Archive for June, 2014

OUTFOXED

June 30, 2014

A recent Fox News show claimed Minnesota was the first state to allow Sharia Law.  The reasoning included Somali cab drivers at MSP Airport, who refused to transport people who carried alcohol and a Muslim cashier at Walmart, who refused to handle bacon.  The latter was re-assigned.  The former?  Well, if a cab driver doesn’t want to take me, there are a lot of other cab drivers who would be more than happy to jump the queue.  We all must decide whether we are willing to take the financial consequences of our beliefs.

Assuming this is true, and given Fox, I would have liked to see this for myself, these are scare tactics, NOT news.  Sharia Law says that a nonbeliever must be put to death after first being allowed to convert to Islam and refusing.  I have been to Minnesota well over forty times, I have spent more than 300 nights in the state, and I haven’t even seen a mosque.  Fox plays on American fears of Muslims, the 25% who believe Mr. Obama is a Muslim (as if it mattered if he were), and Muslim beliefs.  Let’s look at a few of those beliefs: eschewing alcohol (like Mormons), not eating pork (like Jews), praying in hundreds (which every large Church does during its service).  Fox omits saying Islam requires charity outside of taxes, limits loan interest, which we would do well to adopt, believes in prayer as a time to reflect upon one’s life (doubt many do that), and fasting to remember how the poor feel. I respect these tenets, just as I respect many in Judaism and Christianity.  There is a lot of good in religion.  The Holy Books have beautiful passages.  The idea is good; the execution often is too good, using a different meaning of “execution”.

In other words, Fox News was cherry picking, and the cherries weren’t ripe to begin with.

Let me demolish the argument right now by going back to 1960, before most of the anchors were born.  John F. Kennedy was seeking to be the first Catholic President of the US.  Back then, people then said that if Kennedy were elected, the Pope would be making American policy.  Yes, I remember that.  We also know that the Pope did not make American policy.

Now, we have over 60 million Catholics in the US, our vice-president is one, and I didn’t hear anybody’s saying that an Argentinian (good heavens, a LATIN-AMERICAN) would order, from ITALY, of all places, Mr. Biden or 20% of our population what to do.  Fox missed the boat on that one.  Indeed, in the process of googling this, I saw a picture of women whose hair was covered, and thought they were Muslims.  They were NUNS. Why is it fine for a nun to cover her hair but not a Muslim woman who desires to do so?

This particular clip upset some.  One said the Somalis should “become Americans.”  What is that?  I think she meant waving the flag (even if you don’t look at it when the national anthem is played), have a yellow ribbon on your car (but never have served), go to a Christian Church every Sunday (but deny people who love each other the right to marry).  We have the right to believe what we wish in this country, no matter how detestable it may be.  They believe life begins at conception, have no idea how the fetus develops, but do not care about the baby’s welfare after birth, especially if a person of color.  The Declaration of Independence said all men are created equal, but didn’t say “physically equal”: some have bad genes and really rotten luck.  As a doctor, I saw many with horrific conditions, some preventable, most not.  How do we handle them?  By dismantling safety nets?

What is an American? Somebody who believes what Fox News says, or somebody who thinks about what they say and disagrees?  Somebody who believes food stamps should be outlawed because of an abuse story, yet thinks guns should be available despite very deadly countable daily abuse?  Food stamps have less fraud than Medicare. Illegal gun sales are common, not just anecdotes.

What is an American?  Somebody who thinks America right or wrong, but tosses litter out the window, or puts a box of kittens out in the desert?  Somebody who obeys laws they don’t like, or grazes cattle on public land without paying?  What is an American?  Is it prayer at public events, Christian prayer, that is, insulting non-Christians and non-believers, like me?  Who is “big government” we love to hate?  Do we hate ourselves?  WE ARE THE GOVERNMENT.  Would we demand government tell a Somali cab driver whom he should carry?  He has the right to refuse to serve a person.  Or do rights belong only to “native born” Americans?

