Interview Nightmares: How to end health disparities question

[HumbleMD]

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So I had an interview on Monday of this week, and it's really starting to set in how horrible it went. The student interview went fantastic, but the faculty was horriffic. She was definitely more of a 'cold prickly' rather than a 'warm fuzzy.'

My question is, what do people do when asked (or grilled) on the issue of solving health disparities? I always like to point out that there are huge social and economic disparities that need to be addressed first, rather than just pointing the finger at the medical establishment. My interviewer must have thought otherwise, because she proceeded to grill me for 5 or 6 minutes on how I would achieve this. I kept reiterating that I hope to figure it out more in med school and perhaps public health dual degree, but she just kept asking... I wanted to throw my hands in the air and retort "I'm an undergraduate biochem major - If I could come up with a perfect answer, I'm pretty sure we wouldn't have a problem anymore!"

What do folks do when this happens in interviews? Are there graceful ways to change the subject, or god forbid, ask the interviewer to move on?

 

[RinaBe]

The interviewer realizes that you are not a policy expert. I think the goal of this line of questionsing is to see that you have made a well thought-out decision about going into medicine. That is, you have thought about issues relating to health care delivery, and you are aware of the drawbacks to our current system. You don't need a perfect answer, but you do need to show that you're thinking about these sorts of issues and that you have a solid understanding of what you will be facing as a physician working within this healthcare system.

 

[Benoit]

I answered that I did not have the proper education and/or knowledge in public policy and medicine as of yet to answer the question sufficiently. I did mention the general problem trends. It would be ludicrous for anyone to expect you to have the answer to the nation's healthcare problem in an interview. They were probably just testing you.

 

[jillibean]

The interviewer realizes that you are not a policy expert. I think the goal of this line of questionsing is to see that you have made a well thought-out decision about going into medicine. That is, you have thought about issues relating to health care delivery, and you are aware of the drawbacks to our current system. You don't need a perfect answer, but you do need to show that you're thinking about these sorts of issues and that you have a solid understanding of what you will be facing as a physician working within this healthcare system.

Agreed. I would just do my best to give a thoughtful answer and say "I don't know" if I really didn't.

 

[Doctor~Detroit]

it *could* also serve as a test of political values, aside from a test of policy knowledge (i have no evidence for this). i just suck it up and give them my sincere response--national health insurance--and bring up the pros and cons.

 

[jillibean]

So I had an interview on Monday of this week, and it's really starting to set in how horrible it went. The student interview went fantastic, but the faculty was horriffic. She was definitely more of a 'cold prickly' rather than a 'warm fuzzy.'

My question is, what do people do when asked (or grilled) on the issue of solving health disparities? I always like to point out that there are huge social and economic disparities that need to be addressed first, rather than just pointing the finger at the medical establishment. My interviewer must have thought otherwise, because she proceeded to grill me for 5 or 6 minutes on how I would achieve this. I kept reiterating that I hope to figure it out more in med school and perhaps public health dual degree, but she just kept asking... I wanted to throw my hands in the air and retort "I'm an undergraduate biochem major - If I could come up with a perfect answer, I'm pretty sure we wouldn't have a problem anymore!"

What do folks do when this happens in interviews? Are there graceful ways to change the subject, or god forbid, ask the interviewer to move on?

It would probably be much hard to resolve all of the social/economic disparities in the country than it would to create a nationalized health care system... IMO.

 

[sheepunite]

So I had an interview on Monday of this week, and it's really starting to set in how horrible it went. The student interview went fantastic, but the faculty was horriffic. She was definitely more of a 'cold prickly' rather than a 'warm fuzzy.'

My question is, what do people do when asked (or grilled) on the issue of solving health disparities? I always like to point out that there are huge social and economic disparities that need to be addressed first, rather than just pointing the finger at the medical establishment. My interviewer must have thought otherwise, because she proceeded to grill me for 5 or 6 minutes on how I would achieve this. I kept reiterating that I hope to figure it out more in med school and perhaps public health dual degree, but she just kept asking... I wanted to throw my hands in the air and retort "I'm an undergraduate biochem major - If I could come up with a perfect answer, I'm pretty sure we wouldn't have a problem anymore!"

What do folks do when this happens in interviews? Are there graceful ways to change the subject, or god forbid, ask the interviewer to move on?

you're right: the contextual determinants of health are too often neglected or only rhetorically referenced in discussions of health inequity. a major step in the right direction, i think, will be to change the popular discourse on health status and identity in this country (and beyond); throughout its history, the US has distinguished health promotion from health protection and placed an overwhelming emphasis on the former, turning health status into a moral "performance" . . .

i think you were right on. in response to persistent grilling, i'd say something like "i don't know the best way to redress health disparities, but i think that it's imperative first to change how we think and talk about vulnerable people in this country . . . "

 

[HumbleMD]

It would probably be much hard to resolve all of the social/economic disparities in the country than it would to create a nationalized health care system... IMO.

