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DJP Update 12-1-2018: DJP Update Enhanced Podcast #4 Bryan Lawton FAST CARS

Dec 01
Posted by Dr. Donald Palmisano in DJP Podcasts, DJP Updates

DJP Update 12-1-2018:  DJP Update Enhanced Podcast #4 Bryan Lawton FAST CARS

Check it out!  Go to:

or you can copy and past this link in your browser:

https://www.youtube.com/IntrepidResources

If you have a passion for cars, I think you will enjoy this collection.

If you missed the other podcasts, go to http://djpupdate.com and click on DJP Podcasts in right column.

Stay well,

Donald

 

Donald J. Palmisano, MD, JD, FACS

Donald J Palmisano Consulting

Intrepid Resources®

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@donaldpalmisano.com

http://www.donaldpalmisano.com/

http://onleadership.us/

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 in bookstores and AMAZON)

DJP Updates:

Twitter: @DJPNEWS  https://twitter.com/DJPNEWS

YouTube: https://www.youtube.com/user/IntrepidResources/videos Check out the videos.

 

This DJP Update started out going to leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends; and now around the globe via Twitter followers.

You can share it with your members and it has the potential to reach 800,000 physicians.

 

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

NOTE:  IF YOU ELECT TO GET OFF OF THIS MAILING, PLEASE SEND ME ALL EMAIL ADDRESSES YOU USE IF YOUR OLD EMAIL IS FORWARDING TO YOUR NEW EMAIL BECAUSE THE LIST IS BY EMAIL AND NOT NAME.  IF YOU SEND ME ONLY YOUR NEW EMAIL I WON’T FIND YOU TO REMOVE.  THANKS!

 

 

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DJP Update 3-13-2017:  1- PPACA (ACA etc.) Repeal and Replace?  2- LAGNIAPPE: The Clock House and Bose QC 35, and don’t forget DJP News Enhanced Podcasts!

Mar 17
Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 3-13-2017:  1- PPACA (ACA etc.) Repeal and Replace?  2- LAGNIAPPE: The Clock House and Bose QC 35, and don’t forget DJP News Enhanced Podcasts!

1.  Unless you have been cut off from communications since the November 2016 elections, you know there is a surprising change in the office of the President and in the Senate and House.  Pundits and polls for the most part got a failing grade.

 Regardless of your political views and your possible excitement or despair, one can be certain that health system reform is on the agenda in the immediate future.  It will be a test of leadership in Washington to see if reason and facts will prevail in the debate or if political rigidity and obstructionism continues based on political party lines.  This also is a chance for medical organizations to stand up and advocate long-standing policy rather than acting like the opportunists in the Vestibule of Hell in Dante’s Inferno (First part of Divine Comedy).

 I won’t dwell on this topic but it is an IMPORTANT issue for our patients and the profession of Medicine.  Time to enter the arena.

 Finally, I list two articles I mentioned in a November 9, 2016 @DJPNews Tweet:  the first is one I co-authored with 2 PhD economists at AMA in 2004 when I was AMA president entitled:

 Expanding Insurance Coverage Through

Tax Credits, Consumer Choice, and Market Enhancements

The American Medical Association Proposal

for Health Insurance Reform

Donald J. Palmisano, MD, JD

David W. Emmons, PhD

Gregory D. Wozniak, PhD

 It is at:  JAMA, May 12, 2004—Vol 291, No. 18, pages 2237-2242 and is based on long-standing AMA policy as of 2004.

The second article is an editorial I wrote entitled The 2010 “Patient Protection and Affordable Care Act”: A Failing Grade.  The citation for it: J La State Med Soc VOL 162 September/October 2010, pages 243-244

It can be found at:

 http://donaldpalmisano.com/html/PEJLSMS2010.pdf

 Now for LAGNIAPPE!

 LAGNIAPPE: 

 1- THE CLOCK HOUSE

New Orleans is a fun place to visit because of the history, the people, food, and exciting traditions like MARDI GRAS and JAZZ FEST.  For those who like to stay in a private home rather than a hotel, Robin and I have a friend who has a place listed in AirBnB.  We visited the place. It is in Metairie and wonderful.  More details below:

 https://www.airbnb.com/rooms  

 Go there, search for “The Clock House” or 1010 Metairie Road, Metairie LA 70005

 A brief summary:

“The Clock House” is a 1943 4-bedroom 2.5 bath home built in the “Grand Cottage” architectural style.  The main floor features a screened-in front porch, a gourmet kitchen, a breakfast area with a built-in banquette, and coved ceilings in the living and dining rooms.  Connecting bathrooms between the two bedrooms are on each side of the center hall on top floor. An arbor with a swing, table and bench grace the backyard where you can enjoy a garden view and bird watching at the feeder.  The home is one block from grocery, coffee shops, banks, and restaurants.  It is 5 miles to the French Quarter, 1.8 miles from the Streetcar line, and 1.6 miles to I-10 access.  The host lives in separate quarters on property.  Cereal, coffee, tea, snacks provided.  $275/night, (+ $150/reservation for housekeeping) for up to 8 guests  (babies & children count as guests.)  Fee is higher on special event weekends such as Mardi Gras, Jazz Fest and New Years.

 2- GADGETS:  Bose QC 35

 A) For trips to do keynote addresses and to attend board meetings, I try to protect my hearing in planes and block out the loud noise.  In the past, I used ear mufflers that are used on noisy construction sites.  But they are bulky.  I now have an ideal solution with additional benefits.  I recently purchased the new Bose QC 35.  The noise canceling is outstanding, the Bluetooth works well, and there is the added advantage of making phone calls with the two built-in microphones. 

