Archive for Editorial – Page 2

Does Village Government cede too much power to the Mayor?

Does the current structure of Village Government cede too much power and control to the Mayor?

Mariemont has always had a strong mayor or mayor-centric form of government which is the norm for small communities. In Mariemont the Mayor is elected for four years without term limits.

Six Village Council members with four year terms are the only counterbalance to the authority of the Mayor.  In January 2014, the two elected official positions of Village Clerk and Village Treasurer were eliminated and replaced with a Mayor appointed ‘Fiscal Officer.’

Typically, two or four Council candidates are nominated at an annual Village Town Meeting in March or April every other year and generally run unopposed. Many prominent residents believe the Village Town Meeting construct is an outmoded and antiquated system that as a ‘default result’ produces weak candidates due to a lack of resident participation. Moreover, councilmen receive nominal compensation of about $1000 per year for their volunteer time and efforts that includes many meetings that deal with mundane matters. It is easy to see why so few Villagers wish to become involved in local government and at the present time, most new recruits for Council are ‘persuaded’ as ‘friends of the Mayor’ to run for Council. It is not surprising that the turnover rate for Village Council members is quite high due to term expiration, resignations and relocation.

Unlike corporate America and larger nonprofit boards, the members of the Village Council are not selected based upon their competitive range of skills, knowledge and abilities and, as a consequence, there is limited diversity and narrow skill sets in council membership. Additionally, there is no formal Village Administrator to handle operations and provide input and feedback to the Mayor and Council.

To understand the dominant power and control equation enjoyed by the Mayor consider the following:

  1. All Departments report directly to the Mayor
  2. The Mayor crafts the agenda for Council Meetings
  3. The Mayor controls council committee appointments
  4. The Mayor restricts committee activities to those he personally assigns
  5. The Mayor unilaterally, without review or approval by Council, produces a monthly Mayor’s Bulletin for distribution to each household in the community
  6. The Mayor is a voting member on the Architectural Review Board
  7. The Mayor is the Chair of the Planning Commission and a voting member
  8. The Mayor maintains an official Village website that gives little transparency to Village Government
  9. The Mayor presides over very perfunctory bi-monthly Council Meetings that last an average of 18 minutes, in which real issues are seldom discussed
  10. The Mayor has a three minute time limit for any Village resident coming before Council.

My suggestions to improve the make-up of Mariemont Village Government include:

  1. Form a Membership or Governance Committee of Council to recruit qualified candidates for Council. The committee could be chaired by the Vice Mayor and comprised of an additional Council member, a Village resident appointed by MPF and a representative from the School Board for a total of 4 members.
  2. Modestly increase the compensation for the Mayor and Council members
  3. Hire an empowered Village administrator that has more than just clerical duties
  4. Reinstate the elected Office of Village Treasurer to act as an independent voice
  5. Increase the number of elected Councilmen to eight with the addition of two at-large-members identified by the Governance Committee
  6. The Mayor should be only an ex-officio member of the Planning and Architectural Review Boards
  7. Term limits: two successive terms for both the Mayor and Council members


Responses to this post from Mariemont Residents:

  1. “Agree with your assessment. There are likely 20 more examples of the lopsided nature of government in Mariemont.”
  2. “The problem stems from the mayor being too power hungry compounded by voter apathy and fear of reprisal. Without new faces, nothing will change.”
  3. “I think we would be better off pursuing term limits and would further support the hiring of a Village Administrator as the remedy for the over control of the Mayor.”
  4. “It should be emphasized that the Code of Ordinances governs the Village, and it specifically states that the Mayor reports to Council, not vice versa.”

Can Mariemont’s chronic shortages of parking be solved?

