Politically Correct Medicine

[McDoctor]

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There was a thread on the Topics in Healthacre forum about whether or not one should ever withhold information or recommendations from a patient regarding their health. The general consensus was that we need to inform patients of all aspects of their health at all times.

I agree with that in principal, but I would argue that we are often encouraged to hold back information from patients in our training years in the spirit of being politically correct. The example I would use is the way we interact with patients who are poor. People who are poor have more health problems and die at an earlier age than people who are above the poverty line. Their children suffer higher rates of asthma, ADD, childhood obesity and others. I would think that by looking at the numbers, the best medical advice that I could give someone who seemingly is satisfied to be getting by on welfare is to get a job and strive to better support him/herself and family financially.

Could you imagine the backlash from a program director in FP if I routinely did this? I would immediately be chastised for a percieved lack of compassion or understanding. I was wondering what other opinions from people out there dealing with patients are regarding the issue of being completely open and honest with patients when it comes to some of the thornier issues of morbid obesity, substance abuse, lower socioeconomics, and others. Am I not withholding information from these patients akin to not informing them of a high cholesterol value when I sugarcoat some issues? Are we doing are patients a disservice by taking major strides to skirt potentially offensive issues?

 

[Flopotomist]

I think it would demonstrate tremendous naivete, and sociological ignorance to suggest that a person on welfare should just "get a better job and stop being poor."

That would be like suggesting to a starving person that there problems would all go away if they would just eat some food.

 

[u_r_my_serenity]

I think in the long-run our "compassion" does a tremendous disservice to society, and it's not specifically with doctors. For example, in ancient Persian and Greek cultures if a person was obese or even born with a congenital malformation, people would call that person obese/defective as if it were a simple fact of life. The obese/diseased person would not obtain high status and would be excluded from participating in many activities. Beauty, intelligence, courage, and strength were regarded highly and society was very open about it. People would state they were good looking or strong and it was not considered arrogant. Society was very uncompassionate in that people who did not meet these standards were treated as inferiors in almost every respect of life. But there were far fewer "inferiors" than today, and both cultures went on to achieve tremednous accomplishment.

Which is the better scenario?

1. Select (through social pressure) against obesity, sedentary lifestyle, weakness, laziness, and many conditions where the individual has absolutely no control over (ex. born with trisomy 21), but have fewer individuals who fit these categories;

2. Show "compassion" to all human beings and have no real selection pressure, ultimately with more "undesirables".

A trend towards option 1 would result in a happier society as a whole because there would not be as many people suffering (ex. obese). Compare that to San Antonio today where 50% have diabetes and almost everyone is extremely overweight. What is society doing to fight this problem? Making physicians fear litigation if they even tell a patient what is blatantly obvious- she is a fat cow. Option 1 is essentially facism, however, and many innocent people whoe cannot prevent their condition will suffer.

 

[8744]

I think it would demonstrate tremendous naivete, and sociological ignorance to suggest that a person on welfare should just "get a better job and stop being poor."

That would be like suggesting to a starving person that there problems would all go away if they would just eat some food.

We haven't "hung out" with many poor people, have we?

It show tremendous naivete to think that everybody on the public dole is helpless and incapable of work.

Or, as one of my patients said to me the other day, indignantly I might add, "Why are you trying to make me take responsibility for myself?"

I love this gal if for no other reason than she doesn't bull**** me or make lame excuses. She wants disabilty and she will do whatever it takes to get it. She doesn't even make a pretense of trying to be a good citizen. She flouts my advice, refuses to take her free medication, misses most of her free clinic appointments and steadfastly refuses to lose weight, stop smoking, or enjoy the occasional celebratory spliff.

I will miss her when I leave in June but hopefully I wil have plenty of patients like this at my new program. They make it all worthwhile.

 

[Flopotomist]

We haven't "hung out" with many poor people, have we?

If by "we" you mean you and I, you are correct. "We" have not hung out. I find it really annoying when people presume to make judgements without knowing me - or what they are talking about. If you DID know me, you would know that I have spent the last 7 years of my life working with the poor, so can tell you that it is ridiculous to think that a significant percentage should just "get a job."

Many (most?) of the poor people in this country DO have a job. However, working for $7 when you have 2 kids makes it difficult to climb up the career ladder. Those kids aren't exactly going to get the best educations because of where they live, and who is at home to help them with schoolwork (Mom will be working her second job just to keep food on the table).

Because of the education of the kids, they too will get crappy jobs, and the cycle continues. SO... climb off your high horse, and do some basic research on the plight of the lower rungs of the socioeconomic ladder before you go spewing your self-righteous BS.

