If you’re like me, the two most common reactions you see from people when politics comes up in casual conversation are negative ones. Either you get an avoidant rolling of the eyes, “Ugh. Not politics again, please” or an angry “I hate those _____ (insert name of party or special interest group)”. Never do you see the giddy passion that people display when discussing exotic desserts, the Super Bowl, James Cameron movies or girly vampire books.

One of the reasons for this is that you have instinctively learned to associate politics and government with a general yukky feeling of dread within the pit of your stomach. Why is this? Isn’t government just another business that we patronize. After all, when we deal with government, how is it different from when we deal with a regular free-market non-government business? In both instances, we pay a price in exchange for something. In the case of government, that price is money (via taxes) and loss of freedom (via regulations). What we get back is a whole other matter and subject to a whole other discussion. For today, let’s dissect the reasons how government interactions differ from other transactions and we’ll better understand why we love shopping but why we hate politics.

You may or may not agree with me on this at first, but I sense that in the end, your gut feeling will be one of agreement. There are two important things that shape whether or not a particular business entity will make us happy. The first is the presence of COMPETITION or from the consumer’s viewpoint, the presence of choices. The second, which helps keep the competition honest, is ACCOUNTABILITY.

Allow me to expand on this, OK? Let’s begin with the concept of COMPETITION. If you think back to some of your best experiences as a customer, what were they? Was it a 5-star restaurant or some luxury resort hotel? Was it that clothing store in the mall with the great deals or that friendly-service mom-and-pop grocery store? Now contrast this with some of your most frustrating experiences. You all have your own. Was it the DMV or the traffic court system? Was it that doctor’s office that you are forced to go to because of your HMO?

Let’s analyze the differences between the good experiences and the bad. Is there a correlation between how good something is and the degree of competition that they face? You bet! And why? Well, it’s just natural that a business can’t afford to be bad and have unsatisfied customers if it is to survive in the face of nearby competition. When disgruntled clients can easily walk away and take their business elsewhere, you can bet that the business will bust their butt trying to be the best it can be. However, if there is no competition and it’s the “only game in town”, or if people are forced to spend their money at that business no matter what, then of course, there’s little drive for the entity to excel.

When it comes to politics, there’s really zero healthy competition to give us options. Sure, there’s this illusion that we can choose between the Democratic and Republican candidates. But really, what kind of choice is that? Pardon the bluntness, but it’s like telling a slave that they should be grateful for having a choice of slavemaster for the next four years. I know that this is a little different because we have the option to leaving this country, but is that really a valid excuse? We, the people, own this country. It’s not the handful of people called politicians who own it or who own us. Our economic and social freedoms are increasingly being squeezed away by both parties in this alternating back and force dance where one side gains power and saps our economic freedom and then power switches to the other side who then suck away our social freedoms without returning a single inch of what the other side stole. Deep down inside, what most of us want is individual liberty and the chance to thrive as a free community. So if that’s the case, then why doesn’t a candidate run on the platform of reducing government and increasing freedom? Well, that’s what they often do, but once they get into office, they are no longer bound to deliver what they promised. And as for the honest candidates who will abide by their promises, well, THEY never make it onto the ballot. The barrier to entry is too great. In order to even make it onto the ballot, you would have to have played the politics game and survived for quite a while. And by that time, you’re already bought-and-paid-for by special interest groups with their fat political contribution checks.

That’s where the second factor, ACCOUNTABILITY, comes into play. If you walk into a free-market store and they treat you rudely, you have the absolutely liberating choice to smile and walk out. If you’re so inclined, you can even eliminate the smile and add a rude gesture back. If you have a bad experience in a restaurant, then you have the option of making that the very last time you ever bring your dollars to that particular establishment, and even leaving a bad review on Yelp to warn others. How does this differ in politics? Like night and day. Once a politician is elected, he is set for the entire term, usually four years. If politicians renege on their promises, it matters little to them because accountability is now out the window. By the way, it’s certainly not just our current president who is egregiously guilty of breaking promises. The one before him who asked you to “read my lips, no new taxes” was every bit as bad. I won’t go into the technicalities and semantics of “new” taxes vs just raising preexisting ones, but clearly, the spirit of the promise was broken without regard. Another thing that reduces accountability is the great distance between the controller (the politicians) and the controlees (we the people). If it’s our mayor or our neighborhood association president who does something we hate, we can let our voices be heard. But if it’s some politician 2000 miles away, you can just give it up because in that case, our voice is heard as strongly as a whisper at a rock concert. Our current system of a representative democracy where a few out-of-touch people control the lives of a great majority, is horribly flawed and clearly not the best way to live.

I’m not alone in being intrigued by yesterday’s turn of events in Massachusetts, what is rightfully being hailed as the political “Upset of the Century”. It stunned me and has given me a glimmer of hope for this country. Why? Because, it could well be interpreted as a sign that the Star of Accountability is trying to shine again in politics. Hooray! Recall that in November 2008, a new president was elected on promises of hope and change by a nation sick and disgusted by the corruption and oppressive practices of the former president. However, once the new guy gets into office, he proceeds to unleash a surprisingly bold set of unpopular policies to further destroy our country’s freedom and economy. It got to the point where this new president and his ruling party got so arrogant as to try and shove down the people’s throats a massive government takeover of the enormous sector known as healthcare. Then, with no remorse, when the people voiced that they didn’t want this, the politicians proceeded to resort to every last bit of political trickery to bribe a vote here and there, just to pass something that the people don’t want. In the past, the collective passive mind of the American people would have been tricked into going along complacently. But thanks to the power and transparency of the internet and our gradual liberation from a biased media, last night’s shocking results give some hope that people are actually getting smart enough to say “enough is enough” and caring enough to do something effective. Wow!

One more thing. It’s certainly tempting to give in to the adversarial two-party game of politics, with half the country cheering raucously at yesterday’s Massachusetts results, and taunting the other side, just as that other side cheered and taunted when Obama was elected, reminiscent of when UCLA beats USC in football or vice versa in basketball. But the wiser approach is to realize that we’re all in it together and cheer it as a minor victory of the people vs the corrupt oppressive big government.

