Interview Nightmares: How to end health disparities question

[HumbleMD]

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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.

Yes! A future surgeon!

 

[1Path]

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..

Yeah, whatever!🙄

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. .

First, I said 'hood OR a rural area.
Why? Because so many of you are ignorant to what the lives of most of the people who live in these places are like. Here's a news flash. I have yet to see someone raised anywhere but especially in the 'hood or applachia say they want to be a crackhead or a toothless meth addict when they grow up. This is just another one of those STEREOTYPES people LOVE to believe about people they don't know jack **** about. And there's no way in hell I don't believe that your stereotypes affects the type of medical care you dish out.

So can you honestly say that diabatic ketoacidosis would even be a part of your differential diagnosis when the dirty, urine smelling old black man comes into the ER with fruity smelling breath? Or would you just assume he was drunk based on his "culture"??

Point 1,000,000 for why we NEED affirmative action.👍

 

[dynx]

Another important factor is communication across cultures. It is often overlooked in many cookie cutter medical students.

Talk about f*cking cookie cutter. You sound like the soundbite pre-hashed lip service feel good wanna be's at my institution.

 

[MonkeyNuts!]

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.

I suppose this is the rationale behind the current Massachussets state health care program where they are requiring everyone to purchase insurance. At first I was like, "well how can they ask homeless/poor to do that seeing as how homeless/poor usually means they have no money." But if what you say is true, then I guess this plan would work. So we will see if your personal accounts of your patients do extend to a much larger population.

I, and perhaps many of the premeds on this site, have read a good deal about healthcare, mainly those texts that blame the system rather than focusing on what's wrong with the patient. I am more than willing to acquiesce that a good chunk of the problem is due to patients. Are there any good books - I suppose these would be books countering the harsh criticisms of the current system/bid for national healthcare - that address these issues, much like your own personal experiences?

 

[somemaybedoc]

c

 

[ryandote]

There is obviously only one answer to the question:

All health insurance business needs to be relegated to the private sector, allow competition and markets to maximize efficiency. The result will be lowest cost and highest quality. To accommodate the po'folks, taxes need to be levied that will allow the gub'ment to provide credits/vouchers to be used toward the po'folks medical expenses.
Anybody who disagrees with this plan obviously has a defective opinion and a defective mind. And I'm hoping they'll take the bait.

Discuss.

 

[MonkeyNuts!]

Point 1,000,000 for why we NEED affirmative action.👍

Crap. Are you really prepared to open that can in here? Cuz the smell attracts the crazies and the trolls and the bandwagon noobies...

 

[8744]

Yeah, whatever!🙄

First, I said 'hood OR a rural area.
Why? Because so many of you are ignorant to what the lives of most of the people who live in these places are like. Here's a news flash. I have yet to see someone raised anywhere but especially in the 'hood or applachia say they want to be a crackhead or a toothless meth addict when they grow up. This is just another one of those STEREOTYPES people LOVE to believe about people they don't know jack **** about. And there's no way in hell I don't believe that your stereotypes affects the type of medical care you dish out.

So can you honestly say that diabatic ketoacidosis would even be a part of your differential diagnosis when the dirty, urine smelling old black man comes into the ER with fruity smelling breath? Or would you just assume he was drunk based on his "culture"??

Point 1,000,000 for why we NEED affirmative action.👍

Whoa. An accucheck (blood sugar) is part of the routine panel for anyone coming in altered. DKA is most certainly part of the differential. This is a pseudo-situation from one of your cultural sensitivity textbooks and not a real occurence.

 

[somemaybedoc]

Yeah, whatever!🙄

First, I said 'hood OR a rural area.
Why? Because so many of you are ignorant to what the lives of most of the people who live in these places are like. Here's a news flash. I have yet to see someone raised anywhere but especially in the 'hood or applachia say they want to be a crackhead or a toothless meth addict when they grow up. This is just another one of those STEREOTYPES people LOVE to believe about people they don't know jack **** about. And there's no way in hell I don't believe that your stereotypes affects the type of medical care you dish out.

I honestly say I still don't give two sh*ts about their background. I have no interest; seeing where they came from won't change anything, the fact is that although their background may have led to their lifestyles, their lifestyles lead to the results we deal with. The job isn't to feel empathetic, it is to treat the patient, if that involves empathy, fine, if it doesn't, screw it. Results are the point, not sensitivity training.

 

[1Path]

Whoa. An accucheck (blood sugar) is part of the routine panel for anyone coming in altered. DKA is most certainly part of the differential.

