Interview Nightmares: How to end health disparities question

[8744]

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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.

My children's school just sent us a letter detailing their plans to have classes on HIV with varying degrees of empahsis and detail depending on whether it is the kindergarterners or the fifth-graders. I am not so old that I don't remember the many hours we spent on "health" in both elementary and high school.

I don't imagine that these things have been abandoned. If I can believe the teenagers I have talked too, they teach 'em plenty about contraception and sex in school, even giving out condoms and other birth control to those whose parents give permission.

Everything is taught except personal responsibility...which can't be taught except by parents, ther very people who have no idea how to do it as they are the products of the same welfare system which you want even more of.

 

[8744]

I have never met a mother over the age of 14 who didn't know that sex causes pregnancy.

Seriously, everybody makes mistakes. A girl can have a momentary lapse and end up with a baby at 17. But two? Three? Four? That's just a girl who either doesn't learn from experience or doesn't care. Or she likes babies (and I can certainly sympathize with that) and sees no penalty to having so many as the government helps her take care of them.

 

[8744]

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?

Don't worry about it. Chances are your interviewer, being a physician himself, will not buy into all of that cheese-eating stuff either. I am an "out" conservative with strong ties to my state's Republican Party, indicated this on my AMCAS application, and did just fine.

 

[Go Time]

My children's school just sent us a letter detailing their plans to have classes on HIV with varying degrees of empahsis and detail depending on whether it is the kindergarterners or the fifth-graders. I am not so old that I don't remember the many hours we spent on "health" in both elementary and high school.

I don't imagine that these things have been abandoned. If I can believe the teenagers I have talked too, they teach 'em plenty about contraception and sex in school, even giving out condoms and other birth control to those whose parents give permission.

Everything is taught except personal responsibility...which can't be taught except by parents, ther very people who have no idea how to do it as they are the products of the same welfare system which you want even more of.

You just described where education isn't "plenty". Handing out condoms and talking about the consequences of sex without skills based education to go with it (which may include "personal responsiblity") is not the full package...

 

[8744]

You just described where education isn't "plenty". Handing out condoms and talking about the consequences of sex without skills based education to go with it (which may include "personal responsiblity") is not the full package...

Seriously, what planet (or part of Canada) do you come from? What exactly is skills based education when it comes to teaching about the consequences of sex? In other words, what skills are required for girls not to get pregnant? Thigh-master training to develop the adductor muscles of the thigh? Castration techiniques? Man-aversion therapy?

 

[8744]

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.

As far as I'm concerned, it isn't a facade. I like most of my patients and try to do good by all of them. But this doesn't mean I slobber all over them or blow smoke up their asses.

I'm going to go out on a limb here and say that I bet my "disadvantaged" patients, even the black ones, would probably like me better than they'd like 1Path. Nobody likes a smarmy doctor.

 

[8744]

duplicate

 

[somemaybedoc]

As far as I'm concerned, it isn't a facade. I like most of my patients and try to do good by all of them. But this doesn't mean I slobber all over them or blow smoke up their asses.

I'm going to go out on a limb here and say that I bet my "disadvantaged" patients, even the black ones, would probably like me better than they'd like 1Path. Nobody likes a smarmy doctor.

What I meant was caring about their life circumstances (their inability to pay for meds, etc) so I should have said sympathy or empathy. I figure empathy might matter to some patients and make them more open, but I can't be sure till I get out there,

 

[8744]

What I meant was caring about their life circumstances (their inability to pay for meds, etc) so I should have said sympathy or empathy. I figure empathy might matter to some patients and make them more open, but I can't be sure till I get out there,

I understand what you mean. The problem with 1Path is that she can't show me in any substantive way how "caring" will have any effect on her patients. I'm sure she has a lot of sympathy for them but as my Drill Instructor used to say, "Sympathy is in the dictionary between **** and syphilis."

Suppose your patient pours out a tale of woe, describing a horrific life of poverty and deprivation that would make Charles Dickens recoil in horror. What are you going to do about it? Whip some education on them? Give them a DARE pamphlet? Refer them to a shelter?

I suppose you could spend six hours of your day trying to get them food stamps, Section Eight housing, and medcaid for their children but you will have other patients and you will have your own family to feed. You can't make any money devoting half of your day to a patient who is "self pay." Even if they paid you for the visit you can't bill for the time you spend talking to Social Services. The best you can do is either refer them to your in-house social worker or give them the number to Social Services and have them get off their until-this-moment lackadaisical ass and call themselves.

