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Bruno Lavrentiev
Bruno Lavrentiev

DEMARCO - IT'S NOT RIGHT


First and foremost, let's define what a dank meme is: Colloquially, "dank" means "disagreeably damp, musty, and typically cold" so right off the bat we can see that dank memes are not a good thing. It's easy to think dank = good because dank is a word often associated with weed, a good thing. So, while we want to assume dank memes are bad, they're not. Dank memes are good.Cynics and jaded memers alike use "dank meme" as a description to indicate the meme has reached Normie levels of popularity. Classifying a meme as "dank" means that it's reached the upper echelon of visibility, the highest place it can reach before being shared to your Facebook by your Aunt Stacy from some page called something like "FUNNIEST Pics Of All Freakin' Time Seriously You Will L O L!!!"




DEMARCO - IT'S NOT RIGHT



It's funny, because it's you, but also because the hang loose hand gesture is so fuckin' tight, right? You are the human definition of the hang loose hand gesture my guy. But once you acknowledge this meme, unfortunately, it stops being dank. Don't ask me why, it just does.


DeMarco: I like technology but it's always ahead of me. In computers, I'm probably the generation that got left behind. It seems that the older generation in many respects, people in their 60s and up, has time to catch up with their computer technology, the younger people were brought up with it, and I'm there in the middle, sort of like BUMC's BCON [a clinical software program now being replaced].


DeMarco: None in my immediate family. According to my paternal grandmother, there were 13 doctors in the family, but I didn't know them. I'm not sure they all went to medical school. My grandmother believed that doctors were something special. My biggest mistake was thinking that I wanted to be a doctor because I was an independent person. I didn't like being told what to do. I had the illusion that doctors weren't told what to do. Well, nothing could be further from the truth. If it's not your patients, it's the administrators, or the politicians, or the payers. So everyone is telling you what to do.


DeMarco: There were things I didn't like. I found psychiatry frustrating because I think we don't have a good way of handling psychiatric illness. I found neurology difficult too. I always liked pulmonology and gastroenterology. John Fordtran was at the medical school when I was a student there and shortly thereafter moved to BUMC. He influenced me a lot. He had a lot to do with my love for gastroenterology and also in choosing to come to BUMC and staying here. The people who influenced me a lot were John Fordtran, Dan Polter, Kent Hamilton, Lloyd Kitchens, Walter Berman, and Ralph Tompsett. I have been around Dan Polter my entire professional life. I jokingly have said that when Dan does retire it is going to be such a shock for me not to have him looking over my shoulder, and it's going to be a shock for him too. I did my fellowship under Dan Polter and Kent Hamilton, two excellent gastroenterologists. Walter Berman had a tremendous effect on me. Lloyd Kitchens was one of the most talented physicians I ever met. I took care of both him and Walter before they died.


DeMarco: Yes. Mike Brown once said that gastroenterology was hurt by endoscopy and screening colonoscopy, implying that the procedure detracted from the intellectual aspects. These procedures have done a lot for the average gastroenterologists, like putting their kids through school. But, I didn't do all this work just to do screening colonoscopies on 50-year-old healthy people. Part of my passion for the new technology is to be on the forefront of our field's development. Also, as director, it's part of my job to bring this new technology to BUMC, which has a strong GI division. We've always been very proud of it. We've got one of the largest GI labs anywhere.


DeMarco: We fly into Leon. It's a 1-hour drive to the city. Once we're at the house, we don't need a car. In fact you don't want a car because it's more of a hassle than anything else. It's like having a car in New York City.


Despite the fact that I am an instrument-rated pilot, I still have a terrible problem with motion sickness. I cannot ride on a merry-go-round without getting sick. Several mornings after flying, I would come to work and be as white as a sheet from motion sickness. I stayed with it and got my pilot's license. After another year, I started training to get instrument rated because that would make me a better and safer pilot and give me more travel flexibility. I've had the instrument rating for about 4 years and am now working on my commercial (multiengine) rating. We now go on lots of trips; my son and I go skiing in Taos, NM, every year because it's easy to get there by plane. We joke that we go to Taos by our plane, then rent a car from Enterprise, and then we stay at the Quality Inn hotel for $65 a night. I try to fly once a week for an hour.