 Here is part of my research:

 http://www.theverge.com/2016/6/21/11975496/bose-qc-35-bluetooth-wireless-headphones-quietcomfort-flawed

 “What’s odd to me is that the reviews have been mostly glowing — CNET, Gizmodo, The Next Web, Tom’s Guide, buyers in the Head-Fi forums all agree.”

—-

http://www.imore.com/i-am-never-taking-boses-qc-35-noise-cancelling-wireless-headphones

 “I can sleep with the QC35 on inside a plane. The headphones are that comfy.”

 “I am never taking off Bose’s QC 35 noise-cancelling wireless headphones.”

—–

http://www.pocket-lint.com/review/139017-bose-quietcomfort-35-review-the-perfect-travel-companion

 “The QuietComfort 35 ‘phones are certainly not everyone’s cup of tea, considering they aren’t particularly fashion-conscious or able to playback grime with the growly thump of bass focused peers, but they are perfectly suited to the travelling lifestyle of their target audience.”

 “A plane journey will never feel quite the same without them.”

 Finally, here is the official Bose Website with more info on these headphones:

https://www.bose.com/en_us/products/headphones/over_ear_headphones/quietcomfort-35-wireless.html?mc=25_PS_BD_BO_00_GO_&gclid=CKCr3Kbz09ICFci2wAodsy4PAA&gclsrc=aw.ds

—–

 Finally, one note of caution.  Popular items are sometimes copied by others and sold as Bose.  Here is some info to protect against that problem:

 How to spot fake: BOSE Headphones – 6 Steps

 http://www.detectafake.com/viewProduct/?269580

 Also call Bose and read serial # to Bose and they will tell you if genuine or fake.

Call 800-367-4008 and ask customer service to confirm. 

I did that when I purchased my Bose QC 35 from Best Buy after problems getting through with order at Bose Website. They confirmed mine were genuine. Customer Service later told me I could order in future by phone.

3- Don’t forget DJPNEWS Enhanced Podcasts if you missed them on publication.  More to come!

Go to:  http://djpupdate.com/

4- I continue to teach my leadership seminar to 3rd and 4th year medical students at Tulane Medical School:  Leadership – How to give a 2-minute memorable speech.

 Stay well!

 Donald

 Donald J. Palmisano, MD, JD, FACS


Intrepid Resources® 

Donald J Palmisano Consulting

 5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@donaldpalmisano.com

http://www.donaldpalmisano.com/

http://onleadership.us/

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates: 

Twitter:  https://twitter.com/DJPNEWS

YouTube: https://www.youtube.com/user/IntrepidResources/videos Check out the videos.  

This DJP Update started out going to leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends; and now around the globe via Twitter followers.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

 

 

 

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DJP Update 11-2-2015 Norman, Oklahoma – Boston, Gloucester, New York City, and New Orleans: Adventures; LAGNIAPPE

Nov 03
Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 11-2-2015 Norman, Oklahoma – Boston, Gloucester, New York City, and New Orleans: Adventures; LAGNIAPPE

The DJP Updates are less frequent because I post daily on Twitter. As stated before, I encourage you to get on Twitter and follow individuals and organizations that interest you. No cost but a very effective way to quickly get all of the breaking news as well as learn new information about just about any topic that interests you. Remember, you don’t have to post tweets! You just can follow lots of news organizations, hobby interests, or individuals.

Click on this link https://twitter.com/DJPNEWS to see some recent ones of the 14,500 I have posted.

This update is about recent travels, speeches, and interviews that I conducted with interesting individuals using state of the art portable equipment for a future “Enhanced Podcast” series.
1- OKLAHOMA

I did a keynote at EXPLORE: Oklahoma Healthcare Summit August 14-15, 2015 in Norman, Oklahoma. Nice folks who showed wonderful hospitality.

I spoke on the 6 Commandments of Medicine and how to survive in the rapidly change healthcare system that interfers with the patient-physician relationship. At the reception, I also signed 250 copies of my book THE LITTLE RED BOOK OF LEADERSHIP LESSONS. Lots of fun. Special thanks to Dr. Carl Hook and the Conference Chair, Shari Moore, RN, BSN. Well-organized Summit.
————

2- Boston: Massachusetts General Hospital Grand Rounds

Once a year, the residents get to pick the speaker for:

MGH Grand Rounds MGH-Department of Anesthesia, Critical Care and Pain Medicine – “Resident Choice Speaker” – October 22, 2015

The residents selected me for this honor and the hospitality was outstanding. Great group of folks, the residents and staff of the department. They also gave me a demonstration of their high-tech simulation lab and a special treat was a visit to The Ether Dome where the first public demonstration of inhalation anesthesia was done October 16, 1846 by dentist Dr William T.G. Morton with Dr. John Collins Warren removing a tumor from a patient’s neck. At the completion of the operation with the patient experiencing no pain, Dr. Warren turned to the doctors in the amphitheater and said, “Gentlemen, this is no humbug.”

(Dr. Crawford Long in Georgia was the first to use ether March 30, 1842.) Lots of photos on all of these adventures during the travels.

The Grand Rounds presentation gave my view how to survive as an ethical science-based physician who always does what is in the patient’s best interest regardless of what healthcare system is put forth by politicians. The 3 elements of the talk with true stories of courage to make the points about the needed leadership.
· Design of a healthcare delivery system with attention to access, quality, and cost.

· A successful system must honor the patient by including the Six Commandments of Medicine as essential. SEC-C plus 2.

· CODAC for making a persuasive 2-minute presentation to defend your views.
————
GLOUCESTER

Dr. Mario Motta and his Telescope! Truly a passionate Galaxy Hunter! He has a 32-inch reflector in his home observatory.

