Archive for September, 2011


A More Natural and Greener Way to Garden – Slow Gardening

Wednesday, September 14th, 2011

Listen to author Felder Rushing on Naturally Vibrant Living.

In the pursuit of the perfect lawn and manicured, sometimes uniform shrubs and annuals, not to mention vegetables, could something be getting lost? Could we be gardening in an overly intense or pressured way? Diane Brandon is joined this week by Felder Rushing, a decades-long gardener who writes and speaks about gardening, who is also the author of Slow Gardening – A No-Stress Philosophy for All Senses and Seasons. Mr. Rushing’s approach could allow you to get the health benefits from contact with the earth, as well as the rewards of gardening, without feeling pressured. It should feed your enjoyment of gardening as well!

Praise for Slow Gardening

“Felder’s enjoyment-based approach, which is what I do and teach but didn’t have a name for til now, is sustainable gardening at its most enjoyable—without the usual anxiety over doing something wrong.”

Susan Harris, cofounder, GardenRant and founder, Sustainable-Gardening

“Felder knows that if gardening isn’t fun, it isn’t worth doing. So if ‘power gardening’ has emptied your wallet and sent your blood pressure soaring like a condor on caffeine, give yourself a break. Try Slow Gardening.”
Steve Bender, Southern Living Magazine

Join Chelsea Green Authors at the National Heirloom Expo!

Tuesday, September 13th, 2011

Gordon Edgar, author of Cheesemonger: A Life on the Wedge, and Jeffrey Smith, author of Seeds of Deception, will be at the National Heirloom Exposition in Santa Rosa, California later this week!

The National Heirloom Exposition is gaining incredible interest among home growers, farmers, school groups and the general public–so much so that it is shaping up to be the “World’s Fair” of the heirloom industry! This is a not-for-profit event, and any funds generated will be donated back to school gardens and food programs. The event will run for three days, September 13, 14 and 15, 2011.

Register here (It’s only $10!).

Schedule of our authors:

Gordon Edgar
Author Tue. Sept, 13th 1:00PM –Cheesemonger: A life in the wedge (Garret Building)

Jeffrey Smith–Keynote Speaker  Tue. Sept, 13th 7:00PM
Institute of Responsible Technology
One of America’s leading experts on the subject of genetically modified foods, and the dangers they pose to human health and the environment. Internationally best selling author of several books on the subject.

See the full schedule of fantastic talks, workshops, tastings and films here.

Listen to Mat Stein on EMPact Radio’s Preparedness Podcast

Monday, September 12th, 2011

Mat Stein is an environmentalist, bestselling author, MIT trained engineer, and green builder. As an inspiring speaker and visionary thinker, he is dedicated to helping people wake up and unite to shift our collective course from collapse to global renaissance. On the practical side of things, as an expert at self-reliance, emergency prep, and survival, his writings and work help people prepare to weather the storms we are facing due to continuing climate change and ecological decline, coupled with a fossil fuel based economy that has recently passed the peak in world oil production and is struggling to cope with impending near-term shortfalls.

Matthew Stein is the author of the bestselling book When Technology Fails: A Manual for Self-Reliance, Sustainability and Surviving the Long Emergency (Chelsea Green 2008) a comprehensive manual on sustainable living skills, survival, and disaster preparations. His new book, When Disaster Strikes: A Comprehensive Guide to Emergency Planning and Crisis Survival (Chelsea Green 2011) is due to release on November  14, 2001, and has received excellent advance praise from experts on survival and disaster preparedness. Stein is a graduate of the Massachusetts Institute of Technology (MIT) where he majored in Mechanical Engineering.

As the owner of Stein Design & Construction, he has built hurricane resistant, energy efficient and environmentally friendly homes.  The mechanical engineering side of his firm specializes in product design and development. Among other things, Mat has designed consumer water filtration devices, solar PV roofing panels, medical bacterial filters, emergency chemical drench systems, computer disk drives, and portable fiberglass buildings.

In recognition of his expertise, Stein has appeared on over a hundred radio and television programs and is a repeat guest on dozens of shows, including Fox News, MSNBC, Lionel, Coast-to-Coast AM, and the Thom Hartmann Show.  He has also written a number of articles on the subject of sustainable living and is a guest columnist for the Huffington Post.

Stein has been an active outdoorsman since he was a small child, an extreme skier and climber (over a hundred Yosemite Valley ascents including several El Capitan and Half Dome big walls), and volunteers as a guide and cross country ski instructor for the blind with the Sierra Regional Ski for Light program. He and his wife Josie live in the High Sierra Mountains near Lake Tahoe, California.