:flashback to interview day:

I'm not trying to debate how best to solve health disparities; wasn't the point of the post. I suppose, even more generally, what do you do in an interview situation when the interviewer seems to have a different idea on a policy or ideological idea, and doesn't really let up? How do you get them to move on?

 

[ahhh123]

:flashback to interview day:

I'm not trying to debate how best to solve health disparities; wasn't the point of the post. I suppose, even more generally, what do you do in an interview situation when the interviewer seems to have a different idea on a policy or ideological idea, and doesn't really let up? How do you get them to move on?

ask them how they would approach this question.. it seems to me that they have a strong opinion that's waiting to be heard

 

[Oculus Sinistra]

I answered that I did not have the proper education and/or knowledge in public policy and medicine as of yet to answer the question sufficiently. I did mention the general problem trends. It would be ludicrous for anyone to expect you to have the answer to the nation's healthcare problem in an interview. They were probably just testing you.

Agreed. Stress test.

 

[TMP-SMX]

Education of health care professionals and the public on preventive measures that can be taken to reduce the incidence of chronic disease... In addition, work toward using generic drugs that are a whole lot cheaper and often work better than the latest me too drug.

That being said, physicians who are asked if they provide discounted care for lower income people and don't offer those services should know where a person can receive care. That physician should forward the patient to another physician. Most physicians have no clue in their clinics. Another problem is physicians using the standardized chart for prescribing drugs for antibiotics and things like that. Many times the drugs don't work, increase resistance, and are often much more expensive. Some hospitals only pay for certain brand names, but for the other cases it takes a little personal responsibility for primary care physicians to get a little smarter and work toward reducing costs. The pharmaceuticals aren't going to do it on their own because they have one of the largest lobbies in Washington. Physicians cannot do it alone either, but they should keep in mind that providing the best care to those who can't afford medications is part of their duty to heal.

Another important factor is communication across cultures. It is often overlooked in many cookie cutter medical students. A translator cannot always make a perfect equivalency and physicians may not understand the different ways that patients may feel about disease. Patients are human and not robots. Minorities often feel neglected among other things and therefore their pain may be augmented. So physicians have to be sensitive about cultural differences.

(It helps to study the topic of culture, politics, and socioeconomics as it relates to health care)

 

[Md_dreams]

Hmm...I think that these can be more like think on your feet questions. I think it makes more sense to talk about a few points that you can argue are important and be clear that this might not solve the entire issue (in this case examples might be preventative care and translators). "I don't know" can come off as "I don't care" or "I don't have opinions about this subject" neither of which seems to be your issue.

Also I definitely don't think this is a stress test. I've had this come up a couple of times in interviews and talking about a few issues I think are important has worked fine. They just followed with questions about the issues I chose.

 

[8744]

So I had an interview on Monday of this week, and it's really starting to set in how horrible it went. The student interview went fantastic, but the faculty was horriffic. She was definitely more of a 'cold prickly' rather than a 'warm fuzzy.'

My question is, what do people do when asked (or grilled) on the issue of solving health disparities? I always like to point out that there are huge social and economic disparities that need to be addressed first, rather than just pointing the finger at the medical establishment. My interviewer must have thought otherwise, because she proceeded to grill me for 5 or 6 minutes on how I would achieve this. I kept reiterating that I hope to figure it out more in med school and perhaps public health dual degree, but she just kept asking... I wanted to throw my hands in the air and retort "I'm an undergraduate biochem major - If I could come up with a perfect answer, I'm pretty sure we wouldn't have a problem anymore!"

What do folks do when this happens in interviews? Are there graceful ways to change the subject, or god forbid, ask the interviewer to move on?

Just grow a pair, look your interviewer in the eye, and say, "As long as the poor can afford cell-phones, beer, crack, and cigarettes it's not my problem that they can't afford to go see the doctor a couple times a year to treat their health problems, most of which are self-inflicted."

You might also point out that there will always be social and economic disparities and any system that tries to eliminate them by government fiat usually entails the kind of dictatorship that a free people will not tolerate.

You might finish by telling her to get her happy liberal ass out of her ivory tower and "cry you a ****ing river."

I mean, if you grew a pair.

 

[8744]

...Another important factor is communication across cultures. It is often overlooked in many cookie cutter medical students. A translator cannot always make a perfect equivalency and physicians may not understand the different ways that patients may feel about disease. Patients are human and not robots. Minorities often feel neglected among other things and therefore their pain may be augmented. So physicians have to be sensitive about cultural differences...

Oh man. Stand by to have your eyes opened.

 

[8744]

...you're right: the contextual determinants of health are too often neglected or only rhetorically referenced in discussions of health inequity. a major step in the right direction, i think, will be to change the popular discourse on health status and identity in this country (and beyond); throughout its history, the US has distinguished health promotion from health protection and placed an overwhelming emphasis on the former, turning health status into a moral "performance" . . .

Jesus Christ. Promise me you'll practice somewhere far, far away from me.

"Contextual determinants." Har har.

