Dying in a leadership vaccum

Hi @CenterField,

Read this thread last night and it got me thinking....then I found this today.
https://www.fiercehealthcare.com/pr...octors-to-take-structural-determinants-health

I would guess the above article has relevance to your OP, especially the racial component. I don’t really care what NEJM does, as I’m not one to base my beliefs on what others think I should. But the whole idea of the medical field trying to change social structures is fascinating.

Leaving Trump out of the picture, what are your thoughts on the medical field determining what social structures are “best” and if they should try and influence such structures, specifically when doing so sacrifices personal choice and freedom for the “common good”? Thanks

 

Thanks, my friend. You know that I'm not authoritarian. I'm no SJW either and I don't try to influence social structures for the "common good." My social activism is focused on favorite charities I donate to, such as UNICEF and the American Red Cross, and I also give money to my church to support its social programs. I give money to my alma mater, earmarked to support scholarships for disadvantaged students. Over the years I've significantly helped a number of students, this way. I donate pro-bono work as well, time permitting. Another part of my professional activity is teaching. By being a good professor, preceptor, supervisor, mentor, and lecturer, I contribute to the education of young doctors and medical students, and in my teaching I often include topics about ethics and fairness.

After doing all that, I feel that I do enough and that I contribute to society this way, in order to pay back for the privilege of having had my education, which gave me access to high-paying jobs that over the decades resulted in a significant net worth. With both my kids now being young professionals who are doing quite well, have no student loans, and have achieved complete financial independence (including, both of them now being homeowners), and my wife also making a 6-figure salary, I don't need all the money I earn, so I do give away a good chunk of it to worthy causes.

In the periods of my long career during which I was involved in solo private practice, I instructed my billing people to never send an unpaid bill to a collection agency. Any patient of mine who said to me "I'm going through some financial trouble; I can't pay this bill right now" I always said "don't worry about it, just don't pay; it's fine. If at some point your situation improves and you can afford to pay me back, sure, I'll take it, but if you can't pay, just forget about it." These cases were a minority anyway, and I saw those losses as part of the cost of doing business, and just assigned them in my mind to pro-bono work and charitable contributions. I have never denied care to a patient in need of it, based on inability to pay.

I think that by doing my job competently, and by contributing to the advancement of the scientific field that is the base of my specialty, I also make a contribution to society this way.

So, feeling largely satisfied with all of the above, in my practice I don't systematically go after what is being recommended by your article, but I do advocate for those patients of mine who are disadvantaged. For example, recently I was able to help a patient of mine in getting a refund from the Billing Department in my hospital, for charges that I considered excessive and unfair. She had tried to argue with them with no success, and she complained to me. I went with her to the Billing Department and talked to the director, who then saw her point and refunded part of the money to her. Also, I do have as part of my team a social worker who helps the patients who need access to governmental benefits, community resources, or charities.

Frankly, I think I do quite enough, and if all my colleagues did like me, we would have a significant social impact. But otherwise, I'm too busy to do more. I'm in a highly scientific specialty, and I think that social advocacy in the manner proposed by this article is likely to be more feasible for primary care doctors.

 

Illness shouldn't even be in the govts jurisdiction. The govt protects us from invading armies and organized crime. Not viruses. A 'leadership vacuum' is precisely what I want from my govt.

 

I don't think anybody loves him. That isn't the same thing ignoring his words and appreciating his actions. I suggest you speak for yourself and not for me.

 

Heckuva job Trumpy

 

Exactly.

 

OK, we the highly educated.

 

Here’s an indisputable fact;

Our second wave, June to Sep, was preventable.

Response from Trump’s loyalists; There’s nothing Trump could have done due to “Separation of Powers”

Horseshit!

 

I appreciate the comprehensive answer.

It looks like we view the subject similarly. I’m also grateful for my education and believe those of us greatly blessed are called to bless others.

I guess it just kind of surprised me that a medical organization was involved in trying to change society’s structure. Haven’t processed it all enough to decide whether it’s good or bad really. I’ve just always experienced the medical community impacting individuals positively as you do, not at an organized societal engineering level. A guy I was friends with a bit in high school and college that is now a prosthetist had a post on Facebook the other day that factors into my original thoughts prompting my question to you. It was a video of himself and a 6-7 year old boy he had just completed the final fitting of a leg for running down the hall of his clinic together. It made me think how my friend changed that boy’s world. I’m sure you know that feeling. Overall I guess that’s how I see the role of healthcare. Serving the individual, not trying to change the whole world. To be clear that’s just my opinion while still processing the issues.

