Inaugural music not so simple a gift

For whatever reason, I feel compelled to finish this languishing draft in a form different than it began, wanting to publicly consolidate some thoughts on last week’s inauguration while not waxing as far as I originally tried about the future of our nation and a renewed hope in our place in the world. To be sure, I am as excited as I was last week about these things, and I am happy to see that after less 10 days in office, Obama has not only repealed some of the shameful legacies of our last president, but clearly has set an unapologetically new tone from the West Wing to the West Bank.

For the record, I fully expect to be disappointed in some things I really feel strongly about not moving forward the way I thought or that he originally promised. Part of being a good leader is adapting to new situations and information; being a better leader is conveying why things have changed for those who were expecting otherwise. We’ve had enough of this “stay the course” because “I’m the decider” bullshit for a lifetime.  I think everyone on both sides of the aisle should be in a position of compromise on domestic affairs in this time of financial crisis.

Having gotten “current events” out of the way, I want to return and remain on the inauguration itself. I saw it partially live, but since I was caring for my daughter that morning, I was unable to see Obama’s swearing in, speech, and after coverage until later from the DVR. Fortunately, one item I did see live just before having to switch off was when Sen. Feinstein announced the names of Itzhak Perlman, Yo-Yo Ma, Gabriella Montero, and Anthony McGill to play the commissioned inaugural work by John Williams, “Air and Simple Gifts.”  I about fell out of my chair when I heard Perlman and Ma’s names. Mind you, we had just heard Aretha Franklin in the broadcast which was already over the top awesome (not to mention that gem-studded bow hat!), but to have Perlman and Ma on the same stage LIVE as a surprise (I hadn’t done any prior scouting or reading of events) was incredible.  Wind instruments aren’t my thing, so I didn’t know the clarinetist, but Gabriella Montero is a phenomenal pianist and gifted collaborator on several cross-over projects; she’s also certainly Venezuela’s most popular export to the classical music world along with Gustavo Dudamel.

The point is, before the music even began the tremendous surge of pride at how serious music and the arts had been given here was overwhelming.  This was no “filler” cocktail quartet music–this was the unquestionable musical “main event.  It also instantly occurred to me that 3 of the 4 musicians were not originally of this country (Perlman and Ma however are both naturalized citizens), and the fourth was African-American. What incredible symbolism of unification and diversity in just the musicians themselves!

Then the music started.  Once they started playing, the realization hit me like a brick across the head: “OH. MY. GOD. It’s 20-something degrees and Perlman and Ma have their multi-million dollar Stradivarius instruments warping in the cold?!”  Just as my heart recoved from throwing a PVC it then hit me: “Wait…the piano!!!!  How is it being kept in tune?!”  You have to understand–it takes HOURS to tune a piano; there are 88 keys but over 200 strings/pegs to adjust since most keys have more than one string (most have 3)–all of which need to be in unison among themselves and in proper relative pitch with every other key.  I think, “So instrument valuation aside, adjusting the four strings of a cello or violin, or pushing in/pulling out the segments of a clarinet would be comparatively simple, yes, but….”

And suddenly I hear that familiar tune, used so gloriously by Aaron Copland in “Appalachian Spring” that’s become part of the very fabric of  American musical existence.  And then it continued. And continued.  “Aw hell no….” I thought to myself, realizing that this was the focal point for Williams’ work.  I was so disappointed, feeling the event was cheated, wondering how Williams could have not come up with something more personal, more evocative of this special moment in history.

The whole point of a commission is to write something new, not re-work a tune that elementary school children could recognize that was already popularized and made iconic by yet another American composer.  GOOD LORD!

I even tweeted the fact that I thought the composition was less-than-desirable in real-time, so this is not a revisionist point of view, but I did look up what people thought afterwards and I’m comforted to know I’m not alone. In the process, I also discovered what probably everyone now knows about the “live” performance and that what we heard on TV and what was broadcast locally over the speakers was in fact a pre-recorded performance from the previous day for the very technical reasons I was thinking as I was watching.  I didn’t feel bad when I found out, because obviously I know why and also that they were in fact playing in real-time; the honor to the event was still maintained if you could hear any of them acoustically. There were just too many damning technical factors to consider outside the players’ control to do the event justice for everyone while still have them on stage in that weather which Yo-Yo Ma himself described as “wicked cold.”