Now before all of us freedom-loving people can rest and celebrate, we have to be wary. What if the Republican party continues this trend of regaining power, but then does nothing to offer tax relief, nothing to lessen oppressive regulations and nothing to reduce runaway government spending? It has happened before and might happen again. Stay tuned and stay alert. But for now, we can focus on the positive, that maybe there is some hope that political accountability is slowly emerging.

In any case, as unpalatable as it can be, we can’t afford to ignore politics, because it’s not merely a remote scorecard of who is in office and which side has more. It’s a matter of what you can eat, whom you can marry, what your children are taught and what you are allowed to do in your life. It’s a matter of how much money is stolen from you every month and how much killing and bombing is being done with that money. So let’s all discuss, read, learn, debate, reason and question as if our lives depended on it, because, as you all know, it really does!

I’m OK. Thanks for asking.

It’s good to know that my two-week absence from blogging has elicited such caring inquiries from many of you, asking about my well-being. Now I need to be a bit more honest. I’m actually NOT OK.

Well, to be more precise, I’m just about as OK as anybody else who lives in the United States, or even more specifically, in the state of California, which at the moment, is not that great. For the first time since perhaps the 9/11 incident, I am questioning the security of our way of life. To put things in perspective, if you were to ask me any time in the past five years this question: “How sure are you that in the next year, you, your friends and your neighbors will continue to have adequate food, water, electricity, lines of communication and safety from people with criminal intent?”, I would have thought “Huh? What kind of silly question is that?” and then answered 99%+ sure. After all, we live in modern-day America, not some impoverished third-world country and not in medieval times. However, if you ask me that same question today, I would say that I am only maybe 70% sure. The significance of this difference to me is HUGE.

We have grown to take for granted that we will always have access to food, water and emergency medical care and that we will always be able to count on the police to protect us from criminals. But reality reminds us that we can’t always do that. The two most glaring examples that come to mind are New Orleans during Katrina and LA during the riots. I learned a lot about the reality of life during Katrina during my trip to New Orleans for the ASRM meeting a few years ago. I befriended a taxi driver and some other locals and learned their war stories firsthand. The tales were surreal, giving me a grim reminder of how quickly life as we know it can revert back to the barbaric conditions of the Middle Ages. I’m also reading a fictional book, “The Tin Roof Blowdown“, which contains some of the most gory graphic descriptions of the chaos that occurred during Katrina.

Just as I went into medicine partially out of a burning curiosity about how our bodies work, I love to regularly research psychology, sociology, history and politics to satiate my desire of knowing how the world works, and I am now of the opinion that there is uncertainty, enough uncertainty that I am officially “concerned”.

Bear in mind that I look with amusement upon the globing warning alarmists or the religious zealots who predict the Apocalypse is coming this week or that week. But I am not fanatically ranting that the world will end tomorrow, or even next year. However, let’s just say that based on my own research AND based on what my own eyes see happening in the real world all around me, I know in my heart that this country is headed in the wrong direction.

Prior to this recent revelation, the life for my staff and me consisted of working our hardest for our patients, which for me, meant willingly giving up around 60 hours per week (including many weekends and some late nights) seeing patients, talking to patients, reading up on new advances and blogging. Some friends would feel bad that I worked so hard, but I reminded them that this was my calling in life. The reward of helping people have babies makes it intrinsically fun for me. Also, as a very important added component, in return for my sacrifices, I was shown gratitude by patients, who paid fair financial compensation so that I was now empowered to accomplish my many other goals and leisurely pursuits. It was a very fair system and is basically the American way, or at least, the American way that was originally laid out by the writers of the Constitution. Equally fitting, my patients were out there productively working their hardest using whatever their own talents were to make life better for THEIR customers, patients and clients. And as a result, they were paid adequate compensation so that they could pursue their goals for happiness, which just so happened to include doing medical treatment to have babies. In this system, everybody had the freedom to choose how hard they worked, with the corresponding reward in return.

However, as I mentioned earlier, things are changing for the worse. Now, I, for one, was  glad to see George W. Bush leave office. I disagreed with his specific policies which led to a further shift in the balance from individual freedom to excessive government power. I was optimistically open-minded (but cautiously skeptical) that maybe Obama’s promises of a “change” were more than empty political promises. But, BAM! Out of the gate, like a slap in the face, the new president showed his true self. My friends tire of me reminding them time and time again that we should judge people by their actions and not by their words. Well, the president’s first major action, deceptively called a “stimulus” package, is what he should be judged by, not by his sweet words of promising to make the country a better place for the people. No, I have not read the entire word-by-word rendition of the package. But then again, neither have any of the politicians who voted for it. However, I have studied it enough to render my strong opinion that it has little to do with helping people and more to do with increasing the massively growing domination of political power.

I have an interest in discussing these details in future posts and I plan to do so, even at the risk of you readers eventually telling me “Enough politics already! Get back to writing about fertility!”, but for now, I just wanted to share with you why I have been absent from blogging these past few weeks. I compare my recent world view to that of a not-entirely-unsuspecting New Orleans resident in the few days before Katrina. Sure, the news keeps warning us something bad MIGHT happen. Sure, we can see the wind and skies outside ourselves. But we don’t really know if, when or how hard it will hit. Meanwhile, though, we’re getting ready stockpiling food, setting up emergency generators, boarding up our windows and making contingency plans to get out of New Orleans. So, in this instance, how am I getting ready for a future collapse of this country? By researching and learning so that I can share information with others. Because, unlike a hurricane descending upon us, the upcoming social and economic disaster IS potentially preventable. I am hopeful that we, as a people can wake up and reverse the ever-growing shift from government dominance to individual freedom. We’ll see.

But don’t worry, I’m still practicing medicine. In fact, things have been busy and pregnancies have been coming in bunches (little bunches, not 8-fold bunches) and I still have lots of good stories and insights to share in future posts. I just realize now that we all have to prepare for a potential disaster that I hope will never come.

Each year, the government insidiously passes more laws to intrude further into our lives. Some laws make life better for society overall, but I really think that most laws make our lives worse. Even if a law is written with a good intention in mind, the overwhelming costs and bureaucracy inherent in the conception, approval and enforcement of that law costs taxpayers a great deal of money and a lot of lost efficiency in life, so most of the time it is just overall not worth it.  Just because something might be bad, it doesn’t necessarily mean we need to come up with a law against it. Otherwise, we would have pages and pages of laws against profanity, laziness, obesity, telling lies to our parents, picking our noses, wearing flip-flops with dress pants and singing in public with your headphones on.