 

[8744]

If by "we" you mean you and I, you are correct. "We" have not hung out. I find it really annoying when people presume to make judgements without knowing me - or what they are talking about. If you DID know me, you would know that I have spent the last 7 years of my life working with the poor, so can tell you that it is ridiculous to think that a significant percentage should just "get a job."

Many (most?) of the poor people in this country DO have a job. However, working for $7 when you have 2 kids makes it difficult to climb up the career ladder. Those kids aren't exactly going to get the best educations because of where they live, and who is at home to help them with schoolwork (Mom will be working her second job just to keep food on the table).

Because of the education of the kids, they too will get crappy jobs, and the cycle continues. SO... climb off your high horse, and do some basic research on the plight of the lower rungs of the socioeconomic ladder before you go spewing your self-righteous BS.

Har har. Hey. You need to try to match at my program next year. (Duke Family Medicine) We make something of a fetish of kissing the collective ass of the sainted underserved. You'd fit right in. Trust me.

Oh man. You are too much. Of course the poor can't succeed. They are too helpless. And stupid. Gosh, those people only think from day to day, a-playin' in the sun and singing that wonderful music. Isn't it nice to sit on the porch of the liberal welfare plantation and listen to 'em sing?

Swing low, sweet chariot.....

 

[8744]

Sing, damn you. I said sing!

 

[fishmonger69]

Many (most?) of the poor people in this country DO have a job. However, working for $7 when you have 2 kids makes it difficult to climb up the career ladder. Those kids aren't exactly going to get the best educations because of where they live, and who is at home to help them with schoolwork (Mom will be working her second job just to keep food on the table).

maybe refraining from having children until financially feasible would help

 

[8744]

maybe refraining from having children until financially feasible would help

Why you judgemental, racist, insensitive bigot. How dare you suggest that people exercise personal responsibility. What is wrong with you? Don't you know that the underserved can't hep' themselves?

 

[DoctorFunk]

maybe refraining from having children until financially feasible would help

They just pop right out, inbetween triple shifts at Burger King. Lord knows they didn't have time for sexual intercourse to actually conceive the children, they are far too busy trying to improve their lot in life.

 

[DrNick2006]

I think in the long-run our "compassion" does a tremendous disservice to society, and it's not specifically with doctors. For example, in ancient Persian and Greek cultures if a person was obese or even born with a congenital malformation, people would call that person obese/defective as if it were a simple fact of life. The obese/diseased person would not obtain high status and would be excluded from participating in many activities. Beauty, intelligence, courage, and strength were regarded highly and society was very open about it. People would state they were good looking or strong and it was not considered arrogant. Society was very uncompassionate in that people who did not meet these standards were treated as inferiors in almost every respect of life. But there were far fewer "inferiors" than today, and both cultures went on to achieve tremednous accomplishment.

Which is the better scenario?

1. Select (through social pressure) against obesity, sedentary lifestyle, weakness, laziness, and many conditions where the individual has absolutely no control over (ex. born with trisomy 21), but have fewer individuals who fit these categories;

2. Show "compassion" to all human beings and have no real selection pressure, ultimately with more "undesirables".

A trend towards option 1 would result in a happier society as a whole because there would not be as many people suffering (ex. obese). Compare that to San Antonio today where 50% have diabetes and almost everyone is extremely overweight. What is society doing to fight this problem? Making physicians fear litigation if they even tell a patient what is blatantly obvious- she is a fat cow. Option 1 is essentially facism, however, and many innocent people whoe cannot prevent their condition will suffer.

You think life was better for the ancient greeks and persians than for people today huh? I would dissagree. Also, your option one seems scary to me on many levels.

 

[futuredo32]

Have you read a newspaper or maybe watched the news on television at all during the last six months? The US economy isn't doing well, jobs that pay well are few and far between. The automotive industry that has employed people for years and people are being laid off.
I have worked with many patients on welfare and they weren't "satisfied" by any stretch of the imagination. The vast majority of them would LOVE to be able to work a full-time job to support their family.

 

[8744]

Have you read a newspaper or maybe watched the news on television at all during the last six months? The US economy isn't doing well, jobs that pay well are few and far between. The automotive industry that has employed people for years and people are being laid off.
I have worked with many patients on welfare and they weren't "satisfied" by any stretch of the imagination. The vast majority of them would LOVE to be able to work a full-time job to support their family.

Dude. The unemplyment is low. Almost to the statistical point that everyone who wants a job can find one. The vast majority would love to work a full time job to support their family? Well no ****. The problem is that the vast majority wouldn't love doing what is necessary such as moving, starting at a low-paying job and working up, taking orders from "the man," disciplinig themselves to get an education or learn a trade, keeping their legs closed and their pants zipped up, or deferring gratification.

I guess most of you have never had to hire the "underserved" or try to get any meaningful work out of 'em.