Regardless though, I’m happy to see that classical music got a prominent moment to shine, even though it was via Williams channeling Aaron Copland cheered on by Wolf Blitzer’s voiceover in the middle of the performance–but I won’t go there lest I get upset all over again…

Small Changes, Big Dividends

Hello and Happy New Year!  I know I took an unexpected blogging hiatus, and while I did plan on taking a small break through Christmas, the rest was, well, unfortunately not how I thought things would go down. I’ll come to talk about things soon enough, but for now I want to concentrate on getting some “real” content flowing. I refuse for the blog to continue to go stale because of things as mundane as personal problems.

Tuesday is an historic day as we swear in our 44th president, Barack Obama. Personally I’m jealous I don’t live in the DC area anymore (Fairfax County across the river, same difference) because I’d love to be part of a part of a part of something that day. Oh well. But it’s just a day in the end, and much work needs to be done in our nation, one of the most pressing issues being health care reform. I’m neither a practicing physician nor a policy analyst, so I’m not going to embarrass myself with attempts at unoriginality against such smarter people, but I can say what works from a patient’s perspective, especially one who can see both sides of the issue natively. “What do you mean? What do patients have to do with health care reform?”  They’re intimately involved in it! Left out of so many policy discussions, the patient-end of the equation is critical, but more on that later.

This last November I had a silly incident with my wrist and the side of a car that hurt at the time but I blew off, blaming as much my clumsiness as anything else. After weeks of not feeling better and rest/anti-inflammatories not making a difference, I finally got it looked at and wound up at this hand-specializing orthopedic surgeon, MRIs in hand (ha ha) showing a tear (that’s a separate post).  I was very impressed with him and his approach, appreciating his conservative management style. I normally don’t let on I’m a med student for a variety of reasons, but he asked what I studied (chart said “Occupation =  student”) and when I told him, he became even more effusive and engaging. Interestingly enough, we talked mostly about policy issues! (it’s on everyone’s mind right now!)

Regarding my condition, he said he wanted to do a steroid/lidocaine injection into the joint space to give short-term relief, re-evaluate in a month. As many of you know, I’m a classical pianist, and while I don’t play regularly these days, the very idea of a complication that could compromise that aspect of my life mortifies me, so I’m happy with baby steps. He’d be back in a bit and added, “Oh, and I have a letter for you,” as he handed me a piece of paper that for whatever reason I noticed immediately was both hand-signed and on good cotton-fiber paper stock. Still a bit taken aback, I asked, “What’s this about?”  He smiled and said, “I’m an old-fashioned guy, that’s all. I’ll be back in a bit,” and closed the door, instructing the other side for his assistant to begin the prep for the injection.

As I waited, I read this hand signed letter. Here are the relevant excerpts:

A Personal Letter From Your Doctor, MD

Dear Mr. Cantu:

Thank you for coming in today to consult with me regarding your medical care. I appreciate and respect your trust in me as your doctor and orthopedic surgeon. I strongly recommend you share in the responsibility of treating your condition. You can do this by following any medical advice given and keeping scheduled follow-up appointments. Timely follow-up is extremely important as delay in treatment could lead to deterioration or, even worse, permanent dysfunction.

On occasion, delays occur in the office. I ask for your patience as these delays are due to attending patients with complex issues. We will try to keep you informed when such delays occur. I assure you that should your medical problem require extra time, it will be fully provided.

Lastly, it is the policy of this office that all proven conservative (non-surgical) treatment options will be embarked on firstly. Surgical intervention is only offered if conservative treatment fails to alleviate your symptoms.

[closing paragraph, thank you, etc]

Is that awesome or what?  I also noticed in the letterhead the abbreviation FRCS for Fellow of the Royal College of Surgeons in the UK (he’s also an American FACS here, for what it’s worth). He had mentioned training in Canada (his ethnic origin is Caribbean of some kind, didn’t ask) but obviously there is some of that “English gentleman” thing going on here. I know good and well it’s a form letter coming off a laser printer at the last minute before entering the room, but it doesn’t matter. And if doesn’t matter for me, someone who sees what the wizard is doing behind the curtain, imagine how much more it can make a difference to an average patient, particularly older patients, who truly feel that they “connected” with their doctor in a unique and personal way–and on the first visit!