Like that's EVER made a difference. 🙄

Misdiagnosis can and does occur and is reasonably common with error rates ranging from 1.4% in cancer biopsies to a high 20-40% misdiagnosis rate in emergency or ICU care. Surveys of patients also indicate the chance of experiencing a misdiagnosis to range from 8% to 40%. This makes misdiagnosis one of the most common types of medical mistakes. http://www.cureresearch.com/intro/overview.htm

Now can we bring this conversation back to the issue of health disparities since poor folks are far more likely to present with DKA due to lack of prior treatment for their Type I diabates?😕

 

[1Path]

I honestly say I still don't give two sh*ts about their background. I have no interest; seeing where they came from won't change anything, the fact is that although their background may have led to their lifestyles, their lifestyles lead to the results we deal with. The job isn't to feel empathetic, it is to treat the patient, if that involves empathy, fine, if it doesn't, screw it. Results are the point, not sensitivity training.

This isn't about empathy this is about education but if you want to remain ignorant about a significant patient population, go right ahead. Just please avoid patient care specialties and for goodness sakes, PLEASE don't become a pathologist!

 

[somemaybedoc]

This isn't about empathy this is about education but if you want to remain ignorant about a significant patient population, go right ahead. Just please avoid patient care specialties and for goodness sakes, PLEASE don't become a pathologist!

It is about empathy.

Treatment does not have to mean that I need to feel for their horrible lives. I have to understand the physical effects of those lives, put on a good facade of caring for effective communication, and have the knowledge and skills to use that information and collect additional info to diagnose and treat them.

At no point do I have to like or understand the behavioral choices the patients make. I don't have to show understanding for their inability to pay; they simply won't and I have to work around that.

Most likely I will go into patient care. Also it is likely that I will not be in an area with a high proportion of indigents.

 

[dynx]

Like that's EVER made a difference. 🙄

Misdiagnosis can and does occur and is reasonably common with error rates ranging from 1.4% in cancer biopsies to a high 20-40% misdiagnosis rate in emergency or ICU care. Surveys of patients also indicate the chance of experiencing a misdiagnosis to range from 8% to 40%. This makes misdiagnosis one of the most common types of medical mistakes. http://www.cureresearch.com/intro/overview.htm

Now can we bring this conversation back to the issue of health disparities since poor folks are far more likely to present with DKA due to lack of prior treatment for their Type I diabates?😕

This response makes no sense at all.

 

[DropkickMurphy]

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.

👍 I agree....I don't feel sorry for the poor, since most of them are that way as a product of their own refusal to change or outright laziness and refusal to work.

 

[HumbleMD]

Most likely I will go into patient care. Also it is likely that I will not be in an area with a high proportion of indigents.

Thank god. But please do let us all know how your attitude works out for you in interviews.

 

[DropkickMurphy]

Like that's EVER made a difference. 🙄

Misdiagnosis can and does occur and is reasonably common with error rates ranging from 1.4% in cancer biopsies to a high 20-40% misdiagnosis rate in emergency or ICU care. Surveys of patients also indicate the chance of experiencing a misdiagnosis to range from 8% to 40%. This makes misdiagnosis one of the most common types of medical mistakes. http://www.cureresearch.com/intro/overview.htm

Now can we bring this conversation back to the issue of health disparities since poor folks are far more likely to present with DKA due to lack of prior treatment for their Type I diabates?😕

Apparently you have forgotten every bit of knowledge regarding what exactly the diagnostic criteria for DKA are.....if they don't have an elevated blood sugar (either on the fingerstick or the metabolic panel that was sent to the lab), then it's not DKA. Also you would see acidosis on the ABG (most ED's will draw a gas on most altered cases), and more than a few ED's will *gasp* do blood alcohol levels on people if they seriously suspect they are drunk.

Maybe if you pulled your head out of your backside you might actually realize that there's a difference between being a good physician and being a spineless liberal coward who is too afraid of offending someone to stand up and tell them the truth.

 

[hormonedoc]

HumbleMD:

I have it on good authority (an admissions committee member at a New York City medical school) the best thing, entirely appropriately, is to say simply, "You know, I am sorry there are health care inequities, but I don't know much about the topic of how to end them." And then move on.
Of course, if it were me, I'd have answered much as you wanted to: We have disparities because of politics and the solutions will be political and not generated from within the medical profession. We can observe, and we can talk about what we see, but unless Joe Sixpack understands he has to do something about it, disparities will never end. Doctors as doctors cannot change the system we have, which is a system of finance and law. Long ago politicians got votes by saying, "Medicine is too important to be left in the hands of doctors." And now they have the power over medical care they wanted.
hormonedoc

 

[DropkickMurphy]

This isn't about empathy this is about education but if you want to remain ignorant about a significant patient population, go right ahead. Just please avoid patient care specialties and for goodness sakes, PLEASE don't become a pathologist!