 

[Flopotomist]

Man - it scares me to think that there are actually people out there that think the way Panda thinks. How can you be a strong patient advocate if you are busy looking down your nose at the "ignorant" Wal-Mart employee who has no health insurance? Or the man who lost his software engineering job to an overseas company? Or to the woman who was divorced and left to fend for herself and her children?

Are there people that fit your ugly stereotypes and just sit around singing all day - sure - but the VAST majority of people aren't like that. Many Americans are living paycheck to paycheck, and when something unexpected happens (eg a hurricane blows through your town) you can't just "get a better job" as you suggest.

It saddens me to think that some unsuspecting poor patient may end up forced to listen to your patronizing drivel some day.

 

[8744]

Man - it scares me to think that there are actually people out there that think the way Panda thinks. How can you be a strong patient advocate if you are busy looking down your nose at the "ignorant" Wal-Mart employee who has no health insurance? Or the man who lost his software engineering job to an overseas company? Or to the woman who was divorced and left to fend for herself and her children?

Are there people that fit your ugly stereotypes and just sit around singing all day - sure - but the VAST majority of people aren't like that. Many Americans are living paycheck to paycheck, and when something unexpected happens (eg a hurricane blows through your town) you can't just "get a better job" as you suggest.

It saddens me to think that some unsuspecting poor patient may end up forced to listen to your patronizing drivel some day.

Ah. The "You Are not as Compassionate as I am so you Don't Deserve to be a Physician Gambit." I should have seen it coming.

 

[Flopotomist]

Ah. The "You Are not as Compassionate as I am so you Don't Deserve to be a Physician Gambit." I should have seen it coming.

I didn't say that you don't deserve to be a physician - I have nothing to base such a claim on. I only suggested that I hope that wherever you end up, you aren't in a position of providing care to the poor because clearly your belief system prevents you from being able to relate to their situation.

 

[u_r_my_serenity]

You think life was better for the ancient greeks and persians than for people today huh? I would dissagree. Also, your option one seems scary to me on many levels.

In some respects I would say life was happier in ancient Persian or Greek society. If we take a society in a typical large US city today, we're less intellectually vigorous and facile than people of the great classical civilizations. We're probably more emotionally frail as well. Great achievements in mathematics, metallurgy, engineering, agriculture, astronomy, navigation, and the various arts and crafts are endemic throughout ancient civilization. And we are talking about thousands of years B.C., and achievements which in many cases we cannot duplicate today. The Persians had a sytem of refrigeration 2,500 years ago more advanced than in most African nations today. The Greeks developed a medicine philosophy of such standards that medical students today take a revised form of the Hippocratic Oath.

Is life better now? For you and I, yes. We have the pleasure of experiencing the fruits of over two millenia of human progress. And you obviously wouldn't be here if you did not push yourself towards bettering yourself through education. It's no great leap to guess that you strive for other ambitions as well. For people living without ambition and motiviation, however, I would guess their life (and their happiness) is miserable. A victim from Hurricane Katrina I saw developed dysentary after drinking stagnant water on the street. 50% of those victims were illiterate. I go to the mall and see 12 year olds with morbid obeseity holding a little fruit roll-up or some other junk food. We are not talking about a single case- we are talking about an epidemic of obeseity. This is tied to our epidemic of diabetes. Too much junk food. Too many video games and televsision and just sitting there in front of a PC. There are children who watch TV 5 hours a day on average. If a child did this from age 5 to age 15, he will have wasted more than 2 years of his life watching TV. No ambition to higher education. Your average patient will read at the 8th grade level and will have a 50% chance of understanding the words that are coming out of your mouth. Go to the grocery store and you will find some fresh vegetables cheaper than the same vegetable in a can, and people still buy the can. We have no selection against it. Many people are leading lives empty of real happiness, even if they are not educated enough to even realize it.

 

[rob14599]

I think it would demonstrate tremendous naivete, and sociological ignorance to suggest that a person on welfare should just "get a better job and stop being poor."

That would be like suggesting to a starving person that there problems would all go away if they would just eat some food.

I know that here in Michigan, 60% of the people on welfare are high school dropouts. A high school education is free, these people chose to drop out, so in those cases I would argue that they are on welfare because of the choices they made. They chould choose to go back and get their GEDs at least and have a shot of getting off of welfare, but they must be motivated to do so.

 

[DoctorFunk]

I only suggested that I hope that wherever you end up, you aren't in a position of providing care to the poor because clearly your belief system prevents you from being able to relate to their situation.

Perhaps that's not such a bad thing. Taking an outsider's perspective on the situation rather than a completely sympathetic view of their life choices may allow the physician to make suggestions that fall outside of the patient's normal "comfort range" and spur them to make decisions/choices that they would normally not believe possible.

