Archives for category: Uncategorized

Each lawyer has a lawyer
And they’re all hunting witches
Megyn’s no Diane Sawyer
White House full of snitches

Each lawyer’s lawyer’s lawyer
Reads their Lawfare daily
Lawyers’ lawyers’ lawyers’ brawlers
Get ready for the melee

When a lawyer’s lawyer’s lawyer
Memoranding through the rye
Meets a lawyer’s lawyer’s lawyer,
May a lawyer testify?

How many lawyers’ lawyers
Can file a meta-brief?
And how many judges’ judges
Confer injunctive relief?

Jews call on one true Judge.
(Be they a Mother or Father.)
But even heaven needs a hedge.
God should get God a lawyer.

Plums-farmers-market-seemingleeI have taken
the insurance
that covered
your children

with which
you were probably
buying
medicine

Forgive me
I think suffering
is so sweet
and so cold

Jeff Beauregard Sessions, whatever he thought,
Disavows rememberance of things past.
He is insulted by accusations and distraught
That erstwhile colleagues think his claims a waste.
Selma’s colored fountains are no more.
While every hash is tagged with healing rights,
The South may rise again, or sip in woe
And moan the insult of many a darkened sight:
Thus he swivels neck at meetings unrecalled
With forgotten Russian type at the Mayflower,
Citing decades’ policies long installed
In justificatory — or exculpatory — power.
But if the while he starts to think on Trump,
He sips once more, and tastes a brackish swamp.

Goodnight Comey

Good night President who doesn’t think.

Good night Navy stewards with food and drink.

Good night door and grandfather clock.

Good night Lawfare’s nonpartisan shock.

Good night, big hooks of Rus.

Good night, Comey hearing fuss.

Good night, director (ex) of FBI.

Good night, Ivanka’s madeup sigh.

Good night, coffee.

Good night, tea.

Good night, honest loyalty.

I’m no Syria expert. (Heck, I’m not an America expert. Or a Maryland genius. Or so knowledgeable about Baltimore. Nor do I know myself.)

But Obama’s doctrine seemed plausible to me because it took into account the falsity of the “something vs nothing” framing wrt Syria. Any choice involves the deaths of innocents. Assad will kill.

Will intervening cause more deaths, or prevent them?That seems a core question. The more aggressive intervention might not necessarily achieve more robust outcomes, but merely more death and distress.

The Iraq lession is not “never intervene.” It’s “know what you’re doing before you intervene” and “intervene based on truth, not lies” — and also “have the end in mind before you start killing people.”

Why individual and community are both undermined by Trump, and both need to be placed at the center of compassionate care as part of anti-Trumpism

The righteous battle to keep ACA from being dismantled saved health insurance for millions. That was salutary in all senses. But the larger terms of the conflict are worth addressing — because they illuminate both why Trump is to be fought, and what we have to do to make healthcare work.

Read more here: https://medium.com/@ZackBergerMDPhD/patient-and-society-in-the-anti-trump-movement-dad56382515

modern-decor-lucite-giraffe-jonathan-adlerCada semana tutorizo (es decir, enseño y superviso) en la clínica de medicina interna a los residentes en las consultas externas del Hospital Johns Hopkins, en la calle Caroline en Baltimore. Los pacientes son en su mayoría de la ciudad Baltimore y afroamericanos, sin embargo recientemente empieza a acceder un número creciente de inmigrantes hispanohablantes.

He intentado algo nuevo estas dos últimas semanas. Cada vez que un residente me presenta un paciente (como nos exige la ley y la buena práctica), escucho la introducción, sonrío y luego me permito interrumpir con la siguiente petición:

-Por favor, dime algo no médico sobre el paciente.

En nuestra cultura médica, los residentes presentan al paciente de esta manera: “Sr. S. es un hombre de 69 años con enfermedad renal crónica, trastorno bipolar, enfermedad arterial coronaria, hipertensión e hiperlipidemia, acude para seguimiento.” Pero a mí me interesa cada vez más saber algo sobre el paciente como una persona con tres dimensiones, cuando no está en la clínica.

Las respuestas de los residentes a esta solicitud mía parecían pertenecera una de estas categorías.

