An attorney must have a factual basis for alluding to, offering, or relying on evidence at trial. That factual basis may not be wishful thinking. There are two requirements for a factual basis — an attorney’s subjective belief, and objective evidence to support that belief.
But none exist here Not one document, reference, record, or any other materials exist that are chronologically consistent with these documents being before the board in 2012.
The only document that exists is the litigation packet date-stamped a month after the hearing
I asked Bertram to either provide the factual basis or admit to the false statements. He’s been ignoring me and will not answer.
The whole picture depicts the respondent as an attorney who, when it serves his advantage, is willing to violate clear norms of professional responsibility and to engage in purposeful deceit which harms others.“
The privilege of practicing law does not come without the concomitant responsibility of truth, candor, and honesty. Because no single transgression reflects more negatively on the legal profession than a lie, attorney misconduct involving dishonesty justifies disbarment.” Id. (quoting In re Young’s Case, 913 A.2d 727 (N.H. 2006)).
No matter what it takes I am going to make sure that is a certainty in this case
Make Medicine Great Again! Please Donate and Help Drain this Swamp!
This Sunday marks the beginning of Sunshine Week, a national celebration started in Florida 15 years ago to promote open government. Transparency is about shedding light. Transparency brings accountability, and, often, meaningful reform.
On June 3, 2016 Governor Charlie Baker signed into law the first update to Massachusetts public records law since 1973. House Bill 4333 imposes shorter time frames for agencies to respond to records requests. Most agencies need to respond within 10-days but can be granted a 20-day extension provided they show good cause for it. Those who believe a state agency has violated its legal obligations can petition the Supervisor of Records and agencies are also subject to punitive damages for failure to comply with the requirements.
Massachusetts has historically ranked at the bottom of the barrel in terms of giving its citizens access to public records. A 2015 assessment by a non-profit investigative news organization gave the state a grade of F and ranked it below Mississippi and Arkansas in the category of public records access (40th in the nation).
Under the new law documents previously provided with missing or illegible date-stamps were requested from the board. The sole reason for this request was to determine if these documents were submitted as evidence and forwarded to the tribunal for consideration at the hearing for which they were considered to be heard a, heretofore impossible task due to toothless public records law in Massachusetts. This matter should be a given. If I mail a letter I do not question or fret over whether or not it was received by the person I sent it to and the same dynamic applies here. It is a given assumption that documents submitted as evidence for at hearing reaches those individuals who are supposed to hear that evidence at that hearing. That is how the system is supposed to work and, like a lost letter, exceptions should be rare as there are safeguards in place to assure it. Here we have a group that has removed those safeguards. The Physician Health and Compliance Unit (PHCU) is part of the medical board but independent of the medical board and exist as a self-contained unit with no oversight, auditing of or accountability. The PHCU was created to serve as a liaison between the state PHP and medical board to handle board cases involving doctors being monitored under PHP contract. Ostensibly they are an objective go-between and these individuals are assumed to seek, follow and tell the truth. Their job is to review the evidence and let the chips fall where they may. They do not. Given the power to act as their own hearing officers and present cases to the board they hold all the chips. All evidence supporting any doctors case before the board in a physician health case must be submitted to the PHCU, not directly to the board and if that evidence contradicts the PHP then it never ever gets to the board. This has been suspected for years but when these documents are later requested to see if they had been reviewed board has been able to delay, withhold and censor them. There has previously been no way to determine these matters and they could get away with whatever they wanted by gaming the system under toothless laws.
Not anymore (hopefully).
The Commonwealth of Massachusetts Public Records Division has been a breath of fresh air. Those I have interacted with have integrity and empathy as well as zeal. Although limited in scope they can hold agencies to account by demanding the provision of complete, legible and accurate records and not backing down.
Pam Wilmot, executive director of Common Cause Massachusetts stated:
“As the cradle of liberty, Massachusetts should lead the way on openness and transparency, not lag behind the rest of the nation. The law Governor Baker just signed will help us catch up and begin to take our rightful place among those states that highly value and promote transparency.”