What you're going to do is give them their Ciprofloxacin, look sad and wise, and say, "Thanks for coming, if it still burns when you pee come back and see me." That's what all of that idiotic empathy and "caring" indoctrination shoved down your throat in medical school comes down to. You simply don't have the time to be a social worker unless you are willing to work for nothing. I have worked in clinics giving services primarlily to the poor and even the shiny, happy doctors who make this kind of thing their life's work can't do much more than a hoary old conservative like me. And they grow to despise many of their patients, something I don't because I don't have as much emotionally invested in them.

The big myth of Medical School is that you will be some kind of compassion demi-god who will have a significant impact on the lives of your patients.

I think 1Path really wants to be a Social Worker.

 

[neurodoc]

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

I did not mean to say that it was IMPOSSIBLE for a 9-10 year-old girl to become pregant. Anomalies and Curiosities of Medicine, a classic text by Gould and Pyle cites some of these cases, but they are very rare, and it is even rarer for a healthy baby to be born (9 months later) in such a case. It would be even more unlikely for the child of such a 9-10 year-old mother to get pregnant at 9-10 years of age and give birth (9 months later, i.e. at 10-11 years of age) to a healthy baby. So no matter how much you spin the facts, there is no epidemic of 20 year-old grandmothers, at least not yet.

Nick

 

[DropkickMurphy]

Is that tobacco stock still payin'? 😀

Although it isn't a bad idea.... I think the NBRC would revoke my credentials for that

 

[DropkickMurphy]

As far as I'm concerned, it isn't a facade. I like most of my patients and try to do good by all of them. But this doesn't mean I slobber all over them or blow smoke up their asses.

I'm going to go out on a limb here and say that I bet my "disadvantaged" patients, even the black ones, would probably like me better than they'd like 1Path. Nobody likes a smarmy doctor.

I know I would like you better than most of these bleeding heart candyasses. You can treat me or any person I care about any time. 👍

 

[1Path]

I understand what you mean. The problem with 1Path is that she can't show me in any substantive way how "caring" will have any effect on her patients. .

Here's a an example. A Black woman who already has 3 kids comes into the office complaing of painful periods. I find out from radiology that large fibroids are her problem.
My solution: Myomectomy if possible, UFE if she's already done with childbearing. Save the uterus at all costs for a number of reasons which I don't have time to elaborate on here.

Your solution: Hysterectomy ASAP. We dont' need to take a chance adding another mouth to feed to the welfare rolls!

The problem with your solution. The woman is only 35 years old, college educated, and wants to have another child WITH HER HUSBAND OF 10 YEARS. But because of your ingrained prejudices/stereotypes of black people, you don't even consider what HER unique circumstances may be because you can't see beyond her race. And this affects your ability to practice medicine in a way that is best for your patient which unfortunately happens many, many times a day.

What you and people who think like you call "care", I call professionalism and it's pretty clear that many docs lack anything that closely resembles that.

I think 1Path really wants to be a Social Worker.

And I think they should reinstate you back into the Marines and send you to Iraq!😉

 

[TMP-SMX]

I always laugh... The best way to scare kids away from having sex like rabbits is simply to show the males photos of what will be coming out of their penis when they contract gonorrhea and the excrutiating pain it will cause while urinating.

As for the females... I don't think the chastity belts are working anymore. I think an introduction to good old Escherichia will do the trick.

Avoiding pregnancy is another issue, and if a district is teaching abstinence only it is hardly teaching personal responsibility. Teen don't have a clue on what is going on about sex, and if you don't give the students the tools to make their own decisions then how can one expect them to when it comes to abstaining entirely.

 

[somemaybedoc]

Here's a an example. A Black woman who already has 3 kids comes into the office complaing of painful periods. I find out from radiology that large fibroids are her problem.
My solution: Myomectomy if possible, UFE if she's already done with childbearing. Save the uterus at all costs for a number of reasons which I don't have time to elaborate on here.

Your solution: Hysterectomy ASAP. We dont' need to take a chance adding another mouth to feed to the welfare rolls!

The problem with your solution. The woman is only 35 years old, college educated, and wants to have another child WITH HER HUSBAND OF 10 YEARS. But because of your ingrained prejudices/stereotypes of black people, you don't even consider what HER unique circumstances may be because you can't see beyond her race. And this affects your ability to practice medicine in a way that is best for your patient which unfortunately happens many, many times a day.

What you and people who think like you call "care", I call professionalism and it's pretty clear that many docs lack anything that closely resembles that.
And I think they should reinstate you back into the Marines and send you to Iraq!😉

He doesn't even work in an office.