I confess that I don’t know all the exact details of all the following new laws for 2009, but I’ll offer my opinion on them based on my initial impressions. In all fairness, I will open-mindedly welcome any feedback and education if I’m reading things incorrectly. The list of laws is all taken verbatim from this article as my only source.

Text-messaging while driving: There is a new law “prohibiting the use of text-messaging devices — including cellphones, BlackBerrys and laptop computers — while driving“. Furthermore, “Motorists may not text at a stoplight“
On one hand, when I am driving, I would like the right to my own safety and not have to worry about some other driver causing an accident because of distracted driving. But isn’t unsafe driving already forbidden? If a driver is applying eye shadow while driving, shouldn’t it also be subjected to the same rules? I’m in favor of this law because I personally believe that text-messaging DOES lead to significantly riskier driving and because it affects others.  On the other hand, if there were a hypothetical scenario where a drivers are 100% sure that their driving does not affect other people’s lives and property, then I would not care. In that case, let them make the decision whether or not to take the risk of text-messaging. But since our highways and roads are public domain, my rights to safer driving are preserved by this law, enough that it worth the $$$ required to enforce it.

Increase in traffic ticket prices: A separate law, aimed at paying for new courthouses, will raise the price of traffic tickets starting today. Infractions will carry a new $35 assessment, and the fee to process a request to attend traffic school and keep the ticket off the driver’s record will be $49, up from $24. Fines imposed upon convictions of misdemeanors or felonies will result in an additional $30 assessment.
I have mixed thoughts on this. The prices and add-on fees for traffic tickets should reflect a balance between discouraging dangerous driving and not causing outrageous hardship for first-time offenders. Make it costly enough that drivers will think VERY SERIOUSLY before ever considering driving drunk or drag racing, but don’t let making a rolling stop or failing to wear seat-belts result in sending someone to bankruptcy.

Hospital employees anti-snooping law: There is a new law “creating a new state office with the authority to investigate and impose harsh new penalties on hospital workers who snoop without permission in patient medical records”
While it is certainly wrong for a hospital employee to look at one’s medical records for their own kicks, we do not need to create another taxpayer-supported new state office to deal specifically with it. It would be preferable that hospitals that fire employees for this infraction be protected from lawsuits for so-called “wrongful termination”. Many times, hospitals have their hands tied from disciplining or eliminating bad workers out of fear of this type of lawsuit.

Nutrition laws: The nutrition law, which affects restaurant chains with 20 or more outlets, requires brochures to be supplied to diners beginning July 1 and calorie counts on menus starting in 2011. Another measure requires that fruity beverages known as “alcopops” be prominently labeled as containing alcohol, starting July 1.
This law is a waste of paper and time. A few years ago, I grew quite fond of the prime rib sandwiches at Quiznos. In a rare fit of health-consciousness, I grew curious as to how many calories they contained. I googled high and low and found nothing. I then contacted Quiznos corporate office to inquire. They informed me that they don’t have that data available for the public. I was surprised and a little irked. Therefore, I stopped being their customer. Let people choose where they wish to eat. If today’s health-savvy customer truly cares about knowing how many calories are in their restaurant meals, then they should reward the restaurants that make the information easily accessible. I might be more supportive of a rule requiring them to produce the information on demand, but I am against the wasteful regulation of requiring reprinting of menus and brochures. My friends own a restaurant (albeit a mom-and-pop place and not a chain), but if you ask them, they’ll tell you it’s a struggle to keep in business. They don’t need further regulations to waste their time and money. As for the alcopops, personally, if I were ever to order a $9 “Tropical Electric Berry Lemonade”, it’s common sense that I pretty much expect there to be at least $1 worth of rum or vodka in there. Is there really a need for a costly new law?

Alternative fuel: Allows drivers who run their vehicles on restaurant kitchen grease to skip most of a $300 fee previously required of anyone who hauled used vegetable oil or other grease away from an eatery. Veggie-oil users will now have to pay $75 for a license.
Reading this was a bit confusing to me. I guess I’m in favor of reversal of a previous wrongful tax. I would not be in favor of the government taking $300 from someone who simply wanted to haul used veggie oil away from a restaurant, so I guess I should be happy that they are reducing it. If this would encourage McDonald’s not to reuse their oil as much or if it will decreased gasoline consumption, then why not do away with the old tax altogether, rather than pass a new law to modify an old law that should not have been in place anyway? Ugh.

Computer bullying: Allows school officials to suspend or recommend expulsion for pupils who engage in bullying by electronic means, including over the Internet.
Do we really need a specific law for this? Bullying is by definition a crime of one student against another. Schools should have the authority to take action to remedy this situation whether the bullying consists of posting nasty things on someone’s MySpace or of incessantly chanting “Fatty fatty two by four. Can’t get through the kitchen door”

Carpool lanes: Makes it a crime to forge, counterfeit or falsify a clean air sticker issued by the DMV to certain low-emission vehicles, allowing them to be driven in high occupancy vehicle lanes. A separate law permits drivers of fully enclosed three-wheel motor vehicles to use carpool lanes.
Isn’t falsification of government-issued documents and stickers already illegal? I wonder how much it costs in time and money for somebody to come up with these things. I get the sense that there government agencies feel driven to manufacture busywork so as to justify their existence.

Dangerous chemicals: Requires the Department of Toxic Substances Control to adopt a plan to identify and evaluate dangerous chemicals in consumer products.
Red light. Red light. I am suspicious when a law calls for “adopting a plan” or “appointing a committee” or “launching a fact-finding mission”. It usually means let’s give somebody a job, paid for by taxpayers to delude ourselves into feeling good that we are doing something.

Drunk driving: Drivers on probation for DUI convictions face suspension of their license and towing of their vehicle if they drive on California highways with a blood or breath alcohol level of .01% or higher.
This would only apply to drivers who have already been convicted of a previous DUI, so I think it’s fair. My understanding that mouthwash an hour ago or a slice of chocolate rum cake would not result in levels even this high. It would take at least one alcoholic drink. Anyway is it a good idea for drivers previously convicted of DUI not be allowed to drive even if they’ve had just one beer? Yeah, why not?