Does being an American mean we need to start speaking and writing English better?  I’d welcome that.  Is it knowing American history?  Then why didn’t we learn from Vietnam and not attack another country in a part of the world that we have little understanding of?

Jews eat Kosher; their diets forbid pork, so I don’t see a problem with a Muslim who doesn’t want to touch pork.  I am vegetarian and don’t want to touch meat. The Native American Church is allowed to use peyote, otherwise illegal.  The Catholic Church uses wine, alcohol, in its services, forbidden by Islam.  Ironically, “blue laws,” which restrict the sale of alcohol on Sundays, affect me, although I neither abuse alcohol nor am a believer.  I have to obey religious doctrine in buying alcohol on Sunday.

How is a Somali’s refusal to transport alcohol Sharia Law?  Do we have Jewish, Catholic or Mormon Law in this country?  No, we have religious beliefs of many types, and we try to accommodate those beliefs.  The NCAA doesn’t make BYU play tournament games on Sunday.  Jews don’t work on their holy days, and we allow that.  Catholics celebrate Holy Week, most of of us Christmas.  Sharia Law?  No.  Are there women who wear the Hijab here?  Yes. Sikhs wear head coverings.  So do nuns.  What’s wrong with that?  At the last funeral I attended, the number of people wearing jeans appalled me.  And we worry about covering hair?  I’m ex-Navy, and I soon learned when one did and did not cover.  One salutes only when covered, not otherwise.  Sounds like covering the head is special.

People have strong beliefs.  I have mine, too, that one may read in the nearly three hundred posts here on the blog.  Some are perhaps irrational; others may appear to be but are not.  Decide for yourself this belief of mine:  Fox News promotes hatred and fear, is biased, too often appears in public places, and violates the interpretation of the First Amendment. There are limits to “free speech,” and Fox has crossed them.  If I am wrong on that, correct me.  Then try to convince me Fox is “fair and balanced.”

If my wife wears a cover in Minnesota, it is to protect against mosquitoes, not Sharia Law.

 

Tags:
Posted in GENERAL STUFF, MY WRITING | Leave a Comment »

24 x 7

June 21, 2014

Recently, I read a post about how the children of the ‘70s survived, despite all the problems they encountered: recalled toys, like lawn darts; not wearing seat belts; no helmets; and leaving kids unattended. Lawn darts caused a few injuries and one death; 12 high school and college students die annually from football, but a lot more play football than threw lawn darts.  It might not have been unreasonable to ban them.  Given football’s propensity to cause brain damage, I think the game must change, a tall order in this country.

We don’t need helicopter parents, not letting their children discover the world for themselves.  Kids need to experiment.  But some experiments we know aren’t a good idea, and we don’t want kids repeating them.  Diving into unknown water is one of those.  Not wearing a seatbelt is another.  I remember when cars didn’t have seat belts; people who first encountered seat belts in cars thought they were weird, like we were going to go flying.  On holiday weekends, we saw in the paper numbers of dead (hundreds) from motor vehicle accidents.  Since 1960, the absolute death rate has fallen, despite a near doubling of population.  The actual death rate per 100,000 is half of what it once was.  Seat belts are the major reason.

Helmets save lives, too.  Recently in my city, an 18 year-old girl hit her head after falling off a skateboard.  She got back on, a little while later was short of breath, collapsed and died.  This was almost certainly due to an epidural hematoma, with the classic lucid interval, and could have been prevented by a helmet.  Anecdote?  Sure.  But data support helmet safety.

Second hand smoke may not have caused cancer yet in the generation born in the ‘70s, but they are still young.  Wait until they become 50 or 60, and some who never smoked die from lung cancer.

The issue is not that you got away with it, and therefore it was safe.  That is Challenger-type of thinking. Challenger was unsafe to fly at the ground temperature it was at.  We had plenty of evidence to suggest that, but no catastrophe had occurred, so launch was allowed.  The issue is probability.  The probability I will die in a motor vehicle accident is very low.  But I can make it lower by wearing a seat belt, which then makes the airbag useful.  The probability I will get cancer from second hand smoke is low, but I can make it less by not being around it.   Smokers can live long lives and non-smokers can die young, but the probability is against such an occurrence.