Listen to the podcast:

PPC#06 Mat Stein

Free Download: Chapter 2 of Killing the Cranes

Sunday, September 11th, 2011

With the tenth anniversary of September 11, 2001, Chelsea Green has had the honor of bringing veteran journalist Edward Girardet’s in-depth and personal history of Afghanistan, Killing the Cranes, into the world.

For a limited time we are offering a free chapter download. Click here to read Chapter 2 – A Coward in Afghanistan.

Girardet has been talking to a lot of people recently about his experiences in Afghanistan since the days just before the Soviet invasion in 1979.

To hear more, check out:

Exploring The Ingredients For Transition with Rob Hopkins

Thursday, September 8th, 2011

Are you inspired by the Transition movement? Do you have a burning  question for the Transition movement founder, Rob Hopkins? Or do you simply want to find out more? Join the folks at Transition US for a talk with Rob Hopkins, author of The Transition Handbook and the upcoming Transition Companion! You can tune in online Monday morning.

Register here.

Date:

Monday, September 12, 2011 – 8:00am – 9:00am PT (11:00am ET)

Descripton:Join us for an insightful conversation with Rob Hopkins, author, Permaculturist and founder of the Transition Towns Movement.

In this conversation we will be asking Rob to go more deeply into the “ingredients of Transition” as well as answering questions supplied by participants. Transition US board member, author and visionary Vicki Robin will be the host for this call.

In July our call with Rob, hosted by Richard Heinberg has been listened to by well over 1,000 people in just a few short weeks. If you have not heard that yet – listen to a recording of our last call with Rob here >>

In case you can’t make this talk, mark your calendar for the next exciting event in the Transition universe, a book launch!

Join Green Books, UK and Chelsea Green for a Twitter launch with Rob Hopkins on Thursday 13 October 2011. Rob will be available to answer questions about himself, his new book The Transition Companion and the Transition movement between 2pm and 5pm. All you have to do to take part is use the  hash tag #TTComp on Twitter to post your comment or question.

Rob will be answering the questions during the session and then we will post a transcript of the entire session, to  make sure that no-one misses out.

Date:  Thursday 13th October 2011
Time: 2pm – 5pm (UK GMT)
Contributor:  Rob Hopkins
Location:  Twitter @robintransition, #TTComp

Preserve the Harvest: Food Book Sale!

Wednesday, September 7th, 2011

It’s unmistakably harvest time! Whether you are looking for a step-by-step DVD, the best grilling and barbecuing techniques, recipes for all the great Fall raspberries or what to do with all the great greens – we have the right book for you.

Save 25% when you purchase any of the titles below to help preserve the bounty of the season and nourish you over the winter months to come.

Here at Chelsea Green we strive to produce books that will be a lasting resource. The books below are foundation books that will be trusted references on your bookshelf for years to come.

Happy reading from the friendly folks at Chelsea Green Publishing.

 

Preserving Food without Freezing or Canning

 

Save 25% Now

We talk a lot about preserving food here at Chelsea Green, but it’s not to be didactic! It’s because we believe in the possibilities of having power over one’s food supply, and being able to seek a more sustainable life, with a stocked larder.

 

We believe in food that is affordable, in spaces for gardens even in the most urban of places, and the RIGHT to grow and process one’s own food. But maybe we should take a moment and rewind, and revisit the whole idea of preserving food from a fundamentals standpoint. Let’s think about the WHY. And the HOW.

Read the full article here

Making the Most of Your Glorious Glut 

Cooking, Storing, Freezing, Drying & Preserving Your Garden Produce

 

NOW 25% Off

Making the most of your Glorious Glut is the answer to the perennial problem of an over-abundance of wonderful fruit and vegetables. From cucumbers to spinach, tomatoes to runner beans or blackcurrants to plums, most gardeners will recognize the sinking feeling that creeps over you when you realize you have had such a good harvest that you cannot actually face picking, cooking or eating any more.

 

- Full of imaginative ideas for using up all your garden produce and avoiding waste
- Shows how you can enjoy home-grown food throughout the year
- Over 250 delicious recipes

Preserving With Friends DVD

An easy step-by-step instructional guide  to putting up the harvest  

 

On Sale for 25% Off

Join urban householder Harriet Fasenfest and friends in her backyard canning kitchen to learn everything you need to know about putting up the harvest.  Presented in an easy and approachable format, Preserving with Friends offers safe and reliable steps for making jam, canning fruits and tomatoes, making pickles, sauerkraut, kimchi, kefir, and kombucha, pressure canning vegetables, drying, freezing, and root cellaring.