Emergency calls: Increases penalties for people who knowingly use 911 emergency lines for calls other than emergencies. The penalty is a written warning on first offense, $50 on second, $100 on third.
About time we had this law. I have heard of people using ambulances to get a ride. Someone wants to visit their friend who lives close to the hospital. They call 911, get the benefit of the world’s speediest chauffeur service and then sign out AMA when they get to the ER. Even though, it doesn’t sound very harsh the way it’s written.

Emergency planning: Merges the governor’s Office of Emergency Services and Office of Homeland Security into a single cabinet-level agency.
Er, is this consolidation and downsizing? Sounds good if it is. The cynical side of me doubts the government would be voluntarily reducing their own scope. I don’t know enough about this to have a strong opinion.

Fire prevention: Improves measures to prevent damage from wildfires, including a requirement that homeowners clear brush from a 100-foot perimeter around their houses. Another law requires California forests to be better managed against tree-killing pests and to make it easier for fire departments to access firefighting equipment.
As you know, I’m usually against government telling us what to do with our homes and property, but since this affects other people, at least in theory, I would tend to support it. As for the second part, it sounds like another example of vague talk. How can you pass a law requiring the government to have better management. Is this in contrast to the current official policy of the government having crappy management against tree-killing pests.

Foreclosure consultants: Provides a registration and bonding process for foreclosure consultants and bars such consultants from entering into certain agreements with homeowners.
I’m not as excited about this law as most people. Yeah, of course it’s bad when consumers get ripped off or misled by the shadier foreclosure consultants as opposed to dealing with the registered, bonded ones. So it’s necessary to have anti-fraud measures in place. However, the opposite extreme occurs when you get too far in the direction of protecting people against their own stupidity. Maybe it’s not quite the same thing, but if I’m going to have my hair cornrow braided by an unlicensed cosmetologist as opposed to a bonded, registered, licensed one, that is the risk that I take.

Green jobs: Requires the state to develop a comprehensive approach to the needs of California’s workforce associated with its budding “green” economy.
Read the wording. I’m sure you know my view on this. Sounds all nice and fluffy.

GPS devices: Allows a global positioning system device to be mounted on the windshield of a motor vehicle only in the 7-inch square in the lower corner farthest from the driver or in the 5-inch square in the lower corner nearest the driver.
You mean drivers are forbidden to stick a GPS device right in front of their faces? By all means, let’s institute an expensive law to explicitly forbid this. But, oh I think a 5-inch square is not strict enough. But let’s just institute this and next year, we can kill a few hundred hours of busywork revising it to a 4-inch square.

Hospital infections: Requires hospitals to develop more comprehensive policies and procedures to ensure that patients are not infected in medical facilities.
I think you’re catching on by now. You can never ENSURE that patients are not infected, nor ensure against any adverse event in medicine. Requiring the “development of policies” means somebody is going to spend many hundreds of hours writing down some rules like “All nurses will wash their hands for 60 seconds every 20 minutes with sterile water running at a stream of no less than x feet per second and have each handwashing event witnessed and signed off by a minimum of 2 supervisors “, with no real evidence that it would do more good than harm.

Human trafficking: Voids any provision of a contract that purports to allow a deduction from a person’s wages for the cost of the person immigrating and being transported to the United States.
Human trafficking is terrible. But I really don’t think this law will put a dent in it. How many of the really bad cases of human trafficking even involve some sort of legitimate contract? Human trafficking is already a crime. Just enforce it.

License plates: Creates a California Gold Star Family license plate for families who have lost loved ones in wars.
Warm fuzzy gesture. How much is this benefiting working Californians? Is this the best use of our state budget?

Meat safety: Makes it a misdemeanor to buy, sell or butcher sick and some disabled animals for human consumption.
This is currently not illegal? I’m not sure of the specifics. If a healthy cow slips and strains his ankle on the way to the slaughterhouse, does this disqualify him from becoming food. Sniff. Just thinking of all this will make me teary-eyed the next time I have kal-bi.

Medical care: Requires doctors treating terminally ill patients to give them comprehensive information about end-of-life options, such as hospice care at home and the right to refuse treatment.
I am a doctor, but I don’t care for terminally ill patients, so I don’t know how much information they actually have regarding their options. To me this sounds like another sheet of paper for patients to sign to add to the killing of trees, but I’ll reserve further comment other than saying quality doctor-patient communication is a very good thing. New regulations specifically dictating what we should or should not say is not a good thing.

Medical insurance: Requires that when insurers cancel someone’s coverage, they allow other members of the family to keep theirs.
No. No. No. Don’t dictate details. Then consumers will have limited choices. Leave things alone and give consumers an option. Do they want to give their business to the insurance company that has this option? Or would they prefer to give their business to the other insurance company that doesn’t have this option but has other things they want, like lower premiums and better mental health coverage?

Another law prevents insurers from refusing to pay the medical bills of customers injured while under the influence of alcohol or drugs.
Again, allow the insurance companies and consumers to agree on this ahead of time. If I anticipate falling down in a druken stupor and injuring myself on a regular basis, then I sure better choose an insurance companies that does not refuse to pay under these circumstances. However, if I feel reasonably confident that I can avoid these types of injuries, then allow me to do business with an insurance company that has other perks that are more attractive to me, but which will not be responsible if I injure myself while drunk or high.

A third new law requires insurers to pay for HIV screening.
Give me a choice. I can either buy insurance that will cover my screening, or I can buy the other insurance that doesn’t cover it, but has other things I want, like lower cost.

Medical techs: Requires California’s Emergency Medical Services Authority to establish and maintain a statewide registry of the status of emergency medical technician licenses. Also mandates that beginning July 1, 2010, all EMTs undergo mandatory criminal background checks.

I’m not sure how EMTs are screened nowadays. However, in general, I think it should be the decision of the employer. I wonder how much the database companies which sell background checks contribute to the lawmakers who passed this law. What’s next? Mandatory criminal checks for waiters who handle our food and vets who care for our dogs?

