Interview Nightmares: How to end health disparities question

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It's unrelated, but I think the world record for youngest pregnancy is five years old. I think she is a Peruvian named Lina Medina.

Oh yeah, as to the original poster, the best answer is sometimes I don't know.

 

[gujuDoc]

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.

A person can still treat a person well and still have an opinion about the sad state of affairs of the american people. We are human beings not robots who are allowed no right to an opinion. It doesn't mean we won't do our job, it just means we don't agree with everything.

Panda is actually an MD already and if you talk with him or any current attending or resident you'll find that most of them feel the same way.

The job a physician is to treat their patients and to try to inform them to what they need to do to prevent themselves from getting that way again but if they don't listen and a physician has repeatedly told them what they need to do if they want to stop getting sick constantly then a physician has a right to be a little frustrated because their words are going in one ear and out the other. Will they treat them?? yes they'll do it and they'll make the small talk they need to with their patients politely. But does that mean that they have to agree with what these patients are doing and talk all flowers and blue skies about them?? No.

 

[8744]

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.

Whoa. the whole premise of "cultural competance" is that we establish a preconcieved notion of our patients, based on race, class, or both and grimly cling to it despite any evidence to the contrary.

When I do it, you call it racism. When you do it you call it celebrating diversity.

It is impossible to be completely open-minded about your patients if you actually have any experience with them. For example, I know that a good number (most?) of my fat, white, middle-aged, female patients complaining of fibromyalgia are drug-seekers. Are they all? No. But enough of them are so I am reasonably prejudiced against fat, white, middle-aged woman with non-specific pain as their chief complaint. If I wasn't, I'd rapidly get the reputation as the Candy Man and our waiting room would fill with drug seekers hoping I'll pick up their chart.

In practice I am pretty lenient with pain meds (as much as my attendings will allow, I mean) because I am not a mind-reader and I always give the patient the benefit of the doubt but that doesn't mean I'm either blind or stupid.

See my point? What you are actually afraid of is that someone will accuse you of being judgemental because you have been conditioned to believe that judgemental people are inflexible, bigoted, and narrow-minded. What you don't realize yet is that judgement does not necessarily come out of an absolute world-view but out of experience.

Now, if that means that I assume a young black man shot in the chest on a Friday night at 2 AM is a gang-banger then that's the way it is. But this preconception does not keep me from his bedside one second longer then if he were the pastor of a local black curch and as soon as I talk to him my prejudice (which is just a working model for reality) is modified to fit the facts of who he really is.

 

[1Path]

When I do it, you call it racism. When you do it you call it celebrating diversity..

Whoa. When you do it it IS racism. Cultyrl competence simply means taking inot consideration that not everyone looks like you, smells like you (that may be a good thing😛 ), dresses like you, ect while maintaining the ability to treat them as well as someone who did.

It is impossible to be completely open-minded about your patients if you actually have any experience with them. For example, I know that a good number (most?) of my fat, white, middle-aged, female patients complaining of fibromyalgia are drug-seekers. Are they all? No. But enough of them are so I am reasonably prejudiced against fat, white, middle-aged woman with non-specific pain as their chief complaint. If I wasn't, I'd rapidly get the reputation as the Candy Man and our waiting room would fill with drug seekers hoping I'll pick up their chart...

Yeah "reasonably prejudiced" until that person looks like your wife.🙄 Again the difference is that your prejudiced likely won't EVER result in a worst health outcome for someoen who looks like YOU they way race has been shown to affect the standard and practice of health for people of color.

Now, if that means that I assume a young black man shot in the chest on a Friday night at 2 AM is a gang-banger then that's the way it is.

Here's the problem. The young black male with a GSW who looks like a "gang banger (and I've had relative in suits be accused of looking like gangbanger minus the GSW 🙄 ) could actually be a cop working undercover and the white male with the GSW in a suit could have been trying to purchase drugs from the black undercover cop. The problem is that when they arrive at your ER, you initially don't know who is who but you ASSume the black dude was the "problem" and attend to his GSW in the upper center chest a lot later than the white dude shot in the leg.

 

[8744]

...Whoa. When you do it it IS racism. Cultyrl competence simply means taking inot consideration that not everyone looks like you, smells like you (that may be a good thing😛 ), dresses like you, ect while maintaining the ability to treat them as well as someone who did...

You know, you throw down that "You Are a Racist" card so often that it has become tattered and greasy. On the scale of insults, calling someone a racist may have once been the atom bomb of criticism but now it has been degraded to telling someone that their mother is fat.

Think of something new. I was never particularly bothered in the past to be accused of racism and I am even less bothered now. I just don't care. It's an accusation made for any criticism of almost anything and as a broad-spectrum insult is pretty close to meaningless.