In the MPF’s Vision 2021, a shortage of parking spots around the Mariemont Square is mentioned many times because it creates an inconvenience and obstacle for visitors going to the Theatre, Quarter, Greaters and the Inn during peak hours. Events in and around the Square also overload parking. One quote from the Vision 2021 Plan states, “While parking changes have been instituted on an as-needed basis, much of it has been reactive and not proactive in solving the underlying parking problems. Parking decks and an increase in on-street parking might curb such issues as the Village aims to attract new businesses and conveniently serve the needs of visitors to the village.” Others suggest, “Create a parking deck behind the cinemas/create garage parking behind The Strand” and “solve the existing parking problem—not enough parking.” For as long as I have lived in Mariemont, inadequate parking has been a chronic problem that has resulted in friction between property owners, businesses, the Mariemont School Board and Village government. It would seem reasonable that a long term strategic plan for Mariemont address this problem in a definitive way.

A parking garage in Mariemont is not a new idea. When the Mariemont Inn was renovated, there was talk and push back about an underground garage.

The parking area behind the Mariemont Theatre currently accommodates approximately 100 cars. I would conjecture that increasing this number to 200 or 250 parking spaces would address Mariemont’s parking needs once and for all. The topography and space behind the Theatre is quite adequate to accommodate an underground parking garage with the upper deck providing the foundation for restoration of the existing storefronts. Parking garages are not cheap and each space typically costs about $20,000 to build. Thus projected costs would run between 4 and 6 million dollars.

The development costs may seem overwhelming, but there are many financial instruments to consider in funding such a project including: TIF financing, municipal bonds, grants, a Community Development Corporation and investment by owners and businesses. To financially succeed, parking fees probably would become a necessity in Mariemont so as to generate funds to service the debt and make up for the lost revenues due to tax abatements. Moreover, with the disappearance of estate tax revenues for the Village, an additional revenue stream may be necessary to balance the Village’s budget in the near future with or without the garage.

A project such as this warrants a feasibility study conducted by outside consultants, qualified local residents and interested developers. If successful, Mariemont would have a real trump card to attract and retain businesses as well as foster gentrification and new business development.

— Dick Wendel, MD, MBA

How can local governments cut expenses?

In a recent editorial in the Enquirer, Mr. Harris, a former city Councilman, contends that in Ohio the operation of local governments is antiquated. He points out that Hamilton County alone has 48 local governments and that each of these has a fully equipped police department. In 2009, Hamilton County taxpayers spent $275 million for these police facilities, some of which provide safety for areas less than 1 square mile.

Let’s focus upon the Mariemont and Fairfax Police Departments within the context of overlapping and duplication of law enforcement services. First, it should be pointed out that the Village of Mariemont occupies .89 square miles and the Village of Fairfax .76 square miles with a combined census of 5,103 citizens.

The Mariemont Police Department has 10 police officers and the Fairfax Police Department has 9 for a total of 19 to cover this total service area of 1.65 square miles. In 2013, Mariemont’s total expenses to maintain their Police Department were $1,248,776 (approximately one-third of the entire budget) whereas Fairfax’s Police Department cost $1,147,240.

I queried a number of friends and our educated guess is that 40 percent of cost to maintain a standalone Mariemont Police Department could be saved by merging Mariemont’s and Fairfax’s Police Departments. If you take 40 percent of Mariemont’s $1,248,776 expenditure on police protection, it comes to a yearly savings of about $499,510. And note that this is just the cost savings referable to the police department.

The next question was whether a merging of the two police departments would compromise safety. The group agreed that it would have a negligible effect upon police services and safety.

Granted, change is always easier said than done when it comes to jurisdictional and power issues, not to mention personalities. At a minimum, if the Mariemont and Fairfax Police shared the night shift coverage, it would equate to roughly $100,000 in yearly cost savings.

Just consider what the Village of Mariemont could do with a half million additional funds a year, or even a hundred thousand. Possibly, hire a part-time Village Administrator, improved street maintenance, free garbage collection (eliminate those stickers), no fee memberships in the swimming and tennis clubs, free land rent for a garden in the South 80, new recreational facilities, rejuvenation of the Historic District and lower taxes could be considered. Longer term, the Village could certainly use better parking facilities, a community center and improvements to the Municipal Building.


–Dick Wendel, MD, MBA

Who are the best Doctors?