Document Submitted as Evidence for Hearings Date-Stamped Long After
In response to a June 2016 request the board provided just one with a legible date-stamp; a December 15, 2011 letter requesting an attached “litigation packet”be considered at an upcoming December 21, 2011 hearing . The documents are all date-stamped January 17 2012 (nearly one month after ).. All of the other documents where illegible or missing dates rendering it impossible to determine if and when they were entered into evidence as required by law under M.G.L. c. 30A§ 11(4) which states:
All evidence, including any records, investigation reports, and documents in the possession of the agency of which it desires to avail itself as evidence in making a decision, shall be offered and made a part of the record in the proceeding, and no other factual information or evidence shall be considered, except as provided in paragraph (5) of this section. Documentary evidence may be received in evidence in the form of copies or excerpts, or by incorporation by reference.
Board Defense counsel Bryan Bertram dismissed the date-stamp as irrelevant and claimed it did reflect when it was entered into evidence but when it was scanned into the Document Imaging Unit (DIU) . He claimed this occurs after hearings not before. See logical fallacy and lies. . We filed a Motion to Produce Documents (SJC-2015-0267, # 44) with legible dates which Bertram opposed in his Response to Motion to Produce Documents
Bertram claimed “board staff” had reviewed its records and minutes and retrieved from “off-site storage” those “materials before the Board in December 2011.” The documents I claimed were suppressed, he claims , “are in fact there.” and provides footnotes:
1 The Board’s staff has reviewed its records and confirmed this to be the case.
2 To be sure, and to put this matter to rest for the Court once and for all, the Board has retrieved from offsite storage those materials before the Board in December 2011. The documents that Dr. Langan claims were “suppressed” are in fact there—and this should not be surprising given the Board’s many orders since that time, all of which have disclaimed any reliance on the July 2011 PEth test.
3 The Board’s staff has confirmed this by reviewing its minutes.
He claimed my request was :
“……nothing more than an attempt to impose upon the Board a duty–absent from any statute, regulation or rule to search for and produce documents to him that are outside of that record. Dr. Langan’s Motion tellingly directs this Court to no authority to support such a request. Because it is devoid any basis in the law, the Motion should be denied.”
As of January 1, 2o17 my request for legible documents does have a basis in the law. Authority does now exist to support such a request.
I filed a Public Records Request under the new law on January 9, 2017. I received a response from Board counsel Robert Harvey ( January 20, 2017 documents provided by board). Most are still illegible or missing dates. The same document date-stamped nearly one -month after the hearing for which it was submitted was provided. One other had legible dates. A document written June 6, 2013 is stamped both electronically and by hand with dates sometime in 2012, before it was ever written.
And in response to an Order from the Supervisor of Records I was provided the very same document date-stamped January 17, 2012. But it is not a copy but original as indicated by the “blue-ink. This original document precludes the existence of any others date-stamped earlier than January 17, 2012. This documents no earlier dated copies could have been submitted as evidence before the hearing. This document was never admitted into evidence and may not be relied upon by the board in its decision M.G.L. c. 30A, § 11(4).
The records, minutes, and materials reviewed and retrieved by “board staff” constitute public records. I requested them. I also requested the board “reports” that would have resulted from “board staff” confirming it was before the board in 2012.
“ABA Model Rule 3.3, Candor Toward The Tribunal, declares that ‘a lawyer shall not knowingly make a false statement of fact or law to a tribunal or fail to correct a false statement of material fact or law previously made to the tribunal by the lawyer.’ If a lawyer ‘has offered material evidence and the lawyer comes to know of its falsity, the lawyer shall take reasonable remedial measures, including, if necessary, disclosure to the tribunal.’
An attorney must have a factual basis for alluding to, offering, or relying on evidence at trial. That factual basis may not be wishful thinking. There are two requirements for a factual basis — an attorney’s subjective belief, and objective evidence to support that belief.
But none exist. Not one document, reference, record, or any other materials exist that are chronologically consistent with the documents being before the board in 2012. The only document that exists is the litigation packet date-stamped a month after the hearing.
I asked Bertram to either provide the factual basis or admit to the false statements. He’s been ignoring me and will not answer.
The whole picture depicts the respondent as an attorney who, when it serves his advantage, is willing to violate clear norms of professional responsibility and to engage in purposeful deceit which harms others.
“The privilege of practicing law does not come without the concomitant responsibility of truth, candor, and honesty. Because no single transgression reflects more negatively on the legal profession than a lie, attorney misconduct involving dishonesty justifies disbarment.” Id. (quoting In re Young’s Case, 913 A.2d 727 (N.H. 2006)).