 

[8744]

...Here's the problem. The young black male with a GSW who looks like a "gang banger (and I've had relative in suits be accused of looking like gangbanger minus the GSW 🙄 ) could actually be a cop working undercover and the white male with the GSW in a suit could have been trying to purchase drugs from the black undercover cop. The problem is that when they arrive at your ER, you initially don't know who is who but you ASSume the black dude was the "problem" and attend to his GSW in the upper center chest a lot later than the white dude shot in the leg...

I just have to say that you need to get more medical experience. Nobody ever, and I mean ever, would occupy the entire trauma team on a guy with a stable lower-extremity gunshot wound when somebody else of any race or background was in the next bay with a gaping hole in his chest. The fact that you throw down that scenario demonstrates that you live in a fantasy world, an anti-Magic Kingdom of sorts where racist white doctors don't check the blood sugars of altered black patients and all criminals are white.

 

[Wrigleyville]

Here's the problem. The young black male with a GSW who looks like a "gang banger (and I've had relative in suits be accused of looking like gangbanger minus the GSW 🙄 ) could actually be a cop working undercover and the white male with the GSW in a suit could have been trying to purchase drugs from the black undercover cop. The problem is that when they arrive at your ER, you initially don't know who is who but you ASSume the black dude was the "problem" and attend to his GSW in the upper center chest a lot later than the white dude shot in the leg.

Do you have any actual experience working in an emergency room? Your ludicrous hypothetical is an insult to health care workers of all stripes and shows a complete lack of awareness as to how an ER operates. Triaging is the order of the day and is the reason people with sniffles sit forever in the waiting room -- higher acuity patients always get seen first.

 

[8744]

Let's say a young black man wearing gang-colors with a gunshot wound to the head is dropped off at the Emergency Department by a group of his friends who then disappear to their regularly scheduled bible study.

Would it be racist or profiling for the unit to post a guard at the young man's door in the hospital or even to, bite your toungue, check him in under an assumed name against the possibilty of his being allegedly finished off by the alleged members of an alleged black criminal gang who allegedly shot him in the first place?

 

[MedvacMoney]

Let's say a young black man wearing gang-colors with a gunshot wound to the head is dropped off at the Emergency Department by a group of his friends who then disappear to their regularly scheduled bible study.

Would it be racist or profiling for the unit to post a guard at the young man's door in the hospital or even to, bite your toungue, check him in under an assumed name against the possibilty of his being allegedly finished off by the alleged members of an alleged black criminal gang who allegedly shot him in the first place?

Thats ridiculous. IF he is wise enough to decide to join a gang then he is wise enough to take what somes for him.

 

[8744]

Thats ridiculous. IF he is wise enough to decide to join a gang then he is wise enough to take what somes for him.

Can't say I understand what you mean. Allowing him to be finished off by a rival gang is one thing, allowing them to spray bullets in the hospital is another.

 

[1Path]

You know, you throw down that "You Are a Racist" card so often that it has become tattered and greasy. On the scale of insults, calling someone a racist may have once been the atom bomb of criticism but now it has been degraded to telling someone that their mother is fat.

Think of something new. I was never particularly bothered in the past to be accused of racism and I am even less bothered now. I just don't care. It's an accusation made for any criticism of almost anything and as a broad-spectrum insult is pretty close to meaningless.

Actually, I've probably only called out 2 people on SDN as racist and I tend to call it like I see it so deal with it.But dude, seriously, don't get so bent out of shape about it. I mean, folks around here call me racist all the time.

 

[1Path]

I just have to say that you need to get more medical experience. Nobody ever, and I mean ever, would occupy the entire trauma team on a guy with a stable lower-extremity gunshot wound when somebody else of any race or background was in the next bay with a gaping hole in his chest. The fact that you throw down that scenario demonstrates that you live in a fantasy world, an anti-Magic Kingdom of sorts where racist white doctors don't check the blood sugars of altered black patients and all criminals are white.

Do I need a law degree to see that black men are disprotionatly represented in the nations prisons? Do I need to be a police officer to know that in some jusistrictions, DWB(driving while black) can get someone killed in some cities/towns in the US? Do I need an MBA to know that paying the IRS is a good idea?

I don't need to be a doctor to know that people of color generally don't get the same medical care as others. I just need to keep the blinders off and I suggest you do the same.

 

[DulcimerDude]

Actually, I've probably only called out 2 people on SDN as racist and I tend to call it like I see it so deal with it.But dude, seriously, don't get so bent out of shape about it. I mean, folks around here call me racist all the time.

I've been following this discussion for awhile but hadn't jumped in. While I'm not saying racism is never a problem, I agree with someone (can't remember who though) who once said that use of the word "racist" has become akin to the use of "heretic" in the 1600's - it is meant to end intelligent discussion by assigning a nasty label. You may have the best point in the world and it may really have nothing to do with race, but someone drops the big "R card" and the discussion is over.