As a physician, many of my friends ask me to comment on the doctoring skills of my medical colleagues. Admittedly, a positive testimonial from a physician about your private physician is reassuring, but is it reliable? Outside of my specialty of urology, I found it very challenging to assess the competency of my colleagues other than by the three A’s of medical practice, first Availability, second Affability and finally Ability in that order. Yet, each year both Cincinnati and Cincy magazines glibly put forth a list of the Top or Best doctors in the Greater Cincinnati area.

Currently, statistical measures do not differentiate the best from the average also. Web site such as may crunch the numbers of millions of medical claims from federal and private sources to rate and rank doctors but their parameters that allegedly factor in experience, complication rates and patient satisfaction are grossly incomplete and subject to arbitrary standards of care.

You might think that primary care physicians and pediatricians (PCPs) would be knowledgably about the quality of medical care rendered by the specialists to whom they refer. But today’s PCPs are generally hospital employees and do not follow their patients in the hospital if they are admitted and thus rarely interact professionally or socially with the specialists. Moreover, the hospital systems (Christ, TreHealth, Mercy Healthcare, UC Health and St. Elizabeth Healthcare) have incentives for their ‘owned’ physicians to refer exclusively to other doctors in the network. The advent of the ‘Hospitalist’ and ‘Intensivist’, new breeds of physician that manages hospital care, has added an additional layer of isolation between the PCP and other physicians.

Moreover, insurance plans often change their panel of physicians and enrollees often change health plans. And when you go to see the doctor, you may be seen by a physician assistant (PA), nurse practitioner or anyone of the physicians covering the practice.

Interestingly, patient satisfaction has become a major focus in Medicare and medical insurance reimbursements to hospitals and medical practitioners. Many patients have already received the 3 or 4 page satisfaction surveys after a routine office visit, outpatient surgery or a hospital admission.  The soft data of patient satisfaction does correlate with quality of care, but the response rates to these surveys are much higher in the outliers of either the very satisfied or very dissatisfied. From a physician’s perspective, they do not paint an accurate picture.

So how does one latch onto the best doctors. Probably word of mouth from satisfied patients remains the best method upon which to judge a doctor. In the hospital setting, possibly, the floor nurses and operating room technicians with whom the doctor works day-over-day give the most reliable testimonials about the behaviors and capabilities of individual physicians.  But there is no surefire way to select the very best. In most instances, it is a leap of faith that ends in a good match based upon trust, bedside manner, accessibility and previous treatment outcomes.

And yet the magazine lists of the best doctors, ambulatory care centers, emergency rooms, hospitals, and medical testing facilities goes on and must certainly sell magazines. However, if your doctor or medical facility does not make the cut, don’t get concerned; the lists are very arbitrary and have little correlation with quality of care.


— Richard G. Wendel MD, MBA

Passive Aggressive Poison

How passive/aggressive individuals can poison a work environment even more than overtly antagonistic employees

The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes passive-aggressive personality disorder as a “pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational situations.” In my experience, it most frequently occurs in the workplace as indirect behaviors that subtly undermine efficiency, authority and interpersonal relationships.

The lazy hostile employee with an attitude is usually not the most disruptive to a functional work environment. You might ask why? It is because those types of individuals are easily identified and, at least, you know where they are coming from. Moreover, management usually terminates these folks before they disrupt organizational culture. On the other hand, more problems are created in the office culture by employees who appear to be doing a reasonable job… but in fact are slowly eroding the performance, attitude, and morale of the people around them through passive/aggressive behaviors.

What do they do?

  1. They frequently use the expression, “That’s not my job.”

To get the work done, it is important to have employees that do whatever it takes to get things done regardless of their title, position or seniority and not procrastinate. “It’s not my job,” really says, not only do I not care about you but I am passively indifferent to the needs both of the company and fellow workers.

  1. By virtue of their position, they think they’ve already paid their dues.

They wish to rest on their laurels and assume that they no longer need to work very hard. This type of passive/aggressive behavior can be especially malignant since it is infectious to other workers that may feel that they have a right to coast also.