But the story doesn’t end there. After the injection I was waiting for 10 minutes or so to make sure it all got nice and happy in the joint space. Sir Orthopod came in and sat down, and started dictating in front of me. I thought this was a bit odd, though it’s happened on occasion before, but it was always when I was in a physician’s office already or in a hallway; in other words, it seemed like it was just occurring as a matter of course. This was different–he came into my exam room on his own volition, sat down, and started dictating into a digital recorder. He even paused once or twice to make sure he got something right, which he did, my thinking he was taking advantage of my being there out of convenience as I sat and listened patiently.

I thought during this he might just be more at ease because by this time he knew I was a medical student and felt comfortable dictating the technical behind-the-scenes in front of me, but in talking with him later, he said that he does that with all his patients. I was shocked! On the surface, it sounds like no big deal, but there’s a lot that can be said that can be taken the wrong way/misunderstood by someone who can’t parse the terminology/jargon, or feel that the physician “didn’t tell me that,” when in fact s/he did, they just used laymen’s terms in the conversation. But the surgeon said he does that intentionally to further avoid liability and increase transparency. It’s rare and more comes up with worker’s compensation and disability claim-type cases he said, but it’s very hard to claim “I had no idea,” when his standard practice–and that’s the key–is to dictate in front of the patient. The dictation is transcribed to the official record, and if the patient is present, that’s yet another opportunity to both 1) correct the record as it’s being dictated should the physician get something wrong, and 2) provide a legal support structure against false/misleading claims. Add a personal letter signed by hand, encouraging patient cooperation and apologizing in advance for minor inconveniences, etc. and you have a framework for the following:

• a happy patient who feels listened to and cared for (less likely to sue, far more likely to refer word-of-mouth to friends/family)
• a physician who knows how to invest, having just spent about $0.02 on a sheet of good paper stock and 1 second signing a letter for literally countless dollars of saved legal headaches, increased referrals, pleasant encounters, etc.
• a physician who spent ZERO extra time, but by dictating in front of the patient provided extra legal protection, greater fidelity of the medical record, and further fosters a sense of transparency and trust with the patient
• a patient whose medical expectations are manged from the start, thinking that because they were referred to a surgeon they need/will have surgery
• a patient whose expectations are managed WRT office wait times not only by telling them it can happen but assuring them their care will not be compromised when its their turn. This also takes the heat off of the front staff, and happy staff makes all the difference too.
• and perhaps most importantly, a patient who is invited to take an active role in partnership for their own care, hopefully achieving greater compliance for not only better outcomes but lower healthcare costs by avoiding complications, unnecessary procedures, etc.

The small steps taken by this doctor might seem trivial on the surface, but to me they’re genius because they accomplish so many good things in an honest way so effortlessly. The goal here is patient satisfaction and success with the added legal protection a bonus. This is just one relatively medium-sized solo practice in a small-medium south Texas city. Imagine if small changes like these were implemented everywhere, how much morale and rapport could improve, frivolous lawsuits could be avoided (or at least provide further disincentive), and how much the climate could change for the better all-around. I’m not idolizing this guy, I’m thinking beyond him to the bigger picture.

The other thing about his attitude, reflected in his letter, is the participation of the patient in their own care. We keep talking about health policy and reform from a top-down approach, changing insurance policy structures, provider reimbursement schedules, etc. rather than a bottom-up approach. While anyone really involved knows it’s a two-pronged approach, the media, and more importantly, too many patients feel they are mere bystanders in both the discussion and the solution, and I appreciate this physician opening the door to that reality for his patients. More on patient responsiblity in a separate post.

Hostile HIPAA

Adding to my new experiences as a patient, I have now run into heretofore unforeseen side of the HIPAA monster. As a patient, it should be protecting me, right? Of course not! Legislated in part to protect privacy, HIPAA is one of the most misunderstood and abused laws by healthcare personnel, particularly clerical staff at the front lines of the patient-physician records interface who may not have much of a healthcare (or all that much educational) background to boot. 