 

Watch a sample now

From the basics of sweet spreads to a guide for making pectin, from simple quick pickles to the history of wild fermentation, Preserving with Friends offers information for the beginning and experienced preserver alike. This independently produced instructional DVD also includes printable recipes and tip sheets to supplement your viewing experience

 

The Farmer and the Grill

A Guide to Grilling, Barbecuing, and Spit-Roasting Grassfed   Meat…and for saving the planet one bite at a time

 

Get it for 25% off

The key to getting the most out of pasture-raised meats is understanding how to cook them properly. In The Farmer and the Grill, Hayes offers useful tips on grilling, barbecuing, and spit-roasting all cuts of pasture-raised meats: beef, lamb, pork, and poultry.
Dozens of simple, straightforward recipes provide all the basic cooking instructions, plus directions on how to make a variety of herb rubs, marinades, and barbecue sauces to accompany the meats. Traditional techniques such as Southern barbecue and Argentine-style asado cooking will help readers grill like the pros. And specific notes from pasture-based farmers on dealing with natural variations in grassfed meats will ensure success every time.

Want to know how to cook the Perfect, Tender Steak?

Click here to read the article.

How to Store Your Garden Produce, Revised Edition

They Key to Self-Sufficiency

 

On Sale Now

This is the modern guide to storing and preserving your garden produce, enabling you to eat home-grown goodness all year round. The easy-to-use reference section provides applicable storage and preservation techniques for the majority of plant produce grown commonly in home gardens.

 

Why is storing your garden produce the key to self-sufficiency? Because with less than an acre of garden you can grow enough produce to feed a family of four for a year. But without proper storage, most of it will go to waste since much of the produce ripens simultaneously in the summer.

 

Learn simple and enjoyable techniques for storing your produce and embrace the wonderful world of self-sufficiency. You will know where your food has come from, you will save money, there will be no packaging, and you’ll be eating tasty local food while feeling very good about it!

From Asparagus to Zucchini

A Guide to Cooking Farm-Fresh Seasonal Produce

 

On Sale for 25% Off

Ever wonder how you’ll ever be able to use all your vegetables? From Asparagus to Zucchini answers the question of what to do with your armloads of greens, exotic herbs (and the never-before-seen vegetables), with recipes that are as concise and doable as they are appealing.

 

Created for and by Community Supported Agriculture (CSA) members, the book is an indispensable tool for anyone who wants to eat seasonally and locally.

 

With more than 420 original recipes created, tested, and enjoyed by chefs, CSA members, and farmers, you’ll never be without a delicious recipe to make the most of the season’s bounty.

Fermentation Workshop with Sandor Ellix Katz

 

Now On Sale

In this new DVD, Katz offers fermentation beginners and enthusiasts a chance to “sit in” on one of his popular workshops and learn through hands-on demonstration and instruction, accompanied by an interview on the benefits of fermentation, and social implications as it relates to food security.

 

Contrary to popular belief, fermenting foods is a simple process. But it needs to be done correctly, and there’s no better person to inform us about managing microbial bacteria to produce highly nutritious food. In fact, with Sandor Ellix Katz as their guide, viewers will find fermentation is much more than just a way of preserving food: it’s a method of self-sufficiency, a crucial historical component to all agricultural movements, and utterly delicious.

Check out the DVD trailer here

This intimate workshop and interview will prove invaluable both for total beginners and longtime fermentation lovers. The DVD includes:

 

- The history of fermentation and culturing

- Information about microorganisms and pre-digestion

- Demonstrations on making kefir and sauerkraut

- Tips on fermentation vessels and storage

- The truth about food safety

Cooking Close to Home 

A Year of Seasonal Recipes

 

Save 25% Now

A collection of over 150 original recipes designed to follow the seasons using the foods available in your region. Whether you are a home gardener, a farmers’ market regular, or a member of a community-supported agriculture program, this cookbook will serve as a seasonal guide to using the foods available in your region. 

 

Each recipe includes useful “Harvest Hints” that explain how to find, purchase, prepare, and preserve fresh and seasonal ingredients.