Click here for part two.

Yesterday, I saw a couple who were back for a third baby. Four years ago, they had done their first cycle of IVF and wound up with twins. After delivering a boy and a girl and enduring sleepless nights feeding them and changing diapers, they apparently did not feel they had suffered enough, so they were now back for a third baby. As our conversation wound down to the financials and the $3K they would have to invest to do a frozen embryo transfer for their third baby, the husband could not help but proudly ask me if I wanted to hear about the "wisest investment decision" he had made. His wife broke into a huge smile, as if there were some huge private joke. I was surprised to hear an off-the-wall comment about investing come out of the blue like that, but part of me was interested in hearing what he meant, because with the recent events in the stock market, it would seem that wise investments are few and far between.

He went on and told me about a coworker of his. Apparently, the two of them shared many parallels. They shared the same first name and were the same age. They worked in the same department of the same company and originally bonded when they struck up a conversation about a the dangers of nuclear attack. One of them was Israeli and greatly concerned about an Iranian nuclear attack some day. The other was South Korean and worried about a launch some day from North Korea. This was what first drew them together as friends. One was an avid Dodger’s fan, while one loved the Angels. They were both married for about 3 years and still childless. Their wives were just four years apart in age. One day, about three years ago, when the company awarded their employees a large bonus, they discussed where to invest it. One of them proudly put it into the stock market and started growing it. The other one decided to take the money and come do an IVF cycle. As a result, one wound up building quite a sizable investment portfolio, getting richer as the stock values increased, while the other friend wound up with twins, a boy and a girl. While one of them continued to grow his money, the other one expended money, first by spending $14K on infertility treatment, and later, by spending close to $1000 per month on various baby expenses for the twins.

Fast forward to a month ago, four years later. The friend who had chosen the investment route now found that he and his wife were four years older, but had a lot of money on which to spend on infertility treatment. They were ready to do treatment, so they could boast that they had both, a secure nest egg and a family. Then all of a sudden, the bottom of the market dropped out and their investment value plummeted. So now, while they still have enough to pursue fertility treatment, they are newly hesitant about dipping into their relatively meager savings (as compared to before the market crash). So now, one of the friends has two lovely children and some frozen embryos for the future, while the other one has about $20K in the bank, which they will have to decide if it is to be spent on infertility treatment.

Life is really about choices and options. Having children is an investment, just liking putting money in the stock market. I wouldn’t advocate going bankrupt pouring all your money into your children, but I would not recommend the opposite extreme either.

One brilliant relationship psychologist, John Gottman, did an analysis of couples and their communication styles. He was able to find four no-no’s that when present consistently in a couple’s interactions predicted a high likelihood of divorce. I have embraced his findings and I try my best to avoid these four in my interactions with EVERYONE. The four no-no’s are CONTEMPT, CRITICISM, DEFENSIVENESS and STONEWALLING.

Yesterday, I was peripherally watching Olympics coverage with some friends when I overheard the US women’s volleyball players Branagh and Youngs having a “strategy discussion” on the sidelines as they were losing to the Chinese team. They were obviously getting their signals crossed and not playing as a cohesive team. One of them said to her teammate something to the effect that “you need to talk”, expressing that their miscommunication was hurting their play. Her teammate shot back with “I AM talking”. Being the communication guru nerd that I am, I took this chance to share with my friends some comments on the concept of defensiveness.

Defensiveness is one of the bigger communication problems present in our world. To me, I define it as spending more energy protecting oneself rather than really listening to what the other person is saying. You can see why this is a problem for couples. If a wife says to her husband “You never spend enough time with me,” the PROPER useful response is to inquire lovingly into why she feels that way and what he can do to address the problem. However, because those words are usually fired in such an accusatory tone, the most common response from the husband is to defend himself with replies like “What do you mean I don’t spend time with you? I spent all Wednesday night at home and before that, we were at your mother’s all weekend. And I’m with you now. What do you want from me?” But as you can see, while defensiveness is the natural response, it doesn’t lead us down productive pathways.

Once I heard the volleyball players interchange, I was pretty sure they were headed for defeat and that’s exactly what happened, as they had more unforced errors and moments of miscommunication. I would have loved to hear an alternate reply like this.

“You need to talk”.
“OK, you’re right. Let’s do it!”

Such a small simple difference changes the whole tone and feel of the situation.

Do you trust your spouse? Do you trust your parents? How about your doctor?

Before you can answer these question honestly, it’s important that we define what we mean when we use the word, TRUST. In everyday life, the word, TRUST, just like the words, LOVE and HAPPINESS, is one that people use to mean many different things. The ambiguous and inconsistent use of these words is responsible for much of the confusion and miscommunication in this world, such as when the boyfriend says to the girlfriend, as he is breaking up with her, “Honey, I DO love you, but I’m just not IN love with you anymore.” What’s with that?

I’m hopeful that we’ll tackle the words, LOVE and HAPPINESS in future posts, but today, let’s focus on TRUST. In an attempt to study this analytically, I recently asked a random sampling of my friends what the word “trust” meant to them. In order to get a more precise answer, I posed the question, “How would you explain the meaning of the word, trust, in terms that a 5-year-old child might understand.” Their replies ranged from being interesting and insightful all the way to being confusing and contradictory. All in all, the answers were quite varied, but I was able to piece together the following common themes.

We use the word trust in at least three ways.

TRUST - Meaning #1. TRUTHFULNESS: When somebody whom you trust tells you something, you can believe that it is the truth. Conversely, when an untrustworthy person tells you something, you can’t quite be sure if they are being truthful or not. On the far extreme, there are those people for whom you can assume that most of what comes out of their mouth is a lie. There’s a certain occupation of people for whom this is often the case and the word for their occupation sounds a lot like the word, LIAR.

Example:
A: I tried calling Bob all day yesterday. He never answered and I have no idea where he was. I finally reached him today.
B: Oh, really? What did he say?
A: He said he left his cell phone at the office and didn’t realize it until this morning. And the reason he didn’t hear it ring while he was at the office was because the battery had died.
B: I see. Do you believe him?
A: I have no reason to doubt him, but somehow, I‘m not sure. I guess I still don’t trust him yet. After all, we’ve only been dating for six years.