After Boston, we traveled to Dr. Motta’s home for the night and enjoyed the hospitality of Mario and his wife Joyce. Unfortunately the sky was cloudy that night but a break in the clouds occurred briefly and we looked at the moon with Mario. He put the telescope on high power. Impressive!

Stories about Dr. Mario Motta’s World’s largest amateur-built telescope on top of his home.

http://bostoniano.info/italiani/mario-motta-world-largest-homemade-telescope-gloucester/
Nice pictures in the Bostoniano article showing Mario with the telescope plus a few views of far away places!

https://www.aavso.org/aavso-president-mario-motta

http://www.skyandtelescope.com/sky-and-telescope-magazine/beyond-the-printed-page/light-pollutions-medical-effects/

http://www.nytimes.com/2007/10/04/garden/04observatories.html?_r=0

http://tuftsjournal.tufts.edu/archive/2007/april/briefs/star_gazer.shtml

http://www.skyandtelescope.com/astronomy-news/u-s-physicians-join-light-pollution-fight/
And here is Mario at AMA with a resolution about Light-Pollution.

An excellent article that Mario gave me is in the May, 2011 issue of SKY & TELESCOPE.
Unfortunately it is not available online to non-subscribers.

This is part of the Lagniappe of being involved with national medical organizations. You get to meet smart people all over our great Land of Liberty. I try to find out what the individual’s passion is outside of Medicine. Mario is just one example. Sometimes you meet individuals who have completely different views of how the health system should evolve but that should not deter you from inquiring and listening to the person’s outside interests. With friendship, it is easier to reach solutions to problems.
———–
MANHATTAN

My wife’s favorite city to visit! After departing Boston, we went to Manhattan. I had business with my publisher on new projects and was able to record interviews with interesting people who will be featured in future podcasts, including the head of Skyhorse Publishing, Tony Lyons, as well as attorney and best-selling author Philip Howard (The Death of Common Sense, etc.)

We walked the Brooklyn Bridge, visit the 9/11 Museum and Memorial (powerful memorial and sad), One World Observatory, Statue of Liberty, and Ellis Island. We met friends from business and did touring with them. Tuesday night Robin and I had the pleasure of celebrating Dr. Bob Rigolosi’s birthday with his wife Professor Elaine, dear friends!

Lots of pictures during the visit that may find their way into Nature’s Reflections®! I also visited the wonderful Hemingway exhibit at the Morgan Library and Museum. The exhibit ends January 31, 2016. A must see exhibit if you have an interest in writing. It shows drafts of manuscripts with the changes he made. In the manuscript of THE SUN ALSO RISES, he told his editor Maxwell Perkins to discard the first two chapters on the advice of F. Scott Fitzgerald and the book then started at chapter 3! Great fun and I learned a lot. Took lots of notes about technique for my novel. Before leaving the museum, I visited again Mr. Morgan’s private rare book vault. I inserted a photo of it in my book, THE LITTLE RED BOOK OF LEADERSHIP LESSONS. Photo taken on a previous visit when writing the book. After leaving the MORGAN, Robin remembered The Authors Guild was nearby and we made it there before it closed. As a member, I learn a lot from this organization about book contracts. Great visit with General Counsel and Assistant Director, Jan Constantine, who is a fun person to know.

And yes, we got to see the “Woman in Gold” Portrait of Adele Bloch-Bauer painted by Gustav Klimt in 1907. It is at the Neue Gallerie in Manhattan. http://www.neuegalerie.org/collection/Austrian/Fine%20Arts?page=1

The 2015 movie Woman in Gold tells the story on the big screen.

More on the story of the painting stolen by the Nazis and the battle to get it back 50 years later is at:
http://www.npr.org/2015/04/02/396688350/after-nazi-plunder-a-quest-to-bring-the-woman-in-gold-home

NEW ORLEANS

I will make a co-presentation with attorney Darrell Ranum of The Doctors Company (TDC) in New Orleans this Thursday at the 2015 PIAA Claims and Risk Management / Patient Safety Workshop – Physician Insurers Association of America (PIAA) on behalf of TDC whose board I sit on. The talk is entitled Normal Recovery or Complication: The Risks of Post-Operative Care. This presentation is an expansion of our article published in the Bulletin of The American College of Surgeons June 1, 2013. See: http://bulletin.facs.org/2013/06/symptoms-of-normal-recovery/

LAGNIAPPE

My wife Robin brought home today the November/December 2015 issue of Louisiana Life Magazine. The orthopedic surgeon, Dr. Felix “Buddy” Savoie, who operated via scopes and a regional block on my rotator cuff problem in March of 2013 is on the cover. Excellent surgeon who is a nice person. He did a great job on my shoulder and I have 100% function and no pain. Dr. Savoie is Tulane Sports Medicine Chief, world-famous, and operates on many high-profile athletes (I certainly am not a high-profile athlete but he did the same wonderful job on me.) His special interest is the shoulder and elbow. Read the article here:
http://www.myneworleans.com/Louisiana-Life/November-December-2015/Savoie-Faire/

And here is the cover with Dr. Savoie: http://www.myneworleans.com/Louisiana-Life/November-December-2015/

Enjoy the read!

Finally, some Louisiana Gumbo advice for taking the time to read this lengthy DJP Update!

TOUR de GUMBO article in November issue of New Orleans Magazine:
Lots of pictures and advice! If you have not had the wonderful Gumbo and Turtle Soup in New Orleans and throughout Louisiana, it needs to be on your Things to Do list!

http://www.myneworleans.com/New-Orleans-Magazine/November-2015/Tour-de-Gumbo/index.php?