  1. They feel that experience is enough.

Experience is certainly important but it is not an excuse to sit in the office waiting for someone to drop by to be mentored and intimidated by showing them your superior knowledge. Holding back and not proactively sharing your knowledge is characteristic of the passive/aggressive type personality.

  1. They lead the meeting after the meeting.

After the group holds a meeting that garners a degree of consensus,

the passive/aggressive tends to hold the “meeting after the meeting” about issues that had seemingly been resolved. They create passive resistance by raising issues that undermine the decisions so that no agreed upon actions can be implemented.

  1. They love to gossip by innuendo and a form of a negative grapevine effect.

Casual back biting and rumor are common tools of the passive/aggressive individual. Even under the guise of harmless banter and being a ‘fun guy’, nothing can more quickly destroy employee morale than negative sarcasm. This can also cause key employees to leave or act as a barrier for promotion based upon merit.

  1. Passive aggressive personalities excel at fence sitting.

This trait is, in my opinion, the most disturbing of this personality complex. They tend to hide and flip-flop on issues at will. Because they avoid making any waves, they are often promoted into managerial positions where the negative impact of their passive/aggressive behaviors is amplified. This is supportive of the Peter’s Principal that proposes that employees have a tendency to be promoted to their level of incompetence.

Transparency, teamwork and congeniality punctuate an ideal work environment and passive/aggressive behaviors do the opposite. Do any readers have experiences to share where these types of negative resistance have created a hostile work environment?  




The role of sugar in cardiovascular health

Research on the potential benefits of sodium reduction for treatment of hypertension has yielded conflicting results, with some evidence suggesting that reducing sodium intake could actually increase cardiovascular and all-cause mortality in patients with diabetes. A review in the journal Open Heart examines the role of sugar, not salt, in cardio-metabolic health, as up to 80% of individuals with “essential” hypertension also exhibit insulin resistance and about 50% of hypertensive patients also have hyperinsulinemia. Numerous studies have linked sugar intake with blood pressure, especially with sugar-sweetened beverages and hypertension. However, naturally occurring sugars appear to not have this same association. One study found that a diet with increased servings of whole fruit significantly lowered systolic blood pressure, even with a fructose intake of about 200g.

The American Heart Association currently recommends no more than six teaspoons of sugar per day for women and no more than nine for men, but does not make specific recommendations regarding added sugars and hypertension. Because added sugars may increase cardiovascular risk by inciting metabolic dysfunction and increasing blood pressure variability, myocardial oxygen demand, heart rate, and inflammation, the authors recommend a greater emphasis on added sugar reduction in hypertension and cardiovascular disease guidelines.

Wounded Warrior Project, why is it necessary?

For decades America has had an all volunteer military force. Without conscripts and with a massive pentagon budget, it would seem reasonable that the Federal Government take care of its employees both in regard to retirement benefits and long term medical care.

Why do we need organizations such as the Wounded Warrior Project to supplement government benefits? In 2012, the Wounded Warrior Project, a 501 (c) 3 charity, raised over $230 million dollars. In 2012, the IRS Form 990 reveals that the total compensation for their two highest paid employees exceeded $400,000 and the net assets of the organization were $166,000,000.  Because we are overdosed with highly emotional appeals for donations to the Project, we can only conjecture how much they spend on TV and prime time media advertizing.

As a veteran of the Vietnam War where I was a combat surgeon, I am very sympathetic to the needs of our wounded soldiers. However, I question the need for private sector funding for medical care for our disabled veterans. Unfortunately, this need may be an indictment of our entire Governmental military system. Or it may represent an opportunistic approach to raising money through empathy so as to create jobs and pads the pockets of the founders of charities such as the Wounded Warrior Project.

– Richard G. Wendel MD, MBA

Medication Expiration dates… What do they mean?

A medical school friend of mine recently threw out some Nembutal capsules he was given on a tour of Ely Lilly tour while in Medical School in 1959. He now wonders if this was necessary.

If a bottle of Tylenol, for example, says something like “Do not use after June 1998,” and it is August 2002, should you take the Tylenol? Should you discard it? Can you get hurt if you take it? Will it simply have lost its potency and do you no good?