 

[MossPoh]

Just grow a pair, look your interviewer in the eye, and say, "As long as the poor can afford cell-phones, beer, crack, and cigarettes it's not my problem that they can't afford to go see the doctor a couple times a year to treat their health problems, most of which are self-inflicted."

Spoken like a true doctor straight outta the ER 😉 You forgot the piercings and tats that play a much bigger role in their lives than the 5 dollar thing of medication for their child.


The liberal thing I don't know. That seems to be a crutch too much just as conservative stuff is....idiots are idiots are idiots and they can all use an awakening bitch slap every now and then.

 

[8744]

Spoken like a true doctor straight outta the ER 😉 You forgot the piercings and tats that play a much bigger role in their lives than the 5 dollar thing of medication for their child.


The liberal thing I don't know. That seems to be a crutch too much just as conservative stuff is....idiots are idiots are idiots and they can all use an awakening bitch slap every now and then.

Hey, I had a patient last night who wanted me to write her a prescription for her three-year-old daughter's children's Tylenol. She said she couldn't afford it and if I wrote her a scrip medicaid would pay. She was adamant about it, too.

Fer' crying out loud. It's three bucks at Target. I buy it all the time. Less than the pack of cigarettes I saw sticking out of her purse.

I asked the nurse to give the child a dose and just give them the rest of the bottle. Why make the kid suffer, I mean.

You might contextually determine that her culture values cigarettes more than the health of their children.

 

[MossPoh]

Hey, I had a patient last night who wanted me to write her a prescription for her three-year-old daughter's children's Tylenol. She said she couldn't afford it and if I wrote her a scrip medicaid would pay. She was adamant about it, too.

Fer' crying out loud. It's three bucks at Target. I buy it all the time. Less than the pack of cigarettes I saw sticking out of her purse.

I asked the nurse to give the child a dose and just give them the rest of the bottle. Why make the kid suffer, I mean.

You might contextually determine that her culture values cigarettes more than the health of their children.

That stuff is what I found most stressful following ER guys around. I loved the variety of medicine, the fact that it is good for my add type personality, and the occasional oh **** moments, but those people just really bother me. How do you handle it day in and day out? I have to say though, whenever a kind legit patient came in, that kind of made it worth it. They were never whiners, or wanted pain meds..just wanted to find out what the hell was wrong. one lost feeling in his left leg, one was coughing up blood, and the other had a grill blow up in his face...all seemed like legit reasons to be in the er.lol

 

[sheepunite]

Jesus Christ. Promise me you'll practice somewhere far, far away from me.

"Contextual determinants." Har har.

pshaw.
the IOM found that only 1 out of 4 doctors practicing today thinks that race matters to health outcomes, even though the IOM also found that health disparities between ethnic/racial groups persist when SES, education, etc. are controlled for. hello? don't tell me you're one of the stupid 3. personal behavior ain't explaining it all.

also, nice crude, mock-anthro reading of your ER patient's situation. way to be a superstar.

 

[eram]

:flashback to interview day:

I'm not trying to debate how best to solve health disparities; wasn't the point of the post. I suppose, even more generally, what do you do in an interview situation when the interviewer seems to have a different idea on a policy or ideological idea, and doesn't really let up? How do you get them to move on?

Along with some of the other approaches here, you can think of this as a test of your critical thinking. Interviewers like to see that you can make an informed decision on a potentially important (in this case social) issue and back it up with a logical argument.

 

[TPROrgoTutor]

When I was asked this I essentially said exactly how I felt. There should be certain reform but I feel that third party establishments are responsible for a good percentage of the problems faced in healthcare but as an undergraduate I do not have expertise on the issue and I feel that anything I said in specific to reforming the issue would be missing many key points and areas that only somebody actually in the field, dealing with said issues would be able to realize. I basically said "I have no idea" in a more articulate manner.

I have since been accepted at this school. Be honest, if you don't know, well say it it...

 

[BucsFan813]

So I had an interview on Monday of this week, and it's really starting to set in how horrible it went. The student interview went fantastic, but the faculty was horriffic. She was definitely more of a 'cold prickly' rather than a 'warm fuzzy.'

My question is, what do people do when asked (or grilled) on the issue of solving health disparities? I always like to point out that there are huge social and economic disparities that need to be addressed first, rather than just pointing the finger at the medical establishment. My interviewer must have thought otherwise, because she proceeded to grill me for 5 or 6 minutes on how I would achieve this. I kept reiterating that I hope to figure it out more in med school and perhaps public health dual degree, but she just kept asking... I wanted to throw my hands in the air and retort "I'm an undergraduate biochem major - If I could come up with a perfect answer, I'm pretty sure we wouldn't have a problem anymore!"

What do folks do when this happens in interviews? Are there graceful ways to change the subject, or god forbid, ask the interviewer to move on?

Keep it simple: Just say that there are 45 million uninsured, many of which are the working poor. Say that you would expand state programs like S-CHIP so that all children would have health insurance. While it won't solve everything, it's a start. They won't "grill" you much after that...

