Thursday, September 30, 2010

Will Your Surgeon be "Socially Just" or "Highly Skilled"?

((((bravo and kudos to Doctor James Gaulte. ))))

First of all doctors (or, in their tadpole-form: medical students ;-) ) should be welcome to have whatever political opinion they choose, not be funneled or channeled into some predilection of a particular power-elite du jour; nor by similar justifications be given preferential (ab initio) medical school admission.

Medical school should be about teaching medicine, and the techniques and science behind it. If and when there are strong compelling political arguments of the day (i.e. always), let's not presume patients are ignorant, and let's not presume patients, when they are having (say) their diabetes treated need to hear our political points of view. Certainly if they ask, we are welcome to supply our own opinions but emphasizing that it is merely just that: our own opinions.

When someday you or I get old (you first please), and need a cataract removed. I hope that the doctor with laser or blade in hand got to that position directly above the waiting eyeball not because of affirmative action, social justice, political opinion, or anything but competence, knowledge, and expertise.

Ironically, just earlier today, I was reading a great post by
Thomas Sowell: Using words to confuse , wherein he touches on the concept that "social justice" may be neither very socially redeeming, nor very just.

Warm, fuzzy words and phrases have an enormous advantage in politics. None has had such a long run of political success as "social justice." The idea cannot be refuted because it has no specific meaning. Fighting it would be like trying to punch the fog. No wonder "social justice" has been such a political success for more than a century... There is a strong sense that it is simply not right – that it is unjust – that some people are so much better off than others.... Is the person who has spent years in school goofing off, acting up or fighting – squandering ...dollars ...spent on his education – supposed to end up with his income aligned with that of the person who spent those same years studying to acquire knowledge and skills that would later be valuable to himself and to society at large?

Friday, September 10, 2010

Dying for a Smoke? Cigarettes versus Mevacor; can't wait until you pay for it

Earlier this week, I had a patient in, visiting me for the first time. He basically a "syndrome X" type of guy: middle-aged, overweight, high cholesterol, high blood pressure. He's not the most personally careful individual, with a history of domestic altercation, some prison time. Almost goes without saying he drinks too much and smokes cigarettes.

Well, now, he wants his cholesterol medication restarted since he has just now started receiving "insurance", i.e. Masshealth, Massachusetts' state welfare benefits program. He tells me he couldn't afford cholesterol medication on his own, notwithstanding a "heart attack scare" a year ago -- and stopped it, after having had it prescribed a few years prior.

Couldn't afford cholesterol medication on his own? Well, a bit of simple calculation shows that he spends about five dollars per day on cigarettes, and at least that much per day on alcohol. If he had chosen to purchase generic Mevacor for his cholesterol -- a fine, cholesterol-lowering, statin medication for the most part, although not state-of-the-art -- he probably would have been out about $.50 per day.

Now that he has "insurance" (call me old-fashioned, but I see insurance as a policy that you actually have to spend on in advance as a gambling hedge against later infirmity while you're actually young and healthy; not a gifted grant of benefits unpaid-for), he is happy to have the other citizens of Massachusetts take care of his cholesterol issue, now five years worse than it would have been had he been able to take some of his cigarette- or alcohol-money -- really only 1/10th of it, and invest it in himself.

How do we get people to properly invest in themselves? Probably there has to be some downside to ignoring one's health problems, rather than having your problem just drop into the laps of your more conscientious fellow citizens. Can you help me with this conundrum?