"You're circling a fir tree on my tie. That is not a macrophage."
Med School Celebrity Jeopardy
In case you missed it, the Duke Lacrosse team has been suspended for the season and the town of Durham thrown into a mess, following an alleged (notice I spelled that right) rape of a black exotic dancer by three white lacrosse players on March 13th.
What makes it more disturbing is the racial overtones of the attack as alleged by the victim. Included amongst her accusations are statements to the fact that racial slurs were used as she was being raped and some talk amongst the media that the players specifically asked for an African-American dancer when they called the service.
From there the picture only gets more confusing:
- Protests against white privilege in a town more than 40% African American
- A D.A. inciting such by talking openly to the media about how guilty the, as yet unidentified suspects are
- Almost all members of the lacrosse team obtaining lawyers
- The 46 white players on the lacrosse team (and there are only 47 total players) giving up DNA by court order, for some reason that isn’t clear considering the three apparent assailants were identified by name by the victim.
There is even talk of reprisal by the community against Duke students.
There are many reasons to put off writing on this topic. Amongst them, the wait for the DNA results and the fact I have exams closing in. But here I am writing. I just read one too many articles on this situation and I couldn’t stop going over in my head what was wrong with some people’s response to this alleged crime and what was wrong with the media’s coverage of it.
I love lacrosse, I’ve played through high school and college, and I love the south. I was as close as any school to attending Washington & Lee University which is a microcosm for many of criticisms lobbed at Duke since the beginning of this catastrophe - white southern affluence, racism, studgy conservatism and entitlement. It may suffer these even more, actually. Because of this, these editorials, and even the “unbiased” fact pieces, seem to irk me.
Listen to the disdain in the words of Greg Garber (his editorial can be found in the link above):
Five signs taped together to the wrought-iron work on the front landing read, “Innocent Until Proven Guilty.”
Another read, “ALLEDGED: Represented as existing or as being as described, but not so proved; supposed.”
The source for the definition was listed as www.dictionary.com, and that online source presumably wasn’t responsible for the first “D.” Apparently at Duke, where the average SAT verbal scores fall between 690 and 770, not everyone has a command of spelling.
As if to say that these white affluent kids who come to this prestigious school, especially the jocks, aren’t quite as good as they think they are. My god, Garber seems to be displaying the same self consciousness and contempt, when discussing those he views as elitists, as any Durham resident he quotes in his little masturbatory op/ed.
While recent studies show that females make up a decided majority at many colleges, 52 percent of Duke’s students are male. According to statistics furnished by the Princeton Review, Duke’s Caucasian population is 56 percent, compared to 11 percent for African Americans. Durham, by contrast, is a city of 200,000; and the 2000 Census placed the black population at 43.8 percent, narrowly behind the 45.5 percent that is white.
This is just inappropriate. I cannot sit here, no matter how many times I read the above paragraph, and convince myself Garber is merely illuminating the differences in composition between town and gown. This is a criticism. The truth, contrasting Duke’s sex ratio and ethnic breakdown as if to show its lack of diversity compared with Durham is nothing but sensationalism.
Playing up the facts for the story, for effect, is no doubt something Mr. Garber shares with his hero Tom Wolfe. Duke’s demographic of 11% African American is much closer to the national average, considering 85% of Duke undergraduates are from out of state, than the Durham average. This is a national university, Mr. Garber. It is a very reasonable rate considering the challenges faced by African American children who likely appear in underfunded schools, that do not prepare then in any way to enter college, at an extreme rate compared to whites.
Tom Wolfe saw all of this coming. Or a lot of it, anyway.
This is the beginning of the long, multi-paragraphed song of praise to Mr. Wolfe in the article.
Anyone who thinks I Am Charlotte Simmons is an accurate representation of the southern “white” university and its fraternity life and varsity sports really has no idea of the situation. I read it a while ago, and nearly choked on Mr. Wolfe’s attempts to recreate what he clearly does not understand. The New York Times. took the time to point out the flaws in Wolfe’s attempt to recreate college life, calling his characters “cartoons” and pointing to…
…some unintentional comedy as Wolfe meticulously delineates a drinking game he has discovered called ‘’quarters,'’ [and] attempts to imitate vulgar rap lyrics…
As the only book of the accomplished Mr. Wolfe that I read I’m sure as the Times say that I merely got unlucky as “it is by far the weakest of his novels.”
Despite its unreliability, I Am Charlotte Simmons seems to be Greg Garber’s only source in declaring the flaws of the southern university in his editorial.