One of my dreams was for him to go to Jesuit because I went there. And we have been very supportive of Jesuit. There is an East-DeMarco Scholarship there. He applied and got right in. (Legacy didn't have much to do with it because he had excellent scores.) I told him that if he went to Jesuit he would be at the top of his class and there were no women to compete with. The minute he started going there as a freshman, he didn't like it. It was perhaps a little bit regimented for him and they made him cut his hair. When I was there they didn't have rules like that. I spent more time in the vice principal's office in his 6 weeks there than I ever did in my 3 years there. After 6 weeks it was quite clear it wasn't working out, so he left Jesuit and transferred to Highland Park. He is ranked about 10 out of 500 in his graduating class. He will be going to Rice. He didn't apply to Notre Dame.


DeMarco: Yes. Weekend call starts Friday night and ends Monday morning. Call is not insulated by the fellows at all. In fact, it's kind of backwards. Our GI fellows can't cover the whole service. The GI fellows take less call than the attendings do. They are on call every sixth day. It's attractive that way and conducive to learning and complies with the 60-hour workweek. When you are on call, you get all the patient calls for everything from indigestion to life-threatening hemorrhage. It's difficult in that regard because both weeknight and weekend calls demand a lot of your time and attention. The only time I can call a fellow in is if it's an interesting consult or procedure. I end up calling them for such things as foreign bodies in the esophagus, but the fellows don't get the first call, I do. I assess the patient and decide whether it's a good case or not and then I will call the fellow. We've worked to change that a little bit, but Larry Schiller thinks that the present system is a real asset to the program. He is probably right.


DeMarco: Our favorite restaurant is Adelmo's on Knox/Henderson. It's close. We try not to go more than twice a month. We live right next to Javier's and smell it every night and it's a good restaurant too. Other times we go somewhere that Michael likes.


Unfortunately, if you don't pay for something, it doesn't get done. Beginning in 2010, Medicare decided to stop paying for consultations. Now we have consultation codes for regular patients that are different than consultation codes on Medicare patients. Because Medicare decided to stop paying the consultation code, we have to code Medicare patients as new patient visit. The primary care physicians think that the consultation codes should be thrown out and that all physicians should get paid the regular new patient code. It's only maybe $10 to $40 difference depending on the level of service, but in principle I feel it's damaging to the specialties. One trains an extra 3 or 4 years to be a consultant and now Medicare is not paying for it. Eventually, I predict that all physicians' pay will fall under Medicare rules. That bothers me. I am concerned about the future of medical practice. The inability of physicians to work together is a challenge.


DeMarco: It's illegal for physicians to unionize or discuss fees with each other, but in other fields it's public knowledge. If it makes business sense, it's probably illegal in medicine. Physicians are a very bright group as a whole but don't have the ability to work together with each other for the benefit of their profession. Organizations like the American Medical Association haven't facilitated that either. Even within gastroenterology there are 3 organizations. I am a member of all 3, but I represent only one, namely the American College of Gastroenterology. The 3 organizations don't talk to each other and hence don't work well together. When it comes to issues, even like screening colonoscopy, each organization has its own agenda. If we could get the 3 societies to work together it would be beneficial to all gastroenterologists. If we could get all the specialties and all the physicians to work together we would all be better off. If doctors could work together, politicians would not be reforming health care. Physicians know more about taking care of patients and the delivery of health care than insurance companies or politicians. But who is doing the reforming?


DeMarco: Yes, a lot of it is being institutionalized. Just look at what is happening locally with the HealthTexas Provider Network and with the hospitalists. The regular doctor can no longer afford to have an office practice and take care of sick inpatients. Everything is being delegated to a hospitalist who doesn't know the patient outside the hospital. I think that all of these movements are leading to the idea of physicians being salaried. I still think, however, that it's going to be less than half the physicians. When it comes down to it, it's just the doctor seeing the patient and the patient wanting to get better and the doctor wanting to make the patient better. The beauty of medicine will still be there. No matter how the physician is paid, there will still be good doctor-patient relationships. I'm still going to be proud to be a doctor, but things are going to change. 041b061a72


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