universal, make waiting periods longer and tighten access to semiautomatic weapons. It would also help if we had far fewer guns , recognized that we don't require guns to support our self-esteem and believe that our precious children have the right to not die from guns.  In addition, to save more of our children's lives we can also enforce speed limits, seat belt use and no texting while driving [or talking on cell phones ]and ensure access to health care for everyone, especially our children.

So, are the lives of 21,000 children each year worth the hassle of background checks, a waiting period before you get a gun, it being more difficult to buy an assault rifle, having to follow safe driving behaviors and having to pay for everyone to have access to health care?

If you believe that our children's lives are worth this, then insist that your congressperson and senator take action now and don't let up on them until they do or until you have replaced them.



When I was looking at the acknowledgments at the beginning of a book by Kate DiCamillo called The Tiger Rising, I noticed that the acknowledgments ended with thanking a specific person for "believing that I could and that I can. And that I will." I rarely look at this section of a book but I did this time and really only at the end that I have quoted above.  Who knows why?  However, I believe that this is one way of talking about or describing what being supportive and encouraging is.

This is important to me because when I am helping my patients to stop feeling and acting responsible for others, they need to have something that they can replace that with. I believe that being encouraging and supportive is a good way to interact with others. However, defining it has been difficult for me. That is why I was encouraged when I saw what Kate DiCamillo had written in her acknowledgments. So, is believing in someone part of being encouraging and supportive?  I think it is and I have focused on people seeing the strengths in others and communicating this to them as a way of being supportive and encouraging. This does not involve giving advice, making suggestions or taking on responsibility for the other person. Often people that we want to help are not feeling confident, nor recognizing their strengths and abilities.  That is why it is important to recognize the strengths of people we care about and also why it is so very important to not undermine their confidence by giving advice or taking over for them.

I have repeatedly seen that it is critical to not take over for others as this undermines their confidence and is not kind or caring or loving. Now, if someone is used to being dependent on others to do for them and people start expecting them to manage for themselves, they may react negatively at first.  Their reaction indicates that they have a beginning awareness of their need to take responsibility for themselves. So, if you are encouraging and supporting others, they may get mad at you.  This is a good thing as it means that they are more likely to change and start taking responsibility for themselves.  What do you think?



People who threaten others should not have access to weapons. As long as we continue to be obsessed with owning guns, even with the evidence that easy access to guns leads to deaths of many innocent people, it is critical that we put safeguards in place to protect innocent people from potentially dangerous people. The information in the title comes from an editorial entitled "The Terrors of Hearth and Home" in the December 32, 2017 New York Times. The editorial talks about the need for laws that allow police or concerned family members to petition the courts to issue orders that prevent potentially dangerous people from purchasing guns. A few states have the option of the police or concerned family members petitioning the courts to issue an extreme risk prevention order keeping individuals from purchasing guns. This can be critical as very often people who are being bullied and emotionally abused are afraid that obtaining a restraining order will lead to the abuser becoming more violent.  Domestic violence accounts for more than 50% of mass [4 or more people] shootings. To be able to prevent access to guns for people involved in domestic disputes who have threatened family members, could save the lives of family members including many children. 

So, if you feel that being able to temporarily keep violent people from buying guns is something we need in our country to save lives then let others know, including local, state and national government officials.



In a guest column in the November 5, 2017 edition of the Asheville Citizen Times by Marsha Fretwell, M.D., she has concluded that she might be the last happy doctor.  This is because she had practiced as a geriatrician and thus had only Medicare to interact with as more than 96% of her patients were covered by Medicare. This allowed Dr. Fretwell to spend the 30 minutes per patient that she feels she needs to properly listen to and care for her patients. The predictable [compared to for profit insurance companies?] reimbursements from Medicare allowed her to reduce her staff as they did not need to spend longer periods of time with for profit insurance companies to get reimbursed for her services. 

Dr. Fretwell also indicated that our countries Surgeon General reported that second only to the opioid addiction crisis, physician burnout is the next most critical issue in health care. Even though Family Practice, Psychiatry and Internal Medicine are typically paid 50% of what other medical specialties are paid, the most often sited factor in burnout was not inequality of pay but the paperwork demands of insurers that took them away from direct patient care. The ability to form relationships with their patients was felt to be critical to providing quality health care and critical to the satisfaction of patients and physicians.  

I firmly believe and have seen in my practice how important spending time with my patients is.  That is why I do not accept payment from insurance companies.  I have maintained a minimum of 30 minutes with my patients and will often spend 60 to 75 minutes depending on the needs of each patient.  Without a relationship with my patients it is much harder to help them to recover from their anxiety, depression, flashbacks, difficulty concentrating, etc. and experience an improved quality of life that they desire.

Dr. Fretwell goes on to advocate for universal health care as she notes that since for profit health insurance providers have been on the scene, overall health care has declined in the United States.  Dr. Fretwell believes that universal health care will lead to less expensive care, better outcomes, and happier patients and physicians. 

What do you think?



We own more than 310 million guns [2009 National Institute of Justice report]. This is the most of any nation in the world with India coming in second with an estimated 46 million guns. So, we have more than seven times the number of guns compared to the second place country. We are also the world leader in gun violence. Every day 93 people die from guns in our country and this number includes 7 children and adolescents.  Congress continues to refuse to expand background checks [make it universal] before gun purchases even with evidence that this would save lives.  There are gun suppliers who can review their store cameras and see people who bought a gun and then are in the paper the next day having killed themselves with the gun that was sold to them the day before. Of course, owning guns is dangerous to children and adolescents.  According to the Centers for Disease Control and Prevention [CDC] in 2015, 26,252 of us in our country died from gunshot wounds and this included 2824 children and adolescents who died from unintentional shootings and firearm homicides. So, why won't congress pass legislation mandating background checks [representing a delay before a gun can be purchased] when it is so clear that many of us can not manage owning guns safely and it is estimated that more than 90% of us want universal background checks. Is Congress' reluctance related to the fact that the National Rifle Association [NRA] provided more than $50 million to the campaigns leading up to the election of Donald Trump.  Mr. Trump got more than $30 million for his campaign. 

Do we need to let our congress know that we want them to expand background checks or they will risk not being re-elected?  Do we care enough to speak out? Is it the right thing to do? What do you think?