The problem I see with trying to change the world or societal structure is the inevitable dive into politics. In my opinion that dive into politics damages the relationship between doctor and patient. As we see in this thread some posters now have reservations about the NEJM. To be fair, it’s the responsibility of consumers to separate politics of providers from the service provided. The current political climate is making that difficult but that is not the fault of the medical community.

To demonstrate my thoughts, a rough analogy of providers being heavily involved in social issues is analogous to having Biden or Trump signs in waiting rooms or exam rooms. It just isn’t helpful in the patient/provider trust relationship.

But these are musings of someone who doesn’t even consume much healthcare. I’m certainly open to all opinions from yourself and others on my thought processes. Oh, and thanks for your generosity. Healthcare professional’s propensity to philanthropic behaviors domestically and internationally is mostly ignored in these days of wealth envy and desire for free healthcare.

 

There’s nothing Trump could have done to prevent Jun to Sep second wave.

Really!

Fact; Trump often used his loud mouth to criticize several Dem Governor’s preventive measures/too strict policies.

Fact; Trump’s loud mouth ONLY criticized the Dem States wanting Covid19 relief money.

Fact; Trump also stated that he’ll cut off funding to states that make it easier to vote.

Question;

Where was Trump’s loud mouth, and his Federal funding threats when several State Governors, mostly Republicans, we’re re-opening their economies at a high positivity rate?

 

There’s nothing Trump could have done to prevent our Jun to Sep second wave.

What about Trump’s Tulsa tally.....No mask, No social distancing.

Yep, there’s nothing he could have done......

I’m not finished!

 

What about “Public Safety” related to health hazards?

 

It’s easy to lay blame in 20/20 hindsight. But blame for what?
For many decades the Government has had an evolving strategic plan for responding to national bio threats that has been amended by each Administration. The various elements of plan can be accessed online. It outlines requirements for preparedness, supporting response and coordination infrastructure, various action plans, etc. for a threat response.
https://www.phe.gov/Preparedness/planning/authority/nhss/Documents/2019-2022-nhss-ip-v508.pdf
Theoretically, the plan is updated on a continued basis and even gamed out like is done with various military threat scenarios. If you read the plan, it is obvious, the Administration was following various aspects of the plan. But, as is often attributed to plans, particularly those of a military nature (which I suggest is equivalent), a plan lasts until the first engagement.
But, again, I as, if there was a failure, was it a failure of preparedness? Which would suggest previous administrations failed to create and maintain an adequate level of preparedness. Was it a failure to adequately train all those expected to play a role in a national response strategy and familiarize themselves with the plan and expectations for their role? Again, a responsibility of every administration. Was it a failure of the administration to adequately carry out the plan? A failure of flexibility and adaptation to meet gap conditions? Or, specifically, what failure? Is any failure specifically attributed to this Administration or shared across many? Given the politicization of the COVID19 threat for partisan objectives, few having to do with improving the response to the threat, it is unlikely we will see an honest review and assessment of the actual strategic response actions as measured against the plan to determine how it should be updated and to understand what measures need to be improved to better prepare for the inevitability of future bio threats whether natural or man-made. Then too, what can be learned about response plans and preparations to address other potential national threats like a nuclear event, national cyber attack, a catastrophic solar event, or something exotic like a massive Yellowstone super eruption, or a Midwest New Madrid Fault massive earthquake? In a political blame game, the object becomes using an event like COVID19 for it’s political value not to actually improve planning and preparations to protect the citizenry.
So, again, I ask... who is to blame? Perhaps, the place to start is an honest assessment of political objectives; the threats we face as a nation are not selective of political aliegances.

 

Both the NEJM and Lancet were caught red handed publishing Fake Science during this pandemic and were forced to retract. Their credibility has been thoroughly impeached.

