Desert Nomadic Values and Religion—Guest Blogger, Andre Le Gallo

99755-guest2bblog-2 My guest blogger this week is author and retired CIA officer, Andre Le Gallo.

He studied the Middle East at The School of Advanced International Studies at Johns Hopkins and lived in Muslim countries. We have reviewed all three of his books on the Middle East: The Caliphate, Satan’s Spy, and The Red Cell.

Readers of this column know we don’t follow the news. However, it was hard to miss exposure to Bill Maher’s recent comment about terrorism when he referenced so many bad apples demanded an examination of the orchard(at the 3:13 point in the video). Killing in the name of religion isn’t good for anyone. Christianity and Judaism can both be

Andre Le Gallo

Andre Le Gallo

criticized for imposition of outdated traditions on their members today although we’re not aware that either endorse homicide or human sacrifice in the 21st Century. There is definitely a need to be selective about which of the ancient values to observe today.

Therefore, it seems relevant to hear from a man who has earned the right to speak on the topic.

Welcome, Andre!

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The discussions on Islam generally miss the point that it is not, strictly speaking, a religion any more than the iPhone is just a means to call your mother. Unlike Christian religions which focus on the individual’s belief in and relationship to God, Islam is a complete package governing every aspect of life on earth.

Islam set itself up as a new and improved version of the two previous monotheistic religions, Judaism and Christianity, whose prophets Islam folded into its own traditions. Islam acknowledged the previous two religions as foundation stones but also claimed that they had been superseded by the latest revelations. If Judaism was the 1.0 version and Christianity the 2.0 version, then Islam was supposed to be the new and improved 3.0 version. The other two were obsolete and no longer supported by God.

It is noteworthy that the Prophet was not only a religious leader; he was also a warrior, a merchant, an administrator, a judge, and a diplomat. An Islamic Republic is a state governed ultimately by “experts” who claim to represent God’s will. Governing with and through man-made laws is not part of the Islamist vision. In his book, What Went Wrong, Bernard Lewis recounts how early Muslim diplomats to Europe felt nothing but pity for countries that had to rely on their constitutions and statutes, all written by men, when they had Holy Law direct from God. Unlike Christianity’s now well-established principle separating religion from government, as in “Give to Caesar what is Caesar’s and to God what is God’s”, Islam draws no separation between the two. This is not to say that Christianity’s path was without martyrdom, usually caused by others unlike the current Muslim experience, and violence. However, it evolved through the Reformation and the Enlightenment two hundred years later. Since the Islamists’ credo is that their religion’s core value is the eternal truth of the revelations contained in the Quran, the path to changes and adjustments, other than to cut out all changes to Islam’s original values, faces an internal roadblock.

Islam’s true believers are not content with simply worshiping Allah and leaving others to worship in their own way. Their intent is to spread their beliefs to all walks of life from justice to finances to equal rights for all.

A set of values compatible with seventh century desert nomads is irreconcilable with Western democracies of the 21st century.

Le Gallo's books are available on Amazon.

Le Gallo’s books are available on Amazon.

Driving in a trance

The Eight Sentences:(Well, nine, I rarely go over the limit. Maybe the moderators will be tolerant.)

“It’s a somnambulistic trance,” blurted Barger.

Dryden spoke up, “Where did that come from? First you reported  the sheriff getting murdered and then all of a sudden you hit us with one of your big-ass words.”

“Well it isn’t that big of a word. I’ve heard of it,” said White.Sleep Walking

“And the sheriff didn’t get murdered anyway. It was the police chief and Barger said he bought it in a shootout,” said Scully.

Dryden replied, “It sure as hell sounded like one of his Tourette moments to me.”

Barger was ready to rejoin the fray, “You’re both correct. It was one of my moments but it wasn’t something out of Mrs. Byrne’s Dictionary. A somnambulistic trance is like when you’re driving down the freeway in complete control of your vehicle and aware of everything around you, but your thoughts are elsewhere–didn’t you ever drive right past your exit that you’ve taken for years?”

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The Setup:

From Chapter Twenty-two my my current serial novel, A Year Without Killing. In this scene, members of the League of Old Men are talking. Hawk Barger’s “condition” has just shown itself. This was introduced in a previous chapter and snippet. He suffers from acquired savant syndrome and often comes out with unusual words at the most inopportune times. In this case, I wrote this scene to immediately follow a scene at the end of the previous chapter in which Star Braun experiences the trance to which Barger makes reference.

NOTE: Mrs. Byrne’s Dictionary will be the subject of a future blog.