  

Recipe: Claire’s Raspberry Upside-Down Cake

 

Note from the Author – This recipe comes from my husband’s Aunt Claire, who lives in Quebec. She has picked her raspberries from her own garden for decades. She shares her harvest with family by making this recipe, and we know that we can count on this treat when we visit her in late August. She serves it with a touch of fresh cream on top. Feel free to substitute the raspberries with any fresh berry in season. If using frozen berries for this recipe, add an extra cup of fruit. 

  

Get the recipe here

Gathering

Memoir of a Seed Saver 

 


Get for 25% off

Daughter of Iowa farmers, Missouri homesteader, and mother of five, Diane Ott Whealy never anticipated that one day she would become a leader in a grass-roots movement to preserve our agricultural biodiversity.

Meet the Author

 

In this moving memoir of a life spent saving seeds, the author tells the history of the of Seed Saver’s Exchange, now one of the largest non-governmental seed banks in the United States.

 

 

Edward Girardet on PBS NewsHour

Wednesday, September 7th, 2011

PBS NewsHour’s Jeffrey Brown talks to Edward Girardet about his new book, Killing the Cranes, which details his personal experiences in Afghanistan — including a debate with Osama bin Laden — and the history of a country at war for nearly 30 years. Girardet began reporting from Afghanistan in 1979, shortly before the Soviet invasion. From the transcript:

JEFFREY BROWN: Now, as the 10th anniversary of 9/11 approaches, we look back with a veteran foreign correspondent at the long years of war in Afghanistan, where American troops have fought ever since the attacks on the U.S. …

Along the way, he’s trekked hundreds of miles through rugged mountains and had innumerable adventures, including a 1989 encounter with Osama bin Laden and his Arab fighters.

In early September 2001, Girardet was waiting to interview Ahmad Shah Massoud, a key resistance leader, when he met a pair of North African men who said they were television journalists also there to interview Massoud. In fact, the two were suicide bombers dispatched by al-Qaida. And their assassination of the popular Afghan fighter foreshadowed the 9/11 attack on the United States just two days later.

Girardet’s new book, Killing the Cranes, is filled with such details, mixing personal experience with the history of a country at war for nearly 30 years.

Watch the video below, or on NewsHour’s site.


Watch the full episode. See more PBS NewsHour.

UPDATE: Ed Girardet will also be appearing on the Kojo Nnamdi show Thursday September 8 at noon Eastern time: http://thekojonnamdishow.org/

And on NPR’s Morning Edition Friday September 9 at 8:30am: http://www.npr.org/programs/morning-edition/

An Update on Flooding from Irene, and Ongoing Recovery in VT

Tuesday, September 6th, 2011

Tropical Storm Irene slammed Vermont last weekend, causing more severe flooding than the state has seen in nearly a century. Many rural highways along mountain rivers were washed out, isolating some towns completely until ATVs, horses, or hikers could make it in. For a country well-versed in hurricane damage, the devastation in Vermont could be hard to read  for what it is–but nobody here saw it coming. A state that plows several feet of snow each winter doesn’t ordinarily expect her summer vacation to be swamped by a tropical storm. But the climes, they are a-changin’…

Despite the mayhem, Vermont and Vermonters are strong and resilient! This past week has seen heroic efforts to salvage flooded houses, get medicine to isolated towns by horseback, and even save sheep by kayak. Roads are busily being rebuilt, water and power are being restored, and life looks to be returning to normal.

To keep up to date with flood response information, ways to help, and to find out which roads are open, here’s a list of online resources. Enjoy, stay dry, and good luck!

On Facebook:

Vermont Flooding 2011: Statewide information is posted here by regular folks. You can often get replies to requests for information about specific road closures and progress within minutes, plus links to tons of other sites with more resources: https://www.facebook.com/pages/Vermont-Flooding-2011/212455332141871

VT Response Blog:  This blog is collecting statewide information for volunteers, requests for help, and other things, like a dog that was found recently in Proctor: http://vtresponse.wordpress.com/

From the Upper Valley area:

Bob Cavnar’s blog: Bob is a Chelsea Green author and part-time Woodstock resident. This is a link to a story on NBC’s Nightly News last week about the disaster. Finally some national coverage!: http://this-small-planet.com/

Julia Carlisle, another Woodstock resident, is keeping the world informed play-by-play on her blog:  http://woodstockearlyworm.wordpress.com/

On Twitter

Search for hashtags #VTResponse and #VTIrene for the latest updates, including those from Governor Peter Shumlin and federal emergency response organizations like FEMA.

In other news, there’s a rumor floating around the office that we may be pulling together some kind of book on the VT floods to serve as a fundraiser for damaged libraries…more on that as it unfolds!

