8 September 2013 Archives

Ringling Brothers: The Greatest Show in Court book cover The photo for my newest book comes from Shutterstock. It’s not a perfect photo. It’s a little dark, a little blurry and out of focus. But no other image worked for the book. When I saw it, I knew this was the image I wanted for my cover. Authors get funny that way, which is why publishers rarely let us anywhere near the cover.

Thankfully, O’Reilly’s Director of Brand Management and expert on all things book covers, Edie Freedman, kindly volunteered to help me pummel the photo into shape. She also helped educate me on what makes a good book cover. For instance, I didn’t know about needing to leave space on all sides of the cover page. I also wasn’t aware that when you’re a relatively unknown author, as I am, you want to put your name at the top of the page; get a little name recognition going. She helped polish away many of the photo’s distractions, and find a font that, I think, really makes the cover snap—especially in smaller sizes, which is what shows up on Amazon pages.

The cover image is probably the only photo I’ll be using from Shutterstock in my book. Most of the images will come from the court case and investigations the book covers. The others are coming from photos at Flickr made freely available for use with a Creative Commons license. You can use a photo in a book, as illustration, if the CC license permits noncommercial use.

Some of the photos are from folks who have attended the Ringling Brothers circus or the associated animal walks. Others, though, come from the Circus collection of the Boston Public Library. This wonderful institution has not only uploaded extraordinary graphics and photos to its Flickr account, it kindly allows people like me to use the photos in a non-commercial setting (such as within a book for editorial or illustrative purposes). My favorite set of theirs is, of course, the one related to the circus.

I’ve always been reluctant about the Creative Commons license, not the least of which, the licenses are a bit confusing. For instance, it took me the longest time to figure out that using a photo as illustration within a book that isn’t focused on selling said photo is not a commercial use of the photo. Or at least, that’s the interpretation I’ve seen most frequently given, and the one I’m sticking with.

I can now see, though, why having a licensing scheme such as the Creative Commons is so helpful. It wasn’t necessary to have older photos and circus posters in the book…but the added color and history makes it more lively.

Old circus poster

I was so grateful to the Boston Public Library that I decided to upload all of my photos to my new Flickr account and offer them for use. The CC license I picked is very open, other than I restrict commercial use because I don’t have model releases for people and buildings and don’t want to hassle with the potential content copyright issues.

I’ve already had one of my photos used in a Missouri Department of Tourism pamphlet, for illustrative purposes. I don’t claim to be the best photographer in the world, and most of my photos are ordinary. But you never know when one of your photos might help someone, so I just uploaded them all, let folks use them or not.

ratty fur coat My roommate was surprised by a card he received from his doctor this week. The doctor stated he was changing the way his practice worked, in order to provide a more “personalized approach”. There will be time to really discuss medical needs, the card noted. The appointments will be unhurried and quickly obtained.

“To achieve these goals, my practice size will be smaller and there will be an annual fee.”

The return address listed a Specialdocs Consultants. A quick look up on Google told us all we needed to know: Roomie’s doctor is going concierge. Going concierge just in time to avoid the unwashed masses who promise to invade medical offices next year thanks to the Affordable Care Act.

The unwashed masses…that’s folks like you and me who for whatever reason, don’t currently have medical insurance. For all the lofty rants about freedom and liberty echoed by those who fought against Obamacare the last few years, bottom line is much of the pushback is coming from folks who don’t want to have to compete for medical care with the additional 10-15% more of Americans who will soon be able to get healthcare when they need it. And compete we all will, if the medical profession meets the newly insured by fleeing to walled practices, doors open only at the ka-ching of a dropped coin.

What can we expect from these new, walled practices?

Lest you’re thinking Royal Pains, and doctors that come to your home (and who also donate much of their free time to treating those who can’t afford their services), the reality is that you’ll still need to visit the doctor in his or her office. However, you will most likely be able to get an appointment more quickly, and yes, the doctor will be able to spend more time discussing your health issues with you. But you’ll get all of this only after you pay a hefty premium. In the St. Louis area, average concierge fees run between $1500.00 and $2000.00 a year.

In a glowing opinion piece on concierge medicine, a doctor writing for Forbes magazine implied that the fees paid are “within the means of most middle class families”. However, there are few families I know that can quickly and easily absorb an extra $150 or more a month, just for the honor of being able to call in for an appointment. For all that doctors bitch about receiving less money from Medicare, they still are doing much better than the average middle class family, whose income has remained fixed as grocery and other costs have increased.

What we’re seeing is the beginning of a class system within the medical industry, with the wealthier having quick access to medical care, while the rest of us scrape by, getting whatever we can get. Of course, there’s always been a class system in the medical industry, but now it’s more obvious.

In the Forbes piece, the doctor wrote:

Over the next decade, we will likely see the evolution of primary care delivery into two tracks. Some patients receive high-quality care from happy, motivated concierge doctors, whereas others will have to make do with rushed “assembly line” care from overworked providers trying to get their patients in and out the door as quickly as possible.

Over the next decade what we’ll see is a different attitude towards the medical community, thanks in part to these new walled off medical practices. Gone will be the days when doctors are treated like Gods. More people will get their medical advice from Dr. Google, than from Dr. Baker or Dr. Hsieh. We’ll also be seeing more of nurse practitioners and physician assistants than doctors, which is a trend we should encourage. Gone, too, are the days when we just accept whatever the doctor says—whether she says it in 10 minutes or 30.

We’re already seeing a change in how we view medicine. Rather than rush in and get antibiotics any time we or our kids get a sniffle, we suck it up and drink our orange juice. We’ve found that antibiotics have been over-prescribed in the last few decades, leading to antibiotic resistant infections that, unlike the common cold, can kill us.

We’re discovering that many of those medical tests our doctors want us to take are unnecessary, or could be replaced by less expensive alternatives. We’re even discovering that the annual physical that we’ve been told is absolutely necessary for good health may not be necessary after all for many of us. As for treating the measles or the mumps, most parents get their kids immunized, and do so at the local school or pharmacy, not the doctor’s office.

(Well, most parents that don’t belong to certain churches. that is.)

We already know what we need to do to be healthier in this country. We need to eat less processed, fat and sugar laden foods We need to lose weight. We need to quit smoking, and not drink so much. We certainly shouldn’t take Molly, or whatever “kill me” drug is currently popular.

We need to get off the couch and walk. And when we walk, we need to turn off the damn phones. We’d do better spending that $2000 on a relaxing vacation or fun new hobby than paying a concierge fee.

In other words, we need to practice common sense when it comes to our health. We don’t need a doctor telling us what we already know if we’d only be honest with ourselves.

So, we need our doctors, true, but we need to work on needing them a lot less. Maybe then the doctors won’t flee from us in terror.

Is roomie going to pay the fee? He visits the doctor once a year. He isn’t particularly fond of him. He certainly doesn’t like him well enough to pay for the privilege of just being his patient.