Yeah, because God knows that pathologists must have good bedside manner.

 

[HumbleMD]

HumbleMD:

I have it on good authority (an admissions committee member at a New York City medical school) the best thing, entirely appropriately, is to say simply, "You know, I am sorry there are health care inequities, but I don't know much about the topic of how to end them." And then move on.
Of course, if it were me, I'd have answered much as you wanted to: We have disparities because of politics and the solutions will be political and not generated from within the medical profession. We can observe, and we can talk about what we see, but unless Joe Sixpack understands he has to do something about it, disparities will never end. Doctors as doctors cannot change the system we have, which is a system of finance and law. Long ago politicians got votes by saying, "Medicine is too important to be left in the hands of doctors." And now they have the power over medical care they wanted.
hormonedoc

😀 Thanks. Wow, is it just me, or was that a response actually on topic? I'm so shocked. Hormonedoc, I wish my interviewer had your attitude.

 

[somemaybedoc]

Thank god. But please do let us all know how your attitude works out for you in interviews.

They go fine because my PS precludes this since I have not conveyed myself as the kind of applicant who seeks underserved care. So far they have still interviewed me even though I am not that kind of person. And the interviews have not focused on that subject matter, but rather on my personal motivation to enter the field, them selling the school, and the occasional ethical question.

 

[DropkickMurphy]

First, I said 'hood OR a rural area.

How about someone who has lived and worked in both? Trust me...it doesn't enlighten anyone with supratentorial function, it just makes us want to pull a SomeMaybeDoc and run away from these areas to greener pastures, leaving the medical equivalents of the tree hugging hippie and the washouts from other areas to tend to the residents.

 

[1Path]

How about someone who has lived and worked in both? Trust me...it doesn't enlighten anyone with supratentorial function, it just makes us want to pull a SomeMaybeDoc and run away from these areas to greener pastures, leaving the medical equivalents of the tree hugging hippie and the washouts from other areas to tend to the residents.

As a person who has also done BOTH, I don't feel the need to run away to greener pastures (ie Derm). If anything, I want to make a difference healthwise in these communities but that may be related to the fact that I'm not pursuing medicine for the money or clean smelling patient population, play on pathology of course.😉

 

[tncekm]

...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...

When I get done with all of my school, get my MD and have put myself through hell, if I ever have someone tell me I'm in a priviledged position I think I'll blow up on them. Priviledge didn't put me anywhere, and it didn't put most doctors and 80% of all millionaires anywhere. Hard work and good decisions did.

 

[somemaybedoc]

As a person who has also done BOTH, I don't feel the need to run away to greener pastures (ie Derm). If anything, I want to make a difference healthwise in these communities but that may be related to the fact that I'm not pursuing medicine for the money or clean smelling patient population, play on pathology of course.😉

Does treating a gun shot wound to save a cop killer help the community? How about saving crack heads and meth addicts?

Medicine is a job, we are supposed to treat people, not communities. We treat them regardless of the effect on the community. In a bad area it's a more mixed bag of people that we are required to treat. I would rather treat a population in which I have to treat fewer people who are a detriment to the community, since I have to treat anyone who comes in the door, I can only control this by working in an area where their are fewer individuals with dubious value to the community. Indigent populations just aren't for me, but there are people that are inclined to the variety of personalities in those populations (such as yourself) and that is a good thing.

 

[8744]

Like that's EVER made a difference. 🙄

Misdiagnosis can and does occur and is reasonably common with error rates ranging from 1.4% in cancer biopsies to a high 20-40% misdiagnosis rate in emergency or ICU care. Surveys of patients also indicate the chance of experiencing a misdiagnosis to range from 8% to 40%. This makes misdiagnosis one of the most common types of medical mistakes. http://www.cureresearch.com/intro/overview.htm

Now can we bring this conversation back to the issue of health disparities since poor folks are far more likely to present with DKA due to lack of prior treatment for their Type I diabates?😕

Again, whoa. Who said we were perfect? I was working up somebody last night for what seemed to be an aortic dissection but turned out to be a PE. Although we caught it eventually, you might call that a misdiagnosis. We miss a lot of diagnosis but as long as we eventually rule out the big bad killers everything works out.

