Hasta La Gadget!

Patients have been coming into my office for several years telling me that they looked me up on the Internet and that I have great reviews. I always dismissed these comments, as I knew that these reviews were influenced by many factors and not necessarily accurate. Plus, the reviews were favorable so I gave it little thought. Eventually, I took the opportunity to Google myself and was amused by much of what I read. Patients often made strong statements about me without much evidence. Again, it was largely complimentary so I let things be.

Over time, it dawned on me that virtually every patient was looking me up. I went back to the Internet and tried to picture what I would think if I were a patient looking me up. I realized I was passively being defined, as opposed to actively defining my own image — and the method of others defining me was often incomplete and arbitrary.

I decided to launch my own website so I could define my online image. I wanted to project what I believe in, and how I practice medicine so that patients who research me can more accurately see if my philosophy truly resonates with theirs.

Of course, it’s not so easy. Just putting something out there doesn’t assure that it will be what patients find when they search. More importantly, it got me thinking about the doctor/patient relationship. It is clear that patients want to connect with their doctors. Doctors, however, seem more ambivalent about making such a connection. To some doctors, it is as if forming a connection will somehow undermine the traditional relationship which is best kept as formal, paternalistic, and standoffish. We are running our practices the same way they were run 30 years ago. This is a terrible mistake.

I believe I can gain more by giving, learn more by listening, and influence more by connecting.

1. Doctors should focus on connecting with patients.
The world has changed. Most other businesses have changed. Every physician should have his or her own website which patients can easily access. If the physician boldly puts his or her personality and philosophy out there for scrutiny, there will be some who like what they see and some who don’t, but the patients who make appointments and ultimately come in to the office will have more productive experiences.

2. Doctors should provide content.
Consumers want content when they do research. Consumers of health care are no different. The best way to advertise is not to yell about how great you are, but simply, to teach. Patients are attracted to content, and particularly, to how the content is presented. You don’t have to tell consumers of your value, when you can provide them with content of value.

3. Doctors should embrace social media.
Most doctors pride themselves in getting patients from word-of-mouth. This has always been considered the most desirable method of growing a practice. But word-of-mouth is not as useful as it has been traditionally considered.

Think about researching a restaurant. What is more likely to draw you to a particular restaurant: hearing from several arbitrary people that it is great or not only hearing from these several arbitrary people, but hearing from some specific people who have a track record of making good suggestions about restaurants and also having access to the menu, the restaurant’s philosophy on cleanliness and the rigor with which food is selected and procured?

Social media is more than simple word-of-mouth. It enables patients to access meaningful opinions, and then make informed decisions about doctors’ practices. Social media gives physicians the opportunity to help empower patients. If a doctor does not embrace this burgeoning technology, his or her prospective patients will end up elsewhere.

With the Supreme Court scheduled to hear oral argument in King v. Burwell next week, those looking for clues as to what the Court will decide later this year when it rules in King need look no further than a very different case the Court decided Wednesday. In Yates v. United States, the Court held, in a fractured 4-1-4 decision, that a provision of the Sarbanes-Oxley Act that bars the destruction of “tangible object[s]” does not apply to the destruction of fish (specifically, red grouper). In their opinions in Yates, the plurality and the dissent didn’t agree about much, but there’s one thing they did agree on, and that principle is key to why the government should win in King: when you’re interpreting a law, context matters.

In King, the Court has been asked to decide whether the tax credits that put the “affordable” in the Affordable Care Act are available to all Americans who meet the income criteria, or only to those who purchase their insurance on state-run exchanges. When one looks at the whole statute in King, the answer is clear: tax credits are available to all Americans who qualify based on income, regardless of whether they purchase insurance on a state-run or a federally-facilitated exchange. The argument made by the law’s challengers rests on a facile reading of four words — “established by the State” — that appear in the formula for calculating the amount of the tax credit (not eligibility for it), as well as the argument that one need not look any further than those four words when trying to understand what the statute means. The recent opinion in Yates makes clear how wrong those arguments are.

In Yates, the Court made clear that when judges or other government officials are interpreting a statute, they can’t just look at a few words in isolation, they must look at the statute as a whole. As Justice Ginsburg wrote in the plurality opinion joined by Chief Justice Roberts, “Whether a statutory term is unambiguous… does not turn solely on dictionary definitions of its component words. Rather, ‘[t]he plainness or ambiguity of statutory language is determined [not only] by reference to the language itself, [but as well by] the specific context in which that language is used, and the broader context of the statute as a whole.'” Put somewhat differently, Justice Ginsburg also wrote, “In law as in life… the same words, placed in different contexts, sometimes mean different things.”