I continued to write that in my youth, we had 3 TV channels, not hundreds.  We did not have Nancy Grace, Fox News, or Keith Olbermann.  Last year, after the Asiana crash at San Francisco, we had extensive coverage, where experts were continuously asked to offer opinions about something about which they had limited facts.  “Dead air” is an ironic killer in 24 x 7 news, and it has to be filled, but if the filler is conjecture, and if it is repeated often enough, the conjecture becomes treated as fact.  Politicians have known that for decades.

If child abduction and murder by strangers were 26 times higher than it is now, we would have a national campaign to protect children.  Come to think of it, we do.  And it works.  The problem is that a child is 26 times more likely to die in an auto crash and 20 times more likely to die at the hands of a family member than a stranger.  But 24 x 7 coverage of an Amber Alert overplays the idea that children are always in imminent danger, when they aren’t.

The idea that we are just seconds away from death at any moment, “It could happen tomorrow” on The Weather Channel, the idea that but for a super hero or a first responder, our lives could be snuffed out in a second, is wrong.  We need counts of deaths, we need proof of dangers, if we can determine such, and they must be peer-reviewed.  Mike to The Weather Channel:  the most dangerous weather system on Earth is a stalled high pressure system.  Heat-related fatalities comprise a plurality of weather related deaths in the US, drought is the cause of more than half of all worldwide weather-related deaths.  Showing storm chasers near electrical storms does not help teach people that lightning annually kills more people here than hurricanes, even with Katrina’s toll factored in.

Such 24 x 7 coverage often pits two “experts” against each other in the name of equal time, whether or not the science is equal.  Climate change is an example. Or, it asks multiple experts to speculate, when speculation may be outright wrong, either because the facts aren’t clear or the reasoning isn’t.  In a country with over 300 million people, there are daily tragedies.  Indeed, each of us in our own lives has tragedy strike numerous times. On an average day, most of us have things happen that we don’t like.  It is probability, and low probability outcomes with large numbers of events lead to a significant expected value of these uncommon outcomes.

There is significant news every day.  It would be nice if it were reported and then left alone until further information becomes available.  Breaking news is not helpful if it glues people to the TV screen, with experts trying to comment upon things they can’t effectively comment upon.  It is akin to diagnosing a patient based upon what they write in a letter or say over the phone.  A good doctor will use extreme caution here.  A good journalist should, too.

 

 

 

Tags:,
Posted in Uncategorized | Leave a Comment »

STUDENT-ATHLETES

June 17, 2014

At the recent Track and Field championship in Eugene, I heard numerous announcements and saw commercials on the big screen about “student athletes”. I don’t like big screen ads during competition, since it is distracting, and I doubt the money generated goes to help students in financial difficulty or to pay grad students better,

It appears the NCAA is pushing the term “Student athlete” vigorously, as former UCLA basketball star Ed O’Bannon is suing them about not receiving compensation for the NCAA’s use of pictures of former “student athletes”.  He was joined by Oscar Robertson, who puts Mr. O’Bannon in lofty company.  O’Bannon was one of the few who succeeded professionally in his sport.  He led UCLA to the NCAA basketball championship in 1995.  He was drafted 9th but played only 2 years in the NBA and 8 years in Europe.  He now sells cars in Las Vegas.  He disappeared, but his reappearance now may be the most important thing he does in his life: change the sham that college football and basketball are played by “student athletes.”

Universities generate $4.5 billion from football and basketball alone, enough to cancel 190,000  student loans of $24K, the average for Oregon.  Or pay grad students better.  Or pay the players who actually do the work, not those who benefit from such work.  Alabama’s football coach makes $5.5 million; Arizona’s basketball coach $2 million, and he is far from the best paid.  The median salary of an associate (tenured) professor of physics is $70,000.   In Eugene, Matthew Knight Arena cost $227 million, a 2002 “facelift” at Autzen Stadium was $20 million.  The NCAA generates nearly $1 billion, mostly from the “March Madness” basketball tournament.  I heard numerous times 89 championships and 450,000 “student athletes,” with 90% of the revenue returning to the schools.  Why would the NCAA be saying what per cent goes back to the schools, unless they felt they were under fire?