 

[MossPoh]

pshaw.

also, nice crude, mock-anthro reading of your ER patient's situation. way to be a superstar.

I stand by Panda in this situation. Go into an ER for a couple of days and it is a recurring event....and it isn't an exaggeration. You will see people with sometimes multiple packs of cigs, oftentimes drug users, body jewlery everywhere, tattoos that are still relativley fresh and they whine about not having the money for tyelnol, or an antibiotic, or any number of things that their child may need. Although all parents may be hysterical, many of these people are worse than traditional parents. What happens when you put a hysterical parent in a room with an injured child? The child flips out because they see their parent crying/yelling and think it is much worse than it is. It doesn't mean if that patient came in later he'd refuse to treat him/her but it is one of the most frustrating situations one can witness. At least with all of my years in the hospital (I'm a premed....but from first grade on I've been surrounded by this)

 

[DrZeke]

Just wanted to say that this thread has been superhelpful in giving me a better idea of how to organize my thoughts or what issues I might want to consider when answering this question in the future.

👍

 

[8744]

pshaw.
the IOM found that only 1 out of 4 doctors practicing today thinks that race matters to health outcomes, even though the IOM also found that health disparities between ethnic/racial groups persist when SES, education, etc. are controlled for. hello? don't tell me you're one of the stupid 3. personal behavior ain't explaining it all.

also, nice crude, mock-anthro reading of your ER patient's situation. way to be a superstar.

Cultural differences are important. But the problem is that they are generally important in a bad way, that is, the cultural differences that we're supposed to celebrate are usually detrimental to good health and usually driven by ignorance, not some kind of ancient wisdom from the ancestoral homeland.

So you see, when you celebrate irresponsible personal behavior under the theory that it is a valid cultural difference, you are being incredibly patronizing and are no different from the Imperial Wizard of the Ku Klux Klan who believes that blacks and Mexicans are irresponsible, lazy, and incapable of making rational decisions. The difference between you and me is that I think a black guy choosing to smoke weed all day rather than buy antibiotics for his children is a lazy, no-account bum while you think he is just living his cultural values. You accept implicitely that this is normal behavior for blacks while I view it as abberant behavior.

Personal behavior, by the way, explains most of the patients I saw in the Emergency Department last night. Three drunks, COPD exacerbation in a gentleman with a 180 pack-year smoking history, facial trauma from talking **** in a bar, cardiac arrythmia from cocaine, not to mention the underlying health complications from morbid obesity, drug use, casual sex, and other irregular pleasures that afflict most of our patients. If people made good personal choices we'd all be out of jobs. In fact, it's so unusual to treat somebody who really was minding their own business (like HCM in a teenager) that these patients are kind of like curiousities.

 

[8744]

Sheepunite:

Current Status:
Other Health Professions Student


That explains it all.

 

[somemaybedoc]

I agree with Panda Bear and MossPoh, if you can afford all the crap to screw up your health, you can afford to forgoe some of the crap you usually spend your money on to see a doc and pay for your meds.

Quit buying cigarettes, liquor, expensive clothes, jewelry, and tatoos and then I'll consider talking about disparities.

I'm also not paying to house you if your house burns down because you get black out drunk and smoke in bed.

I remember one guy who gave his entire family CO poisoning because he didn't pay his electric and ran a generator in basement (I think to get power for the TV), he had on him at the time he was brought in 1 pack cigs, 150 dollar jeans, brand new Air Jordans, and 500 dollars in cash.

 

[sheepunite]

Sheepunite:

Current Status:
Other Health Professions Student


That explains it all.

The difference between
you and me is that I think a black guy choosing to smoke weed all day
rather than buy antibiotics for his children is lazy, no-account bum
while you think he is just living his cultural values. You accept
implicitely that this is normal behavior for blacks while I view it as abberant
behavior.

nope, this is wildly inaccurate. good to know you came away from med school with such nuanced critical thinking skills. i was questioning your eagerness to completely dismiss the relevance of structural issues, like poverty, weak social services provision and poor public transport, among many others, to the health behavior and outcomes of your poor patients. i don't discount your experience as an ER doc, but i *was* asking for broader acknowledgment of the incredibly difficult conditions under which (most of the world's) people are asked to live their lives.

my disgust with the way you disparaged your patient was not to condone the woman's decision (let alone elevate it as a "cultural" practice - duh), but to question your privileged position, as someone who was fortunate enough to train as a medical doctor in this country, and the elitist disdain that's so apparent in your posts.

and with regards to that line of implied bullsh1t, regarding my background: there are tons of physician advocates out there, whose experience exceeds your own and who understand these structural issues to be of vital import to population and individual health. you're just the anti-paul farmer, which is fine, but it's invalid to imply that my stance simply reflects the naive, unpracticed idealism of a non-doc.