1Path, as to your last post, please post some sources for your statements, particularly as pertains to level of medical care received. I am tired of people making blanket statements with nothing to back them up. I work for a surgery center in an area that has a high minority population (hispanic in this case) and I have NEVER EVER EVER seen a minority treated any differently than white folks by ANYONE - surgeons, nurses, EMT's, office staff, etc and I know that I certainly don't. I think it's an insult to imply that highly trained professionals like PandaBear would give a lesser level of care to anyone based on their skin. If you think I'm wrong on this, then please, post links to some credible sources.

Thanks everyone for listening to my thoughts 🙂

 

[DulcimerDude]

I don't need to be a doctor to know that people of color generally don't get the same medical care as others.[/QUOTE]

And I don't need a degree in statistics to know that people who make statements like this without any backing or sources generally have no idea what they're talking about.

 

[sheepunite]

I don't need to be a doctor to know that people of color generally don't get the same medical care as others.

And I don't need a degree in statistics to know that people who make statements like this without any backing or sources generally have no idea what they're talking about.[/QUOTE]

there's actually nothing controversial in this particular claim by path1, although it may be necessary to parse medical care from health outcomes. nevertheless, the national academies institute of medicine has been documenting disparities in care for some time: http://www.iom.edu/CMS/18007.aspx

that race-based (and other) health disparities exist is taken as a virtual given (that's been demonstrated again and again) these days.

 

[DulcimerDude]

Fair enough, thanks for the source.

 

[1Path]

1Path, as to your last post, please post some sources for your statements, particularly as pertains to level of medical care received. I am tired of people making blanket statements with nothing to back them up. I work for a surgery center in an area that has a high minority population (hispanic in this case) and I have NEVER EVER EVER seen a minority treated any differently than white folks by ANYONE - surgeons, nurses, EMT's, office staff, etc and I know that I certainly don't. I think it's an insult to imply that highly trained professionals like PandaBear would give a lesser level of care to anyone based on their skin. If you think I'm wrong on this, then please, post links to some credible sources.

Thanks everyone for listening to my thoughts 🙂

I get so sick and tired of seeing you guys ask this "post your souce" bullcrap. I refered someone to the center at NIH dedicated to researching health disparities and the Grand Poo Ba AKA Panda Bear discounted it. Now what? As a former practicing Epidemiologist I feel confident in telling you to go find your own dam stats!

I've PERSONALLY experienced less than standard medical care, I've seen relatives receive less than standard medical care, and I work with an underserved population that has told me their stories of receiving less than standard medical care. So why in the he!! would I spend ANY time proving anything to you or anyone else in this thread? You mind was made up before you ever read ONE word, so continue on in ignornace since that seems to work well for you.👍

 

[8744]

I get so sick and tired of seeing you guys ask this "post your souce" bullcrap. I refered someone to the center at NIH dedicated to researching health disparities and the Grand Poo Ba AKA Panda Bear discounted it. Now what? As a former practicing Epidemiologist I feel confident in telling you to go find your own dam stats!

I've PERSONALLY experienced less than standard medical care, I've seen relatives receive less than standard medical care, and I work with an underserved population that has told me their stories of receiving less than standard medical care. So why in the he!! would I spend ANY time proving anything to you or anyone else in this thread? You mind was made up before you ever read ONE word, so continue on in ignornace since that seems to work well for you.👍

I don't believe I discounted anything. I just pointed out that your assertions that we wouldn't draw a blood sugar on somebody who was altered because he was black or we would let some suspected black gang member bleed to death out of a gaping hole in hole in his chest while stitching up a flesh wound on his white arresting officer are absolutely ludicrous and based on peverse wishful thinking on your part. That's just not the way things work and if you got out more into the real medical world you would realize it.

 

[HumbleMD]

And I don't need a degree in statistics to know that people who make statements like this without any backing or sources generally have no idea what they're talking about.

there's actually nothing controversial in this particular claim by path1, although it may be necessary to parse medical care from health outcomes. nevertheless, the national academies institute of medicine has been documenting disparities in care for some time: http://www.iom.edu/CMS/18007.aspx

that race-based (and other) health disparities exist is taken as a virtual given (that's been demonstrated again and again) these days.

The confounding factor that no one ever controls for in finding racial disparities in healthcare is the obvious disparity in income. I would love to see a study that compared healthcare access but actually did so (I'm currently reading a paper on health disparities, specifically latina women and their access to breast cancer information and treatment - but again, the study didn't control for income or education). I hate to sound like Paul Farmer, but the key here is poverty.

 

[1Path]

That's just not the way things work and if you got out more into the real medical world you would realize it.

If Rodney King came into your ER and stated to you that white cops had "beat him up", would you have believed him? Your comments in this thread tell me no, in fact I bet you probably think someone "doctored" the tape clearly showing him being assulated by the police.

You know, I don't much care if you think the examples I posted are part of my "preverse wishful thinking". My guess is that there are Germans and others who think the same thing about the Holocaust and Jews. But I think because you simply don't care about these issues, that not believing that incidences similar to the scenarios I mentioned HAVE happened and DO happen (however rare)makes you a danger to anyone who may have the (dis)pleasure of ending up in your ER.