If Garber didn’t graduate from some liberal arts college tucked away in the northeast or the west coast during the 1980s then I don’t know anyone who did.
Greg Garber drew my ire only for the date of publication and extensiveness of his own rant. It was the “last straw” that pushed me into putting my own thoughts, on the situation and on the drivel coming from the media, down into print. That is what this blog is for, right?
In anycase, he certainly isn’t the only writerto have already judged the accused or cheered on the outrage of the citizens of Durham. I think it should be pointed out however, that it appears the more verbal displays have come not from the townies alone but from the lacrosse team’s fellow students. Not all of them are so judgemental of course.
For those near to burning effigies and memorizing the faces of the lacrosse team members from posters (lest they fall victim themselves) I suppose we have the joys of liberalism in higher education to thank. Yet here we have a crusade making 40 some odd men, not yet guilty, scapegoats for years of social and racial tensions and problems. How truly liberal are such judgments?
The most disgusting commentary of all is the District Attorney inflaming the situation.
“If it’s not the way it’s been reported, then why are they so unwilling to tell us what, in their words, did take place that night?” [the District Attorney] told Smith on Thursday. “And one would wonder why one needs an attorney if one was not charged and had not done anything wrong.”
Yes, I wonder why the hell I would get a lawyer when I’m a person of interest in an investigation that will lead to charges that carry a minimum of 16 to 20 years (quote above taken from this link).
The fact he already has enough evidence to apparently convince him what happened and make a case sans DNA does raise an eyebrow. Where are the charges then? And why the hell did he even get DNA? And from all 46 players? It seems like he doesn’t even know who to charge.
His words are incitive and contradictory to his role as a public servant. There is no free speech issue here. If he doesn’t want to shut up he shouldn’t run for reelection (and it is coming up soon…what a coincidence). Then he can blab about any case he wants to as a private citizen.
All his talking and early exclamations may have the D.A. back posturing a bit. He now says that after the DNA evidence comes back it may take some time for charges to be filed. Nor is he sure that he’ll make the DNA results public, which is a little peculiar considering how much he’s been talking so far…the results would just be one more thing out of his mouth. The entire case, the entire story of the night seems somewhat fishy so far.
If Mr. Nifong’s big mouth has done anything it is to provide anyone willing to pay attention with a sense of just how weak the case seems to be so far. Mr. Nifong is stacking up his cards in a very public display and I for one am concerned with how weak the foundation appears so far. Still, we need to give victims their due…especially when it comes to alleged sexual violence.
Me and the District Attorney do agree on one thing however, if this report is true:
The Herald-Sun also reported that some lacrosse players gave accounts of what transpired on the night of the alleged attack to university administrators. Nifong told the newspaper that he would ask the school to disclose those accounts voluntarily. If the university withholds the information, Nifong would seek a court order to obtain the testimonials.
If you don’t want to talk to investigators then don’t talk to anyone but your lawyer. That being said, I don’t know my law very well, but how much are such statements worth unless they were made to campus police? What type of hearsay rules apply to these things?
Something terrible probably happened at that party on March 13. If it did someone should pay the price. But, probably is not certainly and innocent until proven guilty. This case should never be tried in Durham if it comes to that, not with this D.A. and the media basically calling for protests. Let who did this rot in prison but realize this is apparently only the last incident in a boiling tense situation between town and gown. A tense situation which may have as much to do with those who watch Duke from the outside as any part of the student body, who the media apparently want to demonize.
When USC football and medicine come together.
Looks like John David Booty will lose some time in trying to impress the Coaches and fend off redshirt freshman Mark Sanchez for the starting QB spot next year. He’ll be out two to three months after undergoing back surgery for a bulging disc. That is unfortunate, the guy was an incredibly talented high school player who could’ve gone anywhere, and he came to USC and has waited patiently 4 years for his chance to play and lead this team. I hope this doesn’t cost him his chance to start next season.
My school hired Patch Adams to come and speak today. It was packed. I admire what he does, but despite his own touting of his intellectual prowess I think his personal philosophy is kind’ve primitive and hypocritical.
He’s a radical, a socialistic and a holist. While he may not use those labels himself I don’t think he’d have a problem with them. He has a bit of an ego himself as well.
He doesn’t believe in psychiatry. He refuses to recognize or treat even dementia/break disorders such as schizophrenia. Maybe he should hook up with Tom Cruise and they can discuss the curative properties of vitamins in these cases.