(Cultural differences are important. But the problem is that they are generally important in a bad way, that is, the cultural differences that we're supposed to celebrate are usually detrimental to good health and usually driven by ignorance, not some kind of ancient wisdom from the ancestoral homeland.

by the way: your statement above is suggesting that, in fact, poor health decisions *are* cultural artifacts. not only that, you're stating that *ignorance* is part of some cultures. egads - who's the patronizing jerk now?)

 

[steppwolf]

Cultural differences are important. But the problem is that they are generally important in a bad way, that is, the cultural differences that we're supposed to celebrate are usually detrimental to good health and usually driven by ignorance, not some kind of ancient wisdom from the ancestoral homeland.

I'm not following this. I think you're feelings about dissolute deadbeats are on target, but it seems to me you are confusing socio-economic issues with cultural ones. Outside of perhaps the deadbeats themselves, who is saying "we're supposed to celebrate" cultural differences that are detrimental to good health?

 

[8744]

The difference between
you and me is that I think a black guy choosing to smoke weed all day
rather than buy antibiotics for his children is lazy, no-account bum
while you think he is just living his cultural values. You accept
implicitely that this is normal behavior for blacks while I view it as abberant
behavior.

nope, this is wildly inaccurate. good to know you came away from med school with such nuanced critical thinking skills. i was questioning your eagerness to completely dismiss the relevance of structural issues, like poverty, weak social services provision and poor public transport, among many others, to the health behavior and outcomes of your poor patients. i don't discount your experience as an ER doc, but i *was* asking for broader acknowledgment of the incredibly difficult conditions under which (most of the world's) people are asked to live their lives.

my disgust with the way you disparaged your patient was not to condone the woman's decision (let alone elevate it as a "cultural" practice - duh), but to question your privileged position, as someone who was fortunate enough to train as a medical doctor in this country, and the elitist disdain that's so apparent in your posts.

and with regards to that line of implied bullsh1t, regarding my background: there are tons of physician advocates out there, whose experience exceeds your own and who understand these structural issues to be of vital import to population and individual health. you're just the anti-paul farmer, which is fine, but it's invalid to imply that my stance simply reflects the naive, unpracticed idealism of a non-doc.

(Cultural differences are important. But the problem is that they are generally important in a bad way, that is, the cultural differences that we're supposed to celebrate are usually detrimental to good health and usually driven by ignorance, not some kind of ancient wisdom from the ancestoral homeland.

by the way: your statement above is suggesting that, in fact, poor health decisions *are* cultural artifacts. not only that, you're stating that *ignorance* is part of some cultures. egads - who's the patronizing jerk now?)

Fine words which butter no parsnips. Chatting with one of my indigent customers last night when things were slow I discovered that he spent twenty bucks a day on "weed" which he smoked with great enthusiasm. That's about 600 bucks a month, give or take. Add to that a modest consumption of beer and cigarettes ("because that crap'll mess you up") and you can see that this father of two and haphazardly employed gentleman spent more on his irregular pleasures than most people spend for heath insurance.

Two of my patients the night before, also poor, also without health insurance, presented with cocaine-induced caridiac ischemia. One of them was such a regular that the nurses knew him by his first name and stopped by to ask how his kids were doing.

Patients like this are the rule rather than the exception. Lifestlye choices are the biggest determinant of health. I would put money on it. Responsible citizens, rich or poor, take care of their health. Unfortunately, it is the prevalent entitlement mentality that leads many to consider expensive heath care a right and self-care an onerous and unconstitutional burden.

I love my nasty, irresponsible, fat, smelly patients. The more crack-whorier the better. As patients, they are both interesting and challenging. I get a big smile when EMS says, "We found him passed out outside a gay bar laying in a pool of his own vomit."

I mean, what's there not to like?

But I don't feel the need to patronize them either.

Once you get into the real world, and from a medical point of view nothing gets more real than the Emergency Department where we see everyone and turn no one away, you will see a surprising correlation between harmful lifestyle choices and the need for emergency (and not so emergent) services.

Your condescension is stunning but typical of many in the SDN pre-med crowd. I think you are confusing me with some trust-fund baby who's biggest hurdle in life was the time he got an A- on an Organic Chemistry test. Print this thread. Put it in an envelope. Read it in six years or whenever you are in the middle of your residency and see if you feel the same way you do today.

 

[Go Time]

(snip) Lifestlye choices are the biggest determinant of health. I would put money on it. (snipe)

I agree that this is significant. What factors do you think influence these choices (good and bad choices)?

 

[8744]

I'm not following this. I think you're feelings about dissolute deadbeats are on target, but it seems to me you are confusing socio-economic issues with cultural ones. Outside of perhaps the deadbeats themselves, who is saying "we're supposed to celebrate" cultural differences that are detrimental to good health?

Look at it this way; If the Hmong want to coin each other until the water buffalo come home it's none of my business. I don't care what crowd of zombie spirits the Hatian invokes. The new immigrant from China may snort all the tiger penis he can handle for all it matters to me. Heck, a pentacostal may handle whatever venemous snakes he can get a hold of and speak in whatever toungue he feels apt to cure his pancreatitis with not a word of protest ever crossing my lips.