Photo: Leila LaRosa

20 Questions: Dr. Maggie Kozel

Monday, September 5th, 2011

This interview was written by Juliet Farmer for Student Doctor Net where you can read and comment on the original.

Maggie Kozel graduated from Georgetown University School of Medicine in 1980 and specialized in pediatrics, completing her residency at the Bethesda Naval Hospital. She then served as a general medical officer on board the U.S.S. McKee and as a pediatrician at the U.S. Navy Hospital in Yokosuka, Japan.

Upon returning to the U.S., Dr. Kozel worked as a pediatrician in the active reserves at the U.S. Navy Hospital in Bethesda before entering private practice, first in Washington, D.C., and then in Rhode Island. For the next decade, she was a pediatrician/partner at Narragansett Bay Pediatrics in RI.

Throughout her medical career, Dr. Kozel struggled with the politics of medicine, which she chronicles in her memoir The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine. After 17 years practicing medicine, Dr. Kozel left the field and is currently teaching high school chemistry in the Providence area.

In the introduction to your book, you cite a 2003 Massachusetts Medical Society survey that indicated less than 50 percent of physicians under the age of 60 would choose a career in medicine if they had it to do over again. Yet, anecdotally, physicians say they would do it again. In your opinion, why the disparity?

This survey has been carried out annually, and the most recent data (www.massmed.org/workforce) for 2010 documents minimal change in workplace satisfaction vs. dissatisfaction (43% vs 41%) and adds the disturbing news that 22% of surveyed doctors are planning a career change, but did not offer comparable results, as far as I could find, on the issue of “would you do it again.” In 2009, however, 44% would not choose or were not sure if they would choose medicine again. So, only a small downward trend.

What was it like to be one of only 40 female med students out of 200 at Georgetown University School of medicine in ‘76?

Surprisingly fun. I tended to have mostly female friends before that, and I had several close female friends in medical school, but I really enjoyed the male companionship. I think the commonality of purpose and shared experiences drew us all close together, and eclipsed the gender piece in many ways.

You talk about the privilege of being a doctor coming at a cost—what do you mean by that?

I suppose it’s true of many of life’s meaningful experiences – they are also the most personally demanding. Having people in your care is a tremendous responsibility, and you are in a situation when others’ needs have to constantly take precedence. On top of that, you have to measure your words and demeanor carefully, and maintain strict confidence. This is true whether things are going well or not, whether the patient is satisfied with you or not. And finally, if you make a mistake, it can torment you for a very long time. The fear of making a mistake is the greatest burden a doctor carries.

What role does truth play in medicine?

We are often inclined to want to protect our patients’ (parents) feelings, or not upset them. That is often true in pediatrics at least. And on top of that, we have a health care system that has cast patients into a consumer role, while we sometimes feel like customer service representatives. That is not a healing relationship. We have to be clear on the boundaries of our expertise, and offer no more or less than that. We need to be able to talk honestly to our patients, and hopefully develop enough trust that they will not simply walk away if we say things they don’t want to hear. That kind of relationship takes time, but is key to a healing partnership. It is our responsibility to deliver truth mixed with compassion.

Do you agree that it’s better to be conscientious than smart? Why?

The best combination of course is to be both, but most errors I have seen have been due to not being careful enough rather than not knowing enough. If you are careful and thorough, you will know when something is wrong, and when you need help. And you are less likely to have miscommunications with your patients. It is when we are rushed, or impatient or dismissive that we make mistakes. Not knowing the answer is a relatively easy fix. Plenty of other people can help you.

Sleep deprivation seems to be a constant theme in medical school…do you think that’s a rite of passage, or a danger?

It’s absolutely a danger. It makes us prone to mistakes, and steals our humanity and compassion. It is a vestige of an old-boy, survival-of –the fittest mentality that serves neither doctor nor patient well. Yet, the current economics of medical practice push us to work harder, see more patients, hire less help. And we all pay the price.

In your opinion, is “to do no harm” unrealistic in medicine? Why or why not?

So many of our interventions have adverse effects or unintended consequences. Mainstream medicine has traditionally geared toward laboratory, imaging and pharmaceutical intervention. We have to be more discriminating about the effectiveness of our interventions if we are going to be able to justify the inevitable adverse effects – not to mention the costs! Yet, our fee-for-service system rewards short conversation and quick fixes. That means knee jerk tests and prescriptions – and all too often more harm than good.