Example:
A: Did you find the missing cash?
B: No, I asked everyone in the office who had a chance to take it and none of them said that they took it.
A: What do YOU think?
B: I trust all of them. I guess I must have miscounted it myself.

In general, it is preferable in life to interact with someone who can always be trusted to tell the truth, even if you don’t always like what they say.
Example:
GIRL: So do you think I’m prettier than Megan?
BOY: Yes. You’re prettier.
GIRL: Do you think I’m prettier than Amber?
BOY: Yes, yes. You’re much prettier than Amber.
GIRL: Am I prettier than Kelly?
BOY: Of course. Without a doubt.
GIRL: Do you think I’m prettier than Erika?
BOY: Er…hey, can we please stop playing this game? I’m getting hungry. So where do you want to go for lunch? By the way, do you know if the Lakers are playing tonight?

TRUST - Meaning #2. RELIABILITY: When you say you trust somebody to do something, you are expressing how reliable you think they are.

Example:
A: We can’t join you. We couldn’t find a babysitter.
B: Aww, that’s a shame. Hey, isn’t Keith’s brother staying with you? Can’t you just have HIM watch the kids?
A: Are you kidding? The last time we asked him to babysit, we came home and found him passed out drunk while the kids were in the kitchen making chocolate syrup sandwiches and setting each other’s hair on fire. No, we just can’t trust him to do that.

TRUST – Meaning #3. BALANCE OF YOUR BEST INTERESTS VS HIS/HER BEST INTERESTS: The final meaning of the word trust is the most difficult to describe. It has to do with how much value that person places on your best interests in balance with his/her own best interests. For example, let’s set a scale of 1 to 10 with 10 meaning that the person in question places YOUR best interests completely over THEIR OWN best interests and 1 being the opposite, with that person’s OWN best interests completely predominating over YOUR best interests.

So in the case of the world’s most devoted mother, her baby can TRUST her at a level of 10. That mother would step into the path of speeding bullet to shield her baby from harm. That mother would walk ten miles barefoot in the snow to fetch food for her hungry baby. Of course, some extremely unfortunate children can only trust their mothers at a level of 1, because their mothers would sell them into slavery in exchange for a hit of crack cocaine.

The typical level you might trust your best friend is maybe a 8. Sure, if you were stranded and emergently needed a ride home, she would instantly get out of bed at 2:00 in the morning and drive an hour to come pick you up. If you desperately needed $1000, she would sacrifice her own rent check to give it to you. Now if you needed a kidney transplant, well, maybe she’s not THAT good of a friend.

In most of our interactions, the level we can trust someone is probably between a 3 and a 6. The reason we can trust even that much is not necessarily a function of that person’s character or that person’s fondness for you, but rather a function of the rules and laws our society have set up. If you work in a grocery store, it’s unlikely that someone will come in, steal the food without paying, grab the money from your cash register and run off. You can trust them not to do that because of the law and the enforcement measures that society has in place. Even “untrustworthy” people will be hesitant to do that. This can change, in certain times of war or natural disasters, when there is no effective law. Then, many people whose actions were held in check during peacetime will become looters and thugs.

Bear in mind that these three components of trust don’t always go hand in hand. In some situations, somebody’s regard for your well-being (meaning #3) may force them to be untruthful to you (meaning #1). Let’s say your child is singing in a school play and messes up badly. Inconsiderate parents sitting all around you are saying how terrible that performance was and how it was the worst part of the entire play. Later, your child asks how he did and you tell him he was wonderful and that everyone in the audience loved it.

Or say that you are a mean boss and your employee hates your guts and wishes you would suffer a cruel fate involving the fleas of a thousand camels. Yet, when you have an important task for him to do, and your job and the fate of the whole company’s well-being rests on this task, he will reliably carry it out. You can trust him to do his job 100% (meaning #2), even though you can’t trust his intentions toward you in other ways (meaning #3).

Now that we’ve defined trust a little more clearly, next time we’ll discuss the specific topic of trusting your doctor.

Click here for The Nature of Trust: Part II

Two of my core beliefs are currently having a knock-down drag-out war with each other. One belief is that if you correctly choose a career that is fun, stimulating, enjoyable and spiritually rewarding, then you will never really “work” a day in your life.  I still hold this to be true. The other belief is often known as the law of diminishing returns.  This law states that each additional unit of something valuable or desired is valued or desired a little bit less than the previous unit. If you give a boy who loves chocolate a large slice of cake, he’ll be happy. A second slice will still make him happy, but not as enthusiastically as the first one did, and so on. Giving him that 37th slice won’t make him much happier than receiving that 36th slice. You get the point. This is a fundamental law of life, so to say that this is one of my beliefs, is like saying I believe in the law of gravity or in the law of 3+6 = 9.

So why do I bring this up? Well, I love my work. I love solving mysteries as to why a certain couple is not getting pregnant. I love coming up with what I believe to be the best strategy to help them conceive. I enjoy reading and learning new developments because I know that my time spent studying can potentially make the difference between success or failure for one of my patients. I especially love sharing in the excitement of finding out a positive result!

However, as much as I love all this, there reaches a point where each additional consecutive hour doing it begins to bring a little less joy and satisfaction than the previous hour, especially as much as it robs from my opportunity to do something else. This past month, many more new patients came to the practice than would be expected given our usual monthly average. Now I was pretty sure that the reason for this was that it was January, when there is almost always a large rebound in activity after the holiday season lull. Plus, we also had some other unusual things to take care of, as I have mentioned in previous posts. This greatly added to the illusion of feeling like things were even busier. However, the pace seems to have let up only slightly in February. So yesterday, on President’s Day, when most of my friends are at home doing nothing, my staff and I saw about 30 patients. The sense of accomplishment we got after taking care of the #30 didn’t really feel as rewarding as it did for #20. No surprise.

So what’s the solution to this dilemma? I’ve been trying as much as feasible to take a long break during lunch to either nap, go to the gym or go home and play piano (I live less than 5 minutes from my office). Each of my staff also get a staggered 90 minute lunch break, although most times they don’t take it, preferring the option of working straight through. That doesn’t work well for me, though as the times that I’m forced to work straight through, I find my productivity slowing greatly by late afternoon.