Finally, if anyone is coming to New Orleans for PIAA or any other meeting, here is a list of my favorite New Orleans restaurants:

http://www.donaldpalmisano.com/html/restaurants.shtml

———

Stay well!

Donald

Donald J. Palmisano, MD, JD, FACS
Intrepid Resources®

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@donaldpalmisano.com

Home

http://onleadership.us/

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates:  http://djpupdate.com/

Twitter: https://twitter.com/DJPNEWS

YouTube: https://www.youtube.com/user/IntrepidResources/videos Check out the videos.

This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 12-8-2014 Tomorrow on C-SPAN 3 Hearing on PPACA; 2- Some Weblinks; LAGNIAPPE: Movies and Louisiana U.S. Senate runoff election

Dec 08
Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 12-8-2014 Tomorrow on C-SPAN 3 Hearing on PPACA; 2- Some Weblinks; LAGNIAPPE: Movies and Louisiana U.S. Senate runoff election

Airing LIVE Tuesday, Dec 09 9:30am EST on C-SPAN 3 re PPACA, the healthcare law.

http://www.c-span.org/video/?323115-1/hearing-jonathan-gruber-marilyn-tavenner-health-care-enrollment

Jonathan Gruber and Marilyn Tavenner on Health Care Law Enrollment
Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner and MIT economist Jonathan Gruber testify before the House Oversight and Government Reform Committee about enrollment issues with the Affordable Care Act.
If you are caring for patients during that time, set your recorder.  It is my view the hearing will not be limited just to enrollment.  Professor Gruber’s comments regarding how the law was designed and what he thinks of the public no doubt will be explored.

2- Some Weblinks to Professor Gruber’s comments and an interesting article in WSJ today about PPACA threat to private practice:
DJPNEWS
“Will Jonathan Gruber Topple Obamacare?” @politico Pro: http://t.co/BsvjJmkgJJ #CSPAN tomorrow = Testimony #Congress . #ACA #tcot
12/8/14, 10:20 AM
Alternative link:  http://www.politico.com/magazine/story/2014/12/will-jonathan-gruber-topple-obamacare-113369.html?hp=t3_r#.VIZVLIer9XZ

DJPNEWS
“ObamaCare’s Threat to Private Practice” @WSJopinion @AEI http://t.co/zvBtuPqWOb #PPACA #ACA #tcot @AAPSonline @AmerMedicalAssn @sonodoc99
12/8/14, 11:21 AM
Alternative link:  http://www.wsj.com/articles/scott-gottlieb-obamacares-threat-to-private-practice-1417990367  (Requires log in)

—————

LAGNIAPPE:  Two movies and one YOUTUBE that we saw recently and enjoyed.  1- Big Hero 6.  We saw this with our grandkids in movie theatre.  Story of a robotics prodigy. A story of genius, tragedy, and triumph.  Stresses education.  2- The Hundred-Foot Journey (based on book of same name)  A tale of a family who suffers a tragedy in India and moves to France.  One son is a gifted chef.  Heart-warming story of family, love, and cooking.  Available ON DEMAND from TV services.  Info about the author, Richard C. Morais, is at:  http://www.richardcmorais.com/

YOUTUBE:  Work of art video;  It shows the design of a Beretta shotgun by Apple designer and the craftsmanship of the folks at Beretta.

http://www.thefield.co.uk/news/beretta-486-apple-designer-marc-newson-26297
TheFieldmag
Is this the most fantastic collaboration ever? @BerettaItalia with Apple designer Marc Newson http://t.co/TofGpD5vLZ http://t.co/Azlu6BGsEj
11/17/14, 5:26 AM

————

Must not forget the La. U.S. Senate runoff election that took place Saturday December 6.

DJPNEWS
RT @BillCassidy: Louisiana, you voted for change. It’s an honor and a privilege to be your next senator. Thank you! http://t.co/Gj7oKa6EKy
12/6/14, 10:21 PM

DJPNEWS
Election results not close in Rep. Bill Cassidy win over Sen. Mary Landrieu for La. U.S. Senate seat. #tcot #GOP http://t.co/OtldoH4DOi
12/6/14, 9:14 PM

The final tally was 56 percent for Dr. Bill Cassidy and 44 percent for Senator Mary Landrieu.

And the Louisiana State Medical Society (LSMS) sends out this message today:

4 LSMS Members in the United States Senate and House of Representatives

“Congratulations to Drs. Cassidy, Boustany, Fleming, and Abraham

“LSMS Member in the U.S. Senate
Dr. William “Bill” Cassidy was elected to the US Senate on December 6, 2014.

“LSMS Members in the U.S. House of Representatives
District 3 reelected Dr. Charles W. Boustany, Jr. on November 4, 2014.
District 4 reelected Dr. John Fleming on November 4, 2014.
District 5 elected Dr. Ralph Lee Abraham on December 6, 2014.”
——-
Stay well,

Donald

Donald J. Palmisano, MD, JD, FACS

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates:  www.DJPupdate.com

Twitter:  www.twitter.com/DJPNEWS

YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.

This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

 

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DJP Update 11-25-2014 OP-ED on Alternative to PPACA by Dr. Healy and DJP; Also Dr. Tenery article; Lagniappe: Some tweets not about health system reform

Nov 26
Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 11-25-2014 OP-ED on Alternative to PPACA; Also Dr. Tenery article; Lagniappe: Some tweets not about health system reform
(Sent yesterday but server problem so sending again today after server fixed. Also added links.)

Here is the link at The Daily Caller with the OP-ED written by a former president of the American College of Surgeons, Dr. Gerry Healy, and me. Published 11-24-2014.