Why do you think the U.S. military seems to embrace universal health coverage?

Part of it is the mindset. Every other area of American life is grounded in an idea (myth?) of rugged individualism. The military doesn’t stress the individual. It stresses the most effective and hopefully most efficient way to address the needs of everyone in the group. The down side of this is that military spending in our society has not had to pay as much attention to cost control as the private sphere has. If we were to adopt such a system in the civilian world, we would have to pair up the efficiencies and benefits of single payer, universal coverage with cost-effectiveness.

What do you think the fundamental difference is between practices that take Medicaid and those that do not?

Business choices. It’s difficult for even the most altruistic primary care physician to absorb the cost of seeing Medicaid patients. My husband, for instance, gets paid $27 for seeing a developmentally-delayed adult on Medicaid; he’s paying for the visit out of his own pocket 10 minutes after the visit begins. The larger the practice, the more the group can absorb the income loss. Smaller groups may simply not be able to afford to. If our national strategy is to have doctors cover the costs of caring for disadvantaged patients, then we have no strategy.

What is your opinion of Medicaid—do they make it easy for doctors to treat patients, or difficult?

These programs are underfunded and do not offer primary care physicians anything close to adequate compensation. As a result, Medicaid patients have inadequate access to care because too few doctors can or will see them. We have a two-tiered system of healthcare in this country, and we need to acknowledge that.

Why is record-keeping communication important in medicine?

Communication is key to good patient care. It offers continuity of care, minimizes duplication of tests or unnecessary interventions, and provides healthcare that is a process rather than a string of incidents. And, just as is true in most areas of healthcare, what is good for the patient is good for the pocketbook. Coordinated care is less expensive care. That’s what good record keeping can accomplish.

Why do you think a national medical recordkeeping system is not used?

One huge obstacle is the start up costs for doctors. A solo practitioner is not going to be able to handle the $20,000 start up costs for medical record keeping. It’s important to realize that switching over to electronic records is good for the patient, and good for cost control. But it is unlikely to generate income for the doctor. It’s just one more cost that is getting harder and harder to absorb.

Also, patients I have talked to have a lot of reservations about e-records, and they find their doctors now more engaged with a computer screen than with them. We will have to be conscious about how e-records impact the quality of the patient-doctor encounter.

Why do you think pediatricians have one of the lowest rates of malpractice suits?

Doctors who have had a good prior relationship with their patients seem less likely to be sued, and pediatricians are good at relationship. And, although poor outcomes are catastrophic in the pediatric population, they are not as frequent as in older populations. Much of malpractice is based on poor outcome as opposed to poor care.

In your book, you mention your assumption that doctors are supposed to be exhausted, aggravated, and maintain miserable schedules. Do you still feel that way? Why?

It is the reality of many practices, especially primary care practices, and will probably be the case as long as we rely so heavily on fee-for-service models where the encounter happens mostly in the doctor’s exam room. Our current system pays for productivity, not quality, and the only way to stay afloat is to see many patients with quick turnover. In addition, many primary care doctors, especially pediatricians, have to take their own after hours call, and this can be completely exhausting.

Why do you think insurance companies are willing to pay physicians to discuss potty training, bug bites, etc. rather than nurses?

It’s a complicated, obsolete system that goes back to the days when you only sought medical care if there was something specifically wrong with you for which there was a quick fix best delivered by a doctor. Medicine doesn’t look like that anymore, but we are still trying to use the same old paradigm of payment. If there is a health care need, even if it’s in the realm of child-rearing advice, or a socioeconomic issue like obesity, it’s hard to get healthcare dollars applied to anything but a doctor visit, no matter how cost-ineffective that is.

The pay by diagnosis notion seems particularly challenging for pediatricians/family physicians. Do you think there should be different insurance reimbursement structures for different fields?

Yes, yes and yes. Much of the Affordable Care Act is designed to address this outdated payment system of ours. Ideas like ACOs and Medical Homes shift the paradigm away from episodically treating illness to optimizing health in a coordinated way with a team approach. We need our public systems, like Medicare, to incentivize health care that has proven value, instead of paying enormous amounts for costly tests and procedures that accomplish little for patients.

How did the incident of the deathly ill infant brought into the ER (when you were paged after the physician on call passed off the patient) change the way you interacted with your peers?

If you are in practice long enough, you get to know many wonderful, dedicated doctors… and a few others. The reality is that there are some irresponsible doctors out there. But not many.