There is a cost associated with taking a long lunch break. At least one night out of each week (like now) and a few hours each weekend, I have to come back to the office after hours to catch up things. This is when I will review the old medical records from patients who failed at other practices. This is when I will catch up on journal articles. This is when I blog. However, I can come and work for an hour, go have dinner with a friend, and come back and do another hour of work. For me at least, it’s definitely more painless breaking it up into chunks like this.

I often share a reminder about the law of diminishing returns with my patients by discussing the difference between the freedom of childlessness and the joy of parenthood. When a couple first gets married, they cherish the freedom of not having any children to burden them. However, each successive year of childlessness has decreasing appeal, until the couple begins to essentially wish for the chance to give up their freedom. Then the baby (or babies) come into the picture and life is completely different, because it seems every waking moment now belongs to your child. From time to time, you will find yourself longing for a brief taste of your past lifestyle. Trust me. Again, I’ve heard this time and time again from patients after their treatments succeed and their child-free years are a thing of the past, forever.

Here are some tips to consider:

• During this time while you are focusing on trying to conceive, make the most of your freedom. Have a date night. Enjoy your reading time. After your baby is here, you will look back and miss these chances.
• Make a conscious effort, even AFTER the baby arrives, to dedicate some time to yourself on a regular basis. This could take the form of one spouse taking the kids for half a day while the other gets his/her free time. Better yet, at least once every two weeks, leave the kids with someone you trust and rekindle the habit of having date night for just the two of you. I know babysitters are costly, but you’ll find it’s worth it.
• One interesting tip I hear over and over again from couples who have done repeated treatments and now have several children (including some twins maybe) is to arrange regular one-on-one “dates” with each child. So one weekend, dad takes the 6-year old boy to the baseball game and the other three kids stay with mom. The next weekend, mom takes one, and just one, of the 4-year-old twins to the zoo. There will be unique value gained from these experiences, so as to make it worth the added effort.

A few hours of a novel experience have much greater value than several hours of the same routine over and over. So, now all of you who find yourselves in a rut of diminishing returns, please go out there and do something different from whatever you’ve been doing over and over these past months.

What exactly are you paying for when you spend your money on medical services? This question was inspired by a post on another blog that I regularly visit. It’s pretty obvious when you go to the supermarket, you come home with bread and eggs in exchange for the dollars that you leave there. When you go to the electronics store, you can exchange your dollars for a wide screen TV, XBOX or an IPOD. However, in medicine, you are paying for a service, not a product. Your money is not going towards the purchase of a material object. More precisely, you are paying for a set amount of your doctor’s time. For example, if you go to the hairdresser, you are paying for 45 minutes of that person’s time. When you watch a movie, you are paying for the cumulative time of the actors, the screenwriters, director, crew, distributors and for the time and energy that the producers put into gathering all these players together in the first place.

When I enter into a doctor-patient relationship, I see it as a prime example of how the world’s economy works. We, as people, engage in mutually beneficial exchanges of our time to make life better and safer for each other. My patient, the piano teacher, spends her time enriching the musical growth of students, for which their parents pay her. My patients, the policeman and his wife, give their time to make my world less dangerous for me and my loved ones. I could go on and on, but you get the point. Everybody contributes their time and energy to make the world better and gets money in return, as a less-than-perfect, but better-than-nothing way of keeping score of how much they contribute. Then, that money can be exchanged to make their own lives better. Every economic interaction involves people contributing something to make someone else’s life better, with the exception of occupations that involve taking money from people by force, without giving anything of benefit  in return.  Examples would include overt criminals and people who engage in legally-sanctioned unethical behavior. But those are just the exceptions.

When I talk about my being paid for my time, I’m not talking just of the time I spend talking with patients, examining them, performing procedures on their behalf and directly interacting with them. I am also referring to the past time I spent in school, studying and learning to acquire the knowledge that I have. I’m referring to the time I spend carefully screening my staff and diligently training them. I’m referring to the time I spend making decisions and carrying out actions so that there is a safe, pleasant environment (my office) where I can interact with patients. I am referring to the sleep lost when I wake up at 6 AM to do surgery or the personal time lost when I stay at work until 8 PM on particulary hectic days.

This weekend, for example, we are replacing the carpet in our office, so I need to come in and supervise the process. This is time I will not be spending with my family and friends, reading my favorite magazines, nor training my dogs. However, I realize that this is just part of life. I am blessed to have the chance of doing something that I truly love every day and I am even more thankful that by doing what I do, I am compensated with the means and options to pursue other worthwhile things in life, as well as prepare food and shelter for my future, when someday, I am no longer able to work.

If you feel that this post has been silly and/or obvious, then you might not be aware of how some other people think. So many people approach life with the question "How can I get money?" My advice to people who are contemplating this question is to think of a different question. Instead, ask yourself what it is that you can do now (or eventually learn to do someday) that will make other people’s lives so much better that they will be willing to pay you well for it. Those who are happy, successful, productive members of society have already asked themselves this and taken the right action.

So back to my case specifically, I view my past and current life choices as taking a series of steps to learn the skills I have so that I can assist people in boosting their chances of a healthy pregnancy. I sell my time and services. I do not sell a product. On the contrary, if you consider the 500 or so babies as a "product" that I’ve helped people conceive and multiply that by whatever dollar figure you try to put on a life, then paying me THAT would easily provide for me in my retirement years.

I’ve always been a risk-taker, risking my own things, not other people’s. This includes taking huge risks such as starting my own infertility practice and making some high-risk high-yield financial investments, which have come to pay off very handsomely. However, I am prone to taking many near-trivial risks in life also, such as waiting for the gas tank indicator to get to the lowest possible point, showing completely empty, before filling up the tank. I’ve only fully run out one time in the past 15 years. That time, it was with a rental car for which I was not that familiar with the peculiarities of the gas gauge. Fortunately, it happened within very short walking distance of the nearest gas station, so it wasn’t all that painful a lesson. My parents are just the opposite in this regard, as they tend to panic and refill the tank if it gets below 1/4 full.