(Copy and paste links into your browser if it doesn’t show up as a hot link here.)

http://dailycaller.com/2014/11/24/we-need-healthcare-reform-but-obamacare-is-not-it/

The OP-ED is on two pages so click page 2 at bottom of first page.

Of course, I did a tweet about it too:

DJPNEWS
OP-ED @DailyCaller Dr. Healy + @DJPNEWS #PPACA + better way http://t.co/bRlEOidgIs #tcot @AAPSonline @AmCollSurgeons @LaMedSoc @BretBaier
11/24/14, 5:06 PM

By the way, if you want your own copy of The Patient Protection and Affordable Care Act (PPACA, ACA, etc.) for review during a discussion, here is a government link that gives you entire law.

The sequence of events and dates of PPACA passage can be found in my 2010 OP-ED: http://www.donaldpalmisano.com/html/PEJLSMS2010.pdf

https://www.govtrack.us/congress/bills/111/hr3590/text

A retweet involving PPACA and the man who found Professor Gruber videos.

This introduces the world to the person who found all of the Jonathan Gruber videos. I find it fascinating that this man is not a reporter but a guy who did his own research in his space time and scooped all of the press and those in Washington, DC. This man doesn’t want any publicity. He merely wanted to document the record regarding PPACA. He deserves a Pulitzer Prize.

DJPNEWS
Tell folks follow! @phillyrich1 RT @Heritage: Meet..Man Who Found the Jonathan Gruber Videos – http://t.co/aCHLvZnFle http://t.co/CuXl23U2tk
11/20/14, 2:44 PM

Try this link if above link doesn’t work: http://dailysignal.com/2014/11/20/meet-man-found-jonathan-gruber-videos/?utm_source=twitter&utm_medium=social

plus the image at: https://twitter.com/Heritage/status/535529301882327040/photo/1

BONUS: Here is a blog posting by Dr. Rob Tenery, a former Chair of CEJA that deals with PPACA. It is entitled: Boondoggle?

Worth reading: http://www.robtenerymd.com/blog/?p=367

LAGNIAPPE: Some of my Tweets/retweets you may find of interest not dealing with health system reform:

Watch the excellent video of a Beretta shotgun designed by Apple designer Marc Newson:

DJPNEWS
Work of #Art – incl video RT @TheFieldmag: … @BerettaItalia with Apple designer Marc Newson http://t.co/xL2J2XJkz4 http://t.co/uYkb1r0IbD
11/22/14, 9:31 AM
If link does’t work, use this instead: http://www.thefield.co.uk/news/beretta-486-apple-designer-marc-newson-26297 and then this one: https://twitter.com/TheFieldmag/status/534306606708953088/photo/1

Here is KitKat the day after the Saints lost on Monday Night Football:

DJPNEWS
Our outside #cat – #KitKat – with inside visitation privileges appears sad after loss #NOLA #Saints last night. #NFL http://t.co/NealmIvZp3
11/25/14, 2:50 PM
Try this link if link in tweet doesn’t work: https://twitter.com/DJPNEWS/status/537347570318594049/photo/1

Here is one of my Double Knockout roses. My daughter Mary Ellen recommends KnockOut Roses because they are so easy to grow and are resistant to disease.
DJPNEWS
Today’s #DoubleKnockoutRose from our garden. #Flowers #Roses #photography http://t.co/9xKweYy30x
11/25/14, 2:43 PM
Try this link for rose: https://twitter.com/DJPNEWS/status/537345797751603201/photo/1

That photo was take with iPhone 6+.
—————

Have a wonderful Thanksgiving!

Donald

Donald J. Palmisano, MD, JD, FACS

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates: www.DJPupdate.com

Twitter: www.twitter.com/DJPNEWS

YouTube: http://www.youtube.com/user/IntrepidResources/videos Check out the videos.

This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 9-28-2014 1- AMA Ethics Award Recipient Dr. Ezekiel Emanuel’s article “WHY I HOPE TO DIE AT 75”. 2- DJP Updates

Sep 28
Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 9-28-2014 1- AMA Ethics Award Recipient Dr. Ezekiel Emanuel’s article “WHY I HOPE TO DIE AT 75”. 2- DJP Updates

The article by Dr. Ezekiel Emanuel is published in THE ATLANTIC September 17, 2014 with the title:

 Why I Hope to Die at 75

H/T to Dr. Art Fougner for the alert about article in the listserv he moderates “Speaking As An Individual” and via his Twitter account: @sonodoc99

Dr. Emanuel’s article is at: http://www.theatlantic.com/features/archive/2014/09/why-i-hope-to-die-at-75/379329/

You have to read his entire article to get his message.  Here is one excerpt re his approach to treatment as one gets older:

“This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age. (When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me. He ordered the test for himself, I told him, not for me.) After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.

“What about simple stuff? Flu shots are out. Certainly if there were to be a flu pandemic, a younger person who has yet to live a complete life ought to get the vaccine or any antiviral drugs. A big challenge is antibiotics for pneumonia or skin and urinary infections.”
————

Bio from article:

Ezekiel Emanuel is director of the Clinical Bioethics Department at the U.S. National Institutes of Health and heads the Department of Medical Ethics & Health Policy at the University of Pennsylvania.

——

Of course, AMA Delegates and the AMA Board know Dr. Emanuel well as he received the AMA Foundation’s “2013 Isaac Hays, M.D. and John Bell M.D. Award for Leadership in Medical Ethics and Professionalism” at the June 2013 Annual AMA House of Delegates.