So, $100,000,000 remains, and I write the number, because seeing it is often useful. The $4,500,000,000 ($4.5 billion) is one-seventh of what America spends on the NIH, which I think does a lot more good for people, but I might be wrong.  Sports are perhaps more important than finding cures for diseases like Alzheimer’s.

The issue the NCAA doesn’t appear to understand, or at least doesn’t want to admit, is that football and basketball are different:  athletes and coaches involved in these sports are not the same as athletes and coaches in other sports.  John Calipari at Kentucky has well over a $35 million package for the rest of the decade.  An assistant football coach makes 6 figures, one has made a million; an assistant track and field coach makes about $20-40K.  Look it up.  I did.

The question for the NCAA is this: how much should men’s basketball and football players be paid?  It isn’t “whether” but “how much?”  These players are abusing their young bodies, not mentally mature, and vulnerable to being used.  They often do not finish college, taking a slim chance they will have a pro career, that in the case of even O’Bannon was short. The probability a college football player’s playing professionally is 2%; basketball is 1%.  OK, 1.2%.  The probability of graduating without a degree and without playing a professional sport is a minimum 15-30 times higher, approaching 70% in some places. These players are not going to find good jobs, their joints worse than mine, and I am 3 times older.  Football brain damage isn’t even being factored in here.

The concept of “student athlete” works if it is a Dartmouth runner who loves to run but must meet high standards of an Ivy League school.  The runner may perform well enough to be in the 5000 meter finals in Eugene, but he was lapped well before the end. This is a student athlete.  He loves track, but his life work will be something else.  Dartmouth, like all Ivy League schools, does not offer athletic scholarships.  If a university does, it is subsidizing an athlete, not a student.  This to me, a Dartmouth alumnus, is an important distinction.  Only a third of the 450,000 get athletic scholarships; four sports: football, men and women’s basketball, and women’s volleyball, give full rides.  Is that payment?  If it is, then they aren’t primarily students.

Football and basketball players are too often athletes who happen to attend classes.  Their graduation rates approach 70%, better than it was, but a significant number of programs graduate fewer than half. What was their major? I doubt it was physics, chemistry, mathematics, English, or literature.  Many athletes on full athletic scholarships are a farm team for the pros, leaving college when they believe they can turn professional.  To put their faces or names on a shirt, while they are in college, so that the NCAA or the school can make money, is using them as pawns.  This happened to Michigan’s “Fab Five” 20 years ago.

There are student athletes, and there are student athletes.  The NCAA compares both equally, and they are not.  The volleyball coach at the University of Arizona knew full well that successful recruiting and funding of his program depended upon a successful football and basketball program. Eleven of Arizona’s 13 programs listed lost money, including volleyball.  The profits from men’s football and basketball were about $26 million, more than enough to compensate.  Graduation percentages are tricky, and I don’t like the 6 year definition; I got through Dartmouth in 4, and the Dartmouth man who ran the 5000 at the NCAAs will likely do it in 4, too.

I am concerned about big corporations buying advertising, using handsome young men and pretty young women with nice voices to push a toxic agenda, be it chemical, like ExxonMobil, or sport, like the NCAA.  Money talks, it talks too much, and it is time to shut it up. Money could be used to pay for good professors, not coaches, lessen the burden of student debt, develop first rate researchers, writers, educators, and try to lift more poor out of poverty.  Ads? Request retired people like me to help tutor or use our experiences and wisdom.  Bet they wouldn’t cost much on a Jumbotron.   This is the 21st century.  We need educated people to understand the growing complexity of this world. Fox News has a simple answer for everything.  There are few simple answers, and that makes life difficult. Instead of embracing complexity, we pay tens of millions to a coach to help young men put a ball through a metal rim.  If your team wins, you feel better about life. Is escape the point?

