My name is Myles Riner, MD, FACEP and I am FickleFinger.

I am a retired emergency physician (after 34 years in the ‘pit’ and close to 100,000 patients) who keeps my hand in the game as a physician consultant and advocate for fair compensation for providers and cost-effective care for patients.  (See the Consultant Services tab in the menu above).

The general gist of this blog site revolves around assessing the present and creating the future of health care, and emergency care in particular.  Rowan and Martin, on Laugh In, bestowed the Flying Fickle Finger of Fate award to salute dubious achievements by the government or famous people, which suggests that the outcome of health care reform is likely to be governed by the fickle hand of fate, for surely politics is the epitome of fickleness.  The ancient Greeks thought that fate and the gods dictated the future (thus, the artwork at the head of this blog site), but I would like to believe that when it comes to the future of health care, we might just be able to bend the fickle finger.

So what makes an emergency physician an expert in health care reform and the future of the health care delivery system in the U.S.?  Emergency physicians have the opportunity to interact with just about every component of the health care system from paramedics to nursing home staff to neurosurgeons, from cardiologists to nurse-anesthetists, and from midwives to coroners. I’ve even had the opportunity to work side-by-side with a Haitian witchdoctor.  ED physicians also treat just about every type of patient of every size and race, and nearly every medical condition known to man, and these conditions are experienced in the most mundane and bizarre circumstances you can imagine.  Jack of all medical trades, and masters of some very critical skills.

In addition, as an advocate, director, and consultant, I have had the unique opportunity to bang heads with, or soothe the ruffled feathers of, health insurance executives and contract negotiators, and with legislators and regulators intent on managing the practice of medicine; and to mix it up with physician leaders and managed care executives and just about every type of government agency and private enterprise involved in health care.

Through this blog I hope to engage in a deconstructive – reconstructive approach to this emotionally and economically charged topic of the future of health care.  Logical reasoning, rants, informed opinion, and the occasional analysis and presentation of data will be offered and will be welcomed from (coherent) readers.  The future of health care in the US (and the world, for that matter) is none too clear at the present time, and the winds of change are blowing.  If we all don’t do it, it will be done to us.

And, No, this isn’t a blog about religion or art, not withstanding the picture in the header.



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