Fantastic. Knock yourselves out. It's your culture and you can celebrate it like it's 1999, just not when I'm treating you, OK? Besides, when soembody comes to an American hospital it is a de facto acknowledgement that there is something to this crazy Western medicine thing, otherwise they'd flock to the Holistic Emergency Department for a stat goat milk enema whenever they had rectal bleeding.

"Cultural competence" is just code for justifying unhealthy beliefs and behaviors. Wouldn't you say that part of our mission as doctors is to educate the public, not patronize their every belief?

 

[8744]

I agree that this is significant. What factors do you think influence these choices (good and bad choices)?

The fact that a Big Mac tastes better than a salad, crack cocaine gives a better rush than playing tag with one's kids, and it's easier to sit on the couch watching the Fresh Prince of Bel Air than to put on a pair of sneakers and jog for half an hour.

Oh, and working blows because nobody will pay a high school quasi-dropout more than six bucks and hour, you have to get up early if you accept this kind of job, and you have to take orders from "the man."

Not to mention that our social safety net has created a world of 14-year-old mothers, twenty-year-old grandmothers, and 42-year-old great-grandmothers. Don't scoff. I have seen it often enough where it doesn't even amaze me. And the great-grandmothers are not even good role models as they are young enough to have lived in a world where it was acceptable to spend their lives seeking out the same irregular pleasures as their daughters and grand-daughters.

Yup. Four generations of success in the same exam room. The only way to tell them apart is the by the quality of their tatoos.

 

[8744]

Other patients last night:

Obese young man with Asthma, sleep apnea, diabetes for asthma exacerbation triggered by smoking.

Drunk man ran car into back of parked police car, air bag deployed and was wearing seatbelt.

Young girl for Tylenol overdose.

Thirty-something woman for abdominal pain that could only be relieved by dilaudid.

Probable alcoholic pancreatitis.

COPD exacerbation in current smoker with a 150-pack-year habit.

Older lady, COPD, lung cancer, ex-smoker, diabetic, with pulmonary embolism.

Drunk versus other bar patrons.

etc.

Oh, I had one married, young, healthy woman with probable food poisoning.

 

[steppwolf]

Look at it this way; If the Hmong want to coin each other until the water buffalo come home it's none of my business. I don't care what crowd of zombie spirits the Hatian invokes. The new immigrant from China may snort all the tiger penis he can handle for all it matters to me. Heck, a pentacostal may handle whatever venemous snakes he can get a hold of and speak in whatever toungue he feels apt to cure his pancreatitis with not a word of protest ever crossing my lips.

Of course these kinds of cultural practices are at odds with modern medical science and, one can easily argue, good old common sense. But you've picked out some rather rare, exotic examples here that hardly speak to broad-based cultural differences regarding good health.

How much does 'foreign' culture rally have to do with most of the cases you are seeing day after day?

 

[Go Time]

The fact that a Big Mac tastes better than a salad, crack cocaine gives a better rush than playing tag with one's kids, and it's easier to sit on the couch watching the Fresh Prince of Bel Air than to put on a pair of sneakers and jog for half an hour.

Oh, and working blows because nobody will pay a high school quasi-dropout more than six bucks and hour, you have to get up early if you accept this kind of job, and you have to take orders from "the man."

Not to mention that our social safety net has created a world of 14-year-old mothers, twenty-year-old grandmothers, and 42-year-old great-grandmothers. Don't scoff. I have seen it often enough where it doesn't even amaze me. And the great-grandmothers are not even good role models as they are young enough to have lived in a world where it was acceptable to spend their lives seeking out the same irregular pleasures as their daughters and grand-daughters.

Yup. Four generations of success in the same exam room. The only way to tell them apart is the by the quality of their tatoos.

Do you believe that our society is to blame, the individuals, or a combination of the two? I think each individual resides on a choice continuum where said health concious decision making (both good and bad) can to a great extent be influenced by factors beyond individual will.

 

[DropkickMurphy]

I answered that I did not have the proper education and/or knowledge in public policy and medicine as of yet to answer the question sufficiently. I did mention the general problem trends. It would be ludicrous for anyone to expect you to have the answer to the nation's healthcare problem in an interview. They were probably just testing you.

I think that would work better than my stock answer of "I don't have any interest in that. I simply want to treat patients and conduct clinical research and will therefore leave public policy to those who actually want to pursue that side of the issues afflicting medicine."

Basically a fancy way of saying "I don't really care, so therefore I haven't paid a bit of attention to it and please don't dig any deeper on this....."

 

[DropkickMurphy]

Do you believe that our society is to blame, the individuals, or a combination of the two? I think each individual resides on a choice continuum where said health concious decision making (both good and bad) can to a great extent be influenced by factors beyond individual will.

The blame rests squarely on the individuals.

 

[MonkeyNuts!]

Just grow a pair, look your interviewer in the eye, and say, "As long as the poor can afford cell-phones, beer, crack, and cigarettes it's not my problem that they can't afford to go see the doctor a couple times a year to treat their health problems, most of which are self-inflicted."