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Share your own EIGHT with us!

oin us here at Weekend Writing Warriors.The  same link will take you to the work of dozens of talented writers. For a treat, please check out their work, too.

Many of the contributors to Weekend Writing Warriors alsoSundaySnip

“Backwards” writing turns me off

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The Eight Sentences:

Sentence structure is a matter of style–every writer has his/her own–and no one is required to like it.

Frequency of use and the authors’ reputations don’t guarantee a pleasurable read.

If you do like a particular author’s style, it stands to reason, you’ll read more of their work.

Does annoying sentence construction take you out of the story?Hat-2-sml

Many of the examples of backward writing that I find most annoying include adverbs and “ing” verbs, both of which only serve to add to my displeasure. Some folks think this style of writing and sentence construction is fine. Apparently, it’s preferred in English class themes. My editor agrees with me in that it has no place in novels where active writing works better.

Where did that come from?

I recently wrote a blog about one of my pet peeves in writing (I only have about 5,280 pet peeves). My intention was to speak from a reader’s point of view. Every reader has her/his own preferences as do editors and authors. I claim no authority to speak from a position of wisdom on this subject, but I do know what I like and dislike as a reader. The entire article can be found HERE.

Share your own EIGHT with us!

oin us here at Weekend Writing Warriors.The  same link will take you to the work of dozens of talented writers. For a treat, please check out their work, too.

Many of the contributors to Weekend Writing Warriors alsoSundaySnip

participate in the Snippet Sunday group on Facebook.

Changes in Healthcare Delivery are Dangerous to Your Health

Pharmacy student, James Herbert joins us today.

Pharmacy student, James Herbert joins us today.

Our guest blogger this week is James Herbert, a Pharm D Student at South College School of Pharmacy, Knoxville, TN. He is a Husband, Father, Doctor Who fan, science fiction fan, philosophy-theology aficionado, and ex-IT guy with dreams of using informatics and technology to enhance pharmacy’s role in improving patients lives. He says, “I’m just a regular guy livin’ the dream because in the end aren’t we all?”

His topic addresses a situation begun decades ago and is now coming to a head. We introduced this subject last week with an article regarding the re-branding of patients to customers. Herbert believes there’s more to it than just semantics.

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James Herbert

James Herbert

A paradigm shift in healthcare begun years ago, speeds toward the downgrade of the patient to a statistical economic construct.
Patients are now being referred to as customers.
This is a dangerous shift that moves the focus of the patient’s medical needs towards the consumption of goods and services. Consumption of services does not require the relationship between patient and healthcare provider necessary for patient care. The purpose of healthcare is to provide appropriate care to patients. This shift away from the fundamental principle of personal attention is detrimental to the public health.
“Customer” is an economic term: A party that receives or consumes products (goods or services) and has the ability to choose between different products and suppliers.1 A patient is a person who has a medical need. In times of an emergency a patient does not have the luxury of choosing who provides their care. In cases of extreme emergency they have no say what so ever. Patients do not consume the “goods” and “services” of healthcare in the same way they would in a traditional retail environment. You will not see patients lined up at a hospital door on black Friday for example.
Dorland’s Medical Dictionary (2008) defines patient care as the services rendered by members of the health profession and non-professionals under their supervision for the benefit of the patient
Taking care of customers is commonly called customer service. “Customer service is a series of activates designed to enhance the level of customer satisfaction –that is, the feeling that a product or service has met the customer expectation.”2
Customer satisfaction is measured by the satisfaction survey. Here is where the disconnect begins
A survey, by its very nature, limits itself to the chosen parameters. That is to say that there are “buckets” that are being weighed as they are “checked off” in the survey. It is in this way that the customer is reduced to a set of statistics. In surveys, the person is irrelevant, it is the data that is important. Chosen members of management chose the parameters.
Data identifies trends and trends can be impacted by a series of scripted efforts. These efforts are called metrics. Metrics reduce customer service to a series of equations. CVS uses Triple S and KPM metrics3 in order to quantify and improve service performance. Customer expectations can be manipulated in scripted measures. Sitting down with a customer influences their perception of the amount of time spent with them4. Adding key words or phrases to encourage additional purchases is another scripted method of providing customer service (See CVS Pharmacy Business Metrics Paper)
Pharmacy may be measured by its Triple S and KPM or similar metrics but for hospitals to be reimbursed for providing care to those with Medicare/Medicaid, HCAHPS is the golden standard. Press Ganey is the leading provider of patient satisfaction surveys designed to help meet the HCAHPS requirements.