No matter what it takes I am going to make sure that is a certainty in this case.
Make Medicine Great Again! Please Donate and Help Drain this Swamp!
Are Physician Health Programs (PHPs) above the law?
Unable to get law enforcement to take cognizance of reported abuse, many doctors I have spoken with believe that the actors involved are impervious to criminal liability. Complaints of fabrication and fraud involving PHPs and their affiliates to the police, the Attorney General and other law enforcement agencies have been given no credence, tabled or dismissed with little investigation.
Believing these agencies are deliberately ignoring credible complaints and the documentary evidence placed before them, some have concluded that state PHPs have been given the power to commit crimes with impunity and immunity.
PHPs are not above the law. It is by removing themselves from and blocking the usual routes of accountability and absolute operational control of the testing, assessment and treatment process that has enabled misconduct to remain hidden, unrecognized or excused. The crimes exist but they remain undetected, unnoticed and unpunished.
What is being touted as “gold standard” and “cream of the crop” is on closer inspection iron pyrite and curdled spit up. I am reminded of the commercials comparing a Granada to a Mercedes when I was a kid. I remember these commercials well as I couldn’t wrap my head around them. In one, as I remember it, two couples arrive at their parked adjacent cars with keys in hand. The Mercedes tries to open the door of the Granada and vice versa. “How is this scenario even possible?” I remember thinking. Had they been drinking? Is this related to “this is your brain on drugs or that old guy in the miracle ear commercial who looks confused when the waiter asks his salad dressing preference and his companion yells at him “he said do you want Italian, thousand island or vinaigrette?” How could anyone in a right state of mind confuse a Ford Granada with a Mercedes 450SE?
PHPs are not the Mercedes of EAPs but the jalopy with no breaks and broken steering of EAPs with Stuntman Mike from Quentin Tarantino’s Death Proof at the wheel.
Like smoke alarms and air bags, EAPs are not in the forefront most peoples minds until they need them and like smoke alarms and air bags they usually work just fine for most people. Discerning and scrutinizing one’s EAP is not a common thing. If your EAP was replaced by the PHP model you probably wouldn’t even know it. That is why this needs to be on your radar. Caveat emptor. Forewarned is forearmed.
PHPs are essentially Employee Assistance Programs (EAPs) for doctors, nurses and other health care professionals. The vast majority of people know little or nothing about Physician Health Programs (PHPs) but they should. The grand plan is expansion to other occupations under what they are calling the “New Paradigm.” Deemed “professional health programs”they don’t even have to change the acronym.
Physician Health Programs (PHPs) are being called the “gold-standard” for EAPs. Claims of unparalleled success are being used to promote PHPs to other populations as a “replicable model of recovery.” Drs. Robert Dupont and Gregory Skipper are promoting PHPs as “A New Paradigm for Long-Term Recovery” claiming an 80% success rate in doctors. An article entitled “What Might Have Saved Philip Seymour Hoffman” claims the actor may still be alive today if he had access to one of these programs and comments they “ought to be considered models for our citizenry” and the “best evidence-based addiction treatment system we have going.”
Mercedes 450 SE
Such is not the case. What is being touted as “gold standard” and “cream of the crop” is on closer inspection iron pyrite and curdled spit up. I am reminded of the commercials comparing a Granada to a Mercedes when I was a kid. I remember these commercials well as I couldn’t wrap my head around them. In one, as I remember it, two couples arrive at their parked adjacent cars with keys in hand. The Mercedes tries to open the door of the Granada and vice versa. How is this scenario even possible I remember thinking. Was it a bar they just came out of and they are drunk? Is this related to “this is your brain on drugs? Do they have some sort of memory problem like that old guy in the miracle ear commercial who looks confused when the waiter asks his preference for salad dressing and his companion yells “he said do you want Italian, thousand island or vinaigrette?” How could anyone in a right state of mind confuse a Ford Granada with a Mercedes 450SE?
Granada
PHPs are not the Mercedes of EAPs but the jalopy with no breaks and broken steering of EAPs with Stuntman Mike from Quentin Tarantino’s Death Proof at the wheel.
Like smoke alarms and air bags, EAPs are not in the forefront most peoples minds until they need them and like smoke alarms and air bags they usually work just fine for most people. Discerning and scrutinizing one’s EAP is not a common thing. If your EAP was replaced by the PHP model you probably wouldn’t even know it. That is why this needs to be on your radar. Caveat emptor. Forewarned is forearmed.