On the other hand, we have stood by a system that financially rewards bad behavior, and punishes good. So, as a society, we all have to bear some responsibility for the fact that bad doctoring can flourish.

Do you recommend sub-specializing?

Using my 20-20 hindsight, if I had to do it all again, I would subspecialize. I was born to do primary care, the way it existed earlier in my career. But if I had subspecialized, I think I would have had more staying power – less time on call, more reliance on the skills I was actually trained in. I might not have burned out. Then again, if our society is ever to turn our worrisome health trends around, we will need a lot more primary care physicians. We need to make practice more manageable and more attractive to this group.

The interview you had with Dr. Watson 30+ years ago seems telling now (in which he advised not pursuing a career in medicine). Do you think, had you been older, you might have considered what he said more seriously?

Yes, I am sure I would have. On the other hand, it is a good thing to enter medicine full of idealism, altruism and hopefulness. That is how we want our doctors to be starting out, isn’t it? I’d like to think that we could come up with a health care delivery system that won’t crush that hopefulness for so many.

Why did you choose to leave medicine completely? Why didn’t you look at other options, such as scaling back, becoming a pediatric hospitalist, working part-time or other options?

At the time I left my practice, I did want a total stop – temporarily. I was tired and demoralized and wanted to regroup. The teaching job gave me a way to do that that was financially sustainable. Still, I assumed I would be getting back into Pediatrics in a short time – a few years at the most. What happened in the process, however, is that I loved my teaching job, and even more surprising to me, I became totally engrossed in the writing process, which is something I did not have the time or energy to do in practice. Even now, with my memoir project completed, I blog regularly for Huffington Post and other outlets about health care reform. It has become my passion. I would love to have some clinical involvement, but malpractice insurance tends to be an all or nothing thing, and I couldn’t afford it on my own.

Meanwhile, I keep up my licensure, AAP membership, and continuing medical education. I am also interested in the fact that the AAP is developing a system to reassimilate inactive pediatricians back into practice. Apparently there are a lot of us who would be happy to be able to offer our skills again.

How do you think the closeted epidemic of sad disillusioned depressed doctors affects healthcare?

You can’t do as good a job, plain and simple. A doctor who is doing a good job is patient and compassionate. These are the first qualities to suffer for any human being who is chronically fatigued and or depressed. Yet, doctors are very slow to change careers. So what we have seen happen is not that all these doctors leave practice. They are just unhappy in their practice, and that is not healthy for anyone.

Managing the gray tsunami

Friday, September 2nd, 2011

It is of no value to live twenty- or thirty-plus years beyond retirement and mostly just exist or worse yet, be waiting to die.
– Dr. Allan S. Teel

My parents died within two years of each other nearly thirty years ago, leaving me and my brother in that odd status of adult orphan. They were both in their late fifties, and as time marched on, I looked around at friends dealing with their elderly parents and decided we dodged a bullet.

Thus, I may not be the best person to review Teel’s book,  Alone and Invisible No More, which describes how to stop warehousing “elders,” as he calls them. Except for this: in thirty years or so, I’ll be the one whose family is trying figure out what to do with Mamo Duncan.

Teel’s book describes a future for elders that anyone could envy—non-institutional, living at home, and at less cost.

If it could only happen.

Tidal wave wall?

In the opening, Teel warns of a “gray tsunami,” some 76-79 million baby boomers needing geriatric care. Unfortunately, it’s not a new warning. Dr. Ken Dychtwald warned about this coming flood in his 1989 book, The Age Wave: How The Most Important Trend Of Our Time Can Change Your Future.

But where Dychtwald merely waved red flags, Teel offers a possible solution.

Teel began his medical practice in a Maine town with several senior care facilities ranging from nursing homes to assisted living. His book describes how he developed a theory of better treatment from this experience.

From his patients, Teel learned a key element in elder care: “each successfully aging person [needs] a purpose in his or her life.”

He saw too many vital and vibrant elders relegated to nursing homes or assisted living by distant families who had decided they were too difficult to have around. This came full circle when his ninety-three year old grandmother moved near him after a fall in her Brooklyn home.

What is “care?”

Unlike what the rest of his family suggested, Teel didn’t institutionalize her—and he considers assisted living facilities and home help just other forms of institutionalization. He put her in an apartment close to his home, got her involved in local activities, found her a new circle of friends, made sure his children got to know her, and checked on her regularly. In this way, she lived happily and healthily for several more years—he believes far more years than if he’d put her in any of the facilities near his home.