That's all just a bunch of unsubstantiated BS conjecture.

You are an illogical individual who thinks with your emotions.

 

[1Path]

He doesn't even work in an office.

That's all just a bunch of unsubstantiated BS conjecture.

You are an illogical individual who thinks with your emotions.

Name calling is so immature and your first sentences clearly illustrates that you're too thick to comprehend the point of the example I used. Why don't you grow up and get back to me when you mature enough to realize that you actually can engage in a healthy debate without storming off like a big baby/calling names.👍

 

[somemaybedoc]

Name calling is so immature and your first sentences clearly illustrates that you're too thick to comprehend the point of the example I used. Why don't you grow up and get back to me when you mature enough to realize that you actually can engage in a healthy debate without storming off like a big baby/calling names.👍

Illogical isn't a name, it's an adjective, one that I found and continue to find quite descriptive of yourself; feel free to prove me wrong in your next post. Your responding to it so harshly after you accused someone of medical incompetence without basis is indicative of your emotional thought process.

My first sentence illustrates that your completely fictional anecdote is not even relevant to the person who you chose to focus on. Examples need to be fact, not whatever your feelings tell you will happen. It is full of assumptions and a lack of grounding within reality, I ask you this: What are the hard facts that your ficticious anecdote contains? You haven't seen him practice. You are just going on your personal belief that he has a negative attitude towards one racial group and that he would allow that attitude to influence his treatment of the patient.

Arguing through the exclusive use of anecdotes is in and of itself indicative of a degree of intellectual immaturity since they are completely subjective forms of proof that have no place in informed debate. The use of a fictitious anecdote is even further off base. If you would like to convince, perhaps you have some hard data that matches patient opinions with physician sentiments.

Your reasoning throughout this argument has been that unless someone is strongly empathetic, they will provide less than ideal medical care, however you have yet to provide any evidence that even begins to suggest that this is correct. You have not shown that relatively unempathetic people cannot do a good job. Either prove it or stop maligning those of us who have a different attitude towards empathy.

 

[8744]

Here's a an example. A Black woman who already has 3 kids comes into the office complaing of painful periods. I find out from radiology that large fibroids are her problem.
My solution: Myomectomy if possible, UFE if she's already done with childbearing. Save the uterus at all costs for a number of reasons which I don't have time to elaborate on here.

Your solution: Hysterectomy ASAP. We dont' need to take a chance adding another mouth to feed to the welfare rolls!

The problem with your solution. The woman is only 35 years old, college educated, and wants to have another child WITH HER HUSBAND OF 10 YEARS. But because of your ingrained prejudices/stereotypes of black people, you don't even consider what HER unique circumstances may be because you can't see beyond her race. And this affects your ability to practice medicine in a way that is best for your patient which unfortunately happens many, many times a day.

What you and people who think like you call "care", I call professionalism and it's pretty clear that many docs lack anything that closely resembles that.
And I think they should reinstate you back into the Marines and send you to Iraq!😉

That is such a bogus scenario. Most OB/Gyns who do TAHs or UFEs charge the same for either procedure so it's all the same to them what the patient wants, except that TAH is a definitive cure for fibroids and UFE is not. It doesn't take any special cultural awareness to offer the patient both treatments and let her decide. If you, however, think she's not a good candidate for UFE then you need to tell her, also that there are no guarantees that her fertility will be preserved with a UFE. (Uterine Fibroid Embolization)

A woman, white or black, with three children is a better candidate for a TAH than a childless woman because she has children already. This is not rocket science.

Myomectomy is fine but not for multiple fibroids and as a surgical procedure is more complex and thus prone to complications than TAH. OB/Gyns don't like doing these things unless they can identify one or two distinct fibroids that are small enough and in good enough locations to make the procedure "doable." They have their liability to think about. Poor people sue doctors, too. Probably more often than anybody else as there is something of a "jackpot" mentality out there. Nothing worse than working for free and being sued by the patient for your troubles. As you know, OB/Gyns are pretty sensitive to lawsuits.

I've rotated a lot on OB/Gyn and lots of white women get TAHs for fibroids, even after they are offered other medical and surgical options.

I have delivered quite a few mouths to feed onto the welfare rolls, by the way.

On another note, I have probably seen 4000 patients as a resident and another 2000 as a medical student. I see anywhere from 12 to 20 unique non-standardized patients every day. As you know, it is rare for me to stand on my experience as some kind of argument stopper but in this case, you need to "STFU" until you get a little more experience.

