This is only the first 10 hours of a 24 hour call at Kaiser which was often many times worse than the workload of a lowly medical resident.
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Physician burnout – a glimpse

On July 16, 1999, just one month after my first son was born, I was having one of many unbelievable on-call sessions at Kaiser Hospital in Orange County and felt compelled to write down my activities for just the first 10 hours….this is what I wrote…

8AM – Performed my scheduled 3rd repeat c-section (my own patient. can take over an hour because of scar tissue)

830AM – Called to ER to see pt with painful 4cm vulvar cyst (refused exam for religious reasons)

930AM – Asked to round on and discharge two Postop day 3 c/s patients for discharge (“responsible” Doctor A was working elsewhere)

10AM – Saw patient who had been waiting >2 hrs in ER for abdominal pain (Doctor B who was going home after taking overnight call “turfed” it to me)

1030AM – Saw Dr. C’s postop day 2 patient from a ruptured endometrioma

11AM – Called to antepartum testing to see patient for Left upper quadrant pain evaluation

1130AM – Performed four newborn circumcisions (none of my patients)

1200PM – Called to ER to see patient for 15wk intrauterine fetal demise

1230PM – Called to ER to admit patient for postpartum uterine infection

1PM – Placed laminaria (dilating seaweed sticks) into cervix for the fetal demise patient (I was only one of 4 doctors who could to the mid-trimester ultrasound-guided evacuation)

130PM – Called to see and discharge Dr. C’s hospital day 4 ruptured ectopic patient (who opted to follow up with me instead of her own surgeon)

2PM – Called about a quantitative pregnancy test from last night’s on-call physician. (No context given/often used to rule out ectopic pregnancy, which is dangerous)

230PM – Discharged a patient from the ER with instructions for follow-up for a post-op wound infection (not my own)

3PM – called regarding no products of conception on pathology from a D&C. Called by RN who was representing Dr. E covering for Dr. C who did the procedure. (this is a red flag because it either means the pregnancy might remain inside or that it was actually an ectopic pregnancy)

330PM – Saw pt in ER for missed abortion (miscarriage that hasn’t happened but embryo has no heartbeat). Pt seen yesterday and declined surgery with on on-call physician then. Prepared her and alerted operating room

330-345PM – Postpartum tubal ligation (mini-laparatomy) – not my patient

400PM – Received a call from clinic RNP to admit a hyperemesis (excessive vomiting) patient for her

4PM – called to postpartum floor for patient with hemorrhage. Held uterus and administered IV medication. 

430PM – Pt who declined AM discharge wants to go home now and needs instructions and a prescription (not my patient)

440PM – Code blue = cardiac arrest (false alarm) called while on phone with doctor who wanted me to admit an uninsured high-risk pregnant patient


(time?) ultrasound called regarding another patient with a fetal demise at 15wk. (That means they could have had a nonviable pregnancy for two months now. The “team leader” at the satellite clinic knew nothing about this case)

(increasingly illegible) – performed emergency D&C hysteroscopy to remove a bleeding endometrial polyp

Hyperemesis patient admitted to ER

Discharged surgical patient after seeing the surgery department

Performed U/S guided 15wk Dilation and evacuation for fetal demise patient

Called to ER to see the incomplete abortion patient from St. Joseph’s with no products of conception (Dr. E for C)

Phone consults for (illegible ) and possible miscarriage

That was only the first 10hrs...

I don’t recall what happened to the second page but there was another 14 hours worth of taking care of other people’s patients, helping the nurse midwives, c-sections and I even recall another mid-trimester D&C and an ectopic pregnancy.

In private practice, I would have been paid a lot of money; at Kaiser, you work for the hourly wage so the incentives are to have other people do your work for you. 

For years, I recall taking eight calls a month and soon after I quit, they hired another on-call doctor because everyone complained about the workload.