Being an idealist isn’t a bad thing but I am a little bit troubled by how much Patch thought he understood the world. He was very proud of the thousands of applications he’s gotten from physicians who want to come work at the hospital he’s building in West Virginia for $300/month. He should be. But later during the Q & A session to cite that as proof that it is a feasible way healthcare can be fixed - all doctors working for free that is - may be noble, but certainly isn’t accurate or reasonable.
He puts great weight in the whole body. I kind’ve do as well, but Patch has gone off the road a bit as we might imagine, ignoring science it seems in favor of other methods.
His distaste for money was rampant. His distaste for film and television was as well, along with sports (that was a big one). Wastes of time; all of them. He admitted he’d had to abandon his plan of never seeking money to fuel his agenda, after about twelve years of working out of a house with several other physicians (all the physicians and their families along with the patients lived there). So he started seeking fame and funds for his institute.
One of the ways he does this is by profiting from a form of entertainment he thinks lowers our community intelligence. He told us everyone should turn off their televisions forever even as the movie ‘Patch Adams’ is probably playing on some channel. That is money for a clown trip to Cambodia or to pay for a bone marrow transplant for some child.
He’s done some wonderful work but anyone going into the 21st century ranting against capitalism (and he certainly did) is just so far out in left field that its difficult to take them seriously. But maybe that is part of his gig…he is a clown.
It has been a while since I’ve updated this, but several months back I posted several times on what really is the amazing medical progress of Randy McCloy, the sole survivor of the Sago mine accident. Well, now, finally, he’s going home.
Wednesday, March 29th 2006
Uncategorized
Absolute Ridiculousness (Is That A Word?)
Texas has begun sending undercover agents into bars to arrest drinkers for being drunk, a spokeswoman for the Texas Alcoholic Beverage Commission said on Wednesday.
“There are a lot of dangerous and stupid things people do when they’re intoxicated, other than get behind the wheel of a car,” Beck said. “People walk out into traffic and get run over, people jump off of balconies trying to reach a swimming pool and miss.”
Seriously, at least present a more sound excuse for the sudden enforcement than what is provided above. If I MIGHT jump off MY balcony and miss MY swimming pool do we really want the government to step in to ‘protect’ me.
Before long if you’re taking a prescription medicine or drinking anywhere you’re not going to be able to leave your padded room.
God forbid I get drunk in the privacy of my own home, forget to turn off my stove and burn my house and maybe my neighbor’s down. Some law enforcement agency better take some preemptive action…and soon.
US Graduates (compared to International Medical Students) filled 72% of OB/GYN residency spots this year in the match. OB/GYN, as a high risk specialty, has been considerably unpopular amongst medical students the past several years. The story is from the subscription required AMNews.
In the 2006 National Resident Matching Program held March 16, graduates of U.S. allopathic medical schools filled 72.4% of obstetrics and gynecology programs, or 835 of the 1,154 positions. It marked the first time that U.S. allopathic graduates matching in ob-gyn has climbed out of the 60% range in three years.
And here I was thinking in ten years all the children would be delivered by foreign graduates.
“Observe that all legitimate rights have one thing in common: they are rights to action, not to rewards from other people. The American rights impose no obligations on other people, merely the negative obligation to leave you alone. The system guarantees you the chance to work for what you want — not to be given it without effort by somebody else.”
– Dr. Leonard Peikoff, from a speech titled ‘Healthcare Is Not A Right’
H/T MUSC Tiger
Monday, March 27th 2006
Health News
Is obesity a national threat? Maybe where I am.
I have trouble getting into the national campaign to fight what really is, most of the time, a personal choice (you either want to put in the effort and maintain the self control to achieve and maintain a ‘healthy’ weight or you don’t) but that lack of concern might partly be because I’m 160 lbs and 6′ 1″ and could eat 3500 calories a day and probably not put on a pound.
But really as individuals if we are truly concerned about health then we need to take prevention seriously, and a huge part of that is nutrition.
Being overweight increases the risk for diseases such as type 2 diabetes, heart diseases, stroke, sleep apnea, respiratory problems and some cancers. Being obese poses the greatest health risks.
A study released last year by the National Institutes of Health suggests average life expectancy could decline by nearly five years if the rising rates of obesity cannot be curbed.
There is a great post (which cites some other blogs) up at Medrants on the reimbursement crisis. This is relevant because I’m trying to put together a ‘How We Get Paid’ lecture series, focusing on the economics of physician practice and the politics influencing reimbursement, for next year at our school. It might be once a month during lunch and targeted towards the basic science years students.