 

[8744]

Here's a an example. A Black woman who already has 3 kids comes into the office complaing of painful periods. I find out from radiology that large fibroids are her problem.
My solution: Myomectomy if possible, UFE if she's already done with childbearing. Save the uterus at all costs for a number of reasons which I don't have time to elaborate on here.

Your solution: Hysterectomy ASAP. We dont' need to take a chance adding another mouth to feed to the welfare rolls!

The problem with your solution. The woman is only 35 years old, college educated, and wants to have another child WITH HER HUSBAND OF 10 YEARS. But because of your ingrained prejudices/stereotypes of black people, you don't even consider what HER unique circumstances may be because you can't see beyond her race. And this affects your ability to practice medicine in a way that is best for your patient which unfortunately happens many, many times a day.

What you and people who think like you call "care", I call professionalism and it's pretty clear that many docs lack anything that closely resembles that.
And I think they should reinstate you back into the Marines and send you to Iraq!😉

On the other hand, let's assume that the patient is unmarried and on welfare with a different and absentee father for each of her three children. I come out of the LSU charity hospital system and this is more the rule than the exception which even you will admit. In fact, a married black woman with children by her husband was something of a rarity at LSU and caused jaws to drop in astonishment and admiration.

Seeing as you're the one who wants to get all up in her psychosocial problems, wouldn't telling her that she doesn't need to have any more children be both honest and compassionate advice, both for her sake and her current children...not to mention the public treasury? It seems to me that if you ignore the consequences of her highly irresponsible behavior you are shirking your duty as the self-designated moral arbritar of her life.

 

[8744]

...Your reasoning throughout this argument has been that unless someone is strongly empathetic, they will provide less than ideal medical care, however you have yet to provide any evidence that even begins to suggest that this is correct. You have not shown that relatively unempathetic people cannot do a good job. Either prove it or stop maligning those of us who have a different attitude towards empathy..

I am empathetic. I just don't get all weepy about it or blow smoke up the ass of the patient. This is because I know my limitations and the limitations of the medical profession.

 

[sheepunite]

And I think they should reinstate you back into the Marines and send you to Iraq!😉

yikes! 🙁

 

[1Path]

As you know, it is rare for me to stand on my experience as some kind of argument stopper but in this case, you need to "STFU" until you get a little more experience.

Weak, just weak. Is that the best you got? Well no wonder my husband the former NAVY officer is always down on folks from the core!

Here's a news flash for your watermelon sized ego. Being a doctor doesn't make you an authority on the plight of negroes in the US, yet you speak with such racist authority based on YOUR medical experiences. Unfortunately, you with your highly polished MD working in ER of all fields, has permanently placed your head in the sand when it comes to the disparity in health care issues in the US, when you are in the very field of medicine where I imagine it's most prevelant. Well isn't that just perfect.🙄

The FACT that minority patients get better care from minority doctors AND those who care about minority issues, is a demostrated fact. And that "bogus" example is from the real life experience of a black woman I know personally yet you dismissed it. Well I'm not suprised. I've heard/personally experienced enough similar stories of blacks receiving "different"/poor care from nonminority physicians to fill a book.

FYI, the NIH founded the National Center on Minority and Health Disparities (http://ncmhd.nih.gov/) to address these issues so obviously SOMEBODY with a MD thinks the issue is important to warrent an entire divison of the NIH to it. And there are similar departments at schools like Hopkins and UPenn. But I guess ALL these folks need to STFU too.🙄.

 

[1Path]

In fact, a married black woman with children by her husband was something of a rarity at LSU and caused jaws to drop in astonishment and admiration..

And let me tell you why. I married black woman be a dam fool to be seen at a place like LSU KNOWING folks like you are probably working there. I mean really, LSU, the deep dirty South, and I bet they have a confederate flag outside the hospital too!!! 🙄

 

[1Path]

Your reasoning throughout this argument has been that unless someone is strongly empathetic, they will provide less than ideal medical care, however you have yet to provide any evidence that even begins to suggest that this is correct. .

YOU have used the word empathy in this thread about 10 times. I have NOT used it once until this post. The other perosn who has used the word is Pookey Bear.

Which essentially says that when issues of race come up on SDN, you get BLIND!!!!

 

[tncekm]

FYI, the NIH founded the National Center on Minority and Health Disparities (http://ncmhd.nih.gov/) to address these issues so obviously SOMEBODY with a MD thinks the issue is important to warrent an entire divison of the NIH to it. And there are similar departments at schools like Hopkins and UPenn. But I guess ALL these folks need to STFU too.🙄.