I can't imagine missing a diagnosis of DKA. We order a CMP almost as a reflex so even if we didn't suspect it in a guy from a socioeconomic group prone to poorly controlled diabetes (as you point out) we'd pick up the high serum glucose and anion gap without which you can't have DKA. Not to mention the ABG which will usually show a mixed respiratory and metabolic acidosis.

 

[neurodoc]

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...

Twenty-year-old grandmothers??? That is physiologically impossible. I think that the minimum age for grandmotherhood would be around 26-28. 😉

 

[tncekm]

Twenty-year-old grandmothers??? That is physiologically impossible. I think that the minimum age for grandmotherhood would be around 26-28. 😉

Reminds me of my last bio teacher...he was telling me this family he lived next to in Oregon had a 14 year old daughter who was having a baby when they moved otu to cali, and amazingly, her mother was 28, and the grandmother was 42. LOL.

 

[8744]

I honestly say I still don't give two sh*ts about their background. I have no interest; seeing where they came from won't change anything, the fact is that although their background may have led to their lifestyles, their lifestyles lead to the results we deal with. The job isn't to feel empathetic, it is to treat the patient, if that involves empathy, fine, if it doesn't, screw it. Results are the point, not sensitivity training.

And, for that matter, who really has time to probe deeply into the backgrounds of the patients? In medical school they make a big deal about empathy and throw you into incredibly unrealistic standardized patient exercises where you sit down and have a careful conversations touching all of the socioeconomic and psychosocial high points. You will never do this in the real world unless you are a psychiatrist. You don't have time. Even in the Family Medicine, the paragon of empathy, you will only have 10 or 15 minutes with your patient.

 

[Ultra7]

Twenty-year-old grandmothers??? That is physiologically impossible. I think that the minimum age for grandmotherhood would be around 26-28. 😉

Sadly, no. This might be a bit unusual, but certainly not impossible. Girls are going through puberty at younger ages (probably at least in part because of increased body fat). The average age of menarche is a little over 12, but the standard deviation is over 1 year, so a substantial number of girls can (and sometimes do) become pregnant at 9 or 10 years of age.

One reference:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9093289&dopt=Citation

See also this non-scientific article on CNN:
http://archives.cnn.com/2000/HEALTH/children/03/31/early.puberty.wmd/index.html

 

[TMP-SMX]

Talk about f*cking cookie cutter. You sound like the soundbite pre-hashed lip service feel good wanna be's at my institution.

Thank you for your compliment. If you want to take the sound byte out of the context that was my original post then go ahead. I am not blaming it on the students I am just saying that things are changing because medical schools are trying to help students along. The process tends to dehumanize medicine and patients into robots. The point is that communication is very important and even more important to primary care physicians. Organ systems interact to cause disease and the mind through culture plays a role in belief systems and often treatment outcome.

 

[sheepunite]

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

er . . .
yeah.

dude, at least panda has some *interestingly* provocative things to say . . .

(because evidence-based medicine is *so* conformist. baaa.)

 

[Go Time]

The blame rests squarely on the individuals.

Is that tobacco stock still payin'? 😀

 

[somemaybedoc]

Is that tobacco stock still payin'? 😀

Someone's gotta take that money people are dying to throw at cigs.

 

[Go Time]

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?

How about better funding for prevention and education (maybe a shift from pay for procedure)? IME, publically funded programs which promote comprehensive teen pregnancy prevention (just using your example) meet with stiff political opposition...from the same groups that oppose post-hock social support.

 

[Go Time]

Someone's gotta take that money people are dying to throw at cigs.

Yeah...someone's always lookin' for the easy buck.

 

[signomi]

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.

This holds for a lot of things pre-meds say.

Oh, and I saw a pregnant nine-year-old in MA two years ago.

 

[somemaybedoc]

Yeah...someone's always lookin' for the easy buck.

It's not that easy, you have to convince the smoker that your cigarette is cooler than the other ones, you have to advertise your product to youngsters in a subversive manner since very few change brands after they are hooked, you have to make it look like you want people to quit while recruiting new smokers, you have to deal with constant litigation without losing too much money, you have to make it addictive enough to sell despite constantly rising prices, you have to sell a product that gets more and more inconvenient to use each legislative cycle and you have to maintain a supply of tobacco despite constant state farm buyout efforts.

So please, a little respect for Big T.