For example, my patients may come in having never exercised a day in their lives and smoking like chimneys. Should I be sympathetic and suggest some exercise (like walking up stairs everyday or parking in the back of the parking lot), and cutting back on their smoking a little, knowing that these lifestyle changes would only reduce their risk of disease by a very small margin? Or should I be uncompromising about my level of expectations and care by suggesting that they quit smoking NOW, and implement a real exercise program that will make a real impact on their cardiovascular health?

By trying to be understanding of their "situation" I think we are just doing them a medical disservice and treating them like children who cannot cope for themselves or understand the decisions they are making. I plan on taking off the kiddy boxing gloves and telling my patients exactly what they need to do to improve their health maximally, with their personal lifestyle choices and financial situation playing only a minimal role in the suggestions I make.

 

[Danger Man]

To all of the above posters, I thank you from the bottom of my heart for the wonderful, informative posts that have reminded me yet again why primary care medicine sucks ass. I wish all of you the best in your frustrating interactions with patients. At one time, I was standing on the edge of the cliff ready to take the plunge and you kindly intervened and said, 'Take a step back. Let me do it.' 😱

 

[futuredo32]

Dude. The unemplyment is low. Almost to the statistical point that everyone who wants a job can find one. The vast majority would love to work a full time job to support their family? Well no ****. The problem is that the vast majority wouldn't love doing what is necessary such as moving, starting at a low-paying job and working up, taking orders from "the man," disciplinig themselves to get an education or learn a trade, keeping their legs closed and their pants zipped up, or deferring gratification.

I guess most of you have never had to hire the "underserved" or try to get any meaningful work out of 'em.

First of all, it's Dudette.
Second, in Michigan, thousands and thousands of people have been laid off. How can one start at a minimum wage job and feed themselves, let alone pay for childcare, feed and clothe their family?
I bet the "underserved" have had a great time being hired by someone as thoughtful and generous as yourself.

 

[8744]

I didn't say that you don't deserve to be a physician - I have nothing to base such a claim on. I only suggested that I hope that wherever you end up, you aren't in a position of providing care to the poor because clearly your belief system prevents you from being able to relate to their situation.

What on earth does "relating to them" have to do with providing health care? I'm treating their hypertensive urgency, not dating their daughter.

 

[Flopotomist]

What on earth does "relating to them" have to do with providing health care? I'm treating their hypertensive urgency, not dating their daughter.

When you treat their hypertensive urgency, are you going to do it with a magic wand? If not, you will need to eventually write a prescription for something - if you aren't relating to your patient, they may not tell you that they won't be able to afford what you prescribe. Also, if you come across as a pompous ass with your patient, maybe they won't tell you that they have been having a burning sensation when they pee, or have chest pain when they walk three blocks, or have an abscess on their thigh from shooting heroin - face it, you will get a better history if your patient feels like they can confide in you without you being a judgemental prick.

 

[deleted87716]

To all of the above posters, I thank you from the bottom of my heart for the wonderful, informative posts that have reminded me yet again why primary care medicine sucks ass.

What does this thread have to do with primary care medicine? Surely you don't think that we're the only doctors who have to deal with these issues.

 

[skypilot]

By trying to be understanding of their "situation" I think we are just doing them a medical disservice and treating them like children who cannot cope for themselves or understand the decisions they are making. I plan on taking off the kiddy boxing gloves and telling my patients exactly what they need to do to improve their health maximally, with their personal lifestyle choices and financial situation playing only a minimal role in the suggestions I make.

There is nothing wrong with telling them what they can do to improve their health. In fact that is your responsibility. But, unless you enjoy spitting into the wind, be non judgemental with your attitude and make incremental suggestions that have a chance of being accepted by the patient.

You can tell them to lose 20 pounds tomorrow, start running 3 miles a day, quit smoking and give up alcohol but what good would that do?

And you have a duty to treat your obese alcoholic smokers to the best of your ability without being judgemental. That includes offering truly useful advice.

How about first asking if they have ever considered quitting smoking?

 

[beyond all hope]

Good thread. Nice to see the kid gloves come off and have people say what they mean.

I can see both sides. Believe me, I may not roll my eyes or sigh dramatically when I see the 300 lb person complain of pain in their knees or difficulty breathing, but I do it on the inside. When the 50 pack year smoker says he's worried about lung cancer, I want to scream at him.

Sometimes that's the best thing.

Being a physician means you have to use every method in your arsenal for helping a patient. Sometimes that means being a shoulder to cry on. Sometimes that means being the voice of reason and pointing out the obvious, like you need to lose weight or stop smoking or stop doing crack.

Sometimes you have to be gentle, sometimes you have to be tough.