And by the way, I've been in the "medical world" longer than you've been a doctor. So I hate to break it to you, but being an MD doesn't give you a bit of "street cred" in the medical world to me. You'd have to be a Nurse to get my automatic respect for your contribution to the field of medicine.

 

[1Path]

The confounding factor that no one ever controls for in finding racial disparities in healthcare is the obvious disparity in income.

Actually, there a more than a few studies that do control for income. And as much as people would like to be politically correct and not hurt the feelings of any racial group, we've run of of viable reasons why health disparities exists....................................................except one.

 

[sheepunite]

The confounding factor that no one ever controls for in finding racial disparities in healthcare is the obvious disparity in income. I would love to see a study that compared healthcare access but actually did so (I'm currently reading a paper on health disparities, specifically latina women and their access to breast cancer information and treatment - but again, the study didn't control for income or education). I hate to sound like Paul Farmer, but the key here is poverty.

i don't have time (or library access, anymore) to find the articles, but *of course* there are studies that control for SES. that's what's so compelling: regardless of class or education, racial health disparities persist.

 

[HumbleMD]

i don't have time (or library access, anymore) to find the articles, but *of course* there are studies that control for SES. that's what's so compelling: regardless of class or education, racial health disparities persist.

I suppose I need to get out of my Anthropolgy classes and start taking more epidemiology where people know proper statistical methods.

 

[sheepunite]

I suppose I need to get out of my Anthropolgy classes and start taking more epidemiology where people know proper statistical methods.

you're at michigan, right?
have you been able to take any of marcia inhorn's classes?
p.s. if you're looking for excellent global health epid classes, check out rachel snow's offerings (school of public health, health behavior and health education). she teaches courses in population demography, HIV/AIDS and repro health.

 

[8744]

If Rodney King came into your ER and stated to you that white cops had "beat him up", would you have believed him? Your comments in this thread tell me no, in fact I bet you probably think someone "doctored" the tape clearly showing him being assulated by the police.

You know, I don't much care if you think the examples I posted are part of my "preverse wishful thinking". My guess is that there are Germans and others who think the same thing about the Holocaust and Jews. But I think because you simply don't care about these issues, that not believing that incidences similar to the scenarios I mentioned HAVE happened and DO happen (however rare)makes you a danger to anyone who may have the (dis)pleasure of ending up in your ER.

And by the way, I've been in the "medical world" longer than you've been a doctor. So I hate to break it to you, but being an MD doesn't give you a bit of "street cred" in the medical world to me. You'd have to be a Nurse to get my automatic respect for your contribution to the field of medicine.

Why would it matter whether I believed him or not? Is that going to effect how quickly I get a CT of his head? Rodney King is a piece of **** and not exactly the kind of guy I'd pick as a civil rights hero. He's no Rosa Parks. I bet plenty of black cops would have liked to have beat the crap out of him too.

But so what? I've treated bigger pieces of **** then him. That's the beauty of the doctor patient relationship. No matter who your patient is you can always find some common ground, their chief complaint, on which to build a good relationship. Medicine is funny that way. I'd call the cops if I saw a drunken Rodney King staggering through my neighborhood but in the department he becomes almost like family and we do what we can to alleviate his suffering. Rodney King, for his part, was probably a different guy to his doctors than he was, let's say, to his wife when he was beating her.

That's the magic of the doctor-patient relationship where even the most tatooed, drug-addicted, abusive heroin addict calls me "sir" and for a minute or two I can almost talk to him like a father to his son. Then of course we discharge them, or they get antsy, and the moment is gone.

In fact, I would venture to say that a patient has to really be a piece of work, has to really work hard at pissing everybody off, to get treated with anything less than respect. That's just how things are. People bitch and moan about this patient or that but it mostly just talk.

I see we both have a great deal of respect for nurses. I reject, however, the whole notion of "street cred" or "street smarts" under the theory that if people on the streets were so smart they wouldn't be selling crack for the equivalent of minimum wage or ending up dead or in prison by age 25. The very idea of "street cred" is an attempt to glorify a life of desperation and squalor.

 

[8744]

...I've been in the "medical world" longer than you've been a doctor...

Perhaps, but you will find out that there is a huge difference between shadowing, volunteering, and working in a support role than being the guy they look to at 3AM for a plan. I say this in humility because I am still learning, I don't always have a plan, and am very thankful, occasionally, for the guidance of my senior residents.

As you know, there are not to many tangible or metaphysical benefits to being a resident. The hours suck, the pay is terrible, and the schedules are preposterous. But one of the benefits, professionally, is that if you act like you know what you're doing people will look to you for leadership when things are going south. I'm still learning this trick but sometimes I get it right.