Oh, if it were only that simple. You forget, our politicians do what it takes to get them votes. That is their #1 priority. Their #2 priority is getting their party votes. Their #3 priority is avoiding damaging information from getting out to the public. Their #4 priority is ruining the reputation of their competitor's and competitive party. Somewhere down at around 20-30 or so is where the interest of the people being prioritized begins.

The NCMHD was founded out of political motivation, not human interest. [That doesn't mean that the NCMHD doesn't serve a good purpose, just simply means it wasn't put there because someone thought there was a problem, its in place because putting it up gets votes and it's going to stay there forever because taking it down will cause chaos.]

 

[slb]

i don't really want to get involved in this thread, but here goes.

i had severe asthma as a child. even though my mother worked full time, there was a rather long period of time during which we did not have health insurance. it was extremely stressful not being able to afford medication. when i had flare-ups, i felt very guilty over costing my family money - the stress of which did not help my health. i did not get the routine preventative care that i could have had because it was too expensive. i ended up in the ED many times.

i am sorry that there seem to be an enormous number of people abusing both their bodies and the system of public health in this country. that really sucks. as i am not yet a physician, i have not yet had to deal with this on a daily basis. but i would like to ask you all to maybe remember, somewhere in the back of your heads, that there are hardworking and honest people in this country that do not have health insurance, and have a difficult time affording health care. it is extremely difficult to be in that situation, especially when you have a chronic health problem (or, perhaps worse, when your child does). they might be few and far between (I don't have any way of knowing), but they do exist, and they are members of all races. they face problems that upper middle class people simply do not have. the health care disparities perhaps affect this segment of the American population the most, because hardworking and honest people tend to be reluctant to take charity (in my experience), so they often suffer in silence.

maybe in your interviews you could think about this specific type of scenario, and think about how to fix it. the working poor really do exist.

 

[tncekm]

I agree 100% that the working poor do exist. I grew up in that environment. However, when I took an honest step back in life and looked at why I was where I was growing up it was my parents decisions. They made bad decisions. And, this is what happens with most people who end up in that situation, not all, but most. In the case of my parents they were very hard working, but having spent a while living in places like a trailer park, a single bedroom (with 5 of us total), a two bedroom apartment with almost 10 ppl, etc, I met many people in similar economic / living conditions and I found that they majority of them were addicted to at least one drug, had poor work ethic, and made very poor decisions in life and it was nobody's fault but theirs.

My parents ended up in and out of reasonable financial positions. Hard work would bring them out of financial hardship and bad financial decisions would bring them back. They do "okay" but they'll never do any better until they step back and take one brutally honest look at themselves.

I believe people in the "modern world" have almost entirely lost the understanding of "self determination".

 

[somemaybedoc]

YOU have used the word empathy in this thread about 10 times. I have NOT used it once until this post. The other perosn who has used the word is Pookey Bear.

Which essentially says that when issues of race come up on SDN, you get BLIND!!!!

Until now I really didn't think this was specifically about race, but rather the idea that certain views are the only ones compatible with quality medical care. I could say that your focus on race blinds you to other issues, but that is pointless, we are simply responding in a way inline with our personal life experiences.

I think your views are informed by your personal experiences; as such I cannot hope to argue with them in a way that will convince you claim extremely strong personal ownership of those experiences, which in your mind gives them supreme legitmacy as evidence.

Therefore I see no purpose in continuing this debate and will withdraw myself from it from here on out.

 

[somemaybedoc]

i don't really want to get involved in this thread, but here goes.

i had severe asthma as a child. even though my mother worked full time, there was a rather long period of time during which we did not have health insurance. it was extremely stressful not being able to afford medication. when i had flare-ups, i felt very guilty over costing my family money - the stress of which did not help my health. i did not get the routine preventative care that i could have had because it was too expensive. i ended up in the ED many times.

i am sorry that there seem to be an enormous number of people abusing both their bodies and the system of public health in this country. that really sucks. as i am not yet a physician, i have not yet had to deal with this on a daily basis. but i would like to ask you all to maybe remember, somewhere in the back of your heads, that there are hardworking and honest people in this country that do not have health insurance, and have a difficult time affording health care. it is extremely difficult to be in that situation, especially when you have a chronic health problem (or, perhaps worse, when your child does). they might be few and far between (I don't have any way of knowing), but they do exist, and they are members of all races. they face problems that upper middle class people simply do not have. the health care disparities perhaps affect this segment of the American population the most, because hardworking and honest people tend to be reluctant to take charity (in my experience), so they often suffer in silence.

maybe in your interviews you could think about this specific type of scenario, and think about how to fix it. the working poor really do exist.