I have patients who are very good people and extremely uneducated. I had a sweet grandma who thought her 5 year old, 3 foot, 100 lb granddaughter was a healthy, good eater. The kid was literally round. She came for AOM, but I spent twenty minutes gently telling all involved (all of them obese) that the kid needs to lose weight or she's in real trouble.

I saw a guy who had his third episode of pancreatitis from EtOH at 25 years old. My first words:

DO YOU WANT TO DIE??!!

I spent a good long time chastising him. I probably didn't do anything but at least I tried. Maybe one patient in a hundred or one in a thousand will stop drinking/smoking/lose weight because of it. That would be worth it to me.

I don't bother chastising the sixty year old drunk. He's not going to change. I'm not going to get a seventy year old woman whose arms weigh more than my torso to lose weight. To those people I just try to be nice. Life is hard enough for them.

Being nice isn't always the best thing for your patient.

 

[Flopotomist]

Perhaps that's not such a bad thing. Taking an outsider's perspective on the situation rather than a completely sympathetic view of their life choices may allow the physician to make suggestions that fall outside of the patient's normal "comfort range" and spur them to make decisions/choices that they would normally not believe possible.

By trying to be understanding of their "situation" I think we are just doing them a medical disservice and treating them like children who cannot cope for themselves or understand the decisions they are making. I plan on taking off the kiddy boxing gloves and telling my patients exactly what they need to do to improve their health maximally, with their personal lifestyle choices and financial situation playing only a minimal role in the suggestions I make.

I totally agree that a physician should make the suggestions that you list - however, the OP is trying to suggest that it is the role of the physician to tell patients to "stop being poor." A patient may be able to stop smoking, may be able to change their diet, but may NOT have the luxery of just changing their socioeconomic status.

 

[Gut Shot]

I would think that by looking at the numbers, the best medical advice that I could give someone who seemingly is satisfied to be getting by on welfare is to get a job and strive to better support him/herself and family financially.

There is currently no federal welfare program to support able-bodied individuals without dependents. The old "welfare queen" program (mythologized by Ronnie Reagan) was terminated in 1996. For a family of three, the annual benefit these days (with maximum food stamp assistance) averages about $8,000 a year. Contrary to popular perceptions, there are relatively few people on welfare in this country, they are extremely poor, are predominantly single mothers with children, and the benefits they do collect are quite meager.

As for your advice, it's tough to put in what God left out.

 

[8744]

When you treat their hypertensive urgency, are you going to do it with a magic wand? If not, you will need to eventually write a prescription for something - if you aren't relating to your patient, they may not tell you that they won't be able to afford what you prescribe. Also, if you come across as a pompous ass with your patient, maybe they won't tell you that they have been having a burning sensation when they pee, or have chest pain when they walk three blocks, or have an abscess on their thigh from shooting heroin - face it, you will get a better history if your patient feels like they can confide in you without you being a judgemental prick.

Oh. I get it. I need to hire a consultant to tell me that the patient is poor. Dude. I write for the cheapest, most generic medication by default and work hard to minimize medication costs for all my patients.

I think you are confusing being polite and respectful with being patronizing. Most of what passes for compassion and good patient skills nowadays is the latter.

 

[penguins]

maybe refraining from having children until financially feasible would help

Sweet! 👍

 

[penguins]

Have you read a newspaper or maybe watched the news on television at all during the last six months? The US economy isn't doing well, jobs that pay well are few and far between. The automotive industry that has employed people for years and people are being laid off.
I have worked with many patients on welfare and they weren't "satisfied" by any stretch of the imagination. The vast majority of them would LOVE to be able to work a full-time job to support their family.

ummm... actually the economy is doing great.

 

[penguins]

There is currently no federal welfare program to support able-bodied individuals without dependents. The old "welfare queen" program (mythologized by Ronnie Reagan) was terminated in 1996. For a family of three, the annual benefit these days (with maximum food stamp assistance) averages about $8,000 a year. Contrary to popular perceptions, there are relatively few people on welfare in this country, they are extremely poor, are predominantly single mothers with children, and the benefits they do collect are quite meager.

As for your advice, it's tough to put in what God left out.

Ummm... not most of the ones I have encountered. Some yes, it lends a helping hand. But it shouldn't be a life long, never ending hand out. It should be a temporary "let's help you get on your feet" thing and if you haven't done something to improve your situation, you should be kicked off. Go visit Flopotomise, he/she obviously doesn't mind giving most of her money to you.

My signature says it all.

What happened to accountability? What happens to private citizens and private organizations being responsible for helping those truly in need? Ummm, that's right THE NEW DEAL was a better idea.

You go, Panda Bear!