See: http://www.ama-assn.org/ama/pub/news/news/2013/2013-11-18-ama-foundation-honors-physician-for-ethics-leadership.page

Comments by others on Dr. Ezekiel Emanuael’s article:

sonodoc99
@AmerMedicalAssn @DJPNEWS Dr. Emanuel stands Primum non nocere on its ear. http://t.co/4iO51DLCra
9/21/14, 8:16 AM

http://nypost.com/2014/09/24/a-pathetic-case-for-stopping-life-at-75/

http://pjmedia.com/ronradosh/2014/09/19/dr-ezekiel-emanuel-to-me-and-others-dont-live-past-75/?singlepage=true
…….

DJP editorial comment:  I disagree with Dr. Emanuel.

Dr. Emanuel’s article is his opinion.  But if the government adopts such an approach though the IPAB (Independent Payment Advisory Board) of PPACA or some other scheme yet to be devised, then we have a problem!  Dr. Emanuel is a chief architect of PPACA/ACA and you already know my views on that law: http://www.donaldpalmisano.com/html/PEJLSMS2010.pdf

My answer to Dr. Emanuel’s view is in my 6 Commandments of Medicine: S-E-C-C + 2.

Science – Ethics — Compassion – Courage and the +2 =

Is this in the patient’s best interest?

Do I have my patient’s informed consent?

I included the 6 Commandments in my commencement speeches to graduating medical students and other medical professionals at Tulane University Health Sciences Center (May 22, 2004), LSU Health Sciences Center New Orleans (May 18, 2002), LSU Health Sciences Center Shreveport (May 29, 2004), and Oklahoma University College of Medicine (May 27, 2006).

See one of my speeches containing the 6 Commandments at:

http://www.donaldpalmisano.com/html/commencement_address.pdf

May 18, 2002 LSU Health Sciences Center Commencement Address

Also published in Vital Speeches of the Day; 9/15/2002, Vol. 68 Issue 23, p764

These speeches were delivered during my time on the AMA Board 1996-2005 and as AMA president 2003-2004 and after.

I am 75 years old and I tell the medical students I teach at Tulane if some future government edict states people my age should be ignored and put on a gurney in the corner of the emergency department if they are in an auto accident, don’t follow the rule.  Show courage and leadership and follow the 6 Commandments.  I remind them it is the least they can do for a clinical professor who teaches them for free and it is the ethical act to do what is in the patient’s best interest, not the government or insurance company!

Throughout history there are people who seek to control, command, and remove liberty from others or use their view of ethics to justify their actions. America’s response has been to fight for freedom and individual self-determination.  Visit Arlington National Cemetery, the National Cemetery of the Pacific in Hawaii, or the Normandy American Cemetery and Memorial for powerful reminders of the price we paid for Liberty..  Remember, LIBERTY is the absence of coercion.

As for various views of ethics and how different results can be obtained using different ethical models, see my 1998 speech:  Hippocratic Oath:  Discarded Relic Or Living Soul of Medicine:

http://haciendapublishing.com/medicalsentinel/hippocratic-oath-discarded-relic-or-living-soul-medicine

Read the entire speech.  Here is an excerpt about the ethical models:

———-Excerpt——–
Let us not go quietly into this abyss, this new Dark Age, a Dark Age of medicine. Let us stand on principle. A revival of the Hippocratic Oath with reasoned discussion of what it means is a step away from the abyss.

We must understand what ethics mean. Never accept blindly a statement that something is ethical without reviewing the analysis that led to that conclusion.

For example, consider the following different ethical models:

• Deontological: rightness is not defined in terms of their consequences; violate no rights.

• Teleological: goal or consequence oriented.

• Social utility: greatest good for the greatness number.

After selecting one of these reasoning models, was an analysis done that considered the following? Autonomy, Nonmaleficence, Beneficence, Justice.

Each of these analyses has additional choices to make in order to complete the analysis. For example, to do the justice analysis, one must decide which of the following theories one will use: Egalitarian, Communitarian, Libertarian, Utilitarian.

Thus it is obvious that it is possible to reach different conclusions as to what is ethical and what is not depending on the ethical model used.

—————- End of Excerpt———–

If Dr. Emanuel is serious about the statements in his article, it would be a good idea for him to do a legal document, an “Advance Directive” (sometimes called a “Living Will”).  This gives instructions regarding medical treatment in the event an individual becomes incapacitated and is unable to instruct the doctors on treatment choices (or no treatment).  Others who wish to have relatives or a trusted friend make medical decisions also execute a “Durable Power of Attorney for Healthcare”.  Such a document turns comments in an article into reality.

2- DJP UPDATES:

Some doctors have contacted me and asked if they fell off my DJP Update blog because they have not received a DJP Update since July 7, 2014.  I informed them that I have not sent any since July 7.  I have been very busy and my spare time writing is on my novel plus Twitter postings, now up to 12,144 tweets as of September 26, 2014.  See @DJPNEWS

Remember, you always can view previous DJP Updates at http://djpupdate.com/

Another reason some individuals don’t receive the DJP Updates is because emails that have thousands of recipients frequently go to junk mail.  That can be avoided by selecting my DJP@donaldpalmisano.com email as a favorite and thus one not destined for junk mail.  Of course, if you want to get off of my DJP Updates, just put REMOVE in reply subject line.

—————
Stay well.

Donald

Donald J. Palmisano, MD, JD, FACS

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates:  www.DJPupdate.com

Twitter:  www.twitter.com/DJPNEWS

YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.