The manipulation of satisfaction scores may have nothing to do with providing safe and ethical healthcare. In one case a physician was able to achieve a 7% improvement in his satisfaction scores by prescribing an antibiotic to all his patients who complained of a cough, sore throat or sinus headache5. Managing low scores can lead physicians to prescribe powerful opiates for toothaches6. Healthcare professionals under pressure to meet metrics, forego patient care to perform customer service. The result is that most satisfied patients tend to be those who have higher healthcare cost, drug expenses, and most shockingly, have higher deaths rates than those who do not feel satisfied with their care7. The customer purchases their “good” but they may not get care for their health.
The retail pharmacy chain is the end game when customer service once and for all trumps patient care. In the retail setting, “wait times”, scripts per hour, and profit margins are king7. The pharmacist as healthcare provider is no longer part of the business model. Overwhelmed with hundreds if not thousands of script per day and skeleton staffing the pharmacist’s role is reduced to that of a dispensing machine. The result is they are not perceived as healthcare professionals. One woman demanded: “Please just do your jobs and fill what you see and stop trying to make yourself something you are not”9. In retail chain pharmacy healthcare is not important. Customer service is. Customer service quantified by metrics.
When results are all that mater then there is no “person” behind the customer or patient. They have been dehumanized. All that is left is the data. People do not get treatment. Data gets manipulated. Customers are not getting service. Data gets manipulated. When all that matters is the data, then the ends justifies the means. Metrics and surveys, by their very nature, dehumanize people.
The future of healthcare is freighting if the focus does not turn back to personal patient care. A therapeutic relationship addressing a patient’s medical need with personal and individual care, trust, and understanding. This includes a healthcare provider who has a specialized set of knowledge and skills that are not available on website, a television ad, or a talk show.
When raw, sterile numbers take precedent over warm flesh, people are no longer in the equation.

 

Without people there is neither health–nor care.

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References:

# http://www.businessdictionary.com/definition/customer.html
# Turban, Efraim (2002). Electronic Commerce: A Managerial Perspective. Prentice Hall. ISBN 0-13-185461-5.
# CVS Pharmacy Business Metrics: http://s3.documentcloud.org/documents/472510/250510-rx-tg.pdf
# Simple tips to improve patient satisfaction http://www.medscape.com/viewarticle/743875?src=mp&spon=25#vp_2
# Patient Satisfaction is Overrated: http://www.medscape.com/viewarticle/821288
# Why rating your doctor is bad for your health: http://www.forbes.com/sites/kaifalkenberg/2013/01/02/why-rating-your-doctor-is-bad-for-your-health/
# Patient satisfaction linked to higher health-care expenses and mortality http://www.ucdmc.ucdavis.edu/publish/news/newsroom/6223
# Pharmacists: Corporate greed putting patients at risk http://www.khou.com/story/news/investigations/2014/11/06/iteam-prescription-errors/18591573/
# LETTER: Pharmacists aren’t doctors http://www.courierpostonline.com/story/opinion/readers/2014/11/17/letter-pharmacists-doctors/19044977/

The Customer May Always be Right, But the Patient Is Not

Last week a new acquaintance asked me what I do for a living. My reply, “I spend my day telling people things they don’t want to hear. I’m a pharmacist and I deliver the news that  “your co-pay is much higher than you expected,” “your insurance company requires a prior authorization,” “your prescription was out of refills and your doctor has not responded to our request for a new prescription.” The list of examples goes on and on, but these are by far the most common.  People have high expectations of me and my department to make sure they leave the store happy and on the road to recovery from the ailment that brought them into the store.

Stew Leonard owns one of the most successful grocery stores in the world. Does his policy work in every situation?

Stew Leonard owns one of the most successful grocery stores in the world. Does his policy work in every situation?

Years ago, a syndicated columnist stated in no uncertain terms “The customer is NOT always right.” The article continued with the author’s evidence to support the claim. In retail sales, the age old standard is a difficult hurdle to overcome. In pharmacy it’s almost impossible. Once a shopper complains to a member of management outside the pharmacy, it’s a sure bet the manager will side with the customer—unless it’s a patient requesting something the pharmacist is prohibited from doing either by law or regulation. The distinction of roles they play once they enter the portal of a retail pharmacy is blurred. Sometimes, the clarity of a sharp focus is never achieved.

A simultaneous reference(customer/patient) to the people who shop in stores that contain a pharmacy became noticeable back in the 1970’s.  Was this duality the precursor to changes we see in the perception of consumers today? Are these shoppers  customers or patients—or both?