"Within days three of the four authors published a retraction. Outside scientists had noted that the study claimed to have data that would have been almost impossible to gather during that time frame. The writers explained in their retraction that those figures came from a fourth author, who, tellingly, would not let them access the raw data. Additionally, the New England Journal of Medicine also retracted a study on COVID-19 and cardiovascular health since it also used data from the same company."
JUST THE NEWS, Erosion of trust: 10 things public health establishment got wrong about coronavirus, By Michael Fumento, June 17, 2020.
https://justthenews.com/politics-po...s-public-health-establishment-got-wrong-about

Fake Science Kills.

 

Politics can kill as effectively as any virus.

 

Fake Science = politics

 

I support informing The People how to protect themselves. I do not support mandating how The People must protect themselves.

For example: I agree that masks and social distancing, and condoms, and gas masks, and tyvek suits, and bleach are likely more of a benefit than a detriment when it comes to reducing the spread of infection, just like I believe carrying a gun is more of a benefit than a detriment when it comes to preventing violent crime. I don't think its the govts job (or legitimate function) to mandate that We The People use any of them.

 

Where does your elderly mother need to go that she can't avoid being near potentially maskless people? I have no issue with private businesses mandating that a mask be worn, and those that do would get all the business from the elderly and at-risk while those that don't will get the business of the revolters who don't see it as a worthwhile benefit. I wouldn't oppose a middle ground in times of emergency mandating a small portion of the day or week where public transportation and facilities are reserved for the at-risk so they can adequately protect themselves while conducting necessary business. But mandating masks and social distancing for everyone at all times puts the responsibility of protecting your elderly mother's health on the whole of society. And as much as I'm sure it makes me sound like a jerk- that shouldn't be our responsibility. It's hers.

There's a host of potential and/or percieved threats one puts oneself at risk of encountering when one goes out in public. This is one more. When we say 'we have to protect eachother', what else is that going to be applied to? Some people think exposure to other cultures, other political ideas, other sexualities is 'dangerous.' By setting this precedent that we have to protect eachother instead of ourselves, all thats needed is for those people to gain political power and we'll be wearing masks and social distancing while not wearing political slogans or having our ankles visible in public.

 

Fake Science = Fake News is a deadly combination.

"But if the state’s numbers indicated the true incidence of the virus, they would mean that more than 1.7 million people in New York City, and more than 2.6 million people statewide, have already been infected.

That is far greater than the 250,000 confirmed cases of the virus itself that the state has recorded.

It would also mean that the fatality rate from the virus was relatively low, about 0.5 percent, Mr. Cuomo said."
THE NEW YORK TIMES, Cuomo Says 21% of Those Tested in N.Y.C. Had Virus Antibodies: Live Updates, The preliminary data suggests that many more New Yorkers may have been infected than was previously believed., Governor Cuomo, Transcript of briefing, 4/23/20.
https://www.nytimes.com/2020/04/23/nyregion/coronavirus-new-york-update.html

 

Yes, Political Science encourages Fake Science.

"A Wall Street Journal columnist wrote that the revision “raises serious questions about the radical countermeasures inspired by public-health experts like Mr. Ferguson.” Even one of Trump’s coronavirus task force coordinator, Deborah Birx, seemed to lean into the questioning of Ferguson. “I’m sure many of you saw the recent report out of the U.K. about them adjusting,” Birx said. “If you remember, that was the report that said there would be 500,000 deaths in the U.K. and 2.2 million deaths in the United States. They’ve adjusted that number in the U.K. to 20,000. So half a million to 20,000. We’re looking into this in great detail to understand that adjustment.”"
THE WASHINGTON POST, Coronavirus modelers factor in new public health risk: Accusations their work is a hoax, 30 times Trump downplayed the coronavirus, By William Wan and
Aaron Blake, March 27, 2020.
https://www.washingtonpost.com/health/2020/03/27/coronavirus-models-politized-trump/

 

Trump was right about one thing. U.S. was not/ill-prepared to handle a pandemic LIKE COVID19.

Key words; LIKE COVID19

However, I strongly believe that our 2nd WAVE (Jun to Sep), was PREVENTABLE.

Also, if we were to assume that the next pandemic will be LIKE COVID19, and Uncle Sam would want us to keep working, then there is only one comparison;

“Taiwan VERSUS the rest of the world”