 

[McDoctor]

There is currently no federal welfare program to support able-bodied individuals without dependents. The old "welfare queen" program (mythologized by Ronnie Reagan) was terminated in 1996. For a family of three, the annual benefit these days (with maximum food stamp assistance) averages about $8,000 a year. Contrary to popular perceptions, there are relatively few people on welfare in this country, they are extremely poor, are predominantly single mothers with children, and the benefits they do collect are quite meager.

As for your advice, it's tough to put in what God left out.

I think we let deadbeat dads off the hook way too often and I agree we sometimes unfairly demonize the single mother.

Alot of people mistake my compassion for judgementalism. I recognize that our current system punishes people who come off welfare and enter the workforce by causing them to lose healthcare benefits in most cases. A solution does not lie within passive acceptance of the inequalities of being poor. When I implore patients to become more involved in the community and workforce, that involvement should include voting in elections to resolve the barriers to upward mobility that they encounter. I admit I don't know what all of those barriers are. I don't try to feign empathy for a situation I have never been in, but does that really mean I lack compassion?

I don't see how advocating personal responsibility makes one a "judgemental prick". Flopotomist, you seem to be the one passing swift judgement and unfounded assumptions in this thread. I started the thread to try to gain an understanding of the other side of the issue, of how far the effort of trying to relate to the patient should be allowed to encroach on doling out what I feel is in best interest for the patient's health and well-being. I have an open mind to alot of what is being said here. I have never told a parient "to stop being poor" as you seem to suggest.

 

[Danger Man]

What does this thread have to do with primary care medicine? Surely you don't think that we're the only doctors who have to deal with these issues.

Primary care docs are not the only ones that have to deal with these issues, but I do contend that they have to deal with these issues more often--too often for me.

 

[McDoctor]

That would be like suggesting to a starving person that there problems would all go away if they would just eat some food.

My job is to do what I can to try to provide the food. I can't make them eat.

Curiously, most of the underserved population I see tend to have problems with obesity. I don't see many malnourished patients unless there are substance abuse issues involved, though I suppose we can classify obesity as a form of malnourishment. I think the poor nutritional quality of most of the affordable food in this country lends itself to that problem.

I'm not saying that people don't starve in this country, but my perception is that obesity is a bigger problem with the poor. My point is not that poor people are gluttonous, but when we try to appeal to a peoples sense of sympathy by proclaiming that most poor people are starving, we may be ignoring a bigger problem.

 

[McDoctor]

.

 

[8744]

Obviously the poor or the "underserved" as we're calling them now to avoid offending anybody are not a monolithic group. You need to avoid falling into the trap of stereotyping them. They are not all the noble creatures struggling mightily against "The Man." Some of them are fat, lazy, stupid and irresponsible.

Sorry.

You liberals are fairly racist if you get right down to it as you believe that the legions of the poor who are minorities are incapable of helping themselves. In this you are no different than my unreconstructed Southern mother-in-law who will insist to her last dying day that the slaves prefered working on the plantations because they were incapable of taking care of themselves.

 

[Danger Man]

You liberals are fairly racist if you get right down to it as you believe that the legions of the poor who are minorities are incapable of helping themselves.

Best post yet. 👍

 

[penguins]

Best post yet. 👍

Ditto! They just don't get that though! 🙄

 

[Poety]

pffffffft.

 

[Danger Man]

pffffffft.

?????

 

[McDoctor]

Obviously the poor or the "underserved" as we're calling them now to avoid offending anybody are not a monolithic group. You need to avoid falling into the trap of stereotyping them. They are not all the noble creatures struggling mightily against "The Man." Some of them are fat, lazy, stupid and irresponsible.

I guess you have a point with the "underserved" statement, I can't argue that there is a lack of services available to them. But you conservatives lose me when you start claiming that your taxes dollars are going to the poor. In many cases, your tax dollars are going to already profitable businesses who happen to provide services to the poor. The poor have no stake in how this money is spent.

Take the medicare prescription drug plan as a prime example of government incompetence. The conservatives have set up a system where there is no shortage of access to Lipitor, but access to exercise facilities and health food stores remains a huge problem for the poor. Which do you think would have a broader impact on public health? The latter also is more cost effective without a doubt.

Why not take a fraction of this money put into the prescription drug plan and make it directly available to the poor in the form of health spending vouchers? Then people can spend it on Lipitor if they'd like, or if they are motivated to be proactive with their health they can use it towards joining fitness clubs and the like. Motivation is not always the problem.

I would put the money more directly into the hands of the poor. I don't have a problem with my tax dollars going to people who make less than $15,000 a year. I do have a problem with them going to companies that make billions of dollars a year.
As far as the economy being good or bad, that is a pointless argument because it is highly subjective. If you own stock in Pfizer, then the economy is good. If you live in New Orleans, then perhaps the economy is not so good.

 

[Gut Shot]

But it shouldn't be a life long, never ending hand out.