 

[sheepunite]

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.[/QUOTE]

sounds like a worthy challenge. alright.
and since we're assuming things left and right here, why don't you print this thread, bury it in your backyard and go work as a doc in tanzania or another country whose healthcare system's been ravaged by structural adjustment/IMF policy. in 6 years' time, you can dig it up and see if you feel the same way you do today.

 

[Go Time]

It's not that easy, you have to convince the smoker that your cigarette is cooler than the other ones, you have to advertise your product to youngsters in a subversive manner since very few change brands after they are hooked, you have to make it look like you want people to quit while recruiting new smokers, you have to deal with constant litigation without losing too much money, you have to make it addictive enough to sell despite constantly rising prices, you have to sell a product that gets more and more inconvenient to use each legislative cycle and you have to maintain a supply of tobacco despite constant state farm buyout efforts.

So please, a little respect for Big T.

You forgot leveraging past profits to keep ahead of litigation...such a cruel dilema.😀

 

[somemaybedoc]

I 😍 the IMF.

Pay your debts third world b*tches. 😀

 

[HumbleMD]

Ugh, I've created a monster, a monster! Is there any way to close this thread or something? The irony is, I posted because I had gotten into an almost endless conversation about healthcare policy in my interview, and wanted to know how to end it or change the subject (and I'm sure no one can understand how that feels at all, given the over 80 posts on this thread). Can we end this?

 

[sheepunite]

Ugh, I've created a monster, a monster! Is there any way to close this thread or something? The irony is, I posted because I had gotten into an almost endless conversation about healthcare policy in my interview, and wanted to know how to end it or change the subject (and I'm sure no one can understand how that feels at all, given the over 80 posts on this thread). Can we end this?

please don't. i think some useful arguments are coming out of it. there's no reason to be afraid of a bit of controversy.

 

[HumbleMD]

please don't. i think some useful arguments are coming out of it. there's no reason to be afraid of a bit of controversy.

There is very little dialogue going on. The thread mostly consists of a certain poster making inflammatory comments simply to (immaturely) "get a rise out of people" (I personally, can't stand those types).

 

[somemaybedoc]

There is very little dialogue going on. The thread mostly consists of a certain poster making inflammatory comments simply to (immaturely) "get a rise out of people" (I personally, can't stand those types).

Trust me, the stuff I wrote about not believing that empathy is that important was serious. I think sensitivity has been hyped so much at this point that we aren't even considering whether or not there are results to justify the time and effort.

The stuff on cigarettes and the IMF were just jokes, I don't expect anyone will react to them.

 

[8744]

....since we're assuming things left and right here, why don't you print this thread, bury it in your backyard and go work as a doc in tanzania or another country whose healthcare system's been ravaged by structural adjustment/IMF policy. in 6 years' time, you can dig it up and see if you feel the same way you do today...

Seeing that I'm an American and have no real interest in living anywhere but the United States, why would I want to go to Tanzania? I mean, as ravaged as their health care system is for whatever reason, why is this important to me and how is it going to effect me in any practical way?

Is it some great revelation that there are poor people in the third world? I have spent some time there although I was generally carrying a machinegun or some other weapon at the time. Since I spent five months in Liberia during Operation Sharp Edge you might say I have more Africa volunteer time than any twenty people on SDN. And, I kid you not, I have held a Dead African Baby.

Not everybody wants to be a "Doctor Without Borders." Heck, I don't even pretend to want to be one. I like both getting paid and spending time with my family, something most "Doctors Without Borders" neglect.

 

[8744]

How about better funding for prevention and education (maybe a shift from pay for procedure)? IME, publically funded programs which promote comprehensive teen pregnancy prevention (just using your example) meet with stiff political opposition...from the same groups that oppose post-hock social support.

When I hear the word "education," I reach for my revolver. We have plenty of education. Everybody knows that cigarettes are bad, beng fat is unhealthy, screwing causes babies, and that drugs will kill you. At least everybody has heard these things, I mean. Whether they internalize the message depends on the value they place on that cocaine rush compared to how they value their health.

I have yet to tell somebody with COPD that they need to quit smoking and have them say, "What the...you mean it's the cigarettes? Whoa. I didn't see that one coming!"

You know we are collapsing as a civilization when we think government needs to educate our citizens on how to brush their teeth and wipe their asses...which is the direction we are going. I explained to one of my pediatric patients the other day how to use a toothbrush and he and his mother looked at me in wonder, awe-inspired at my command of such arcane and mysterious knowledge.

What we need is for the government to stop trying to save everybody from themselves. We're not exactly encouraging personal responsibility.