Physician Health Programs (PHPs) claimed “gold standard” for addiction treatment. “80% success rate” being used to promote “new paradigm” to other populations.
The claim of an 80% success rate is a 2009 study published in the Journal of Substance Abuse Treatment entitled Setting the Standard for Recovery: Physicians’ Health Programsand authored by Robert Dupont, A. Thomas McLellan, William White, Lisa Merlo and Mark Gold. This study is the cornerstone of the “PHP-blueprint.” It is the very foundation on which everything else is based, a Magnum opus used to lay claim to supremacy that has been endlessly repeated and rehashed in a plethora of self-promotion and treatment community blandishment.
To date there has been no academic analysis of the “PHP-Blueprint.” There has been no Cochrane type analysis or critical review. There has been no opposition to its findings or conclusions which are paraded as fact and truth without challenge or question and there is a general lack of concern from those both within and outside the medical profession.
One major problem with this claim of an 80% success rate is that close to 80% of those coercively enrolled in these programs do not fit the diagnostic criteria for substance use disorder or any other psychiatric diagnosis. In reality these programs cause far more harm and if we really looked at the impact of these programs and compared them to traditional EAPs the success rate would be abysmally low.
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The Expansion of Physician Health Programs (PHPs) to Other Populations
1. Although these programs claim to help doctors they may actually be harming many and contributing to suicide.
2. The plan is to greatly expand these programs to other populations and you could be next.
In 2012 Robert Dupont delivered the keynote speech at the Drug and Alcohol Testing Industry Association annual conference and described a “new paradigm” for addiction and substance abuse treatment and proposed expansion of this paradigm to other populations including workplace, healthcare, and schools.
It is therefore critical that the “PHP-blueprint” be examined using critical reasoning and evidence base. All of this needs to be assessed in terms of legitimacy and intent.
The claim of 80% success rate in physicians is based on Setting the Standard for Recovery: Physicians’ Health Programsis unfounded. The study is a poorly designed using a single data set (a sample of 904 physician patients consecutively admitted to 16 state PHP’s).
It is non-randomized and non-blinded rendering the evidence for effectiveness of the PHP treatment model over any other treatment model (including no treatment) poor from a scientific perspective. The study contains multiple flaws in both reasoning (type I and type II errors) and statistical analysis that render its conclusions invalid.
In addition the impact of undeclared but substantial financial conflicts-of-interest (including funding by drug testing and addiction treatment industries) and personal ideological biases (including personal 12-step recovery from addictions) in the authors of this study also needs to be considered.
Moreover the misdiagnosis and over-diagnosis of addiction in physicians in this paradigm incentivized by lucrative self-referral dollars for expensive 90-day treatment programs is a significant factor.
False Endpoints and High Mortality Rate
The mean age of the 904 physicians was 44.1 years. They report that 24 of 102 physicians were transferred and lost to follow “left care with no apparent referral.”
What happened to them? These are physicians with multiple identifiers (state license, DEA, UPIN, etc) not transient drifters.
More importantly what happened to those 48 who were reported to the Medical Board for noncompliance and had their licenses revoked–that would be the critical time when this population would be at most risk for completing a suicide. That would be when hope was lost and the coerced physician, knowing that the fight was over, would take that step.
The outcomes they used were the last reported status of the PHP participant enrolled in the program. Measuring success of program completion in doctors compared to the general population is meaningless as the short-term outcomes are quite different in terms of the external consequences imposed. The consequence of not completing a PHP is the invariably career ending. So what happened to the 24 of who “left care with no apparent referral,” the 85 who “voluntarily stopped or retired,” and the 48 who “involuntarily stopped or license revoked.”
Whether you leave a PHP voluntarily, involuntarily, or with no apparent referral it is the end game and your career is over. Comparing this to other populations where the consequences of failing to complete the program are not so final is inappropriate. Claiming superiority over programs with a 40% success rate is unfounded because for most of those people the consequences are not so final and may mean nothing more than an increase in testing frequency.
The big question is what happened to the 157 physicians who left or stopped? How many of them killed themselves. With an average age of 44 there were 6 reported suicides 22 deaths, and another 157 no longer doctors. I would venture to say the number of suicides is a lot higher than they claim. But using the last recorded PHP status as the final outcome obfuscates this.