In other words, are drug manufacturers being honest with us when they put an expiration date on their medications, or is the practice of dating just another drug industry scam, to get us to buy new medications when the old ones that purportedly have “expired” are still perfectly good?

These are the pressing questions I investigated after my mother-in-law recently said to me, “It doesn’t mean anything,” when I pointed out that the Tylenol she was about to take had “expired” 4 years and a few months ago. I was a bit mocking in my pronouncement — feeling superior that I had noticed the chemical corpse in her cabinet — but she was equally adamant in her reply, and is generally very sage about medical issues.

So I gave her a glass of water with the purportedly “dead” drug, of which she took 2 capsules for a pain in the upper back.

About a half hour later she reported the pain seemed to have eased up a bit.

I said, “You could be having a placebo effect,” not wanting to simply concede she was right about the drug, and also not actually knowing what I was talking about.

I was just happy to hear that her pain had eased, even before we had our evening cocktails and hot tub dip (we were in “Leisure World,” near Laguna Beach, California , where the hot tub is bigger than most Manhattan apartments, and “Heaven,” as generally portrayed, would be raucous by comparison.

Upon my return to NYC and high-speed connection, I immediately scoured the medical databases and general literature for the answer to my question about drug expiration labeling. And voila, no sooner than I could say “Screwed again by the pharmaceutical industry,” I had my answer.

Here are the simple facts:

First, the expiration date, required by law in the United States, beginning in 1979, specifies only the date the manufacturer guarantees the full potency and safety of the drug — it does not mean how long the drug is actually “good” or safe to use.

Second, medical authorities uniformly say it is safe to take drugs past their expiration date — no matter how “expired” the drugs purportedly are. Except for possibly the rarest of exceptions, you won’t get hurt and you certainly won’t get killed.

Studies show that expired drugs may lose some of their potency over time, from as little as 5% or less to 50% or more (though usually much less than the latter). Even 10 years after the “expiration date,” most drugs have a good deal of their original potency.

One of the largest studies ever conducted that supports the above points about “expired drug” labeling was done by the US military15 years ago, according to a feature story in the Wall Street Journal (March 29, 2000), reported by Laurie P. Cohen.

The military was sitting on a $1 billion stockpile of drugs and facing the daunting process of destroying and replacing its supply every 2 to 3 years, so it began a testing program to see if it could extend the life of its inventory.

The testing, conducted by the US Food and Drug Administration (FDA), ultimately covered more than 100 drugs, prescription and over-the-counter.

The results showed, about 90% of them were safe and effective as far as 15 years past their expiration date.

In light of these results, a former director of the testing program, Francis Flaherty, said he concluded that expiration dates put on by manufacturers typically have no bearing on whether a drug is usable for longer.

Mr. Flaherty noted that a drug maker is required to prove only that a drug is still good on whatever expiration date the company chooses to set. The expiration date doesn’t mean, or even suggest, that the drug will stop being effective after that, nor that it will become harmful.

“Manufacturers put expiration dates on for marketing, rather than scientific, reasons ” said Mr. Flaherty, a pharmacist at the FDA until his retirement in 1999. ” It’s not profitable for them to have products on a shelf for 10 years. They want turnover.”

The FDA cautioned there isn’t enough evidence from the program, which is weighted toward drugs used during combat, to conclude most drugs in consumers’ medicine cabinets are potent beyond the expiration date.

Joel Davis, however, a former FDA expiration-date compliance chief, said that with a handful of exceptions — notably nitroglycerin, insulin, and some liquid antibiotics — most drugs are probably as durable as those the agency has tested for the military. “Most drugs degrade very slowly,” he said. “In all likelihood, you can take a product you have at home and keep it for many years.” Consider aspirin. Bayer AG puts 2-year or 3-year dates on aspirin and says that it should be discarded after that.