I've volunteered in an ER and seen some of the things you stated (although I'm sure on a doc's end it's a whole different kind of frustration) - things like people coming in looking for their next fix or people coming in unable to purchase drugs and then whipping out their cell phones to answer their buds who scored their next fix (yay Baltimore!).

But I've also worked in homeless clinics where people come in with nothing, don't have any history of drug or alchohol abuse (yea yea hearsay, but for argument's sake) and still can't afford basic healthcare.

So I guess my question is that could it be possible that the ER may see the stereotypical junkie who states he can't afford proper meds but can somehow pay his smackdaddy for his weed and cocaine (simply out of the functional characteristics of an ER) and that there are actually plenty of people out on the street who don't have these problems and truly can't afford it?

And if so, this population, in addition to the growing number of underinsured patients in the middle class - are they all to suffer because of a bunch of crackheads?

 

[DropkickMurphy]

pshaw.
the IOM found that only 1 out of 4 doctors practicing today thinks that race matters to health outcomes, even though the IOM also found that health disparities between ethnic/racial groups persist when SES, education, etc. are controlled for. hello? don't tell me you're one of the stupid 3. personal behavior ain't explaining it all.

also, nice crude, mock-anthro reading of your ER patient's situation. way to be a superstar.

It's nice that you have sheep in your user name, because obviously you like to follow the flock..... 🙄

 

[MonkeyNuts!]

FWIW, it's not right to assume that the drugusers are specifically on 'crack.' This processed form of coccaine is acually on a down swing in popularity as amphetamine is rising in it's place. Keep in mind that 85% of the homeless people are pre-meds with high MCAT scores who did not score well on their boards. It is important to not take for granted that the MCAT does not guarentee future success in medical school and beyond.

Goddammit. Can't you trolls be imaginative for once. Mimicking someone's name and tricking the admins into banning said person instead of you is pretty n00b, no one falls for that crap anymore.

 

[8744]

...So I guess my question is that could it be possible that the ER may see the stereotypical junkie who states he can't afford proper meds but can somehow pay his smackdaddy for his weed and cocaine (simply out of the functional characteristics of an ER) and that there are actually plenty of people out on the street who don't have these problems and truly can't afford it?

Yes. It is both probable and possible. But these are not the people who are sucking up most of the health care resources. In other words, what does a normal guy like me really need for health care? A cheap blood pressure medication? Maybe something for cholesterol? The odds are that barring something like cancer or major trauma, I probably won't need more than a couple or three thousand dollars worth of medical care for most of my life.

This is not a poor country. Even most of our poor have disposable income. Odds are that if you live only a moderately healthy lifestyle you will need only a visit or two to the doctor every year and a few low cost generic pills which will cost far less than most people, even the poor, pay for their cable TV, cell phones, and other luxuries. They pay for these things because they value them and more importantly, unlike health care, if you don't pay you don't get them. Even the poor would think it nonsensical to get their cable TV for free.

My 32-year-old crack-head, on the other hand, has been in the ICU several times in his life burning up 3000 dollars a day in hospital costs which he can't pay and will never pay. he visits the Emergency Department every couple of months and if not admitted at least occupies a bed and gets the usual work-up even if we know it's cocaine and he's not going to quit. Additionally, he has a gigantic sense of entitlement and would shed self-righteous tears if we asked him for a 20 dollar co-pay (the price of two crack rocks).

Same with the smoker with asthma or worse yet, the child with an asthma exacerbation who's parents smoke in the house.

"We never smoke in the house, Doc," they say as my eyes tear up from their smoke-impregnated cloothes.

I repeat, the majority of every patient I have seen both in the Emergency Department and on the wards was there for some problem which was either directly caused or exacerbated by lifestyle choices like smoking, drinking, over-eating, doing drugs, screwing around, and ignoring medical advice when it was easy to ignore.

 

[8744]

Do you believe that our society is to blame, the individuals, or a combination of the two? I think each individual resides on a choice continuum where said health concious decision making (both good and bad) can to a great extent be influenced by factors beyond individual will.

Society is to blame. After all, can you blame some 14-year-old mother of two for having babies seeing that her mother and principal role model was herself a teenage mother?

The solution, however, is not to throw even more benefits at the irresponsible. Why create a bigger dependency class?

 

[1Path]

and it's easier to sit on the couch watching the Fresh Prince of Bel Air than to put on a pair of sneakers and jog for half an hour.

.....................

 

[steppwolf]

The odds are that barring something like cancer or major trauma, I probably won't need more than a couple or three thousand dollars worth of medical care for most of my life.

Well, here's hoping you're that lucky. If you so much as stub your toe, however . . .

I think you make some good observations PB, but something about your condescending posting style tells me you've overlooked a thing or two in your quest to become an authority on life.

 

[8744]

Of course these kinds of cultural practices are at odds with modern medical science and, one can easily argue, good old common sense. But you've picked out some rather rare, exotic examples here that hardly speak to broad-based cultural differences regarding good health.