I did say I was leaving this debate, but I did want to respond to this post first.

It is my sincere hope that I will never let my personal opinions and biases (I think we all have at least some) reduce the quality of care I provide.

 

[8744]

And let me tell you why. I married black woman be a dam fool to be seen at a place like LSU KNOWING folks like you are probably working there. I mean really, LSU, the deep dirty South, and I bet they have a confederate flag outside the hospital too!!! 🙄

And yet, there they are, black people I mean, living in the slums. I rotated both at LSU Shreveport and E.A. Conway in Monroe (the poorest city in the nation, by the way) and I'd say that the large majoriity of our patients were poor and black. I also think that even you will admit that the majority of black children are born to single mothers. How pointing this out makes me a racist escapes me as it is a fact which is recognized by the entire civil rights establishment.

Is Jesse Jackson a racist? How about Bill Cosby?

I'll make a deal with you. If you tell me, forcefully, that as a black person you don't think that single black mothers having babies with multiple and largely absent fathers is a problem then I won't mention it again. It's a problem in the white and hispanic community too but you don't hear me minimizing it just to avoid embarrassment.

From what I have seen of the black community, I would say that the single biggest problem is the lack of a stable family structure with a father and a mother raising the children. Almost every social problem we have, among all races as a matter of fact, stems from this one problem as the family is the foundation of civilization.

 

[HumbleMD]

Is Jesse Jackson a racist? How about Bill Cosby?

Yes, and an adulterer to boot.

No, he's incredible.

 

[1Path]

And yet, there they are, black people I mean, living in the slums. I rotated both at LSU Shreveport and E.A. Conway in Monroe (the poorest city in the nation, by the way) and I'd say that the large majoriity of our patients were poor and black.

You pretend as if being poor and having welfare babies is a black thing. THAT is my problem with you and people who think like YOU. What you are either too thick or ignornat or racist to realize is that there will NEVER be more poor black people on welfare than whites because THERE SIMPLY AREN"T ENOUGH BLACK FOLKS IN THE US!!!!! You people manipulate stats like the fact that a greater percentage of blacks are on welfare than whites and speak it like it's gospel. THAT is my problem with YOU.

I also think that even you will admit that the majority of black children are born to single mothers. How pointing this out makes me a racist escapes me as it is a fact which is recognized by the entire civil rights establishment.

From the US census data:
http://www.census.gov/population/www/documentation/twps0020/twps0020.html
In 1990-94, significant differences in the proportion of births either premaritally born or conceived are noted between White women (46 percent) and Black women (86 percent). Hispanic 3 women had an intermediate proportion of first births premaritally either born or conceived (55 percent).

What about all the black folks born between say 1940-1990??? That's 50years where the MAJORITY of black folks were born to parents who were married. Yet you want to focus on birth rate among blacks for 4 years which is the most current census data I could find.

What you also fail to recognize that WHITE women are having babies out of wedlock in greater numbers too, not only that they are having them from black men/interacially in numbers greater than any other race of women but I don't see you talking about that on the internet! Naw man, let's not talk about THAT!!!!

Is Jesse Jackson a racist? How about Bill Cosby?

Is Bill O Reily? How about Regis Philban?

It's a problem in the white and hispanic community too but you don't hear me minimizing it just to avoid embarrassment.?

No you just focus on Negroes.🙄

From what I have seen of the black community, I would say that the single biggest problem is the lack of a stable family structure with a father and a mother raising the children.

And what in the hell makes you an expert on issues in the black community? Have you finally decided to rattle the skeletons in your closet and a mulatto fell out?

I think the biggest problem in the black community is racism AND poverty. Because it was RACISM ie slavery that tore our FAMILIES apart in the first place! The slave trade destroyed the families and culture of african slaves 200 years ago and now you wonder why so many families are destroyed today??? I have educated ancestors going back over 100 years so it's no suprise that 6 generations later, I'm educated too (and let me keep this real having relatives that looked/passed for white helped them GET educated in the first place). But what about slaves that worked in the fields with decendants that are STILL poor today??? Do you know how hard it is to overcome GENERATIONS of poverty? Better yet, how many of your med school classmates had grandparents that were sharecroppers, both black and white? I'm guessing very few.

 

[gujuDoc]

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.