When I cared about basketball, O’Bannon was a name to be feared in Arizona.  Now, I wish him every bit of success off the court.  Stay with this cause, sir, for this is where you may make your mark in life.  I bet you never expected that.

 

 

 

Tags:
Posted in GENERAL STUFF, MY WRITING | 1 Comment »

BROKEN SYSTEM: C2 FIXING IT

June 11, 2014

An elderly man is seen in a major hospital in a large city with neck pain following an automobile accident.  He is evaluated with neck X-Rays, read as normal, and discharged in a cervical collar.  A day later, he goes to another hospital in another large city with the same complaint and is found to have a fracture of C2, the second cervical vertebra, the so-called “hangman’s fracture”, because this bone is broken in hanging, compressing the spinal cord above where the phrenic nerve, which runs the diaphragm and breathing, exits.

The man will survive, and he will survive without deficits, although he will require a surgical procedure to stabilize the fracture.  Elderly people tend not to complain about head and neck pain the way younger people do.  When I practiced, new onset headache and neck pain in the elderly was something I took seriously.  You won’t read about this in books; a lot of neurology I learned in practice.  I noticed things, and I counted.

Had the man been rear-ended or even had a minor fall, he could have died suddenly.  At his age, with no autopsy, he might have been diagnosed as “heart attack,” with the outpouring of grief and comments about his life cut short.

And nobody would have noted the error.

The system will continue unchanged, with the first hospital’s staff thinking they provided high quality care, not knowing that they made a major error; they missed an odontoid (the name of that part of C2, the axis) fracture.  Somewhere in their clinical evaluation, they failed.  They don’t need to be sued, nor do they need to be publicly humiliated or embarrassed.  They need to learn from this error.   I learned medicine through gamesmanship and humiliation when I made a mistake; making people feel fearful, stupid or embarrassed (or sued) isn’t how they learn.

Ironically, 12 years ago, I went to this hospital and explained to the CEO why we needed a reporting system for medical errors.  He told me that they had one of the best systems in the country.  If that were truly the case, for this problem to occur a dozen years later says the quality of our programs to prevent errors needs immediate attention.

Doctors make mistakes.  They are human.  They make errors for all sorts of reasons: There may be insufficient knowledge, hurry, distractions, interruptions, lack of sleep, shift changes, miscommunications, and other reasons.  To assume a doctor is perfect is to deny reality.

What is needed is recognition of this reality and building of systems robust enough to find problems before they become critical.  How the system works is a matter of involving those who are involved.  It doesn’t come from the government, although if the medical profession doesn’t change, it will some day, and will have all the problems that come from government regulation.  Changes don’t come from the CEO or the head of the emergency department either.  They come from involving the doctors who work in this department, the nurses, the technicians, the people who first see these patients, the first responders who bring them there, and the radiology department.

The question to be answered is this:  How do we ensure we never miss this problem again?  The goal should be 0 misses, which means that part of the solution has to be followup with the patient, the way my veterinarian calls me at home the day after she does dental surgery on my cat.  If a cat can get better followup medical care than a human, then I have a major complaint with the medical system in America.

Hubris.  “World class.”  “We will take care of it.”  “We don’t need you.”  “Centers of excellence.” “99.99% of our patients do fine.”  The last I particularly worry about, because it means that 1 in 10,000 does not do fine, and if it is wrong-sided surgery, that is 2 cases a year in a busy hospital.  There are some things where percentages are appropriate, and there are others where counts are better.  There should be 0, null, zero, cases of missed odontoid fractures after an automobile accident.  Does everybody need a CT scan of the neck?  No.  Who should get one?  Look at the literature.  We put people in cervical collars routinely, when they have no neck pain, no neurological findings, no drug or alcohol abuse, and no tenderness to palpation of the neck.  Having all of these negatives was shown two decades ago not to require a collar.  Yet, we do it anyway, “just in case”.  In case of what?

