A few points regarding your post.
1. You still haven't given me an example. Case in point, as well- that these issues are extremely difficult to solve. A simple inaccessibility to proper healthcare is as deeply entrenched in our healthcare system as it is in our political system.
2. Please don't question the intentions behind the author by disparaging their emotions or interests. Are you saying that their experiences are not valid, but yours are? If so, write an article about why these opinions should not be making it into NEJM or into any medical or scientific field.
3. What exactly are they pandering too? What political interests could the author possibly have. Yes, the author is the health commissioner of NY, but she's not the first one to have come out about this issue. What political pandering am i, a soon to be medical student, possibly doing by emphasizing the importance of such viewpoints in the medical field?
And cigarettes don't cause cancer. Correlation is not causation, I'm sure you learned that somewhere along your path to becoming a medical student. The author draws these connection, which even the act of doing you find toxic, because your average medical professional either doesn't know or doesn't care (out of ignorance), as I've seen plenty of times on SDN forums.
To your point, however, no, racism does not inherently create any medical pathologies in one's body, but that's not what the article is saying is it? And that's not what I'm saying either. What I'm saying is that batting your eyes to the socioeconomic and political factors that govern your patients' day to day interaction with health and medicine is sheer ignorance. There is a reason why latinos, african americans, and native americans are disproportionately represented with higher incidences in certain pathologies. If you live in south central LA, are african american, and spend money on fast food because it's cheaper than healthier options, then of course you're going to have a greater risk factor for cardivascular illnesses. What advice are you going to give your patients? Eat healthy? Assuming that your patient is even educated (a huge assumption and a discussion for another time), your patient probably already knows to eat healthy. So as a medical practitioner, what are you going to do?
1) Rather than complaining about healthcare disparities and saying "MORE AWARENESS," how about she offer some kind of solution for addressing those disparities in a real, pragmatic way? Apply similar logic to every point brought up in the article.
2) No, I'm not saying that at all. The difference is I'm not arrogant enough to submit an article to NEJM lambasting the medical profession for its moral failures without actually offering any ways to attempt to solve the problem. I would never submit an article to NEJM on this topic because I don't have any solutions and have nothing to contribute to the discussion - much like the author of the article.
3) The pandering is the idea that we need to do ever more - we need to never stop - at trying to help these poor lost souls who just can't seem to take care of themselves. That is the pretext between the lines, whether you're aware of that argument or not.
As far as your point in your final paragraph, what do you propose doing? I'm of the mindset that at some point people need to make an effort to take an interest in their own health. Sometimes that requires sacrifices. For example, it's easy for ANYONE - rich, poor, white, black, yellow, brown - to sit around the house, pop Pringles into your mouth, and watch TV all day. It takes an inherent interest in your own health to make lifestyle changes to benefit your health that are intrinsically "unpleasant." You pose an interesting question in your last sentence yet don't provide an answer. What are
you going to do? Before setting up a strawman, don't interpret that as meaning that I don't want to provide any kind of resources or don't think that we should do anything to attempt to help those people. The ultimate question, though, is what those things should be.
My argument is that physicians do not bear the responsibility for all aspects of a person's life. Should we work to improve the lives of our patients? Absolutely. Am I going to walk with them to make sure they buy this but not that? If I care about my patients' health, does that mean I must by necessity support political goals like expanding welfare or whatever "solution" is proposed to solve these problems? Where does it end? I guess that's what I don't understand about this line of argument. No doubt that are disparities in the healthcare system. But what are we actually going to do to attempt to solve those issues? That's the million dollar question to which no one seems to have a viable response short of continuing to push out messages of shame, failure, and inequity.
I'll give you an example from a patient I saw at a free clinic just last weekend. This was an older guy who had bilateral "leg weakness" for three years. Physical exam was essentially normal with the exception of some findings suggestive of arthritis. There was absolutely nothing we could do for this guy given our essentially non-existent resources. We offered to give him a referral to the county hospital, where he can receive
at no charge all of the diagnostic testing and therapeutic intervention that
could actually solve his problem. His response? He kept demanding some kind of magic pill that would fix his problems and make him feel normal again. He refused to go to the county hospital because that would require getting on a bus, and he didn't have a bus pass. This encounter took ~30 minutes - time that could've been much better spent seeing a patient that actually had a complaint we could address and who would take advantage of a referral we might offer him/her if indicated. Interestingly, he came to the clinic during the previous week and was told the exact same thing and given a referral. I'll let you guess whether or not he took advantage of that.
So what are we supposed to do for this guy? Just how far backward are we supposed to bend to make it possible for him to go receive
free medical care? This is my point. Are all people like this guy? Of course not. But the point is the same: at some point, you have to make sacrifices. There aren't always easy fixes.