Hey, I saw 223 patients this month in the ED. I bet that's about my average for all of my 18 months post-graduation. That's 4000 patients plus or minus which has got to count for something.

 

[1Path]

I reject, however, the whole notion of "street cred" or "street smarts" under the theory that if people on the streets were so smart they wouldn't be selling crack for the equivalent of minimum wage or ending up dead or in prison by age 25. The very idea of "street cred" is an attempt to glorify a life of desperation and squalor.

With all that experiecne working with folks in the ER who use terms like "street cred", you lacked the ability to make the proper inference about exactly how I was using it this time. Or could it be that when black person uses the term "street cred" it ALWAYS mean the same thing?

Perhaps, but you will find out that there is a huge difference between shadowing, volunteering, and working in a support role than being the guy they look to at 3AM for a plan......Hey, I saw 223 patients this month in the ED. I bet that's about my average for all of my 18 months post-graduation. That's 4000 patients plus or minus which has got to count for something. .

I wouldn't care if you had seen 1 X 10E7 patients by now, you illustrate a complete and total disdain for lives of your patients. You think their problems were caused by their own actions in EVERY case, and most important of all, in ignorance, you don't believe health disparities exist. Saying that you don't have to care about patients to be a good doctor is like saying you don't have to care about peoplle to be a good priest. People will be reluctant to communucate vital medical info to a person who has your attitude and THAT could cost them their life.

And BTW, the absolute BEST experience in the ER or medicine for that matter, is BEST gained from being a patient.

 

[The pK]

I think 1path is picking a fight with the wrong person.

I'm an MS0, so I don't have tons of experience to back this up, but it seems like the people who choose EM do so because they DON'T care to follow their patients around spoon-feeding meds to them and slapping their hands away from french fries and crack pipes. And how effective can educating patients in the ED be, honestly? The repeat offenders are not likely to change their habits, and the occasional "good" patient probably makes responsible choices already. Just an observation.
Also, 1path, what do you expect Panda to say? Really. And what is the point of throwing out those ridiculous scenarios? You're doing nothing more than drawing attention to your own ignorance of EM, and it makes me feel sorry for you, because I realize that you feel strongly about racism being the cause of disparate health care, but your ineffective arguments make it difficult for anyone to take you seriously.

 

[8744]

With all that experiecne working with folks in the ER who use terms like "street cred", you lacked the ability to make the proper inference about exactly how I was using it this time. Or could it be that when black person uses the term "street cred" it ALWAYS mean the same thing?

I wouldn't care if you had seen 1 X 10E7 patients by now, you illustrate a complete and total disdain for lives of your patients. You think their problems were caused by their own actions in EVERY case, and most important of all, in ignorance, you don't believe health disparities exist. Saying that you don't have to care about patients to be a good doctor is like saying you don't have to care about peoplle to be a good priest. People will be reluctant to communucate vital medical info to a person who has your attitude and THAT could cost them their life.

And BTW, the absolute BEST experience in the ER or medicine for that matter, is BEST gained from being a patient.

Man. You don't even know me. And you are in for a shock when you start doing anything almost everywhere in the medical field because "disdain" is mild compared to the way many of our nurses, for example, feel about many of the patients, particularly the frequent fliers.

And look, shooting heroin, smoking crack, or driving drunk...not to mention capping a mofo...are all concious choices made by people acting with free will. What this has to do with patient care I don't understand. I would say that with the exception of some of the trauma and most of the minor accidents, almost nobody in the ED is a victim of anything other than lifestyle choices.

 

[8744]

...And BTW, the absolute BEST experience in the ER or medicine for that matter, is BEST gained from being a patient...

Pure horse****. Unadulterated, unprocessed, politically correct, mamby-pamby, phoney baloney, plastic bananna, good-time-rock-and-roll horse****.

The best experience in the ED or medicine comes from seeing a lot of patients with varied presenting complaints and comorbidities. All you know from being a patient is that you don't like having your blood drawn, doctors are sometimes in a hurry, and hospital food sucks. Having spent time in the hospital may make you a little more sympathetic towards your patients but that's about it. And like I said, sympathy is in the dictionary between **** and syphilis.

 

[1Path]

You're doing nothing more than drawing attention to your own ignorance of EM, and it makes me feel sorry for you, because I realize that you feel strongly about racism being the cause of disparate health care, but your ineffective arguments make it difficult for anyone to take you seriously.

I can think one one very good place for you to put your pity and it rhymes with brass.😉 Ignorant of EM? Of course I'm ignorant of EM but what I'm NOT ignorant of are the different health outcomes of people of color who end up in the ER. More likly to die of an MI in the dam ER, more likely to NOT have their strokes symptoms treated in a timely fashion, more likely to have a diabetic coma confused with being drunk, and on and on. And I'm not the only one who feels that racism plays a HUGE role in health disparities. I'm just the only one without DR in front of their name bold enough to just come out and say it.