From this experience and from using his patients as focus groups, he developed a new type of assisted care he called the Eldercare Network, with facilities that were more “home-like” than existing assisted living places. Unfortunately, he doesn’t go into much detail describing how Eldercare Network was an improvement. Rather, he cites anecdotes from residents about how wonderful living there was. Frankly, from what detail he did provide, I didn’t see much of a difference between his Eldercare Network and a typical assisted living facility like Greenspring Village in Springfield, VA.

Eldercare Network was smaller in scale. Unlike Greenspring, it took in those who could not afford private assisted living and provided care at a cheaper rate.

That economy, in fact, led to the State of Maine providing Eldercare Network even more funds to take in its indigent elderly. State funds meant following state regulations on paperwork and state requirements for senior care, which Teel found tedious and distasteful. After a dispute with the state over some unintentional paperwork mistakes, Teel concluded that when it comes to care of elders, we need to “…separate the bureaucrats from the process…”

But does he understand what that would mean?

I certainly, in a few decades, don’t want to be someplace where the bureaucracy has been separated from overseeing that facility.

Eldercare Network eventually failed for lack of funds, though not completely from bad management. When private assisted care institutions had exhausted their residents’ funds, they kicked them out into Eldercare Network. The state could no longer afford the $2,500 per patient it paid Eldercare Network.

The Maine Approach

But the experiment with Eldercare Network led Teel to develop a better concept, which he calls the “Maine Approach.”

At its simplest, the Maine Approach is virtual assisted living from the elder’s own home coupled with a broad social network which emphasizes adjusting the level of care provided to the individual’s need. Also, the elder gets to determine the level of care and independence, not just the elder’s immediate family. They are involved, of course, but the elder’s wishes take precedence.

The Maine Approach involves a volunteer network of care providers and non-medical volunteers who drop in to check on a person, engage them in volunteer work, or run errands. The aim is to keep the elder in his or her own home for as long as possible using this volunteer system, video monitoring, regular check-in phone calls, panic buttons, and home doctor visits. For elders who can no longer drive, a transportation and errand service is provided.

Teel suggests the Maine Approach works best on a community by community basis rather than as a large, state or multi-state system.

Very technology-dependent, the Maine Approach uses Skype, video-conferencing, broadband Internet, and WiFi to allow home-bound elders to virtually attend club meetings, interact with family living far away, or consult with healthcare providers.

Teel has worked out deals with cable Internet providers and other ISP’s for reduced-cost contracts. Equipment such as computers, web cams, and other technology are covered by the cost of the package of individualized elder care services. Training, based on the elder’s level of technology awareness, is also provided. Teel maintains that even given equipment, wiring homes, and other factors, that costs are considerably less than regular at-home care, assisted living, or nursing homes.

Cradle to grave

Teel is right when he says that warehousing our elders in nursing homes and assisted living facilities deprives us of a tremendous source of knowledge, experience, and skills.

Seniors have knowledge that could help in a post-oil world. Skills such as canning, curing meats, sewing, farming and in-person community organizing come to mind. They also have a font of knowledge in their memories, sometimes more detailed than any history book.

By shutting elders away in nursing homes, the insular assisted living, or home care where they are alone most of the time, Teel says we not only rob ourselves of that knowledge, but we probably hasten their demise. Consequently, part of the Maine Approach is to set a schedule of activities each month for the individual, which includes volunteering at schools, day care, or looking in on other elders. The schedule is adjusted and developed according to the elder’s cognitive abilities. Teel accepts that in many cases dementia is inevitable. But, he claims, again anecdotally, that the Maine Approach allows elders many more productive years before that unavoidable decline.

Teel also believes the Maine Approach could address our health-care costs in this country. In the communities in Maine which have adopted Teel’s approach, the cost for the community per elder is around $300 a month, compared to $10,000 a month for people in hospitals or nursing homes.

Rah-rah us!

The book closes on a plug for money for Teel’s organization, Full Circle America, which provides communities with the information they would need to use the Maine Approach in other states.

Teel’s vision is an admirable one, but now it’s also more of a utopia than reality, especially with its emphasis on technologies and transportation that are not alternative-fuel based. However, it’s community-based nature, i.e., grassroots, is certainly evocative of the philosophy of mutual care and benefit in the Transition Movement. The book is a worthwhile read because if enough of us believe in that vision, it could become a reality.

–Maggie Duncan

This article was reposted from Transition Voice.

Listen to Dr. Teel speak about the Maine Approach on Frankie Boyer’s podcast.


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