I completely agree with Panda Bear. I don't think he's being insensitive nor do I think he's anti Paul Farmer. I don't know where the other poster got that from. I remember being in a class at a communitycollege many years ago and there was a pregnant girl who was smoking a few cigarettes a day though she was having a baby and already had one baby that she gave up for adoption who was mentally ******ed. On top of that she claimed she didn't want to work because she'd lose welfare and to think she was a prenursing student who'd be working in the health industry. I shudder at that image. There were others like her in that class too. Its sad when people use poverty as an excuse for things such as alcoholism, being abusive, smoking and doing other drugs extensively. Its even sadder that little children have to live among parents who do these things when what they need is a more positive influence in their life but that doesn't mean you should blame your poverty for every bad thing that happens in your life. I have friends who don't have health insurance and are border line poor but they've never done these things and broke the cycle through hard work while I know of people who continue to fall in this pattern because they don't care to do anything but blame everyone else for their problems.

 

[1Path]

Yes, and an adulterer to boot.

Well at least he kept it heterosexual (which I'm SURE his spouse was happy about) unlike the CONSERVATIVE, REPUBLICIAN, right winger The Rev. Ted Haggard. 🙄

 

[gujuDoc]

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

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

Off topic, but the baby in your avatar is adorable!!! Go time's child's pic is also adorable!!!!!! 😀

 

[tncekm]

Because it was RACISM ie slavery that tore our FAMILIES apart in the first place!

Wrong, big time. 50 years ago african american marriage rates were much higher than now. Something else has recently torn families apart, and it wasn't racism or slavery. Remember, there is nobody alive today that is responsible to even the slightest degree for what happened before their lifetimes, and especially hundreds of years ago.

What, specifically, would you suggest we could do the allow the african american community to move up in life?

And don't talk about racism. Believe it or not, white people don't sit around in groups figuring out how to keep Latinos and African Americans down while taking bribery checks from Indians and Asians.

 

[gujuDoc]

Name calling is so immature and your first sentences clearly illustrates that you're too thick to comprehend the point of the example I used. Why don't you grow up and get back to me when you mature enough to realize that you actually can engage in a healthy debate without storming off like a big baby/calling names.👍

I know I promised myself I would stay out of this, but you do realize that he's an ER doc for gods sake and not planning on being an OB/GYN anytime soon. So how your example applies to him is really what I have to question. It borders on the line of making an argument just for arguments sake.

 

[gujuDoc]

My children's school just sent us a letter detailing their plans to have classes on HIV with varying degrees of empahsis and detail depending on whether it is the kindergarterners or the fifth-graders. I am not so old that I don't remember the many hours we spent on "health" in both elementary and high school.

I don't imagine that these things have been abandoned. If I can believe the teenagers I have talked too, they teach 'em plenty about contraception and sex in school, even giving out condoms and other birth control to those whose parents give permission.

Everything is taught except personal responsibility...which can't be taught except by parents, ther very people who have no idea how to do it as they are the products of the same welfare system which you want even more of.

Exactly. I can remember my middle and highchool sex education courses pretty well. I also remember my elementary school DARE classes on drugs and alcohol etc. The problem is that a lot of kids have poor influences out of the schooling system (i.e. parents) but how are doctors supposed to be responsible for someones bad job of raising their children with morals? Are physicians to be responsible if a parent is abusing their child? Are they to be responsible if a parent uses bad language in front of children? Are they to be responsible if children are not taught proper values? No physicians are there to treat the ill and educate them, but that doesn't mean the majority of people will ever listen to the doctors orders if they are doing something that is unhealthy. To live a healthier lifestyle and change your habits it must come from within you and no amount of a doctor telling you to do something means anything if you yourself don't take personal responsibility for your actions.

 

[1Path]

Wrong, big time. 50 years ago african american marriage rates were much higher than now. .

Dude, you really gotta learn HOW TO READ!!!!

That's 50years where the MAJORITY of black folks were born to parents who were married.

If a person's prejudices can't allow them to get a quote of the internet correct, how in the world are they going to treat their pateints?

I know I promised myself I would stay out of this, but you do realize that he's an ER doc for gods sake and not planning on being an OB/GYN anytime soon. So how your example applies to him is really what I have to question. It borders on the line of making an argument just for arguments sake.

You'll NEVER "get" my point because your lips are placed a little too closely to the a$$ of Pokey Bear's opinions. Oh yeah, that's a metaphorical example too!😉

 

[1Path]

.