This morning, being a Saturday (yes, RE’s work on weekends), I left just enough to time to get gas and then get to work at the time when the first patients were scheduled. The tank had been at the completely empty mark (which I define not at as the point where you first get a warning flash, but as the point where the indicator could not possibly get any lower) since I got home late last night from going out with friends. It had been so cold and it had been late, and I calculated that I could leave home this morning with enough time to spare to refill the tank.

While pumping the gas this cold morning, I heard the familiar noise of a car’s wheezing and grinding as it attempted unsuccessfully to start, a noise I heard many times when I lived in the snowy Midwest. Apparently, someone had pulled up to the pump before me, gotten his gas and was now having trouble restarting the car. A tall old man about my grandfather’s age stepped out and in a raspy voice sounding like Homer Simpson’s dad, asked if I had jumper cables. I replied yes. You see, my car is well-prepared with a first-aid kit, jumper cables, two bottles of drinking water, a spare blanket, a hand-crank flashlight that doesn’t require batteries and a book in case I get stranded somewhere and need something to occupy my time while waiting for help to arrive. Although I am not afraid to take risks, I also try not to take any unnecessary risks. Waiting for the gas tank to get down low before refilling has a benefit in that it minimizes the hours of my life that I have to waste pumping gas, so I don’t see that as a completely UNNECESSARY risk.

I asked back to the old man "Can’t the gas station attendant help you?"
He grumbled back "You would THINK. But they don’t even have cables. I asked already."
That didn’t surprise me. Sitting in his warm office, was the bored Middle Eastern gas station attendant, watching his tiny black and white TV while surrounded by neatly arranged displays of chewing gum, lip balm, maps and lottery tickets scratchers, oblivious to the world except to interact with the occasional customer asking to get $40 on pump #3.

I processed the situation. I was probably going to be a few minutes late for work as it was. If I stayed and did the decent thing to help this poor old man, I might be an additional 10 minutes late if the best case scenario played out of a quick easy successful jump start. However, having jumped-started many batteries already throughout my driving career, I know that it could sometimes take an unexpected turn and require a lot longer than expected. It would not be fair to my patients to make them wait. I finished pumping gas, popped open my trunk with the remote and got out my coiled and wrapped set of cables. I handed them to the man along with my card, telling him he could wait for the next motorist or the attendant to help him and that I trusted him to drop them off at my office (2 minutes away) after he was done with them.

However, things were not to be so easy. After talking to him more, and observing his less-than-crystal-clear cognitive status and his apparent inability to read the fine print on my business card, I had a sinking feeling that after I lent these cables to him, chances were high I would never see them again. Still, the risk-taking decision-maker part of my brain had already clicked and I had already committed that I would gamble the loss of my cables if it meant a reasonable chance of making this other person’s day go easier. Suddenly, fate came to the rescue. A man who had apparently been nearby and who had overheard our conversation, walked up to us, looked at my business card and while walking into the office to pay the attendant turned back and said to us "I don’t have cables, but I can use yours to help him and then I’ll drop them back to you". Problem solved. The safe return of my cables was no longer at the whims of the elderly man’s mental faculties, but rested solely on the honesty of the second man.

I got to my office and started seeing patients. Each time, I came out of the room and back to my desk, I asked my staff if someone had dropped off the cables and each time, I became a little bit more disappointed with humanity when I got the answer. Almost an hour had passed and I got wrapped up in a lengthy graduation ultrasound for one of our patients. This is the final ultrasound done at about 12 weeks pregnancy where we burn a movie of the baby dancing around onto a DVD  to give to the patient as a small good-bye present before they leave us and go back to the OB who referred them originally. Caught up in the happy couple’s wave of excitement as I showed them all the baby’s parts, I had already forgotten about the lost jumper cables as I hugged the couple goodbye.

As I went back to my desk, something caught my eye. There on the corner were my jumper cables, coiled even more neatly than they had been originally, and tucked securely back in the vinyl bag. The fact that it had taken an hour to make it back to me suggested that the nice man had spent a lot of time to help the old man. Also, next to the cables was a business card belonging to my tag-team partner good Samaritan. I kept his card for future reference. So, if you live in southern California and are ever in need of an honest contractor to remodel your kitchen, you might want to check out Abby Vasquez Construction 714-519-1400. I know nothing of his skills, but you can surprise him and tell him that you know all about his good deed helping an old man jump start his car that cold Saturday morning.

According to this clock, my life is predicted to end some time after the year 2050. Please don’t misinterpret my sharing this as an example of morbidness and pessimism. On the contrary, I reflect on this from time to time to remind myself the importance of enjoying and appreciating each and every day with which we have been blessed.

Earlier this year, my father signed up with some plan from our local electric company to install energy regulators and shut-off devices on his air conditioning unit at home. As a reward for his contribution to energy conservation, they sent him a $20 gift card to Starbucks. You should understand that my father had never stepped foot into a Starbucks in his entire life, but ever since he received the gift card, it started burning a hole in his pocket. His thrifty upbringing (or dare I say, his traditional Chinese upbringing) will not allow him to let anything go to waste, especially if it is free. Every week, he has been calling regularly, asking if I will go with him to Starbucks on some Saturday to have a relaxing morning of father-son conversation. I finally was able to grant his wish this past week, which was especially nice because my sister was visiting with her family from Sacramento. So the three of us got to have some quality time as a family, reminiscing together over three cups of latte. It was an unbeatable experience, even if the coffee would not have been free.

This past year, many of my friends have had the misfortune of losing one of their parents. There’s not much one can say or do to change the fact that we all grow old and move on some day. However, one lesson I learned long ago keeps me inspired and focused. Because we can’t prevent the inevitable, we should focus on what we CAN control. Someday, when our loved ones are gone, rather than mull with regret over things we could have done, words we could have said or times we could have shared, why not seize the golden opportunities NOW, while we still can? My parents are amazing in that they both run at least a mile almost every day. Their health would predict that they will be around for quite a while, but I’m not taking any chances. I do my best to spend time with them on a regular basis, using the chance to build up great memories. Someday, these memories will be all I have left of them, so I’m greedily accumulating them now while I have the chance. If it’s not too late for you, I pray that you take the chance to enjoy the company of your loved ones now and make this a resolution for 2008!