Take the "W" or the "L"

At Kaiser, the doctors work for the hourly wage or the “W” as they call it. That slowly increases and you can retire age 55 if you survive. I’ve never regretted leaving and taking the “L” or loss of the pension and benefits because working in a collectivist passive-aggressive environment where patients are treated as a burden is soul-crushing.

The death of a calling

With the advent of Diversity, Inclusion, and Equity criteria for medical school admission, the expansion of administrators and insurance gatekeepers, activist medical boards and the FDA, patient loss of confidence, forced vaccinations for employment, bribery to professional organizations for silence, and medicine by fiat cookbook, the art of medicine has been under constant attack. 

An autonomous patient and ethically-motivated physician are now relics of a past that was never really there but now is not even aspired to.

I don’t mean to decry Kaiser because I knew many excellent physicians and nurses working in the system there and if you are well, the system works quite well. Kaiser Permanente began as a cost-cutting measure for the Steel manufacturer which began to repurpose fluoride into our water supply despite neurotoxicity.

In fact, the only time I ever heard of insurance paying for exosomes was a Kaiser patient who was allowed to bill them for osteoarthritis knee injection (because it was cheaper than a knee replacement). 

The Kaiser system was the model for HMO’s but the IPA (independent practice administrations) became the model for overly aggressive “medical loss ratio” management. That means the motivation within the system was to deny health care while capturing insurance monies from “capitation” or getting a monthly check for every “head” insured. 

While a fee-for-service model once had doctors playing golf on Wednesdays, investing in real estate, and driving fat Cadillacs, the profession is now one which mindless political commissars can now do as long as they sleep well knowing they did was best for their overlords and not the patients themselves. 

A fellow refugee

Yesterday, I spent nearly an hour talking to a 65-yo patient in Indianapolis with trigeminal neuralgia for nearly forty years. With this condition, I have had four patients with nerve pain in the face and all four improved. 

I was reminded of my friend, Dr. GH, who had a horrible trigeminal neuralgia which resolved after nasal injection of exosomes a year ago. I was delighted to hear that she retired from OBGYN and has been doing naturopathic only for the last month. Here are some of her texts to me as she stuck with clinical OBGYN longer than I did:

You deserve to know (after that awful experience in OBGYN) that you were giving your all…and the patients/family were sucking your chi out from you. With no regard whatsoever for your welfare. [I am now] pain free. Grateful. [heart emoji]”

The left image is me three years into my Kaiser “tour of duty.”  I don’t look well, do I?  

I believe that the major part of my journey is not knowing how to say “no” and set boundaries…so I developed a strong work efficiency and resilience instead of asking for help. 


Primum non nocere

The section of the Hippocratic Oath that resonates with me is “above all, do no harm”.

When I get people trying to get me to switch exosome brands, I think of this. If it is not a product that I understand and have used over 2000 times safely, I am not interested. 

I am constantly invited, cajoled, and enticed into trying other brands of exosomes but some sad news came to me yesterday. 

A young lady who had been using exosomes and almost was treated by me committed assisted suicide. She trusted another brand of exosomes despite my pointing out that the doctor who recommended that brand was on the board of directors of the company. She refused to see me because I was not Covid vaccinated and then she had a horrible flare of her autoimmune problems after a recent Covid booster. Her poor health led her to commit suicide in her early 20’s.

We can do a deep dive personally on the phone or you can watch this video to learn more about why some exosomes might not be active.

Of note, the scientists involved just repeated the study of competitors and if their results are to be believed, what others call “exosomes” may not appear to be that at all. Stay tuned for the updated results of QA testing on the available brands of “exosomes”

Here is video that explains why I am only using one brand despite many invitations for me to switch. I am not opposed to the idea but at the end of the day, I need to use what I know is safe and effective. I have never heard anyone say my current brand is not effective but I have talked to many physicians who have experimented and returned back to the Kimera Labs brand.

Check out my book

If you are interested in learning more about the prospects of staying younger and healthier for longer, read or listen to my book, “Exosomes: Songs of Healing”

In cases of immune derangement, the exosomes are not as effective. Learn more in my book. 

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