Due to the severity of the consequences a 20% failure rate is quite concerning. This is of particular concern because many doctors (if not most) monitored by PHPs are not addicts.
As noted above, PHPs are essentially Employee Assistance Programs (EAPs) for doctors. Most EAPs, however, were developed in the presence of trade unions and other organizations working on behalf of the best interests of the employee. This collaborative effort led to EAPs that were more or less “organizationally just” with procedural fairness and transparency.
Imposed 12-step ideology and use of non-FDA Approved Drug and Alcohol Testing
No such organizations exist for doctors. Due to the absence of oversight and accountability PHPs have been able to use non-FDA approved laboratory developed tests of unknown validity on doctors without any opposition.
The distinction between professional and private life as a fundamental value of our society and the importance of this boundary was also upheld by these groups.
In the PHP paradigm no procedural fairness or transparency exists and the boundary between professional and private life has eroded.
PHPs impose 12-step ideology on all doctors referred to these programs. State Medical Boards enforce this in violation of the Establishment Clause of the 1st Amendment yet there is little recourse for doctors as they are threatened with non-compliance and loss of licensure.
Selling the PHP Paradigm
The use of 12-step is most likely not ideologically driven but profit driven.
Abstinence based 12-step programs justify the use of frequent drug and alcohol testing with ongoing lifelong assessment and treatment. As with drug-courts, PHPs provide a lucrative model to the drug and alcohol testing, assessment and treatment industry.
The plan to expand this to other populations is outlined in the ASAM White Paper.
This concerns all of us. The first step needs to be a critical appraisal ofSetting the Standard for Recovery: Physicians’ Health Programs, the foundation of their claims of an 80% success rate and a conflict-of-interest analysis of its authors. The legitimacy of the study and its claims needs to be questioned.
It does not take a Cochrane review to see that the emperor has no clothes. This is not difficult. It is straightforward and simple.
As an illegitimate and irrational authority it is necessary that this opinion remain unchallenged. We need to challenge it.
Historical, political, economic and social analysis reveals that the “PHP-blueprint” is a false-construct built on circumnavigation and obfuscation. An evidence-based scrutiny of the literature would reveal it to be invalid and of little probative value.
But if nobody speaks up it is inevitable that they will expand the “PHP blueprint” to other employee assistance programs and schools.
This is not just about doctors. You too are at risk for coercion, control, conformity and forced adherence to a lifetime of abstinence and 12-step indoctrination and if you do not speak up now it won’t be a risk but a certainty.
PHYSICIAN OR PROFESSIONAL HEALTH PROGRAM SURVEY
Please click on the link below and complete the following survey if you have been monitored or are being monitored by a PHP.
This is a confidential survey. If you have concerns about anonymity please create an alternative alias email address (this video shows you how to create an alias G-mail address), then use the alias email address as your “name” for future correlation.
The attorney pool is currently over-served by those serving two clients and most of those outside simply do not know enough about the “physician health” legal issues related to doctors. When they appear before the board it is as if they are a deer in the headlights. It is a new terrain where all due process and familiar protocol have been removed. Of course this was all facilitated by changes in administrative and medical practice acts orchestrated by the physician health movement “in the interests of protecting the public. This must be recognized and addressed.Skilled negotiators and lawyers with administrative law experience would do well to consider representation for doctors before medical boards regarding “physician health” matters.It is not that esoteric, complicated or difficult. As with the rest of the population, most have just not critically analyzed the issues behind the curtain.
America, this is serious. The brightest minds in this country are running away from careers in health care. Many of our best doctors are being forced out of business. We must start an open dialogue with doctors ― the individuals who are the most influential in advancing our health care system. The success of our health care system absolutely depends on the caliber of talent we attract to become and remain our nation’s physicians. Short-changing the individuals who are sacrificing everything to save lives will lead to the biggest threat to our nation’s health care system.
Want to make health care great again? We must all reach out to doctors and do everything in our power to demonstrate that we value our country’s physicians before it’s too late.