However, Chris Allen, a vice president at the Bayer unit that makes aspirin, said the dating is “pretty conservative”; when Bayer has tested 4-year-old aspirin, it remained 100% effective, he said. So why doesn’t Bayer set a 4-year expiration date? Because the company often changes packaging, and it undertakes “continuous improvement programs,”

Mr. Allen said that each change triggers a need for more expiration-date testing, and testing each time for a 4-year life would be impractical. Bayer has never tested aspirin beyond 4 years, Mr. Allen said.

Dr. Carstensen, professor emeritus at the University of Wisconsin’s pharmacy school, who wrote what is considered the main text on drug stability, said,

“I did a study of different aspirins, and after 5 years, Bayer was still excellent. Aspirin, if made correctly, is very stable.

Okay, I concede. My mother-in-law was right, once again. And I was wrong, once again, and with a wiseacre attitude to boot. Sorry mom.

Now I think I’ll take a swig of the 10-year dead package of Alka Seltzer in my medicine chest to ease the nausea I’m feeling from calculating how many billions of dollars the pharmaceutical industry bilks out of unknowing consumers every year who discard perfectly good drugs and buy new ones because they trust the industry’s “expiration date labeling.”

By Richard Altschuler

Choosing the Best Doctor

 What is the Best Way to choose your Doctor?

As a physician, many of my friends and acquaintances ask me to comment on the doctoring skills of some of my medical colleagues. Some take it a step farther and ask who the very best doctors are in a given field of medicine. Admittedly, a positive testimonial about the skills, knowledge and abilities from a physician about your private physician or specialist is reassuring.

But even as a physician, it is difficult to judge the competencies of other doctors and how their practices treat patients. Only in my specialty of urology was I confident that I knew with certainty who were the better practitioners. For instance, I knew the number and types of procedures they were performing at the hospital and often took care of some of their complications or patients that were dissatisfied with their care. In addition, I knew them socially and attended the same scientific and medical conferences. As they were competitors, it was unusual for me to refer patients to other urologists.

Judging medical practitioners outside of your medical specialty is very challenging and most often based on subjective and second hand information. Certainly the doctor’s reputation amongst his colleagues is important, but not always accurate because it may relate more to friendship and social skills than ability. However, the opinions voiced by the floor and operating room nurses and staff with whom the doctor works, however, are usually right on target. Other considerations that may or may not influence your decision include malpractice actions and catastrophic medical complications plus any disciplinary actions against the doctor by the State Medical Board or curtailment of privileges by a Hospital.

You might think that primary care physicians and pediatricians (PCPs) would be accurate in their assessments of the quality of medical care rendered by the specialists to whom they refer. But the typical PCP refers only a few patients to any one specialist and rarely has the time to discuss the patient’s experience with that doctor’s practice when he or she returns. Additionally, PCPs today rarely follow their patients when they are admitted to the hospital and in large groups specialty practices the new patients are often assigned a doctor that has openings rather than the doctor the PCP referred the patient to in the first place. Moreover, physicians no longer congregate in the morning in the hospital medical staff lounges to socialize, provide curb stone consults and get to know one another.

Adding to the difficulty in assessing the quality of an individual physician is the very structure of today’s medical marketplace. For starters, insurance plans often change their panel of physicians and enrollees often change health plans. Most physicians are now in large medical groups and when you go to see the doctor, you may be seen by a physician assistant (PA), nurse practitioner or anyone of the numerous partners that happens to be on call. Moreover, the hospital systems are buying medical practices to form large vertically ‘integrated’ healthcare systems and this disrupts traditional referral patterns by the hospital’s insistence that their physicians refer only to other doctors in their system.

Interestingly, patient satisfaction has become a major focus in Medicare and medical insurance reimbursements to hospitals and medical practices. In fact, within Obamacare, up to 2 percent of reimbursements will be linked to patient satisfaction in the near future. Many patients have already received the 3 or 4 page satisfaction questionnaire after a medical visit, outpatient surgery or a hospital admission.  Response rates to these extensive surveys are generally low and the majority of patients that complete the survey are either the very satisfied or the very dissatisfied. Thus, from a physician’s point of view, these surveys have limited ability to quantify quality.