In my case, I called wanting a report from a minor surgery a few weeks after I had it done. I had already called the surgeon’s office and they said that while they did have a copy via their electronic medical record (EMR), the actual operative report was the hospital’s property and they couldn’t give me a copy; they just had viewing privileges, I was told. In the past, I’ve received every copy of everything I’ve ever wanted. This “ownership” business was nonsense–after all, this was my surgeon and the paper copy was in my chart. As long as I was there and asked for it, a simple copy had always been made for me to walk out with said report in hand. To be clear, I’m talking about post-HIPAA, not some wistful recollection of the way things were back in the “good old days.” Said surgeon recently moved into a brand spanking new office, has a ton of new staff, and I just thought that this was just a miscommunication–escalating to a supervisor or the like should resolve the problem.

Obviously it didn’t, but the fun was just about to begin. My instructions–reasonable, I might add–were to contact the hospital’s medical records department since they “owned” the information, and they could help me further. It was speaking to the medical records (“MR” below, because I like the double-entendre) office that thing became unglued. Below is a faithful transcript of our conversation, edited only for general length and idle banter:

Me: [explain my needs] So what procedure do you have for me to get a copy of the report?
MR: You need to come by–in person only with a picture ID–fill out some paperwork and pay a processing fee that starts at $42.50 for first 10 pages.
Me: $42-what?! The report is just one page, I think–maybe 2 at most. I mean, it’s on the screen–just hit ‘Print’
Me: Doesn’t matter if it’s 1 page or 10; it’s the same price.
MR: But wait, my family doctor’s been FAXed records from here–did you charge his office too?
MR: No, we don’t charge physicians because the request is for continuation of care. If we give a copy to you it’s not for continuation of care, it’s for your personal use.
Me: But the same work is being done, you just aren’t charging the doctor but are charging the patient? So it’s not a cost recovery, you’re penalizing the patient.

MR: We give it to the doctor electronically [not true, only applies to affiliated doctors in same med center]. We charge you or an insurance company because we have to physically process the record [what, press "Print" from the screen interface?!?] If it the report is for a doctor, they can access it electronically.
Me: But the doctor is in [my home city, 35 miles away], he’s always gotten records by fax.
MR: Well, we just went live with our new system in October.
Me: But if your system wasn’t live, you’re still saying you would charge me and not him.
MR: That’s correct, but slightly less than $42.50.

Me: OK, but I’m saying my doctor I know has no login credentials to your hospital, no privileges, nothing. So how can he get a copy?
MR: I’m guessing he’ll have to apply for access, but–well–I don’t know–I’m not the one that handles that, but in the meantime if he can’t get to it online, someone will have to pull the records, process it [again, this is just a quick computer search that takes 5-10 seconds], and send him the records–
Me: –which is my point: you’ll have to send him the records manually, but you aren’t going to charge him for the same work you’re going to charge me–
MR:  –That’s right! [Proudly, as though she's won an argument b/c I'm agreeing, which was most disturbing]
Me:  –someone is going to have to physically process this–
MR: Yes sir! [again, defiantly]
Me:   –and send it to my physician without charging him.
MR: Yes, because it’s for continuation of care [emphasis theirs, spoken slowly] and that’s something very different.
Me: [previously explained about my having been in Mexico, do have a "continuation of care" issue for my own recordkeeping] I already told you, I need the records for a physician in Mexico.
MR: If you can provide us with the name and address, we can release the records to him and mail them.
Me: To Mexico?!?!
MR: Yes sir, we can mail them.

Me: You have no idea what mail is like in Mexico; it will take a month at least if at all. I doubt you’ll pay the $30 for FedEx for that one page. Besides, are you sure all these fees are consistent with HIPAA and state regulations concerning access, etc?
MR: Yes sir, I can even provide you with a fee schedule.
Me: Can you fax that to me?
MR: Of course, let me get your fax number.