 

[8744]

..You'll NEVER "get" my point because your lips are placed a little too closely to the a$$ of Pokey Bear's opinions.

Come on, 1Path. I thought we were friends.

 

[1Path]

Come on, 1Path. I thought we were friends.

Yeah dude, we're friends but I'm not going to join the rest of your friends and start giving you a virtual a$$ kissing!

 

[slb]

I agree 100% that the working poor do exist. I grew up in that environment. However, when I took an honest step back in life and looked at why I was where I was growing up it was my parents decisions. They made bad decisions. And, this is what happens with most people who end up in that situation, not all, but most. In the case of my parents they were very hard working, but having spent a while living in places like a trailer park, a single bedroom (with 5 of us total), a two bedroom apartment with almost 10 ppl, etc, I met many people in similar economic / living conditions and I found that they majority of them were addicted to at least one drug, had poor work ethic, and made very poor decisions in life and it was nobody's fault but theirs.


I believe people in the "modern world" have almost entirely lost the understanding of "self determination".

I agree with you, for the most part. However, it is unfortunate that people's children suffer for their poor judgement. Not receiving good care as a child can hurt you for the rest of your life - because your parents made bad decisions. Perhaps some kind of universal health care for children would be the way to go. At least then people wouldn't be starting out with such a deep inequity. I'd include dental insurance in that, too... it's hard to get a good job at 18 when you are missing teeth. i say that not from personal experience, but from observation...

 

[8744]

I agree with you, for the most part. However, it is unfortunate that people's children suffer for their poor judgement. Not receiving good care as a child can hurt you for the rest of your life - because your parents made bad decisions. Perhaps some kind of universal health care for children would be the way to go. At least then people wouldn't be starting out with such a deep inequity. I'd include dental insurance in that, too... it's hard to get a good job at 18 when you are missing teeth. i say that not from personal experience, but from observation...

Just for people who don't know, we do have universal health care for children from poor families under CHIPs (Childrens Health Insurance Program), which is a part of Medicaid, and covers children of poor and lower middle-class families. (In may state the income cut-off for a family of four was $34,000 per year.)

This is why I can get a patient at 3 AM who has been waiting in for six hours just to get some tylenol for her child. CHIPs pays for all prescriptions so she'll haul her kid out of bed to save five bucks even though she has a cell phone, cable TV, and an impressive manicure.

I reiterate. The children of the poor have heath insurance. Don't believe the hype that they don't. All their parents have to do is sign them up which unfortunately many are too stupid to do. It's not that they don't want the freebie, just that it is too much trouble to make and keep an appointment with social services.

A larger component of the so-called health care crisis could more aptly be called a crisis of basic stupidity.

Oh, and there are medicaid dentists as well. It's just that dentists are smarter than doctors and have a better lobbying effort which protects them from working for free so they are harder to find.

 

[psipsina]

And let me tell you why. I married black woman be a dam fool to be seen at a place like LSU KNOWING folks like you are probably working there. I mean really, LSU, the deep dirty South, and I bet they have a confederate flag outside the hospital too!!! 🙄

Hey, no need to hate on LSU.

 

[lublufsb]

 

[1Path]

Hey, no need to hate on LSU.

LSWHO????

From your local Gator Alumnae!😀

 

[celltech2000]

I am sorry to say that some of the people who have posted on this thread will be future doctors in America. I would say binge drinking can be as bad as smoking weed everyday; eating McD's can be as detrimental to one's health as smoking a cigarette; drinking sweet tea as harmful as casual sex.

Maybe I am wrong, but I thought the point of being a physician was to treat people and preserve life regardless of the background, personal beliefs or habits of the individual. If you are going to be as judgemental and prejudice as a physician as you are now, you may want to choose another profession.

 

[123165]

I am sorry to say that some of the people who have posted on this thread will be future doctors in America. I would say binge drinking can be as bad as smoking weed everyday; eating McD's can be as detrimental to one's health as smoking a cigarette; drinking sweet tea as harmful as casual sex.

Maybe I am wrong, but I thought the point of being a physician was to treat people and preserve life regardless of the background, personal beliefs or habits of the individual. If you are going to be as judgemental and prejudice as a physician as you are now, you may want to choose another profession.

I don't believe anyone has mentioned their level of care being altered.

 

[celltech2000]

I don't believe anyone has mentioned their level of care being altered.

Your right! But, when a physician walks into a situation with preconcieved notions about his patient, he will almost undoubtably treat his is patient different than if he came into the situation open-minded. It is like making an assumption about how a certain dish (food) tastes before ever taking a bite.