Personally, I think everyone in this thread should go to the local ER, sit in one of those cheap gowns with your a$$ out for 4 hours, then get back to this thread about how you feel medicine is practiced. It's pretty obvious that some of you are NEVER going to "get it" until you have some expereince as a patient under your belt and hopefully it will be at one of those hospitals that serves the underserved.👍

 

[8744]

I can think one one very good place for you to put your pity and it rhymes with brass.😉 Ignorant of EM? Of course I'm ignorant of EM but what I'm NOT ignorant of are the different health outcomes of people of color who end up in the ER. More likly to die of an MI in the dam ER, more likely to NOT have their strokes symptoms treated in a timely fashion, more likely to have a diabetic coma confused with being drunk, and on and on. And I'm not the only one who feels that racism plays a HUGE role in health disparities. I'm just the only one without DR in front of their name bold enough to just come out and say it.

Personally, I think everyone in this thread should go to the local ER, sit in one of those cheap gowns with your a$$ out for 4 hours, then get back to this thread about how you feel medicine is practiced. It's pretty obvious that some of you are NEVER going to "get it" until you have some expereince as a patient under your belt and hopefully it will be at one of those hospitals that serves the underserved.👍

They only had to sit in the department for four hours? That's service. We have people sitting around all day, some for minor complaints like "abdominal pain" that is relieved, finally, after a bowel movement. I tell many of my patients who complain about the time it takes to get things done, "Look, you felt sick enough to come to the Emergency Room and we're taking you seriously enough to do a work up. Think about it like you've been admitted to the hospital for the day."

Then we make sure to get them chow (if they can eat) and people are usually happy, or at least resigned to the fact that things move slowly. They have pretty good TV in most of the rooms and bays. And it helps if you "round" on your sitters every now and then when you have time just to keep them up to date.

Seriously though, if you come for a minor complaint, like a "chest cold" or a little nausea and vomiting in an otherwise healthy four-year-old you just need to be prepared to both wait a while in the waiting room and sit for a while once they bring you back. Or what part of "Emergency" didn't they understand?

Also, almost nobody dies of an MI in the department. They are either dead when they get here or they die in the CCU after transfer. Also, nobody ignores somebody of any race or class who's actively infarcting. Everybody with chest pain gets a stat EKG and if you are brought in unconcious you get one even "stat-er." I don't know 1Path's level of medical knowledge but the EKG changes for someone actively infarcting are pretty apparent most of the time. People do have NSTEMIs with no acute EKG changes but these are the people with milder anginal symptoms, not somebody coming in pale, sweaty, vomiting, short of breath, and grabbing his chest...people who are at death's door in other words.

In the rare case that someone is having a severe NSTEMI, well, clinical presentation and judgement trumps lab tests and studies a lot of the time.

Come on 1Path. 'Fess up. You may be a cracker-jack social worker but you know next to nothing about medicine. Tell us your level of medical experience or cease and desist.

Oh, and the typical poor stroke patient, and I had two the other night, waits a while before coming in. I think this a function of education more than anything else. The first question we ask the patient or the family is "When did the symptoms start?" As 1Path may or may not know, there is nothing really to be done for a stroke more than three hours old. If it's 1500 and the wife says that her husband started stumbling around at around noon, we are already out of the window for thrombolytics or much of anything else. They get a stat head CT to make sure there is no acute incranial bleeding that might cause them to herniate, and sometimes they find a big aneurysm that hasn't burst but which can be coiled but usually they just go up to the stroke unit and everybody stands around doing practically nothing because there is nothing, acutley, to do.

 

[1Path]

Come on 1Path. 'Fess up. You may be a cracker-jack social worker but you know next to nothing about medicine..

And where exactly did I claim to be an expert in medicine? But get this, neither are you! And hopefully when I do finish my MD/PhD I won't allow acheivements to turn me into educated fool. You're at ground zero for seeing health disparities yet you keep your head stuck in the sand. Then when I say the reason you're so blind is because of your racist views, you and "your posse" get your boxers in a bunch.

What I do claim to KNOW both from personal experiences, shadowing experiences, the stories of others and published papers, is that health disparities are a problem in this country.

OK I'm done. Talking with you about health disparities is a fruitless endeavor!

And BTW, being called a Social Worker is indeed a compliment, if the alternative is being a so called physician like you!😉

 

[8744]

And where exactly did I claim to be an expert in medicine? But get this, neither are you! And hopefully when I do finish my MD/PhD I won't allow acheivements to turn me into educated fool. You're at ground zero for seeing health disparities yet you keep your head stuck in the sand. Then when I say the reason you're so blind is because of your racist views, you and "your posse" get your boxers in a bunch.

What I do claim to KNOW both from personal experiences, shadowing experiences, the stories of others and published papers, is that health disparities are a problem in this country.

OK I'm done. Talking with you about health disparities is a fruitless endeavor!