I am telling the medical community to fix their broken systems, for they are broken when an important bone is broken and not recognized.  We have the ability to easily diagnose these problems when they occur, and we know enough about algorithms to know when we should work these patients up further, and when we do not need to.

I get follow-up surveys from nearly every company I deal with.  Amazon now surveys the packaging process.  I don’t know if anybody actually does anything based on these surveys, but if there is a mistake, they sure hear from me.  I would bet a great deal of money the hospital never called the patient to find out how he did.

If Comcast, for heaven’s sake, surveys, and if my veterinarian calls me to ask about my cat, it would appear maybe medicine ought to start doing the same thing.  Aviation has been investigating errors and disseminating the results for 40 years.  In 2001, I suggested medicine do the same.  I contacted 64 different groups.  Nothing happened.  Fine, don’t use my system, but put something in place to address this problem, because it happened once and it shouldn’t happen once; you guys aren’t learning from your mistakes, and you aren’t even counting.  

I wonder in the past 13 years how many hangman’s fractures were missed, causing death.

I wonder if in the next 13 years we will address the issue.  The smart money bets no.

 

Tags:
Posted in GENERAL STUFF, MY WRITING | Leave a Comment »

OLD SCHOOL

June 9, 2014

While hiking today, a woman my age commented that her 89 year-old father, an “old school” doctor, loved medicine more than anything else, volunteering in medicine after he had retired, 27 years earlier.  I was jealous.  I burned out in medicine, and nobody needs a neurologist as a volunteer abroad, where most major medical issues are handled by surgeons. Come to think of it, not much was needed from neurologists here at home, either, except when it came to people with normal tests, post-surgical disasters, and chronic pain.  Looking back, probably the best thing I did was to know when enough was enough and did the thankless job allowing patients to die without further intervention.

I was the one who heard the comment, “We won’t know the extent of damage until he wakes up,” and replied, “he won’t wake up.”  People didn’t like this truth.  I used the word “die,” one of the strongest words in the English language, not “pass on” or “expire.”  I took issue with miracle full recoveries after years in coma, when these people were either vegetative or severely disabled.  Misquoted anecdotes and reflexive smiling in vegetative states has led to numerous patients being supported in irreversible coma for weeks, months, or in some instances years.  I discontinued tubes, when doctors and nurses both believed once a tube was placed, it had to stay.  No it didn’t.  I took the first responder “saves” and stopped the ventilator a week later, when the patient still showed decerebrate rigidity and would not survive.  I told more than one family I was a “hard marker,” and “he squeezed my hand” did not count, if a patient could not hold up three fingers to command.  I listened to “he never wanted to be like this,” and if the time were right, acted.  These actions in retrospect had a great deal of value, but made me unpopular.  I was told I would deal with my parents’s deaths differently, but I didn’t. I kept my promise to them.

When there were no living wills, my job was more difficult, which is why I was incensed when the concept of paying doctors to discuss death with the elderly was referred to as “Death Panels.”  I hope many of these ignorant people may some day understand.

To me, “old school” doctors remind me of “the good old days,”  during which we had legal segregation, unsafe cars, frequent plane crashes, drunkenness was funny, smoking was cool, and adult women were “girls.”  On the other hand, we didn’t have the singing commercial, “your call is important to us,” and weren’t addressed by our first name by a stranger a third our age. In the “golden years of medicine,” when I trained, doctors were king.  Nobody questioned their actions, when questioning should have occurred.  “See one, do one, teach one,” was a problem to those of us who simply couldn’t do one right.  We didn’t track outcomes, we hid errors, we referred to friends, rather than those who had the best outcomes.

In the “good old days,” patients didn’t expect as much; we couldn’t do as much.  Medicine was simpler, costs were less, charity care was expected, and patients stayed in the hospital a lot longer.  It was a different world.  We had poor ventilators, so pneumonia was called the friend of the elderly, except now a ventilator can tide some over and lead to resumption of normal life.  Cancer was a disease of children, not adults, as it is today.  We did disfiguring radical mastectomies and kept heart attack patients in bed 6 weeks, both procedures harmful and long since abandoned. Mental illness was treated by commitment to awful hospitals, although the present “right” to not take medication and to live on the street is the current price.  I’m not sure where we should go with that one.  No firearms for them would be a start.