Wednesday, March 22nd 2006
Uncategorized
Some explanation for why H5N1 isn’t spread easily for humans…for now.
The Japanese-American team found that, as expected, H5N1 avian flu is drawn to the 2,3 receptors. Luckily for humans, they also found that 2,3 is most abundant on cells within the alveoli, the most remote, microscopic branches of the lungs’ “respiratory tree.”
H5N1 was much less likely to bind to cells in the upper respiratory tract.
In contrast, common human flu strains prefer to bind with the 2,6 receptor, which is found in plentiful numbers on upper respiratory tract cells. That makes sense, experts say, because every time humans cough or sneeze, droplets from this area are easily expelled into the air, making human-to-human transmission of ordinary seasonal flu possible.
H5N1 colonizes a much deeper, tough-to-access region of the lung — making infection more difficult to spread and treat in humans, the researchers said.
I found this link on this weeks Grand Rounds (@ Healthyconcerns.com). The question is how many people are uninsured by choice, as presented by InsureBlog, which I may start reading more often. Estimates and figures on those who lack health insurance and truly cannot afford it are extremely controversial and subjective.
Take the poverty line for example, an oft quoted figure in any debate concerning government welfare. It likely grossly overestimates true “poverty”.
While as the story points out what is a necessity varies over time, it is only fringe arguments that will recognize a television (which 91% of those in the poorest 10% own) or a stereo (42%) as a necessity in my lifetime. Many of the same truths concerning “poverty” naturally concern the debate over the uninsured as well.
For example, as with the poverty figures a closer look at the uninsured shows that many are transients, briefly passing through as uninsured over a matter of a few months, which I will admit is still significant if not as emergent as some of those for a right to health coverage would have us believe. As I’ve commented on before, this along with other errors (some of which the Bureau has admitted and corrected) make the most cited figure of 40+ million highly dubious.
But this is a post over different numbers. Cases certainly vary and specifics need to be known, but as InsureBlog points out imagining a scenario where an average family brining in ~50,000 dollars, even with several children, could not find and afford minimal health insurance, and thus dissipate at least a good chunk of their healthcare costs, with at least a little effort is unlikely.
I don’t know what it would be like to be poor and the correct assault on my piece here is certainly that it is easy from my position (in front of my expensive computer and high definition television) to claim that certain items are “luxuries” and that the vast majority of the uninsured are choosing such items over insurance. But, really, when you step back from the shock of the medical bills, from the upset families on 60 minutes, that is what it looks like.
This is one of the greediest, consumption driven civilizations in the history of the world and it extends from top to bottom. The drive for luxury goods, not just William - Sonoma as in the story but non-necessities, certainly extends down into the lower classes. Does the fact that everyone else has a television, has a dishwasher, has two cars mean that this large group of the uninsured deserves (I use this word very intentionally) them as well?
I find that hard to buy, and I’m sure most do as well, as it reeks of notions of economic equality.
The numbers will always be debatable, and I’m sure plenty can be cited against me, as it is simply too subjective to try to define what is “enough”, yet, often times I feel that proponents of universal health coverage approach the problem with their heart on their sleeve and ignore the real possibility that the large majority of the uninsured in this country might be choosing their condition in exchange for immediate quality of life improvements.
Of note, the conservatives who make the arguments like I have above, well, they were the whiny insecure kids. Meanwhile the self-reliant, confident kids grew up to become smart, free thinking liberals who fight for the rights of the poorest Americans. Of course, the study was done in Berkeley (boy, I hate Cal…but that is a PAC 10 thing).
Even if the figures fall in my favor, and I’m not claiming the book is closed as this post is merely part of a debate, the question may be: so what? So the number is 7 million (I pulled that out of thin air) that truly cannot afford health insurance instead of 30 or 40 million, but the situation may be, as some people view it, that even 1 person without the healthcare, and insurance to pay for it, that they need is unacceptable. I can respect that argument even as I don’t agree with it.
H/T Slate
So flipping through Google I’ve learned that in the early 90s less than two thirds of medical schools used SPs and nowadays its probably approaching 85 - 90%. I’ve also found several interesting links although I expected to find more in the media.
Here’s a University of Michigan student newspaper bit piece:
“You have to be able to give them the story line and improvise,” she says. “You go into that room, and you really become that person. It feels like you’re in a doctor’s office, and you really feel that nervousness.”
The problems and benefits of standardized patients being the main judges of student performance during OSCEs. This is the case with my situation.
