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91 degrees in Harlem
=================

one of those days
when ancient chewing gum
scuffed into the sidewalk
blisters up hot--

angrily glopping to the undersides
of your shoes;

folks brandish super-soakers
on street corners--
spraying friends and strangers
with equal ambition
and everyone is grateful;

I turn my eyes to children--
how they tromp about in water-shoes,
just in case a fire hydrant
erupts in their paths--

and I hope they can always wear
such soggy and secure abandon

 

I impaled a potato
with chopsticks;

suspended it over water
in my plastic Hoosier cup--

old court heroes dribbling
in circles around its side.

A green film
has begun to line the inside,
even as stems and leaves
have risen from without,

and I cannot tell
if this slime is a sign

of potato health or hell.

 

what have you learned?

that it's ok to be lonely--

a bit like feeling sleepy at 2
in the afternoon,

something that will pass.

there is no need
to clutch, to clench,
to rub furiously at your eyes--
keying your fears into a screen,

she nor she nor she
cannot solve this for you,

there is nothing to be solved.

sometimes a siesta is exactly
what you need

 

An endless stream of tests

2 min read

In response to this video by PBS Idea Channel.

The other day at lunch, I wondered aloud to my classmates whether a high score on medical board exams predicts for better subsequent clinical outcomes. My classmates seemed to agree with each other that it would be very difficult to track, quantify, and compare clinical outcomes across the huge diversity of sub-specialties that med students match into. They said the exams aren't meant to be used as predictors of successful practice.

So then I asked how we know the exams are actually useful. Again, they seemed to agree that what a high exam score actually signifies is superior clinical reasoning skills. Residency programs value board exam scores because they verify that incoming residents are competent clinical thinkers. That seems reasonable to me, but it seems like superior clinical reasoning should translate into better outcomes. What am I missing here?

Also, considering the rising movement to tie heath insurance reimbursement to provider performance, it seems disingenuous to argue that it's too difficult to measure/compare clinical outcomes across medical disciplines. If it can be done for reimbursement purposes, why not for evaluation of standardized tests as well?

It's not like I'm going to stop studying for the boards. I'd like to think that these tests really do reflect what caliber of physician I am to become. But with an endless stream of certification tests on the horizon, it'd be really nice to know that they actually mean something.

 
 

Field Trip!

Field Trip!

Spent a couple hours at the BODY community garden with some fourth graders from the local elementary school.

 

Should I as a (future) physician be allowed to speak with you about guns?

4 min read

The patient-doctor relationship is inherently intrusive. It's an unfortunate, yet necessary part of the process. I can and do ask questions of complete strangers that I would not ask my closest friends. Understanding people's sexual habits, drug use, violent thought-content, and gun-ownership status helps me (a training physician) work with them to mitigate risks to their health. That being said, I understand that access to such intensely private information opens the door to abuse.

In my school's curriculum--and I'm assuming at other schools too--there's a significant push to refactor the patient-doctor relationship into one of partnership rather than authoritarianism. I hope that this change in culture empowers patients with greater agency over decisions made about their lives. But it would be naive to think that even now, as a student on the wards, there isn't some sort of power dynamic at play when I speak with patients. I meet people at some of the most vulnerable moments in their lives. If I wanted to push personal agendas onto my patients, it would not be so difficult. As such, I think its crucial that checks be established over what I can and cannot do with a patient's personal information. If I abuse a patient's trust, there need to be repercussions.

Ok, now that you know where I stand, lets turn to the matter of guns--specifically in Florida. As the law currently stands, physicians are explicitly prohibited from asking patients if they own guns. I think this is gravely mistaken. Guns are valued by many as powerful tools of self-subsistence and defense. If you live in the United States, it is your protected right to own and use these tools. But they are not without risks.

Lets say I'm interviewing a patient who discloses to me that at multiple times in the past he has intentionally harmed himself, at one point going so far as attempted suicide. Most of the time he feels happy and satisfied with the course of his life, but sometimes he's overcome with spontaneous self-loathing. He feels he must punish himself for the ways he believes he has hurt other people.

I harbor significant doubt that such a person should own a gun. Even so, you might still be able to convince me that it's not my business to ask this man to cede ownership of his firearm. But at the very least, I would want to ensure that he keeps that firearm locked and unloaded in a safe place. Yes, this might impede his ability to quickly defend against home invasion, but this is a matter where disparate risks need to be balanced against each other. It is very much within the scope of my role as a physician to problem-solve through such a situation with my patient. Sometimes even to report to authorities if I believe that he poses a danger to himself. Whatever my opinion on guns, my first priority is to keep patients safe.

Florida law does not allow for such moments of physician intervention. By prohibiting a conversation about guns, the state's legislators implicitly state that the risk of me violating a patient's privacy far outweighs any good I might do in helping him make safe choices. I think this is wrong.

This post builds off of a video blog post made by Aaron Carroll, a pediatrician practicing in Indiana. In many ways, I have echoed the sentiments of Dr. Carroll. However, I felt the need to write this because I don't think he adequately acknowledges the very real risk that doctors might abuse their positions of power to force their opinions about guns onto their patients. Doctors are a mostly well-intentioned bunch, but they (we?) also have very strong opinions about the right way to do things. Sometimes that means we overstep our bounds.

I don't want patients to blindly accept that I will do what's right for them. I need to earn their trust. That being said, Florida law would effectively cut me off from operating in a critical realm of their safety. That needs to change.

 

Grass is great for all kinds of stuff---picnics, croquet, soccer, sunbathing with a book, etc. But I really hate how we use it as our default ground cover. We waste soooo much water and fertilizer in order to maintain this "perfect" veneer of uniform, emerald grass. It's poor stewardship of our resources. I would so much prefer we landscape yards like the National Museum of the American Indian does. It's beautiful and sustainable. http://nmai.si.edu/visit/washington/architecture-landscape/audio-tours/

 

"Saying something nice when you have freedom of speech is like using a Starbucks gift card for a bottled water." --David Malki

 

I think Khan automatically sets his voice to patronizing if he detects you're over the age of 20 and watching an arithmetic video.