 

[1Path]

When I hear the word "education," I reach for my revolver. We have plenty of education. Everybody knows that cigarettes are bad, beng fat is unhealthy, screwing causes babies, and that drugs will kill you. At least everybody has heard these things, I mean. Whether they internalize the message depends on the value they place on that cocaine rush compared to how they value their health..

And when I read MOST of your posts, I wanna grab my husband's Glock.🙄

People like you don't care about ANYONE or ANYTHING until if affects YOU. So OK, you don't care if the inner city baby that can't afford, or whose parents aren't educated enough to be aware of, or whose parents simply don't give a dam about their kid getting a small pox vaccination. No, you don't give a dam until the terrorist of the world come up with a way to weaponize small pox, drop a little "something, something" in Durham,NC. Then that the dirty little black baby, with the ignorant, crack smoking parents who sit around all day eating high cholesterol welfare cheese sandwiches and watching Fresh Prince, ends up at the DUKE ER scratching, touching, and slobering as babies do, on everything including the toy that YOUR baby, who was already there for treatment of his croup, just put into his mouth.

THAT's when people like you start to care about health disparities.

 

[Go Time]

When I hear the word "education," I reach for my revolver. We have plenty of education. Everybody knows that cigarettes are bad, beng fat is unhealthy, screwing causes babies, and that drugs will kill you. At least everybody has heard these things, I mean. Whether they internalize the message depends on the value they place on that cocaine rush compared to how they value their health.

I have yet to tell somebody with COPD that they need to quit smoking and have them say, "What the...you mean it's the cigarettes? Whoa. I didn't see that one coming!"

You know we are collapsing as a civilization when we think government needs to educate our citizens on how to brush their teeth and wipe their asses...which is the direction we are going. I explained to one of my pediatric patients the other day how to use a toothbrush and he and his mother looked at me in wonder, awe-inspired at my command of such arcane and mysterious knowledge.

What we need is for the government to stop trying to save everybody from themselves. We're not exactly encouraging personal responsibility.

In terms of the pregnancy issue in my post...what educational programs are you referring to which qualifies as "plenty"? IME, prevention in general is grossly underfunded and must compete with lifestyle marketing...from both the corporate world and peers.

 

[8744]

And when I read MOST of your posts, I wanna grab my husband's Glock.🙄

People like you don't care about ANYONE or ANYTHING until if affects YOU. So OK, you don't care if the inner city baby that can't afford, or whose parents aren't educated enough to be aware of, or whose parents simply don't give a dam about their kid getting a small pox vaccination. No, you don't give a dam until the terrorist of the world come up with a way to weaponize small pox, drop a little "something, something" in Durham,NC. Then that the dirty little black baby, with the ignorant, crack smoking parents who sit around all day eating high cholesterol welfare cheese sandwiches and watching Fresh Prince, ends up at the DUKE ER scratching, touching, and slobering as babies do, on everything including the toy that YOUR baby, who was already there for treatment of his croup, just put into his mouth.

THAT's when people like you start to care about health disparities.

Um, I live in Lansing now so while I wouldn't want any American City attacked by terrorists, if I had to pick one.....

Why is it important that I care? I spend my day providing high quality medical service to many of the people who you care about and this service is indistinguishable from service provided by somebody whose heart bleeds for their patients. I mean, seriously, you can get into a deep meaningful conversation with your welfare mothers on how hard the mean streets of Lansing are but how is that going to change your treatment? Are you going to find her a better job? Are you going to follow her home and protect her from her abusive boyfriend? Will you snatch the cigarettes from her purse and shame her into eschewing the things forever?

Of course not. This is why all the empathy and "community medicine" stuff is so bogus. You can feel everybody's pain and give your patients a shoulder to cry on but at the end of the visit they are still as fat, unemployed, lazy, ignorant, drug-addicted, and hopeless as they were before. If you're lucky you will have at least addressed their chief complaint and they will go home with a UTI on the way to being cured.

You know the question we ask a lot in the Emergency Department?

"What do you expect us to do for you today?"

This is usually asked to somebody with a vague, mostly psychosocial complaint. It takes people aback. What they want and expect is for us to cure them of everything that's wrong with their lives which is impossible to do. That's the entitlment mentality in operation.

 

[Trismegistus4]

Panda Bear, my views are similar to yours. How does one get into medical school holding such views? My greatest fear about the interview process is getting grilled by some liberal adcom member about whether I'm liberal enough to be worthy of becoming a doctor. I mean, I don't support socialized medicine, but I don't believe in lying either. What does one do?