And BTW, being called a Social Worker is indeed a compliment, if the alternative is being a so called physician like you!😉

In no way did I mean to insult you by calling you a social worker.

I also never claim to be an expert doctor. One of the most amusing things about SDN, however, is how pre-meds lecture residents on what being a physician is all about, and seem to imply that they know better even though their entire world view comes from shadowing a doctor for a couple of days.

 

[1Path]

One of the most amusing things about SDN, however, is how pre-meds lecture residents on what being a physician is all about, and seem to imply that they know better even though their entire world view comes from shadowing a doctor for a couple of days.

Not quite as amusing as folks thinking that once they earn an MD, they suddenly become experts on EVERYTHING related to medicine (Ironically, I've never seen this type of behavior among DO's......hmmmmmmmmm). You're denial about the existance of health disparities is certainly NOTHING to be praised and you're just pi$$ed because a premed called you out about it.😛

 

[dynx]

Not quite as amusing as folks thinking that once they earn an MD, they suddenly become experts on EVERYTHING related to medicine (Ironically, I've never seen this type of behavior among DO's......hmmmmmmmmm). You're denial about the existance of health disparities is certainly NOTHING to be praised and you're just pi$$ed because a premed called you out about it.😛

👍 👍
I give this thread two thumbs up for outright hilarity! 1Path, you my friend are going to LOVE medical school, the real world...not so much so.

 

[1Path]

👍 👍
I give this thread two thumbs up for outright hilarity! 1Path, you my friend are going to LOVE medical school, the real world...not so much so.

Truthfully the real world has been a BLAST, 40 years an counting up..............The only exception of course, are in those instances where I or someone I loved had to see a physican who thought I/they didn't deserve to receive the same meical care as everyone else. Actually, the ONLY expections are my all too frequent run in's with racism.

 

[etf]

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

that's me. altria group (aka phillip morris tobacco) is my single largest holding. it's also one of the best (if not #1) performing stocks of the 20th century.

 

[Gut Shot]

Truthfully the real world has been a BLAST, 40 years an counting up..............

If you don't mind me asking, are you premed? In medical school? In graduate school? In a postdoc? Other?

 

[8744]

Not quite as amusing as folks thinking that once they earn an MD, they suddenly become experts on EVERYTHING related to medicine (Ironically, I've never seen this type of behavior among DO's......hmmmmmmmmm). You're denial about the existance of health disparities is certainly NOTHING to be praised and you're just pi$$ed because a premed called you out about it.😛

DOs are no different than other doctors. I'm sorry you buy into this myth too. I am in a combined MD/DO program at a hospital that is majority DO. DO surgeons are just as malignant as MD surgeons, DO Ob-Gyns are just as bitchy, and DO Family Practice are just as fruity.

There is no functional difference between the amused cynicism of a DO Emergency Medicine attending and her MD counterpart.

Sorry to burst that bubble too.

1Path would be a fun patient. She would come in with a viral URI and then throw you evil looks because she's convinced that we keep a supply of virus-killing antibiotics in the back just for the white folks.

Yeah. We keep them in the same freezer as the "Whites Only" transplant hearts.

And she's cry racism because that white guy who was thrown from his car was triaged ahead of her just because he was a "member of the club."

 

[1Path]

If you don't mind me asking, are you premed? In medical school? In graduate school? In a postdoc? Other?

Ummm........ this year I've been EVERYTHING but a post doc. Next year I'll again be EVERYTHING again but a post doc. From there until I graduate, I'll be an MD/PhD student. I don't expect to be a post doc until the year 2016 but perhaps I'll see you on my next trip to a USCAP meeting!😉

And dear Panda bear, prescribe yourself some prozac, PLEASE!!!!!!!!!

 

[8744]

Ummm........ this year I've been EVERYTHING but a post doc. Next year I'll again be EVERYTHING again but a post doc. From there until I graduate, I'll be an MD/PhD student. I don't expect to be a post doc until the year 2016 but perhaps I'll see you on my next trip to a USCAP meeting!😉

And dear Panda bear, prescribe yourself some prozac, PLEASE!!!!!!!!!

So. No clinical experience. I thought so.

 

[Gut Shot]

Ummm........ this year I've been EVERYTHING but a post doc. Next year I'll again be EVERYTHING again but a post doc. From there until I graduate, I'll be an MD/PhD student.

I'm not sure how this is possible.

 

[1Path]

I'm not sure how this is possible.

My husband look at the last page of his thread and laughed his a$$ off!

Let's just say that there's more than one way to skin a cat and that in EVERYTHING I do, addressing health disparities is my number #1 priority.👍

And dearest Pookey Bear, I couldn't have made it to this point with having some clinical experience! And a belief in health disparities hasn't hurt either! Beleive it or not, wanting to address health disparities led to one of the clinical expericnes I currently throughly enjoy, however depressing it is on some days. Of course, the depressing part is knowing that a lack of proper medical care led to more than a few of the patients needing the services I voluntarily provide in the first place.