Technology changed the world, along with a medical arms race among hospitals from CT, MRI, and helicopters (about 10 deaths a year are caused by medical helicopter crashes, making it one of the most dangerous occupations).  Scans are expensive; CT radiates more than most doctors realize.  Doctor’s labs were found not to be good, privacy wasn’t, leading to HIPAA, which has created issues for non-relative “best friends,” and the profession almost bankrupted the country by charging fees they set and expected to be paid.  Lawsuits occurred, which seldom brought justice to many who deserved it, adversely affected the physician-patient relationship, and a reason I left medicine. 

Medicine in the old days I compare to Phoenix in the old days.  It was nice, a lot smaller, people liked it, and all was fine, but completely unsustainable.  We have known for a long time medicine limits access; good care isn’t affordable for everybody.  We haven’t wanted to address the issue, but it won’t go away.  [Phoenix is unsustainable, for there is no way we can continue growth where rainfall is diminishing, the climate is warming, and water supplies are tenuous.]

Medicine has opportunities and a potentially wonderful future.  The solutions to the problems, however, will not be implemented, because as much as voters say they want politicians to tell the truth, no politician, no matter how charismatic, can tell the truth and be elected.  I don’t have the charisma that the Republican challengers for Arizona’s 8th CD have had, but I am smarter than they are and better educated.  But try to tell voters that we can improve access to and quality of health care only by increasing tax rates, including a net worth tax, an investment tax, and concomitantly decrease military spending to true defense, not wars.  We need a reporting system for medical errors, and in the era of computers our inability to have medical statistics 6 months after the end of a year, rather than 4 years later, is inexcusable, appalling and achievable. There is absolutely no way anybody can get elected saying the above, but I think the above is close to the “truth.”

Old school medicine was easier.  We didn’t worry about cost of hip and knee implants, because we didn’t do joint replacement.  Trauma patients died, “tragically,” because the skills we now have didn’t exist.  Breast cancer presented as an eroding mass, not a minimally invasive lesion that could be excised, radiated, and treated with aromatase inhibitors.  We didn’t have HIV, pulse oximetry, and colonoscopy, which saved my life.  GI bleeds were irrigated with ice water, rather than treated quickly with endoscopy.  People with ulcers had infusions of milk, rather than drugs, occasionally exsanguinated, not cured with endocscopy.  Cholecystectomy was 2 weeks in the hospital, not outpatient.  Prostate cancer presented with fractures due to bone metastasis, not caught early.

Where will we go with medicine?  Every generation of doctors is at the dawn of a new era.  The “giants” in medicine and the “golden years” were neither large nor golden.  They performed in their world.  We must now perform in ours….better.

Tags:
Posted in MY WRITING | Leave a Comment »

NO ANONYMITY WITHOUT RESPONSIBILITY

June 3, 2014

“I can’t find a goddamn parking place in this  f——- town!” we heard, while walking to the Prefontaine Classic.

The middle-aged man walked away from a series of parking meters that were good for 2 hours, not quite long enough to see the event.  On the other hand, had he been willing to walk a few more blocks, he would have been able to park for free.  Had he anticipated the potential problem parking, he might have left home earlier, wherever home was.  He had “skunk anger,” and I quickly recalled my arm, after I had begun to point out parking spots.  Nowadays, it doesn’t take much to set some people off, and with the only restriction on firearm possession these days appearing to be price, I thought it wise to quietly walk away.

Public displays of anger are scary.  I vividly remember a fist fight breaking out over who was next in line at a gas pump during the 1973 oil shock.  I saw a man pummeled in Nairobi once, and stayed far away.  Over the phone, it is too easy to express anger, for one doesn’t see the effect upon the other person.  Sadly, many who receive these nasty calls weren’t involved in setting up the faulty system or designing the flawed product.  Highly paid executives are shielded from much of the difficult work that is “customer service.”