This isn’t news, of course. It’s a fundamental canon of statutory interpretation, as evidenced by Justice Ginsburg’s citation to other cases that make the same point. One of those cases explained that it is a “fundamental principle of statutory construction (and, indeed, of language itself) that the meaning of a word cannot be determined in isolation, but must be drawn from the context in which it is used.” Indeed, while the dissenters in Yates disagreed strongly about how the text and context should be interpreted in this case, they agreed on this fundamental point of statutory interpretation. As Justice Kagan wrote in dissent (in an opinion joined by Justices Scalia, Kennedy, and Thomas),

I agree with the plurality (really, who does not?) that context matters in interpreting statutes. We do not “construe the meaning of statutory terms in a vacuum.” Rather, we interpret particular words “in their context and with a view to their place in the overall statutory scheme.”

When one construes the words “established by the State” in the context of the ACA, it’s clear why tax credits should be available on all exchanges. The ACA expressly provides that a tax credit “shall be allowed” for any “applicable taxpayer,” and it defines who qualifies as an “applicable taxpayer[s]” based on income level, not state of residence. While the formula for calculating the amount of the credit does refer to an “exchange established by the State,” that language is there to make clear that the relevant exchange for calculating the amount of the credit is the exchange in the specific state where the individual purchased his or her insurance, whether the exchange is state-run or federally facilitated. Indeed, other provisions in the ACA make clear that when states elect not to set up their own exchanges, the federal government may set up “such exchange[s]” in their stead, and those federally-facilitated exchanges are the functional equivalent of state-run exchanges. The law’s challengers want the Justices to ignore all of that context, but Wednesday’s opinions in Yates underscore why they shouldn’t.

In her plurality opinion (again joined by the Chief Justice), Justice Ginsburg made another point that seriously undermines the case made by the ACA’s challengers in King. They have long argued that Congress intentionally limited the tax credits under the ACA to state-run exchanges to encourage states to set up their own exchanges; the law’s defenders have long responded that it would have made no sense to bury such an important provision in the formula for calculating the amount of the tax credit. Justice Ginsburg made a similar point in Yates:

It is highly improbable that Congress would have buried a general spoliation statute [i.e., a statute preventing the destruction of evidence] covering objects of any and every kind in a provision targeting fraud in financial record-keeping.

Elsewhere, Justice Ginsburg noted that if Congress had meant to do that, one would “have expected a clearer indication of that intent.” Indeed, that’s exactly what members of Congress said in an amicus brief filed in King:

Drawing the connection between the tax credits and the Exchanges so obliquely… would hardly have made sense if, as [the law’s challengers] argue, the purpose of the tax credit was to induce States to establish their own exchanges.

With the King argument just a week away (and no doubt on the minds of the Justices), the ACA’s challengers can’t be happy to see the Court’s opinions in Yates. And the government, although surely disappointed by its loss today, should be taking some solace in the reasons for that loss. It may well be that the government’s loss today signals a more important win down the road.

This piece is also crossposted at CAC’s Text and History blog.

By Marti Maguire

RALEIGH, N.C., Feb 25 (Reuters) – The North Carolina state Senate voted on Wednesday to allow government officials to refuse to marry same-sex couples without fear of being fired, adding a new twist to the gay marriage debate in a region where such unions have faced strong opposition.

North Carolina, which began allowing gay marriages last year to comply with a federal court order, had banned same-sex matrimony in a 2012 referendum. It is among 37 states where gay marriage is legal.

The U.S. Supreme Court last month agreed to decide whether states can ban gay marriage in a ruling that will determine whether 13 remaining state bans will be struck down.

In North Carolina, some of the civil officers who perform marriages, known as magistrates, threatened to resign rather than perform unions that ran counter to their religious beliefs.

While the bill does not mention gay marriage explicitly, it allows employees to recuse themselves from performing marriages by citing a “sincerely held religious objection.”

After submitting their objections in writing, magistrates would be barred from performing any marriage for six months or until they removed their objections.

Senate leader Phil Berger, the Republican who sponsored the bill, cited a case in his home county in which a magistrate was forced to resign over his refusal to perform gay marriages.

