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Hi, I'm Daniel Riggins, a fourth-year medical student living in the Bronx.

danielriggins.com

 

You probably don't want to eat bugs and I think that's a problem

2 min read

I was talking tonight with one of my favorite sparring partners about one of my favorite topics--eating bugs. Most people (including myself) viscerally react with disgust at the idea of eating a cricket. That's a valid feeling. Most people in the United States grew up associating bugs with filth and disease. I'm sure some of us as toddlers were about to eat a bug and then Mom or Dad ripped it out of our hands, sternly telling us that bugs are not food. Fine.

The problem is that as our population continues to grow and our climate continues to...change, our traditional food sources may not be inadequate to feed everybody. Bugs like the cricket or mealworm are nutritious, fairly easy to raise, and resource efficient.

With that in mind, I find it frustrating that the biggest obstacle to expanding our use of these critters for food is everyone's collective cultural disgust.

I readily concede to my sparring partner that a person's opinions and choices cannot be divorced from emotion, nor should they. Emotions are a valid means of evaluating the world around you. But I don't think they are sufficient reason to reject an idea without engaging with its possible merits.

Maybe if there were an obvious alternative means of supplying the world with cheap, sustainable food, entomophagy would be an amusing, hypothetical, what-if question. But until that's the case, your emotions are not enough. I reject the notion that feelings are immutable. They can and should change if the context demands it. Now let's go make some chocolate-chirp cookies!

 

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.

 

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.

 

*Not for That City* by Charlotte Mew

1 min read

Not for that city of the level sun,

     Its golden streets and glittering gates ablaze—

     The shadeless, sleepless city of white days,

White nights, or nights and days that are as one—

We weary, when all is said , all thought, all done.

     We strain our eyes beyond this dusk to see

     What, from the threshold of eternity

We shall step into. No, I think we shun

The splendour of that everlasting glare,

   The clamour of that never-ending song.

   And if for anything we greatly long,

It is for some remote and quiet stair

     Which winds to silence and a space for sleep

     Too sound for waking and for dreams too deep.

 

no pigeons (poem)

1 min read

there are no pigeons
under the bridge tonight--

though we speculate
that saying so may invite
their presence,

I hop and coo about a bit
and you tell me I do a pretty mean
impression, asking how long
I've known I could--

I bob my head down to peer
at my in-turned toes, silent--
just to maintain the mystery,

sometime in the past few months
the city rigged a motion-sensing light
amidst the arches of the bridge,

we pass the appointed place
and it wakes to illuminate our grocery-bagged
arms in the dim Bronx dark,

I half expect it to expose some
beady-eyed figure from the shadows--

someone at home amidst the dry-bone
flapping of wings, someone who yet
still wishes to be seen,  

there are so few people left
who still remember how
to inverse-auger omens
from the sedimentary layers
of bird shit beneath our boots--

those who can interpret wills
amidst broken glass, spent rubber gloves,
the torn bits of Happy Meal boxes
long-since picked clean

 

Mindful Living

1 min read

In response to this post.

 

I think something that unconsciously scares a lot of people about disconnecting is that it forces them to confront their negative thought loops. Say I'm worried about getting fired from my job. It's easy to avoid this anxiety if I have candy crush or twitter to distract me. But then when I finally get caught alone with my thoughts (say while going to bed), I may not have the mental tools to fight getting stuck in fixation and dread.

 

To me, living deliberately (or mindfully) means that I have the power to recognize that I'm worried about my job, to determine a proper response to that anxiety, then to set it aside, freeing up my mind to think about other things, to be comfortable in the stillness that follows. In this way, I would push back against the notion that deliberate living undermines "meandering aimlessly". Rather, at least in the form I describe, mindfulness actually allows me assume a state of aimlessness without fretting about what stress might wait for me when I return to the day to day drudgery of life.

 

 

fulgurite (poem)

1 min read

every time i ghost along 

our shoreline, my mind traces

the pattern of stakes 

piercing its sand,


i want to know how these truths snake

their circuit together, how they draw

lightning to their hearts--


seared by the sky, bubbled 

into sinuous forms--

tubes just hollow enough to fit

my fingers

 

On Eric Garner's Death

2 min read

I just watched Bill O'Reilly's coverage of Eric Garner's killing and I have three thoughts:

1) To be honest, I didn’t know what an indictment was until I looked it up after the ruling came out from the Michael Brown case. Please clarify if I get this wrong, but an indictment is a formal accusation of a crime. It is a necessary prerequisite for a criminal trial. Importantly, it is not a definitive statement of guilt, it is an accusation that leads to further investigation. The grand juries for the Michael Brown and Eric Gardner cases did not need to unequivocally know if Darren Wilson or Daniel Pantaleo were guilty, they just needed to decide if the evidence justified a trial. Please correct me if I misunderstand. 

2) O’Reilly speculated that the reason Daniel Pantaleo was not indicted was because Pantaleo did not intentionally kill Gardner. But why couldn’t they charge Pantaleo with involuntary manslaughter? This seems to be another issue where a lawyer’s explanation would be helpful.

3) O’Reilly argues that there is no racial prejudice behind these cases. He uses statistics showing that the absolute number of African-American people killed by police is “miniscule” compared to the total population. I don’t think these statistics are relevant. If you really wanted to quantify “prejudice”, it would be more useful to know proportionally how many African-Americans are killed by police officers compared to other races and also what proportion of police officers are indicted in cases involving death of African-Americans compared to other races. I will also say that regardless of whether there is conscious prejudice, it is still very possible that implicit bias has played a role. 

All of this being said, here are my opinions: It is an injustice that Pantaleo and Wilson were not taken to trial. Regardless of whether or not conscious prejudice is in play, these injustices have broken the trust of many people, both African-American and otherwise, in our legal system. I want to know how we as a society can regain trust in each other. It would seem that some sort of restitution is in order.


 

must i be mean, (poem)

1 min read

must i be mean,


in order to mean something?

need there be intent

behind my creation?

how many rocks must i throw

into the lake, before i strike 

a fish on the head?--


a fish the most sentient

thing that i'm still willing 

to kill--


i reach into its world from one

where water dances so small,

we cannot see--


and i feel ashamed 

when we face to face--

two facets of one medium--


the way it never blinks--

seeing all:

the way we writhe, and flip,

and spit--


just to spend one more night,

hoping for more--