Mexico Medical Student |

Sid Schwab posted an entry the other day about EM blogs (I’m including nurses in what I write here) and their penchant for not only being right-of-center politically, but “vitriolic.” I want to say off the bat that I’m not here to defend his remarks point-by-point, but what he said about his post not being directed at any one blogger in particular and specifically that it was written months ago is absolutely true. In fact, he shared the draft with me in November of last year. The draft then is very close to the post of the other day, down to the same witty ending. In that sense, what is written really is representative of how he feels, not some knee-jerk rant.

But why did he share the draft in the first place? Because I said that I was going to post about that very topic because I had come to many of the same conclusions independently. I’m unapologetically liberal on most issues, but I keep an open mind and try not to let the occasional offhand remark about “lefties” keep me away from an otherwise informative or entertaining blog. Unfortunately, there are some sites that I just can’t read because of in-your-face right-wing screed brought up with no provocation, or commentary that is so ill-informed, it begs the question if the poster has MPD to also be a healthcare provider with [assumedly] a necessary component of humility and compassion. When I took stock of the sites that fit that category as I was trimming my newsreader’s feeds, I came to an inescapable conclusion: almost all of them were EM blogs.

EM has been corrupted by being made into the PCP of the disenfranchised and uneducated, as well as the pressure valve for inpatient floor inefficiency as admitted patients crowd the ED, further straining things. I get it. I was a volunteer at Ben Taub Hospital in Houston for over a year, primarily acting as an unofficial Spanish translator. Ben Taub is a model of your classic, inner-city urban hospital. Analogies would be Parkland in Dallas or King in LA. Houston, being the 4th largest city in the US and given its demographic, the ER population was primarily Black and Latino, both seemingly unable to speak decent English. I’m not going to pretend that my experience means a damn by comparison, but I wanted to make clear that I’m not talking out of my ass here.

I give the benefit of the doubt to any blogger of any kind when ranting that this the blowing off of steam is not representative of the patient care, that the “dumbass welfare mother” did not get treated at 30% of the care as the “private insurance patient.” But when blowing off steam or generalizing various patient populations is a near-daily occurrence (so much so in one example of a nurse blogger that ™ed the phrase “Medicaid Mentality,” as if it took much mental muscle to come up with it), ultimately I see it as a sad state of the person that wrote it. Just as it’s the height of stupidity to tell a cop, “My tax dollars pay your salary…” it’s just as stupid and self-important to say, “My tax dollars paid for that Mexican’s CT scan.” You don’t make enough to make a difference in anybody’s hospital bill as you aren’t that important. Abuses will occur in any system, and to the best of the ability of those responsible, it should be reported and dealt with. But the cost of tracking down every thug who has some drug money stashed away who might just be on Medicaid is ridiculous (watch your tax dollars go away even faster with the new Medicaid Police Enforcement Unit!). The fact that they come into your ER wearing far more jewelry than you’ve deemed appropriate for your label of what their economic/Medicaid status should be is irrelevant at best, pompously arrogant at worst.

On the subject of labels, “liberal” is used as a mild pejorative by those on the right, with “pinko,” “tree hugger,” “moonbat,” “terrorist sympathizer,” and many other colorful words to use for stronger effect. What words are used to describe those on the right? “Conservative” is simply a proper term (except this administration is anything but; real conservatives despise the “neocons” just as much as we do). “Fascist,” perhaps, but there’s a lot in between. You see, therein lies a big difference: there isn’t nearly the same screedy list to choose from because collectively, we try not to be that way. Everyone is guilty of generalizing to a degree as a necessary evil, but profane name-calling and deriding those who are “too stupid to go to their PCP/OBGYN” is not a staple of most any medical blogs outside of the EM ones. For the blogs that are offenders here, the tone of “I’m better than you” (you = patient/family, boss, administration, co-workers) is unmistakeable.

There are very polarizing issues in health care, such as is healthcare seen fundamentally as a right or a privilege? How much should the economics of medicine be market based vs. government regulated? There are no easy answers to these questions, yet too many simply state their simplistic opinion and accept no other. I don’t care if someone’s on the wrong side on an issue from my POV, but a well-stated argument–however ill-informed I think it to be–deserves respect. Too many right-wing bloggers don’t even bother…not they they owe me or anyone else an explanation, but at the same time some of these are the same that jump on others’ sites sniping their tired rhetoric there as well.

When I saw the comments to Sid’s post both on his site and others, it struck me how some didn’t even read it properly; the answer to their question was right in front of them had they simply turned off their prepackaged assumptions. Worse still, some clearly read it by quoting and commenting and STILL overlooked the obvious. It occured to me at that point that Sid’s post acted sort of like a political Rorschach test–in reading it, one would see what one wants, perhaps a reflection of oneself.

Lastly, a modest request to the right-wing EM bloggers that can’t help but make commentary on sociopolitical issues of their less fortunate patients: when there is a positive story (and there are, don’t lie), share it and don’t ruin it with a caustic comment about this or that. Write about a surprisingly positive encounter for what it is. It’s not right to have a situation where your assumptions were turned upside down, proved dead wrong, only to mentally chalk it up as an anomaly. No one here is so naive as to think that there isn’t a definite pattern among certain patient populations, but the exceptions are far more interesting than the rule. Share them.

(Update 6/26/08: The SCOTUS just ruled the DC handgun ban unconstitutional. Believe it or not, I agree with the majority and Scalia’s written opinion that any complete ban that prevents law-abiding citizens from protecting their home is against the spirit of the 2nd amendment. I’m from Texas, after all. Just another example of how none of us are 100% anything politically)