And with that deliciously ironic ending, the “labor” and “pulling records” was equal to the fax of that one page which they were all too willing to perform for free so their fees could be proudly shared. The 10 minute phone converation could have pulled at least 5 records and faxed as many copies. This is robbery, plain and simple.

HIPAA was crafted for portability (change in jobs, location, etc. doesn’t make one “start over” in terms of coverage) and security/privacy above all. It is, in spirit, supposed to be protective of the insured at the unfortunate and unfunded responsibiity of the healthcare provider caught in between trying to both comply and do right by the patient. I sympathize with this, but to selectively push costs back on the patient and not a physician–or more to the point, another business entity capable of absorbing said costs as the price of doing business–is predatory and in stark contrast to the spirit of the law. Moreover, HIPAA left way too much open to vague enforcement with language like “reasonable fee.”  It’s no wonder that individual state agencies and other entities are pushing the envelope with what’s “allowable” at the patient’s (ie, the person most exploitable and vulnerable) expense.

In the end, I got my report–not by paying $42.50 to the hospital, but at my next surgeon’s visit, I simply asked him if I could get a copy.  Without hesitation, he said “Sure!” and directed his nurse to go up front and make a copy for me on my way out.  Done. Piece of cake. HIPAA be damned.

The Worst Political Commercial EVAH

Is it about Obama being a turban-headed Muslim terrorist?  Is it about Palin’s $150,000 wardrobe that ostensibly will go to charity afterwards?  Is it about McCain’s gorilla-rape joke? No, no, it’s none of these silly, misguided attack ads. This “my friends” is about a Palin impersonator shilling for a CHINESE BUFFET RESTAURANT:

What is not evident in the video above is the fact that, like many buffets of this caliber, it’s mostly full of grease-laden crap bearing no resemblance to fresh, bright Chinese food of any kind.  It’s so catering to the fried-chicken crowd that it even sports a drive-through. I kid you not. With the commercial and the food, clever gimmicks and bad substitutes go hand-in-hand. And there is no lack of people willing to eat it up.

Election Edition Grand Rounds

Grand Rounds, the Election Edition is up at Nurse Ratched’s Place. Go check out the best of the medical blogosphere.  Although these posts have already been vetted and voted upon, YOU can still vote in the BIG election if you haven’t already.  Exercise your right or don’t complain later!

I’m a Victim of Voter “Fraud!”

I, like many others participating in early voting, welcomed the opportunity to avoid the pandemonium of Nov. 4th.  On Halloween oddly enough, I went to my local voting center to proudly cast my vote for Barack Hussein Obama/Joe Biden, etc. phone video camera in hand in case any tricky-tricky vote-flipping nonsense were to occur that I had read about. (You KNOW I would have posted it here and notified everyone I could–if it can even happen to Oprah you can’t be too sure!)

Imagine my surprise when I gave my driver’s license and after a long wait involving some phone calls I was told that I was not a registered voter.  “That’s impossible!” I said.
“Do you have your registration card?” the lady asked.
“No,” I replied. “Everyone has told me–even your signs say–you only need your driver’s license. What’s going on?”
After some hemming and hawing, a supervisor came over, review the situation and asked me, “Did you vote in the primaries?”
“No.”
“Ah well, there you go, you were probably purged from the voting rolls.”
“WHAT?! So everyone here voted in a part primary? That’s the most ridiculous thing I ever heard!”

By this time, this conversation was drawing some attention, so the supervisor lady and I stepped behind this divider where we could talk with a bit more privacy.
“When did you register, then?” she asked.
“When I renewed my license, two years ago in 2006.”
“Oh well THAT explains it. DPS [Department of Public Safety, state troopers + drivers license division] just doesn’t send the information all the time, this happens.”
Now I’m ready to punch a kitten I’m so mad. “WHAT?!?! Now this is DPS’ fault?! ‘They’ are the ones responsible right?  Why doesn’t everyone else have a problem then? Because that’s how most people register.”
“No, most people register through us [county].”  Typical small-minded “my world = everyone else’s universe” thinking.  Like the “motor voter” initiatives were small potatoes, what a laugh. “And besides,” she continued, “if you haven’t voted in the last two years, you’re purged from the rolls anyway.” [this isn't true, it SHOULD be two federal election cycles, not two years]

It was clear I was going to get nowhere with her, or even a phone call to the county voter person because, well, this is about as busy as it’s going to get outside Nov. 4th, and by the time I get through to someone, what are they going to do? I filled out a provisional ballot which may or may not be counted for the general election, depending on the mood of whomever reviews the ’cause’ of my ‘affidavit’ contained therein that in fact, I am eligible to vote.  Great.