What exact "life long, never ending hand out" are these people receiving? Like I said, the cash entitlement welfare program of yore was ended ten years ago.

 

[penguins]

What exact "life long, never ending hand out" are these people receiving? Like I said, the cash entitlement welfare program of yore was ended ten years ago.

Not quite!
Ah, I fondly remember my summer job (less than 10 years ago by far) where people would come cash out the "living expenses" portion of their welfare checks and as I counted the money for each girl in the group - I overheard them designating who was getting the liquor, who was paying cover, who was grilling the steaks.
Another job at the grocery store. People buying up to 20 steaks, name brand chips, salsa, coke, one person even bought caviar!, and then they swiped their welfare card. They would even talk amongst themselves about how they got the good steaks! What the heck? You are using semantics if you think those days are really gone.
Granted, about 5-10% of all people that came through with welfare cards for groceries really were buying legitimate food. And it was a big deal that they got their kids a candy bar while waiting in line. Those people I wanted to take money out of my own pocket and help them pay. Unfortunately, they were a VERY small minority.

 

[penguins]

The reason why the money isn't put into more productive and preventative things (IMHO) like excercise and healthier lifestyles, etc is because most voters don't support things like that because they are soooo short sighted. They want a quick fix just like everyone else and it is a hard concept to peddle. Then you have media coverage and political attack ads (by both sides) tearing the ideas apart and pushing what can be done NOW.

The same philosophy that put the person in the position where they need the lipitor is what is driving them to vote.

If the current admin hadn't given them something he would have been painted as a mean, tight fisted man who doesn't care that someone's mother-in-law has to take her dog's meds because she can't afford her own. Why her multimillion dollar son-in-law couldn't make them part of her Christmas present is beyond me. Oh, wait, he made that up too.

It is just like SS reform - the plan that would actually fix it all is too scary for people's tiny little short sighted brains to grasp. They can't fathom sacrifice in the present (which the media and politicians falsly claim there will be) for the future.
Different problem, same reasoning.

 

[McDoctor]

The reason why the money isn't put into more productive and preventative things (IMHO) like excercise and healthier lifestyles, etc is because most voters don't support things like that because they are soooo short sighted. They want a quick fix just like everyone else and it is a hard concept to peddle. Then you have media coverage and political attack ads (by both sides) tearing the ideas apart and pushing what can be done NOW.

The same philosophy that put the person in the position where they need the lipitor is what is driving them to vote.

If the current admin hadn't given them something he would have been painted as a mean, tight fisted man who doesn't care that someone's mother-in-law has to take her dog's meds because she can't afford her own. Why her multimillion dollar son-in-law couldn't make them part of her Christmas present is beyond me. Oh, wait, he made that up too.

It is just like SS reform - the plan that would actually fix it all is too scary for people's tiny little short sighted brains to grasp. They can't fathom sacrifice in the present (which the media and politicians falsly claim there will be) for the future.
Different problem, same reasoning.

I don't remember voters having much of a choice. Bush's plan was a wholly undesirable mess, but to his credit fairly clearly stated. I don't recall Kerry offering anything beyond vague statements that pandered to the latest poll. That shouldn't get him off the hook, though, especially with conservative republicans who tout themselves as the party of fiscal responsibility. President Bush's answer to everything seems to be to open up the checkbook. That kind of governing is the epitome of short-sightedness.

I've got to side with Havarti666 that you haven't really articulated which program you are referring to when you speak of cash entitlement "hand outs".
You give anecdotal evidence of people buying food at a grocery store, which kind of points out that the reformed system makes a reasonable effort to ensure that monetary aid goes toward necessary items. I'm not sure what you're talking about when you make a distinction between "legitimate food" and the supposedly illegitimate items outlined: steaks, potato chips, liquor, and ... gasp... salsa!

Although that goes back to my original post that we don't do enough to encourage our patients to make smart choices for themselves and push personal responsibility hard enough. I do think that the FP residency training programs I was exposed to as a student and am currently training in has a tendency to be far too patronizing to its poor population, and that the perpetuation of the idea that "poor people are victims" is harmful to the poor themselves. This was the basis for my original post. But some on these boards seem to be labeling the plight of the poor as entirely a product of their own behavior, which is also overly simplistic.

 

[penguins]

I don't remember voters having much of a choice. Bush's plan was a wholly undesirable mess, but to his credit fairly clearly stated. I don't recall Kerry offering anything beyond vague statements that pandered to the latest poll. That shouldn't get him off the hook, though, especially with conservative republicans who tout themselves as the party of fiscal responsibility. President Bush's answer to everything seems to be to open up the checkbook. That kind of governing is the epitome of short-sightedness.