Berger said the bill will allow the state to comply with the law while preserving religious freedom.

“While the courts have taken steps to provide special rights to some, we must not ignore the constitutionally protected rights of others,” Berger said in a statement after the bill passed.

Supporters of gay marriage condemned the legislation, drawing parallels to officials’ past reluctance to perform bi-racial marriages.

“This discriminatory bill treats gay and lesbian couples as second-class citizens and distorts the true meaning of religious freedom,” Reverend Jasmine Beach-Ferrara, director of the Campaign for Southern Equality, said in a statement.

The bill, which also applies to the registers of deeds who issue marriage certificates, would require local governments to ensure that eligible couples are not denied the right to marry.

The bill passed the Republican-controlled Senate by a 32-16 vote and heads next to the Republican-controlled state House, where final action on the bill could come as early as Friday. (Editing by Jonathan Kaminsky and Steve Orlofsky)

Dawn Murdock just happened to be on Facebook when she saw that the Friendship Circle page had a post about the Great Bike Giveaway. She checked out the types of bicycles that would be given away, and knew that a Buddy Bike would be perfect for her son Kain. A Buddy Bike is a special bike outfitted for kids with special needs.

“I signed him up,” Murdock said. “There was only two days left in the contest. Long shot, I know, but I did it anyway. By the first day he had enough votes to be entered in the drawing. And believe it or not, Kain won the bike.”

Murdock explained that her 14-year-old son has a form of autism known as pervasive developmental disorder, and that his attempts to learn to ride a bike were frustrating for Kain due to his difficulties with motor skills. “When I saw the Buddy Bike it was perfect for Kain,” Murdock said. “Kain sits in the front and helps peddle, but the adult steers and peddles from the back.”

Cycling is a great way for anyone to get some exercise and enjoy the outdoors. For many people with disabilities, an adaptive bike can offer a sense of freedom that they have never experienced before. I started cycling about seven years ago with an adaptive sports program in Philadelphia, and I know firsthand what an amazing feeling it is to get on my three-wheel cycle and leave everything else behind. I also know how lucky I was to find a cycle that fit my needs — and my budget.

Friendship Circle is an organization in Michigan that serves the disability community with a goal of providing support to families with children who have special needs. The organization gave away the first bikes in 2012, according to Tzvi Schectman who directs the program and is the Family Coordinator at Friendship Circle. The contest has resulted in more than 150 adaptive bikes a year given away since it launched three years ago. Schectman says they hope to giveaway 300 more bikes this year.

And it all started with one man’s desire to fulfill a promise to pay forward the generosity of a stranger who gave him a bike as a kid.

Mikhail Reytsman and his family were in the United States for less than a year when he was nominated to receive a bike from a man looking to pay it forward with the gift of a bicycle that he’d received from his stepfather as a child. The only condition was that Reytsman promise to give a bike away to someone else by the time he turned 30. When the time came, an acquaintance suggested he contact Friendship Circle to find a recipient for the bike he wanted to give away. Reytsman wasn’t deterred by the prospect of giving away an adaptive bike, which can be more expensive than a typical bike.

“I didn’t even realize the specifics,” he said. After the initial offer, “Friendship Circle asked me if I could sponsor a more expensive [adaptive] bike and I said that as long as the kid needs it and it’s not thousands of dollars it shouldn’t be a problem.”

Excited by the offer to giveaway a bike, the staff at Friendship Circle wanted to include more kids.

“We really didn’t know what we should do,” Schectman said. “We started thinking of potential children who could really use a bike, but we kept on saying, ‘How can we give it to one child over another?’ From there we decided to see if we could give away more than one bike and turn it into a contest.”

Sponsors and donations have helped build the contest into what it is today. This year’s contest is open and entrees can be submitted until midday on March 3. The contest is open to anyone in the continental United States under the age of 30 with a special need.

“I would never have been able to get my son this bike,” Murdock said, pointing out, as she put it, how “spendy” adaptive bikes can be. “I am truly thankful for all that have donated and spent their time on this contest. It is a true blessing.”

This article originally appeared on The Mobility Resource.

If you’ve flown Delta recently (or most domestic airlines) and tried to use the onboard Gogo WiFi, you know that it’s often a crapshoot. A combination of where you’re flying over and the number of passengers attempting to use it leads to either a dec…