We like to think of one person, one vote as if that makes a real difference. Without a tirade on the electoral college, the fact is Texas as a whole is as red as it gets. We’re the home of George W. Bush for crying out loud, as well as other notable figures destined for punishment in the afterlife such as Tom Delay and Phil Gramm. My vote, even in my own county, would probably diluted to the point of irrelevance, but in the end, I wanted to say I was there on this momentous election year, to feel like I was one lever-pull, touch-screen, whatever part of history. Now I won’t even know until after it’s done.

I’m just happy that while my vote may be diluted to irrelevance, hundreds of thousands of others will not. Tonight we will signal a new era in American politics, and come January, we’ll be putting this train back on the tracks. I’m tired of seeing Democrats act like simpering schoolchildren–Pelosi especially–caving to a perceived bully. With Obama in the White House, maybe Congress can not only act on initiatives that I feel are important, but restore some dignity in doing so.

I will watch events unfold today like everyone else, and whether my vote will count or not will not affect the outcome of this historic day.

Protected: Chr1s R0ck on Politics (HB0 2008)

EM Blogger “Hate”: Nature or Nurture?

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)

Sicko: OB/Gyn Love

I’m in the middle of studying for a huge exam on Monday (more later on that), but I simply could NOT WAIT to post this, probably one of the best Bushisms I’ve ever heard:

I’ve only watched the first 20 minutes or so, but if I’m brave enough I’ll post my useless review/opinion in the next day or so. Of course I’m leaving off how I got the video. It’s confidential research materials, after all.

P.S. For those returning readers wondering where the school posts of late went, I’m going to make a final update on that later today. Don’t worry–it’s not bad news. (for once)

Ann Richards: RIP

I know I’m late with this (and with everything here this week), but I had to say my peace regardles: Texas and the nation lost a true heroine with the passing of Ann Richards this last week. Unless you are a Texan or a die-hard Democrat, it’s likely you may not really know who Ann Richards was. She was the second female governor of Texas from 1991-1995, losing her re-election bid to current president G.W. Bush. I won’t go into all of Ann Richards’ accomplishments, accolades, etc., but I will say two things that stick with me personally besides all the other things.

First, she never apologized for having had a drinking problem. I respect people immensely who have a problem, own up to it, get help, and beat it. For a woman to do it and have the attitude in a good-ol’-boy state, “You got a problem with that, wise ass?” is remarkable. So many “famous” people either refuse to get the help they need or treat rehab like a revolving door. Not Ann.

Second, I can’t imagine a better role model for women. I will tell my daughter one day about Ann Richards. Her rapier wit was matched only by her huge heart. She championed so many women’s and minority’s rights while in all offices she held. The list of landmark reforms in her tenure are more than impressive. You may disagree with her politics, but you can not disagree with her humanity.

OK, so I said I wasn’t going to go on and on, so I won’t. Instead read a great article here.

A great story from Molly Ivins sums it up pretty well:

[State comptroller Bob] Bullock, 20 years in Texas politics, knew every sorry, no good sumbitch in the entire state. Some old racist judge from East Texas came up to him: “Bob, my boy, how are you?”

Bullock said, “Judge, I’d like you to meet my friends: This is Molly Ivins with the Texas Observer.”

The judge peered up at me and said, “How yew, little lady?”

Bullock, “And this is Charles Miles, the head of my personnel department.” Miles, who is black, stuck out his hand, and the judge got an expression on his face as though he had just stepped into a fresh cowpie. He reached out and touched Charlie’s palm with one finger, while turning eagerly to the pretty, blond, blue-eyed Ann Richards. “And who is this lovely lady?”

Ann beamed and replied, “I am Mrs. Miles.”