This labeling of shoppers took on more prominence with the rise in popularity of chain drug stores in the late twentieth century.

When pharmacists (usually independents) began leasing space for a pharmacy inside department or discount stores (such as Walmart’s precursors like “Gibson Wholesale”) the change  in,  shopping nomenclature picked up speed as well as consumer awareness of the trend.

Pharmacies are now being paid for talking to patients.

Pharmacies are now being paid for talking to patients.

Contemporary retail practice settings such as a prescription department in a grocery store or Walmart, continue that same tradition with shoppers being both customers and patients. I worked for Walmart for 7 years and by the time I left, we had to document counselling encounters in the computer—yet another conversion of a patient to a number.

Another significant event in the change in perception of shoppers was the influx of non-pharmacists into upper level management of both hospitals and chains. [Historical note: Eckerd Drugs (which no longer exists) had a chain of command of pharmacists supervising pharmacists from store level all the way up to the highest echelons of corporate management. The Sr. VP of Pharmacy reported directly to the CEO. Non-pharmacist management types could influence pharmacy only via him. Those days are gone with the wind. By contrast, the top pharmacy position at Walmart is a medical doctor(or was a few years ago.) ]

Retail pharmacists are now required by law to offer to counsel patients on new prescriptions. The requirement comes not from a concern for customer service, but from the government wanting patients who received government funded medication to use it correctly. Uncle Sam wants the most bang for his buck. Insurance companies now reimburse pharmacists for these same “cognitive services.”

Simply stated, insurance companies want pharmacists to talk to their beneficiaries and, just like our Uncle, get the most bang for their buck.

Many pharmacists complain that the reimbursement is not commensurate with the time involved. Many patients don’t want these extra services. They just want their prescription so they can get home, eat supper, and watch television. Perhaps they don’t mind being just another number. Such a mindset could be dangerous to their health.

Whether they consider themselves customers or patients, the shoppers I serve have one thing in common;

they’re all on drugs.

Has the game left me behind?

Signalling a penalty in Sept. 2011.

Signalling a penalty in Sept. 2011.

At the end of the 2012 football season, I retired as a high school football official after sixteen seasons. In retrospect, it was a good decision.

The stars of tomorrow. Do they have to start so young?

The stars of tomorrow. Do they have to start so young?

As a spectator, I lost interest in professional sports almost twenty years ago. Now I’m concerned about the state of college level sports and the influence it has on high school sports. How far does the influence reach?  Is there a level of sports, especially football, that is unblemished?

Acting on the premise that others may share my concerns, I turned to long time coach and official, Joe Sturniolo. We met online in a forum for officials. His comments and opinions have inspired, consoled, and entertained the members of our group for several years.

I didn't realize just how much the uniforms had changed!

I didn’t realize just how much the uniforms had changed!

This weekend, I begin a series of blogs to work out my thoughts on football, sports, and their places in my life. My interview with Coach Sturniolo is presented in two parts. Today is part one, conclusion is tomorrow.

Here’s a preview of one of the questions. Coach Sturno’s answer is thought provoking.

FCEtier: Overheard last week in a sports bar, “I lost interest in basketball when the men’s shorts got longer than the women’s.”

Your reaction?

For part one of the interview, including his answer to the above question, please click HERE.

Skulls and Bones

Find us on FaceBook.

Find us on FaceBook.

The Eight Sentences:

Hula girls and a skull dagger.

Hula girls and a skull dagger.

Claudia asked, “What’s up with the choice of shirts?”
“The dagger bothers you?” asked Debert.
“I’m not sure…” she hesitated wondering what Debert was up to. “Is he mocking me—or is this some dark metaphor?” she asked herself.
Debert assumed a dignified frown, lowered his eyebrows and intoned, “You remember from your study of history, that in medieval times, before the age of printing, events were often documented with marks on the handles of knives.”
“Mmmmm…..that does ring a bell,” Claudia remembered, “and this shirt with a skull at the junction of the blade, handle, and guard?”
Debert smiled, “Well I have no idea how many skulls, or notches on your gun you might have, but I thought one would represent what you do in addition to all of them in toto.”

The Set Up:

In this scene from The Tourist Killer, Claudia is having breakfast with Mr. Debert at the Sandestin Hilton in Florida. His choice of attire becomes the subject of their conversation. And in the news, Claudia got a great 4 star review this past week. Check it out, HERE.

Got eight lines to share? 