New Statistical Ways to Choose a Doctor

In a recent USA TODAY article they talk of a revamped website as a new tool to research doctors. This site uses about 500 million claims from federal and private sources to rate and rank doctors. It claims to factor in experience, complication rates and patient satisfaction. Problems arise with selecting a physician in this way because:

  1. Some physicians treat sicker patients than other doctors and accordingly might have higher complication rates. No severity of disease adjustment of patient populations is possible.
  2. Medical treatment still lacks broad standardized parameters of medical care for all but a few common clinical conditions such coronary artery bypass surgery, diabetes, asthma and pneumonia.
  3. The collection of electronic data covering large populations of patients is still in its infancy and the current statistical data is insufficient to evaluate individual physician performance.
  4. The geographic, insurance and technical barriers to properly match patient and physician are many.
  5. Patient satisfaction statistics may be the only valid indicator because patient satisfaction does correlate with quality and outcomes.

Both Cincinnati and Cincy Magazines rate the ‘best doctors’ in Cincinnati based upon surveys sent to all or some of the 5000 physicians practicing in Hamilton County. The surveys are quite simple, “who would you send your relatives to for care?” With large group practices dotting the medical landscape and hospitals owning a large swath of medical practices, this type survey causes business interests to surface rather than objectivity in physician evaluation. There are few independent physicians in solo practice who ever make the list of best doctors. Moreover, the survey response rates tend to be less than 20 percent and, at best, this exercise becomes a ‘popularity contest.’ In my review spanning many years of these ratings, I have been unable to see any correlation between the survey results and the quality of care administered by those selected.

Lists of the best doctors, ambulatory care centers, emergency rooms, hospitals, medical testing facilities and so on must sell magazines and attract viewers because the numbers of lists in all media just proliferate. In Cincinnati, virtually all major heart, orthopedic and neurosurgical clinics claim to have high national ranking. You must ask how and by whom or just chalk it off to the hospital’s or practice’s aggressive marketing efforts.

In the medical field, physicians and physician specialists all read the same scientific journals, attend the same medical society meetings and, as a consequence, no one has ‘special’ knowledge or revolutionary techniques. Some efficient hospital systems such as the Mayo and Cleveland Clinics have perfected their processes to expedite medical care and achieve a reputation through exemplary patient satisfaction. Additionally, if a surgeon or hospital does 500 open hearts a year, they usually are more proficient than if they do 50-100 per year.

So how does one latch onto the best doctors. Probably word of mouth from satisfied patients remains the best method upon which to judge a doctor. But there is no surefire way to select the very best. In most instances, it is a leap of faith that ends in a good match.. At the end of the day, you, the patient, are the best custodian of your health. A healthy lifestyle has greater survival benefit than selecting the best of the best doctors.


– Dick Wendel MD, MBA

Sore Knees and Ringing Ears

A recent editorial in the Cincinnati Enquirer strongly resonated with me. It was titled ‘standup guy’ a growing force with the standup guy being the Bengals fans that stand up continuously throughout the game even when nothing is happening on the field. This blocks the line of sight for the fans behind them and this standing stance cascades or ascends through the spectators much like an ‘upward wave’ and leaves everyone standing. This phenomenon is seen even in those stands close to the playing field.  It is useless to complain and there seems to be no way to reverse this ‘wave’, because to do so might result in physical and verbal altercations, especially with inebriated fans that are hyper excitable due to alcohol.

If being forced to stand were not enough, the sound levels at Bengal’s games are deafening. There always seems to be a few fans with loud shrill voices (usually sitting immediately behind us) that elevate the noise to decibel levels that assault the ear drums. This is especially true if you have seats located in the end zones. As a physician, I would suggest that all fans bring ear plugs with them to the games.

These two elements of the experience when you go to see a professional football game is the primary reason I gave up my Bengal’s season tickets years ago. I have no solutions to the standing and noise problem, except to have friends that have enclosed boxes and invite you to the games.

I enjoy watching football in the comfort of my home and am pleased that home games no longer need to be sold out to avoid a TV blackout.

-Dick Wendel MD, MBA