These results suggest that SP examiners are acceptable to medical students, SP rate students higher than physicians and, unlike physician scores, SP scores are not related to other measures of competence.
The Association for Standardized Patient Educators.
A young child’s physicians in Britain recently lost a court case against his parents in which they wanted to take him off his ventilator and allow him to die. The catch:
The case was believed to be the first in which doctors had asked to allow a patient who is not in a persistent vegative state to die.
So, in my first year clinical skills course, like so many other medical schools I get to work with standardized patients. First off, I’m scared we may not be getting the cream of the crop. I wouldn’t be surprised if I opened an exam room door to find this guy, as he is.
I’m not sure if it’s my school of just the standardized patient pool in general. Don’t get me wrong, there are some great standardized patients…but there are some wierd ones. And of course, even from my own experience you can take “standardized” straight out of the previous sentence and it holds just as true but this is a rant on trying to turn retirees and the likes into quality actors.
Second, I’m trying to rationalize my experiences with the SPs with what I’ve seen from my work in medicine and my shadowing experiences.
I don’t want to diminish the great opportunities standardized patients bring to us medical students but let me relate this story. I had my first clinical skills test the other day. There were five exam rooms, in our beautiful new clinical skills center, I had to stop at.
There was a “chart” on the outside of each door, and it had the chief complaint and some basic history and then it instructed you to perform some aspect of the physical exam and/or history. For example, “Do A Lung/Chest Exam.”
I get to my first door and am instructed simply to “Take A Sexual History”. I don’t think the patient was quite grasping the point of the exercise, as here is how it went down:
I knock, enter, and introduce myself. As I’m washing my hands I start questioning.
Q. So, Mr. X, what brings you in today?
There is a pause.
A. Uh, I don’t know. Just a check up for my insurance.
I take a seat, and am taken back a bit. Is this a test about getting information form a reluctant patient? I look up at the camera filming me, a little annoyed.
Q. So, nothing seems to be wrong? You don’t have any concerns about your health?
A. No. (Standardized Patient comes out of character) Did you even read the scenario outside? I think you’re suppose to be doing some kind of sexual history or something.
I sit there dumbfounded. I guess I’m going to have to hit the situation right on the head.
Q. Uh, okay. So, Mr. X, how is your sex life?
A. I’m concerned about getting old. Sometimes I can’t get an erection.
Finally, there we go.
It would’ve been more appropriate no doubt for me simply to sit down and say I had been sent in to ask some questions about the man’s sexual history and if he would mind but really, the patient should’ve been able to adapt to the situation.
There’s some loose wiring here between an insurance physical and coming in complaining of ED. It clearly wasn’t intentional, like the standardized patient was instructed to pretend he was coming in for an insurance physical and I’m suppose to find that he’s also concerned but embarrassed about ED.
Of course this is a guy whose write up of the encounter will also play a major role in my grade.
It is difficult to see what these standardized patient exams have to do with medicine. Except I awkwardly bumble through these actors, trying to impress a grade out of them (it was ugly on my part let me tell you), way worse than I do around real patients.
I’m not the med student who was an EMT or a nurse before but still, I’ve worked in ortho-spine office and an optho practice. In fact if we forget about the summer working the funnel cake hut at a Six Flags (and I desperately try to block that from my memory), then medical office work is the only real job I’ve ever had. Granted my experience in the real world is limited to weighing patients, asking what medications they’re on. Even so, something doesn’t feel right about these standardized patients.
I guess close counts more than just in horse shoes and handgrenades and these clinical skill exams being more of a place to practice physical exam skills than actual accurate medical scenarios, that they play their role in my education.
After the test I realized there is something pleasant about being down in the ER. Even beyond the trauma cases, the homeless guy with the abscess or the IV drug user whose needle snapped off in his arm, they know why they came to the ER and the doctors know why they’re there. Okay, not all the time. And most patients don’t come into the doctors office without knowing why they’re there. However, there’s an urgency to the emergency department that makes the relationship between the doctor and patient more on the nose.
The attraction to that may say something about my person-to-person skills.
There’s usually a definitive problem, there may be a lot of detective work to do on its causes, but none of this fumbling around the issue like the other day, with standardized patients whose Oscar dreams exploded on the launch pad.
I guess it is a rite of passage and as much as I criticize it, the ability to practice the doctor-patient relationship and physical exam skills is a valuable one. Indeed I’m sure in my time I will meet innumerable patients more awkward, frustrating or bizarre than any standardized patient I will ever see. How very few are my experiences.