So let's bring this thread full circle, anyone who can't answer a question about health disparities probably doens't need to matriculate into med school. And any physician who can't answer a question about health disparities shouldn't receive HIS license to practice.

 

[8744]

My husband look at the last page of his thread and laughed his a$$ off!

Let's just say that there's more than one way to skin a cat and that in EVERYTHING I do, addressing health disparities is my number #1 priority.👍

And dearest Pookey Bear, I couldn't have made it to this point with having some clinical experience! And a belief in health disparities hasn't hurt either! Beleive it or not, wanting to address health disparities led to one of the clinical expericnes I currently throughly enjoy, however depressing it is on some days. Of course, the depressing part is knowing that a lack of proper medical care led to more than a few of the patients needing the services I voluntarily provide in the first place.

So let's bring this thread full circle, anyone who can't answer a question about health disparities probably doens't need to matriculate into med school. And any physician who can't answer a question about health disparities shouldn't receive HIS license to practice.

You are such a goof, 1Path, but loveable all the same. I love your absolutism, it's almost pruritanical in its intensity. It might even keep you out of medical school but I hope it doesn't. It will be a rare pleasure to read, maybe five years from now, how you handled your first drug-seeker by giving him a prescription for 800 vicodin...and then the next day reading your description of the inexplicable increase of walk-in visits at your clinic with an actual line stretching out the door full of people who want to see Dr. 1Path and nobody else.

For my part, my two big issues are "End of Life Care" (the fact that we spend an inordinate amount money essentially animating and renanimating corpses in the ICU) and "Working Conditions for Residents" (including being anti-call and very much against the low wages for residents).

 

[Dimness]

For my part, my two big issues are "End of Life Care" (the fact that we spend an inordinate amount money essentially animating and renanimating corpses in the ICU) and "Working Conditions for Residents" (including being anti-call and very much against the low wages for residents).

The bold emphasis is mine. This is a subject that I'm somewhat familiar with, but I was wondering about something Dr. PandaBear. I've thought about making a living will. Based on your personal experiences, can living wills be challenged in court? The way I see it, I hope I raise kids with some good common sense, and I'll take out a nice life insurance policy. I bring this up because this sounds like something you might be familiar with given the high emotions that run in the ICU.

 

[8744]

The bold emphasis is mine. This is a subject that I'm somewhat familiar with, but I was wondering about something Dr. PandaBear. I've thought about making a living will. Based on your personal experiences, can living wills be challenged in court? The way I see it, I hope I raise kids with some good common sense, and I'll take out a nice life insurance policy. I bring this up because this sounds like something you might be familiar with given the high emotions that run in the ICU.

I guess anything can be challenged in court. It's not the court challenge you need to worry about, it's your spouse deciding that they just can't let go of your contracted, demented, stroked out, kidney-less body even if you do have a living will because if the spouse says you actually wanted to be one of the undead, then that's what usually happens.

 

[Gut Shot]

Let's just say that there's more than one way to skin a cat

I understand that, but I still can't discern why you're not answering my question in a simple, intelligible manner. And I still have no clue what you are. If you're concerned that you might "out" yourself that's fine, just say so.

and that in EVERYTHING I do, addressing health disparities is my number #1 priority.👍

Um, okay, you've answered a question I didn't ask.

My number one priority is getting into practice before the age of 55.

 

[1Path]

You are such a goof, 1Path, but loveable all the same. ).

Thanks Pookey Bear!

I love your absolutism, it's almost pruritanical in its intensity. It might even keep you out of medical school but I hope it doesn't.

It didn't before, so I seriously doubt it will. In fact, I'm a much better candidate NOW than I was THEN.

It will be a rare pleasure to read, maybe five years from now, how you handled your first drug-seeker by giving him a prescription for 800 vicodin...and then the next day reading your description of the inexplicable increase of walk-in visits at your clinic with an actual line stretching out the door full of people who want to see Dr. 1Path and nobody else..

I'm going into pathology, for sure man! Now, I'm not an MD and I'm no expert in pathology matters, but I seriously doubt a corpse is going to need prescription vicodin.

I understand that, but I still can't discern why you're not answering my question in a simple, intelligible manner. And I still have no clue what you are. If you're concerned that you might "out" yourself that's fine, just say so..

Listen dude, I'm a 40 year old BLACK WOMAN, interested in pursuing an MD/PhD. I don't know how much more I could do to "out myself" not that I would be concerned about that anyway. I've NEVER lost an opportunity God himself decided to give me!😉

My number one priority is getting into practice before the age of 55.

Cool. Me too!👍

 

[Gut Shot]

Listen dude, I'm a 40 year old BLACK WOMAN, interested in pursuing an MD/PhD.

There, right there, "interested in pursuing and MD/PhD." That's what I was curious about.

Thank you. Finally.