Join us here at Weekend Writing Warriors.The  same link will take you to the work of dozens of talented writers. For a treat, please check out their work, too.                                     

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Book Review: A Man for Kate by G.S.Bailey

Welcome to Goran Vale. A small (fictitious) town in New South Wales.

It isn’t far from Sydney and Melbourne.

It’s a long way from home—and farther from the truth than most folks find comfortable.

Author G.S. Bailey places readers right into the heart of town with vivid and detailed descriptions. We can close our eyes and see a little town reminiscent of Twin Peaks—without the picket fences.

A Man for Kate

A romance served with murder receives 4 of 5 stars.

Meet Kate.

She was left standing at the altar by one of the men in her life.

Early on, we meet them: Paul (her boss), Bobby (adopted brother), Ben (the friendly police officer), Stephen (her first love), and Lance (American insurance salesman). Will one of these candidates be the man for her?

One of them is “special” character. He’s the common denominator that links the major characters. He’s the glue that holds the story together.

Minor characters in Goran Vale are introduced and we learn that everyone seems to have secrets and several have skeletons in their closets (literally.)

Parallel plot lines follow Kate as she looks for the right man and Ben, the cop, who looks for the killer of poor little Melanie Rose.

Bailey does a superb job of weaving a page turner as we rush to learn which search is successful. Clues to the murder turn up when the shooting starts.

Which of the leading men will win Kate’s heart?

Will Kate and Ben find the same man? How do their paths cross en route to the story’s denouement?

A Man for Kate previously appeared as Remains of a Local Girl and Bailey does an efficient job of creating two female characters for whom either title would be eponymous.

A Man for Kate plays well as both a romance novel and a whodonnit. Such are the mysteries of love.

In the end, we leave Goran Vale secure in the knowledge that more books in the “Mystery Loves Romance” series are forthcoming.

Can you hear the Angelo Badalamenti soundtrack?

Forty by Fives

February 20 of next month will mark the fortieth anniversary of my liscensure as a pharmacist. I’ve been counting tablets and capsules by fives, for four decades.Counting Tray

I earned a B.S. in pharmacy at Northeast Louisiana University [now known as the University of Louisiana–Monroe] and graduated in December of 1974.

It’s been an interesting forty years, including a seven year hiatus in which I left pharmacy for Dale Carnegie Training and New York Life. I returned to pharmacy in 1992.  For “About Me” descriptions in the social media, this is what I list: “Husband, father, grandfather, pharmacist, photographer, and published author.”

Over the next twelve months I’ll post a few blogs with reflections on my career along with some guest blogs by other pharmacists and health care folks I’ve met along the way. In addition, there will be a few blogs to chronicle the my evolution from small town farm boy to small town pharmacist.

Maybe someone will find them of interest.

A Visit to Mayberry–Weekend Writing Warriors

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The Eight Sentences:

Mayberry Soda Shoppe

Walkers(with the green awning)=Mayberry Soda Shoppe. Notice the open space awaits our guys from LOOM.

White had listened to the conversation and at the same time, looked up Mt. Airy on his Smartphone, “Tripadvisor has a bunch of good ratings for the Mayberry Soda Fountain. It’s on Main Street so it should be easy enough to locate–it’s also known as Walkers.”

Barger smiled at Dryden and said, “Maybe we’ll run into Barney Fife and he can tell us all about the Hummer that did a flip into the New River near Austinville.”

Dryden winked and said, “Yeah, and maybe you can use some of that two hundred bucks you won to buy us lunch.”

Scully executed a perfect parallel park and the four men walked into the restaurant. As they walked in, Barger asked, “How did you get lucky enough to find a space right in front of the restaurant?”

Scully smiled, patted his obese friend on the back as he waddled through the door and answered, “They saved it for me.”

The Set Up:

In this clip, readers learn the result of Hawk’s bet with Mr. White along with my choice of how to handle the scene. I chose this route rather than a detailed description of the shot, the bullet crashing through the windshield, and the explosion of the driver’s head. I think my readers can figure out what happened without a review of the blood, the guts, and the gore. Writing a scene like this is, for me, analogous to writing a sex scene. Everyone knows what happens between the sheets. It’s more fun if it happens in the readers’ imagination anyway. Feedback, please.

You got eight sentences?

Join us here at Weekend Writing Warriors.The  same link will take you to the work of dozens of talented writers. For a treat, please check out their work, too.

Many of the contributors to Weekend Writing Warriors alsoSundaySnip

participate in the Snippet Sunday group on Facebook.

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