This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 6-17-2014 Travel, Tweets, AMA, ABA, ON LEADERSHIP now an audiobook, Stanford Commencement Address by Bill and Melinda Gates; Gadgets

Jun 17
Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 6-17-2014 Travel, Tweets, AMA, ABA, ON LEADERSHIP now an audiobook, Stanford Commencement Address by Bill and Melinda Gates; Gadgets

1- My DJP Updates have decreased in number because of the lure of Twitter.  I tweet daily at @DJPNEWS and it is a good way to learn how to be concise as the total number of characters cannot exceed 140.  Plus by following reporters and news channels one can get the breaking news immediately.  The TV news almost becomes unnecessary.

2- Lots of travel so far this year to board meetings plus PIAA in Ontario, AMA Annual Meeting, and presentation with son Donald Jr. at American Bar Association just after AMA meeting in Chicago.  Next week we go on the 2nd of the planned grandchildren adventures!  We are taking Alexis, our granddaughter to Paris, not in France but the Las Vegas Paris Hotel.  She picked Paris as the destination but she will have to wait until high school graduation for her parents to take her.  These trips are great for one-on-one time with the grandkids.  I highly recommend it.  Just about finished designing the new course I will teach at Tulane Medical, how to make a powerful 2 minute presentation.  The goal is to encourage the students to be comfortable using rhetorical devices plus understanding the importance of C.O.D., namely Content, Organization, and Delivery.  With the large number of students in the USA not getting a residency spot such a course should make them better able to convince the residency to select them.

3- My book ON LEADERSHIP has been selected by Audible.com as an audio book!  In addition to the print version, having the book in digital reading format and digital audio means it always will be available.  That is nice.

Reviews of the print version can be found at:  http://onleadership.us/pages/reviews.php

4-  I won’t depress you with my views about the continued problems with PPACA, SGR, ICD-10, etc.  There are too many depressing stories on other topics in the news today.  Perhaps we will get to the truth of the current controversies soon.  But courage and leadership will be required.  It will require truth to trump politics.

5- Stories are a powerful way to get a message to the audience.  People in the audience remember stories years later, long after they forgot the rest of the speech.  Watch and listen to the 2014 Stanford Commencement speech delivered by Bill and Melinda Gates.  Bill and Melinda both share stories that are powerful.

Here are my comments about the speech:

Bill’s first story about the lack of reliable power source for computer in Africa  points out the importance of what I call “walking the halls”.  One has to go to the site of action to see what is really happening.  I tell that to hospital administrators all the time.  Can’t run a hospital from the fancy office on the 12th floor.  Go visit the wards, the O.R., and the Emergency Dept. and learn what the real problems are.  Talk to the surgeons in the surgery lounge at 7 A.M. and hear their frustrations.

My favorite story was Melinda’s account where she personally carried a dying woman with AIDS to the roof of the “Home for the Dying”. “The stigma of AIDS is vicious and the punishment is abandonment.” Powerful.  Melinda is a natural storyteller and she does it without notes.  I can picture the woman holding Melinda’s hand on the roof top as woman watches the setting sun just before dying.

Here is my @DJPNEWS tweet with the link and location in the timeline of the commencement address.  BTW, H/T to Raymond French, father of Melinda, for the alert about the speech.

I strongly recommend you listen to this commencement address.

DJPNEWS
Stanford 2014 Commencement Address: Bill/Melinda Gates. 1:01:42 of Webcast and ends at 1:31. Powerful esp. 1:19:17 https://t.co/ttLxbFvcfk
6/16/14 5:40 PM
Melinda and Bill Gates are shining examples of leadership and they work through their foundation to try and solve horrific ills in the world.  Think Malaria, Polio, HIV, and more!  Read more about their work at:

http://www.gatesfoundation.org/

Some specific programs:
http://www.gatesfoundation.org/What-We-Do/Global-Health/Malaria
and
http://www.gatesfoundation.org/What-We-Do/Global-Development/Polio
and
http://www.gatesfoundation.org/What-We-Do/Global-Health/HIV

6- GADGETS:  Tomorrow, June 18, Amazon is announcing the Amazon smart phone.  Amazon Prime customers now have over one million songs available to hear as a bonus in addition to the free movies with the Prime service.  The new gadgets, software, high-speed streaming via Internet are akin to magic.  Great adventures for techies.

One last thing.  I have a new camera for the trips with the grandkids.  It had to be a camera with a long zoom but small enough to fit in my jacket pocket.  After testing many cameras, I settled on the Olympus Stylus 1.  It has an adequate sensor and the zoom goes to 300 mm equivalent.  The sensor is large enough for 11 X 14 enlargements with excellent quality.  It has an easy to use Wi-Fi and photos can be sent to a smart phone immediately for sharing.  Nice!  The first one I bought had a software problem with freezing up but my favorite camera store, Bennett’s Camera in Metairie, immediately exchanged it for another new one.  A big stimulus for this camera was the safari at “The Wilds” in Columbus Ohio at the Columbus Zoo where we ride in the back of a pickup truck going by the animals on the plains.  Didn’t want to carry the large Nikon and the Canon 110 did not have enough zoom.  The Columbus adventure is in July with two more of the grandkids, Diego and Pablo.  They wanted to travel to Ohio to see where “Nana” Robin was born!