The AMA is seeking to test older physicians. This is no doubt due to the influence and lobbying of the “impaired physicians movement” and the “addiction medicine”…
America, this is serious. The brightest minds in this country are running away from careers in health care. Many of our best doctors are being forced out of business. We must start an open dialogue with doctors ― the individuals who are the most influential in advancing our health care system. The success of our health care system absolutely depends on the caliber of talent we attract to become and remain our nation’s physicians. Short-changing the individuals who are sacrificing everything to save lives will lead to the biggest threat to our nation’s health care system.
Want to make health care great again? We must all reach out to doctors and do everything in our power to demonstrate that we value our country’s physicians before it’s too late.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.
The AMA is seeking to test older physicians. This is no doubt due to the influence and lobbying of the “impaired physicians movement”and the “addiction medicine” specialists who brought us the “impaired” and “disruptive” physician constructs. As do all groups of this ilk, they want to expand. It is predictable and that is what we are seeing here.
As a specialist in geriatric medicine I have experience in taking care of a number of doctors who were referred to me for suspected memory problems. Still operating and teaching residents in his 70s, myfirstwas a well-respected surgeon, a pioneer or Maverick who had made advances in his particular subspecialty. Known for hisdetailed knowledge of the history of medicine and sharp clinical acumen, he had not seemed himself for a while. His colleagues notedhe appeared slower,fatigued and forgetful at times (not…
America, this is serious. The brightest minds in this country are running away from careers in health care. Many of our best doctors are being forced out of business. We must start an open dialogue with doctors ― the individuals who are the most influential in advancing our health care system. The success of our health care system absolutely depends on the caliber of talent we attract to become and remain our nation’s physicians. Short-changing the individuals who are sacrificing everything to save lives will lead to the biggest threat to our nation’s health care system.
Want to make health care great again? We must all reach out to doctors and do everything in our power to demonstrate that we value our country’s physicians before it’s too late.
The Alienation Of America’s Best Doctors | The Huffington Post Doctors are hurting and they don’t have the time to reach out. Melinda Hakim MD—CEO of DoctorCPR.com—a medical career site that…
America, this is serious. The brightest minds in this country are running away from careers in health care. Many of our best doctors are being forced out of business. We must start an open dialogue with doctors ― the individuals who are the most influential in advancing our health care system. The success of our health care system absolutely depends on the caliber of talent we attract to become and remain our nation’s physicians. Short-changing the individuals who are sacrificing everything to save lives will lead to the biggest threat to our nation’s health care system.
Want to make health care great again? We must all reach out to doctors and do everything in our power to demonstrate that we value our country’s physicians before it’s too late.
If you or someone you know needs help, call 1-800-273-8255 for the National Suicide Prevention Lifeline. Outside of the U.S., please visit the International Association for Suicide Prevention for a database of resources.
Doctors are hurting and they don’t have the time to reach out.
Melinda Hakim MD—CEO of DoctorCPR.com—a medical career site that reaches over 500,000 medical professionals looking for jobs and resources.
I grew up in the ‘80s in awe of my dad who was a talented general surgeon. As a kid, I used to make rounds with him at the local hospitals in Los Angeles and had the opportunity to witness the overwhelming appreciation his patients had for his work. Our home was inundated with dozens of homemade baked goods, knitted scarves, gift baskets, and colorful “thank you” cards carefully prepared by his patients. He never complained about his job. Even if he had to leave a family event or wake up in the middle of the night to do a trauma case ― he was never resentful. He…
An attorney must have a factual basis for alluding to, offering, or relying on evidence at trial. That factual basis may not be wishful thinking. There are two requirements for a factual basis — an attorney’s subjective belief, and objective evidence to support that belief.
What is being touted as “gold standard” and “cream of the crop” is on closer inspection iron pyrite and curdled spit up. I am reminded of the commercials comparing a Granada to a Mercedes when I was a kid. I remember these commercials well as I couldn’t wrap my head around them. In one, as I remember it, two couples arrive at their parked adjacent cars with keys in hand. The Mercedes tries to open the door of the Granada and vice versa. “How is this scenario even possible?” I remember thinking. Had they been drinking? Is this related to “this is your brain on drugs or that old guy in the miracle ear commercial who looks confused when the waiter asks his salad dressing preference and his companion yells at him “he said do you want Italian, thousand island or vinaigrette?” How could anyone in a right state of mind confuse a Ford Granada with a Mercedes 450SE?
This concerns all of us. The first step needs to be a critical appraisal of 
Disrupted Physician 