Letters may also be hurtful. Virtually everybody has regretted at some time hitting “send” too soon.  Angry letters require rereading and preferably should sit 24 hours before being sent.  It is remarkable what will be deleted after waiting.  Many such letters I never sent.  Still, angrily written letters have a name and an address; they are not anonymous.

The Internet has brought anonymity to public discourse, which I find both disconcerting and dangerous.  Read the comment section of an online newspaper article.  The comments do not sit for a day before posting, the grammar and spelling are often atrocious, the venom almost visible, the comments close to libelous, and the points often not factual.   Anonymity allows every frustrated individual to write whatever he wants: a free pass for hate mongers, the ne’er do wells, a public voice for those who used to say their indecent words in private, or at least not in my presence.  People I never will meet vent about all sorts of topics, truth being the greatest casualty, the beautiful English language a close second.

Letters to the editor are difficult to get published, because they require knowledge of basic English grammar, which many do not have.  These letters have an approximate 150 word limit, requiring careful thought, not a long-winded exposition.  I find it ironic that many who decry the use of Spanish—a language I wish I could speak fluently—cannot write a decent English sentence.

Online, every time I read one’s advocating physically fighting the government or secession, I wonder why these people don’t have their IP addresses tracked and informed their comments are treasonous. Many say the government is incompetent, rather than taking the small step to say some people who work for the government are incompetent.  Yet, this same “incompetent government” is somehow able to keep secrets about Area 57, currency reform, 9/11, the New World Order, and faked the Moon landings.  The inconsistency of these two concomitantly held viewpoints baffles me.

What I almost never read in diatribes are detailed suggestions how we might fix problems.  Perhaps many of us have given up. Ideas are seldom seriously considered by any organization I’ve sent them to.  Message to those in power: you do not have a monopoly on good ideas; they can come from anywhere, not just your staff or the same people that have been in the public eye for decades, some of whom need to move on.  You might be surprised what we have to offer.

Simplistic suggestions: “Deport all of them,”  “lower taxes,” “repeal Obamacare” are not solutions.  Mandatory national service, encouraging national volunteerism and using the experience of older people are starting points. I have been open to different ideas, so long as they have data, inferences, margin of error, ways of tracking effectiveness, and are well thought out.  My name is visible, and information about me is available.  It’s is clear what I believe, and it is clear that I may be influenced.

I had no idea the jerk I heard—and the man was a jerk, continuously swearing at the top of his lungs in a quiet neighborhood about a city I happen to love—would lead to an article.  It didn’t quite, until I read online in the Green Valley News (Az.) that a Hispanic shot and killed by the Border Control was an unarmed US citizen.  He had a prior record, was stopped and allegedly fled on foot, not at all a physical threat.  He was hauling marijuana, not human flesh.  He broke several laws, no question, but he didn’t deserve death.  I wonder whether those who have decried illegal immigration will speak out against killing our own citizens in these circumstances.  I chose not to read the comments, because I suspected I would read “the man deserved it”, “most of these people are illegal,” “his papers were probably forged”, “we still need a wall”, and of course “this is only one instance,” which in the issue of death happens to be irreversible. Is there no shame?  The Border Patrol has a difficult job, but we cannot use that as an excuse.

Anonymity is used by cowards.  My name is on my posts and letters; I don’t hide behind “Blueheeler2”. Stating comments in public requires thought. I suggest we edit these sites, in order to make some of the comments readable, shorter, and enforce common decency.  We used to, and violent threats online ought to be investigated.  They have led to shootings, which takes me full circle.

Some say anonymity is the price we pay for the Internet.  I say we shouldn’t pay it. If WordPress wants to edit me, fine.

Please, however, don’t have your editors make grammatical mistakes in their comments.  That annoys me no end, but I will try to be polite in my letter to you.

 

Michael S. Smith, MD MS (Stat.)

 

 

 

 

Tags:
Posted in GENERAL STUFF, MY WRITING | Leave a Comment »