P.S.  To all the folks I photographed on the trips, I will send the photos by email but it will take a while to get to it.  Some of you saw your photos on Twitter at the AMA meeting with the hashtag #AMAmtg

Some examples:

DJPNEWS
#AMAmtg : Also = renewal of friendships. Robin and I visit 2 wonderful bright ladies after the day’s work. @PeggyMP http://t.co/35iqmX5UsY
6/9/14 2:22 PM

DJPNEWS
Standing ovation #AMAmtg for Dr Monica Wehby, fmr AMA Board member candidate for U.S. Senate Oregon. Go Regency D 5PM http://t.co/JsNKq4A4gt
6/7/14 4:49 PM

And one taken by moderator at ABA panel!
DJPNEWS
Thx! @doctorscompany RT @CountrymanClay: First time Donald Palmisano Jr and Sr presented on same panel #PHYLAW14 http://t.co/oensKgRuZx
6/12/14 4:16 PM
Stay well,

Donald

Donald J. Palmisano, MD, JD, FACS
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, LA 70006
USA
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us
(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)
DJP Updates:  www.DJPupdate.com
Twitter:  www.twitter.com/DJPNEWS
YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.
This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an  email stating “Join DJP Update”
To get off the list, state ” Remove DJP Update” in subject line.

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DJP Update 11-1-2013 Some doctor friends in the news; LAGNIAPPE: Paracord bracelets

Nov 01
Posted by Dr. Donald Palmisano in DJP Updates

DJP Update 11-1-2013 Some doctor friends in the news; LAGNIAPPE: Paracord bracelets

One of the joys of being involved over the years in organized medicine at the local and national level is the opportunity to meet dedicated doctors and staff of organizations throughout the USA (and beyond) and make new friends.

Here are examples of two friends in the news.  I know you can share others but I mention these individuals as illustrative of the dedication of physicians throughout the nation.

1- Dr. Robert S. Rigolosi received THE SPIRIT OF HEALING AWARD October 12, 2013, from Holy Name Medical Center for his medical achievements and commitment to outstanding patient care.  As most of you know, Bob is the current chair of the New Jersey Delegation the the AMA.

He received the award at THE FOUNDERS BALL held at a gala event at Pier Sixty in New York City.  Robin and I attended and it was truly gala.  Robin and I sat next to the wonderful Dr. Walter and Susan Kahn at the event.  Great fun.  Dr. Rigolosi has many achievements including creating a facility that is a model for hospital-based dialysis centers throughout the United States.  A brunch with Bob and Elaine, his professor wife and author, gave us the opportunity to visit further.

Bob’s medical accomplishments are well-known but here are two little known facts that I learned years ago when AMA president and visiting New Jersey.

a)  Bob was a champion boxer who made it to the finals in 1956 for the American boxing team for the Olympics.  He was offered an alternate spot but turned it down to finish his last semester in pre-med.  Because of his boxing experience and fluency in Italian, Bob was called to the 1960 Olympics in Rome and “asked to chaperone an 18-year-old Cassius Clay, who went on to win the gold medal and then changed his name to Muhammad Ali.”

See more at: http://www.northjersey.com/sports/Paramus_Dr_Bob_Rigolosi_never_lost_his_Olympic_spirit.html?page=all

b)  In addition, Bob was an actor in a number of Italian movies.  Love the posters of Bob in the movies!

Remember, every doctor you meet has a story outside of Medicine!

2-  Dr. Monica Wehby, pediatric neurosurgeon and member of the AMA Board of Trustees, is running for the United States Senate from Oregon!

If there is anyone who has not met Monica, that person is in for a real treat.  I had the privilege to testify with her before the Oregon Senate when I was AMA president advocating for medical liability reform in Oregon.  She is a dedicated neurosurgeon, smart, and articulate.  She does a great job testifying and handling questions using her experience as a neurosurgeon treating very ill children.  Check out her Website and Twitter posts.  See below.

Website:  http://www.monicafororegon.com/

Twitter:  @MonicaForOregon

She is running against an incumbent and the campaign will be expensive.  Help her out with your support, including donations!  More details at her Website.  It is a nice Website and has a great photo of Monica.  Also, be sure to watch the terrific video on on the home page.

Here is an excerpt from the “WHY I’M RUNNING” link from her home page.

“That pioneer spirit that our state was founded upon is under attack by a federal government that wants to control every aspect of our lives, our education, our healthcare system, and our businesses.  When I talk to small business owners they are very concerned about all these new regulations, new laws, new taxes coming out of Washington D.C..  They don’t know whether to invest and grow their business, or hold back and see what happens to this economy.  They don’t feel like they have a senator who is looking out for them.”

LAGNIAPPE:  I always enjoy hearing of entrepreneurial adventures.  That is an important part of the American Spirit.  The individual who is the Webmaster for my Websites, Intrepid and On Leadership, decided to make paracord bracelets (made of parachute cord) and offer them for sale.  I noticed his “WhoDat” version on his wrist.  I ordered the same for myself and Robin.  Oldest daughter requested one too and she now has it.  These bracelets can be taken apart for 9 feet of very strong cord if needed for emergencies on camping trips etc.  Also, the WhoDat version has a whistle built in.

Fun.  Check it out:

http://extremepara.com/custom-bracelets

Close up of “WhoDat” below:

http://extremepara.com/custom-bracelets?product_id=258

Finally, here is Webmaster Bart Colosino on YouTube demonstrating how to make a paracord bracelet:

Stay well.
Donald

Donald J. Palmisano, MD, JD, FACS
Intrepid Resources® / The Medical Risk Manager Company
5000 West Esplanade Ave., #432
Metairie, LA 70006
USA
504-455-5895 office
504-455-9392 fax
DJP@donaldpalmisano.com
www.donaldpalmisano.com
www.onleadership.us
(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)
DJP Updates:  www.DJPupdate.com  (See previous updates at this site.)
Twitter:  www.twitter.com/DJPNEWS
YouTube: http://www.youtube.com/user/IntrepidResources  Check out the videos.  You can post your views on your own YouTube site.
This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an  email stating “Join DJP Update”
To get off the list, state ” Remove DJP Update” in subject line.

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