I've got to side with Havarti666 that you haven't really articulated which program you are referring to when you speak of cash entitlement "hand outs".
You give anecdotal evidence of people buying food at a grocery store, which kind of points out that the reformed system makes a reasonable effort to ensure that monetary aid goes toward necessary items. I'm not sure what you're talking about when you make a distinction between "legitimate food" and the supposedly illegitimate items outlined: steaks, potato chips, liquor, and ... gasp... salsa!

Although that goes back to my original post that we don't do enough to encourage our patients to make smart choices for themselves and push personal responsibility hard enough. I do think that the FP residency training programs I was exposed to as a student and am currently training in has a tendency to be far too patronizing to its poor population, and that the perpetuation of the idea that "poor people are victims" is harmful to the poor themselves. This was the basis for my original post. But some on these boards seem to be labeling the plight of the poor as entirely a product of their own behavior, which is also overly simplistic.

The point was that they were hosting parties!!! Not that people on welfare can't have parties, but this happened every month... saw same people do the same thing.
I do not think the plight of the poor is ENTIRELY a product of their own behavior.
Just because $20 bills aren't being handed out does not mean it isn't a cash entitlement program. That is semantics.

I won't bother with the checkbook comments. It is all open to interpretation there but I do maintain that voters are short-sighted and that is why nothing will ever be done to change things like prevention versus drug plans. I am an optimist, however, hence my party colors.
If it was up to me, the government wouldn't give people a cent or a pill. Then maybe the private blessed citizens would step up to the plate more often for the people who really need it.

 

[8744]

...The reason why the money isn't put into more productive and preventative things (IMHO) like excercise and healthier lifestyles, etc...

Penguins, can you open your mind a little to contemplate that maybe it isn't a legitimate role of government or a good use of your tax dollars to cajole and wheedle people who are out of shape to exercise and eat right? I suppose the welfare system is here to stay as we have entire generations who know nothing but and would probably starve their children if we cut them off from their food stamps. Do we really need to take it up a notch and create a fitness beauracracy to spend even more money chasing another unsolvable problem?

I mean, if your going to do it do it right and monitor people through the telescreen as they do their "morning jerks."

I am waiting for the well conducted studies showing that spending for lifestyle education has any impact at all. Certainly the studies they have shown us here at Duke are the proverbial "dry holes."

Nothing. Nada.

With this in mind, and with neither evidence nor a possible experiental method to support your claim, why are you so sure that education on exercise and lifestyles is going to have an effect? You have nothing but anecdotal evidence and I have just as much showing that my patients never lose weight despite my counseling them until I am blue in the face.

 

[sabre518]

I'm not sure what you're talking about when you make a distinction between "legitimate food" and the supposedly illegitimate items outlined: steaks, potato chips, liquor, and ... gasp... salsa!

I agree. Liquor is the foundation of the food pyramid. Without it all underprivilaged people would starve... OK OK, enough of my sarcasm. Still, I have seen people who are way-way overweight buy potato chips with their food stamps. Doesn't that seem like a problem? Those same people will be having a CABG done in 10 years that you and I will be paying for. So indirectly were paying now to spend more later? Maybe I don't have a liberal enough mindset for this...

Man, and that WILL be a difficult intubation!

 

[penguins]

Penguins, can you open your mind a little to contemplate that maybe it isn't a legitimate role of government or a good use of your tax dollars to cajole and wheedle people who are out of shape to exercise and eat right? I suppose the welfare system is here to stay as we have entire generations who know nothing but and would probably starve their children if we cut them off from their food stamps. Do we really need to take it up a notch and create a fitness beauracracy to spend even more money chasing another unsolvable problem?

I mean, if your going to do it do it right and monitor people through the telescreen as they do their "morning jerks."

I am waiting for the well conducted studies showing that spending for lifestyle education has any impact at all. Certainly the studies they have shown us here at Duke are the proverbial "dry holes."

Nothing. Nada.

With this in mind, and with neither evidence nor a possible experiental method to support your claim, why are you so sure that education on exercise and lifestyles is going to have an effect? You have nothing but anecdotal evidence and I have just as much showing that my patients never lose weight despite my counseling them until I am blue in the face.

I don't think the government dollar should be spent on anything like this at all. I was saying that in response to McDoctor who said, "

Take the medicare prescription drug plan as a prime example of government incompetence. The conservatives have set up a system where there is no shortage of access to Lipitor, but access to exercise facilities and health food stores remains a huge problem for the poor. Which do you think would have a broader impact on public health? The latter also is more cost effective without a doubt."

I don't think it would matter how much money we threw at the problem, it wouldn't go away. If people had to pay for their own Lipitor and CABGs then that might help. I certainly don't want a fitness enforcing branch of the government.

Ronald Reagan said something like... the scariest words in the english language are "I'm from the government and I am here to help"
Amen to that!