How much does 'foreign' culture rally have to do with most of the cases you are seeing day after day?

Not much. We tend to see standard white and black Americans Ver 2.0 with a smattering of Arab-Americans. I have not had to use a translator since I've been here (but which was an every day thing at Duke where I did my intern year).

With that being the case, what's the big deal about cultural competance? They certainly have no totally off-the-wall customs. I'm not black, for example, but black culture is pretty ingrained in general American culture, right down to a lot of the slang we use and, without claiming to have some magical rapport with my black patients, I do understand them passably well. You don't have to be born in the 'hood to have the professional authority to select and prescribe the appropriate antibiotic for "My **** be dripping." And the fact that I am a white guy has never caused one of my black patients to say, "Screw you, honkey, I'm not taking the white man's antibiotic of oppression!"

You guys are reading too much into the patient encounter. They come to the doctor, they tell you what's bothering them, you try to diagnose them and come up with a treatment plan. That's pretty much it. You're not considering them for marriage to your daughter. They're usually polite and respectful. You're usually poilte and respectful. They have their culture, you have yours. If they don't want that evil Western medicine they would have gone to their local feng shui practitionor.

 

[1Path]

good to know you came away from med school with such nuanced critical thinking skills. i was questioning your eagerness to completely dismiss the relevance of structural issues, like poverty, weak social services provision and poor public transport, among many others, to the health behavior and outcomes of your poor patients. i don't discount your experience as an ER doc, but i *was* asking for broader acknowledgment of the incredibly difficult conditions under which (most of the world's) people are asked to live their lives. by the way: your statement above is suggesting that, in fact, poor health decisions *are* cultural artifacts. not only that, you're stating that *ignorance* is part of some cultures. egads - who's the patronizing jerk now?)

👍

See here's my thinking. If Panda was in Johnson City, TN doing an ER residency he could subsitute the hood for a trailer park, crack for meth, and the Fresh Prince for Jeff Foxworthy. Of course, then he probably wouldn't be here on SDN spewing this crap with it's not so subtle racial undertones.🙄

If I had ONE wish for the admissions process in picking accepted students, it would be to require that EVERY student spend either 1 year volunteering at a clinic in the 'hood or in a rural area before they can even submitt their apps. That way when the question about health disparities is raised the applicant will have the common sense combined with volunteer experience to know that this issue is more about CLASS then about RACE!

And FYI, ANYONE that can't answer this one common sense question, shouldn't be admitted to med school!

 

[8744]

Well, here's hoping you're that lucky. If you so much as stub your toe, however . . .

I think you make some good observations PB, but something about your condescending posting style tells me you've overlooked a thing or two in your quest to become an authority on life.

I wouldn't go to the Emergency Department for a stubbed toe. Most people don't, just like most people don't go to the doctor for a cold. But the ED waiting room is usually full of people with a little bit of a cough or a slight headache who we send home with nothing but a polite "thanks for coming" and some motrin.

I am not an authority on life. But I can see through a brick wall given time and I can tell a hawk from a handsaw. I not an authority on health care either. I'm just telling you what I see.

 

[8744]

👍

See here's my thinking. If Panda was in Johnson City, TN doing an ER residency he could subsitute the hood for a trailer park, crack for meth, and the Fresh Prince for Jeff Foxworthy. Of course, then he probably wouldn't be here on SDN spewing this crap with it's not so subtle racial undertones.🙄

If I had ONE wish for the admissions process in picking accepted students, it would be to require that EVERY student spend either 1 year volunteering at a clinic in the 'hood or in a rural area before they can even submitt their apps. That way when the question about health disparities is raised the applicant will have the common sense combined with volunteer experience to know that this issue is more about CLASS then about RACE!

And FYI, ANYONE that can't answer this one common sense question, shouldn't be admitted to med school!

That's how I know that most of you have no real hospital experience. Everybody, black or white, watches the Fresh Prince of Bel Air. It's the only thing on at 3 AM. Just like during the day the only thing on is the Price is Right.

Why should I volunteer in the 'hood? that's essentially what I'm doing now. And I do come out of the LSU system which is all charity, all the time.

Man. I think most of the medical school application process is idiotic and you've just managed to make a suggestion that would make if even more so.

 

[somemaybedoc]

That's how I know that most of you have no real hospital experience. Everybody, black or white, watches the Fresh Prince of Bel Air. It's the only thing on at 3 AM. Just like during the day the only thing on is the Price is Right.

Why should I volunteer in the 'hood? that's essentially what I'm doing now. And I do come out of the LSU system which is all charity, all the time.

Man. I think most of the medical school application process is idiotic and you've just managed to make a suggestion that would make if even more so.

I am curious, how would you like the application process to be? I'm not a big fan of the current system. It makes lyers out of many of us.

If this proccess had to be one year longer, I would rather spend a year becoming more competent than trying to become a sappy quivering pile of compassion for the poor.