Hay algunos que obviamente no habían pensado en tal enfoque. Uno dijo: “El paciente es muy agradable. ¿Eso cuenta?”. No, dije. Algunos residentes parecían reconocer que realmente podrían preguntar, por ejemplo, dónde vivía el paciente o qué hacía, pero les faltaba tiempo.

Otros habían preguntado sobre tales cosas, pero necesitaban permiso, por así decirlo, para mencionarlas desde el principio – para permitirse dar al amor por el paciente por los crucigramas, la devoción al coro de su iglesia y a la colección de figuras de jirafas, la misma importancia que la adherencia a la medicación y su nivel de creatina.

(Hubo incluso una residente que se rió, y siguió con su presentación – no estoy seguro si no lo entendió, o simplemente me ignoró).

Ninguno de los residentes dió dicha información personal sobre el paciente en la introducción de su presentación sin que yo lo hubiera pedido. Sólo se permiten ciertos tipos de conocimiento de los pacientes – sus datos biomédicos, sus disfunciones fisiológicas, y (algunos de) sus síntomas. Pero no su vida personal, no lo que hace que su vida – ellos mismos – les merezca la pena vivir. No ellos como personas.

Por supuesto, los criterios de conocimiento permisible se transmiten sólo implícitamente en la escuela de medicina y en la residencia. Pero son poderosos. Son una atmósfera que envuelve al médico en la clínica – tanto que incluso yo, varios peldaños por encima de los residentes en la jerarquía, me siento consciente pidiéndoles que me den una (¡sólo una!), “cosa no médica” como nombre justificativo, acerca de un paciente. E incluso entonces, debo justificarlo: “Se trata de ver al paciente como una persona completa”.

¿Qué cosas no médicas le han preguntado a su paciente o compartido con su médico?

No soy hispanohablante nativo y le doy gracias a un colega generoso de Madrid que me ha editado este blog. Por supuesto llevo la responsabilidad para todas infelicidades de estilo y errores gramáticos.

modern-decor-lucite-giraffe-jonathan-adlerEvery week I precept (teach and supervise) in the residents’ internal medicine clinic at the Outpatient Center of Johns Hopkins Hospital, on Caroline Street in Baltimore. The patients are mostly Baltimoreans, mostly African Americans, though an increasing number are Spanish-speaking immigrants.

I tried something new these past couple of weeks. Whenever a resident presented a patient to me (as is required), I listened to the introduction, smiled, and then let myself interrupt with the following request:

“Please tell me one non-medical thing about the patient.”

You see, most often, the patient is presented this way: “Mr. S. is a 69 year old man with CKD [chronic kidney disease], bipolar [disorder], CAD [coronary artery disease], hypertension and hyperlipidemia, here for followup.” But I was interested in knowing something about the patient as a person, when he’s not in clinic.

The residents’ responses to this request of mine seemed to fall into one of several categories.

There were those who had clearly never thought of such an approach; one said, “The patient is very pleasant. Does that count?” No, I said. A number of residents seemed to recognize that they might indeed ask about, for example, where the patient lives or what they do, but they hadn’t had time.

Still others had asked about such things, but needed to be given permission, so to speak, to talk about such things right up front – to give the patient’s love of crossword puzzles, devoted membership in her church choir, and collection of giraffe figurines the same pride of place as her creatinine and medication adherence.

(There was even one resident who gave a laugh and went right on with her presentation — I’m not sure if she didn’t understand, or was just ignoring me.)

None of the residents gave such personal information about the patient in the lead-in to their presentation before I asked for it. Only certain kinds of knowledge of patients are allowable – their biomedical data, their physiological malfunctions, and (some of) their symptoms. But not their personal lives, not what makes their lives — to them — worth living. Not them as people.

Of course, the criteria of allowable knowledge are transmitted only implicitly in medical school and residency. But they are powerful. They are an atmosphere all around a doctor in clinic – so much so that even I, several rungs above residents in the hierarchy, feel self-conscious asking them to give me one (just one!), apologetically named “non-medical thing,” about a patient. And even then, I must justify it — “It’s about seeing the patient as a whole person.”

What non-medical thing have you asked your patient about, or shared with your doctor?

Happy Purim 2017 from Zack, Celeste,

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