Those of you with well-functioning neuronal synapses will remember my prior journal entry, Why we DON'T need more Allergists. Frankly, who could forget it?  But wait!  Somewhere out there, in that vast stagnant wilderness of bureaucratic allergy with monocognition, a similar voice to mine cries out. No, I'm not kidding.  Scarey, right?  And this guy takes off the gloves and kicks some serious butt when he takes on the big allergy establishment over "why we don't need more allergists.   Let's see what Dr. Rodney M. Mann MD of Lexington Kentucky says in a Letter to the Editor in the latest Annals of Allergy, Asthma, and Immunology, Nov. 2007: the following are excerpts--

It was with bittersweet amusement that I read the "Allergist Report:  America Faces an Allergy/Asthma crisis," dated April 2007.  The report makes a number of unsubstantiated statements in an attempt to persuade that a critical shortage of practicing allergists is eminent....I am troubled by the committee's obliviousness to real-life factors, such as primary care physicians' reluctance to refer to specialists, (as well as)  otolarynologists, pulmonologists, primary care physicians, chiropracters, and alternative medicine practitioners practicing allergy...it should not be forgotten that most patients with allergic disease and asthma never see an allergist.  Also, training more allergists will do nothing to encourage the new allergists to seek out underserved areas, typically rural and undesirable, to practice in.  I believe it is shortsighted and irresponsible to encourage more training program slots in a specialty that is underused..."

So Rodney, this Bud's for you...and you have given the Angry Allergist the inspiration for a new award that will be given by me to original-thinking Allergists.  Allergists who don't go with the crowd.  Allergists who aren't, as our California Governor put it, "girlie-men".  Allergists who don't follow the herd--they shoot the herd...Allergists who aren't afraid to strip to the waist, put on a headband, pick up a fifty-caliber and let the Allergy establishment have it...you guessed right...

The Angry Allergist Rambo Award.  For Allergists.  Allergists who can kick ass. 

And when Rod called the committee "shortsighted and iresponsible" , "oblivious to real-life factors" he just grabbed, without realizing it, The First Rambo Award.  The first, I hope, of many more to come....

Congratulations, Rod.  Enjoy your award.  Then, let's lock 'n load, buddy; we've got work to do...  

Later, Dude 

P.S.  Female allergists will have their OWN award.  Coming soon to a browser near you...

Maybe it's just because some of my relatives have recently had "less than optimal" interactions with their health practitioners, or maybe it's because of some recent patients I've seen who have also had "less than optimal" interactions with their former allergists, but I've gotten to thinking...about compassion...Now, I realize that thinking is a very dangerous activity for the Angry Allergist.  But what the hey...I live on the edge.  

Now, I realize some of you are 5 sentences ahead of me already..."man, now he's accusing allergists of not being compassionate to patients--this time the Shock Jock of Allergy has gone too far."  Well, before you degranulate all your mast cells...hear me out...but I warn you, the Shock Jock will nevertheless send a few volts your way...

You see, after 26 years, I've had alot of contact with patients.  And also alot of contact with allergists.  And in general we are compassionate to our patients...with one teensie eensie caveat--

You see, we  allergists are compassionate to patients---on our own terms. 

Conditional compassion.  

Compassion on our terms.   For the diseases we like to treat.

And we've got a bad case.  And this, in my opinion is the real crisis in allergy, not the crisis I spoke about in my earlier blog entry "why we don't need more allergists".   

What is conditional compassion?  It simply means when we see patients who "fit into the box" of our easily treatable diseases--asthma, rhinitis, we like them and have compassion for their plight.  We feel comfortable being around them, teaching them inhaler use, monitoring peak flows, etc.  And it seems more and more allergists are making little asthma clinics and becoming little "asthma doctors", catering mainly to the asthmatic patient, to the exclusion of other patients. Certainly our major allergy societies are codependents in this regard, with their incessant litany of "asthma-this and asthma-that".  So we want asthma patients.  Nothing else, if you please.  But what about the patient who walks in our office with a question on food intolerance? A history of delayed reactions to skin tests or injection immunotherapy?  A history of hyperactivity that seems definitely food related?  Chronic fatigue?   Headaches from foods?  Be honest.  How many of us want to really be compassionate and listen to a patient presenting with multiple complex food and chemical sensitivities?  How truly compassionate are we?  Judging from what I've noticed:

not very.  

Point-in-fact:  , we can't wait to get this type of  patient out of our office.  We find these patients distasteful.  A few perfunctory skin pricks,  a quick pat on the back telling them that they're "not allergic" and whoof!--out the door.  We just don't care. Don't believe me?  Then you're not living in the real world I live in.  I see it all the time as a consulting allergist. Compassion.  Conditional compassion. 

It wasn't always like this.  In the Golden Age of Allergy, allergists were interested in symptoms on all mucosal surfaces and involving multiple body organs--not just the lungs. Allergists really listened to their patients....And when Dr. Francis W. Peabody, on October 25, 1925, ended his lecture to Harvard Medical Students on "The Care of the Patient" he closed with the now classic dictum "the secret of the care of the patient is caring for the patient".  I don't recall he said anything about "caring for the patient with asthma exclusively".  Don't recall that at all.  (But then, again, I wasn't at that lecture in 1925 either...)      

But with conditional compassion the real tragedy is ours.  Not the patients.   Because when we don't care about the patient (except on our terms) , we don't really seek to find out what's really wrong with them if our perfunctory prick tests are negative.  But with compassion comes a sense of urgency--curiosity--in finding out what's really wrong with our patient.  And to seek--and find--what's really wrong with them--allergy or no allergy--, adds to our knowledge.  And with accumulated knowledge and experience comes wisdom. 

So the Spiritual Trinity of the Superior Allergist is compassion--knowledge--wisdom.  But the greatest of these is compassion...and we need more...unconditionally

Later, Dude