Archives for posts with tag: medicine

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.

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Please come and hear me read from Making Sense of Medicine on Tuesday, August 2, at 7pm, at Baltimore’s Ivy Bookshop.

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Great first class yesterday at the Berman Institute in my new course, Ethics of Healthcare Decision Making. What is needed for a decision? What are the goals? More to come on these topics, and our fascinating discussions.

In recent months, two stories of mine, both having to do with medicine, healing, and Baltimore, have appeared in two literary journals.683788737

In “A Letter for You,” appearing in Gravel, a white doctor tries to orient himself with regard to his African-American patients.

In the first issue of Dryland, a new litmag from LA, you can read my story “Pain and the Machine,” in which a floor buffer chases a janitor down the hall.

I’d love to hear your reactions to these.

My Facebook feed is riven in two. On the one hand, there are free-thinking, scientistic doctors, patients, and those who love them (or tolerate them enough not to hide their status updates). On the other, are Jews: and, for some reason having to do with personal curiosity and involvement with Yiddish speakers, many of them are Jews who are Chasidic, used to be, or are somewhere in between.

Both camps are in the throes of realignment. The former, because evidence-based medicine is screeching towards the end of a game of chicken, the other competitor being (unfortunately) the patient as a person, with power over her own decision making.

Let’s take the most recent example of this hair-raising collision: statins. Cholesterol medicines, in other words, and what to do about them. Yes, we should probably get rid of these artificial numerical targets, it seems like most people agree on that. But the new guidelines, according to which (grosso modo) everyone with an estimate 10-year heart disease risk of 7.5% “needs” to be on such a medication, are rightfully controversial. If you are the type to read JAMA articles, you will be entertained by John Ioannidis (he of the “half of all scientific findings are wrong”) on the one hand, who darkly prophesies “one of the worst disasters in medical history” due to vast overtreatment with statins. (Um. Flu? AIDS? The plague?), and, on the other hand, a professional, prudent take by some collaborators on the new guidelines themselves, who take what seems to be the best defense possible: The science is better; we are working towards incremental improvement of guidelines. In short: nothing’s perfect. This is a step forward from where we were.

If you read the articles back-to-back, it seems an awful lot like the internal breakup currently convulsing ultra-Orthodoxy. Belief and practice are at loggerheads, and tiny fish are getting squished between the logs. Are you a believer or not? Are you an incremental advancer or a revolutionary? Are you willing to listen to doctors by virtue of their social standing and hereditary place as healers, even if their advice might not be better than random chance?

Does medicine need a revolution to upend received wisdom – even the new received wisdom of our day, which is the dogma of evidence-based medicine – enthroning in its place the empowered singular patient? Sure, if you are the type to upend and revolt. But not even the most engaged of patients want to get rid of everything the medical establishment has to offer. Similarly, even those about to leave their hidebound religious communities sometimes find themselves at peace with a stable compromise. They don’t have to believe in everything.

If a revolution is possible, but we choose an incremental change, are we being sensible – or hypocritical?

Without noticing it, I crossed a threshold. Or perhaps I walked right into a mirror without realizing it? Do I look different? Do I have bruises?

It’s been ten years since I started blogging, first here, then here. Now I’m blogging at the book site too, in parallel.12_Pictures-Generation_Kruger_Untitled-You-Are-Not-Yourself_1981

As the Hebrew poet Y.L. Gordon asked, “Le-mi ani ameil?” Who am I laboring for? As a doctor, the answer is clear: I have a patient I am trying to help. As a researcher, there is a community of peers I am trying to satisfy (and a hoped-for public that the research benefits).

For the writer, whether creative or expository, the answer is less clear. Sometimes there is no other reader, and that’s okay. Sometimes the blog is a diary. Thoughts sound different when let out in the open air than when kept inside the head. I can be a writer and reader at the same time. This might help me develop thoughts which are useful to others, or can be expressed in longer form with greater attention to satisfying a certain public.

Talking To Your Doctor has been out for six months, and there is still a steady trickle of purchases. I am grateful for that. But it’s time to move on to the next book. That means less frequent posts – perhaps a decrease here and there in the level of polish and rationality. Maybe some more experimentation as I try and flesh out some thoughts.

Happy New Year to all, and I look forward to providing more details about this coming project as it finds form.

I haven’t written much about parenting, because most of it is hard and boring. Like maintaining health, either as a doctor or a patient, it’s usually a slog, requiring wellsprings of confidence to remain sure that what one is doing in the moment will have some measurable impact down the line. To that end, I have decided to found an organization to inspire such confidence, while establishing standards that can make most of us – the average parents, the pretty-good providers – feel supported in the slog. It is called the Adequacy League, and will have at least two arms, one for parents, one for physicians and patients.

The League of Adequate Parenting will emphasize that most of us who bellyache about child-rearing, and fear that we are not doing well enough, are actually doing just fine given our circumstances. This means, of course, that if we are parenting in resource-rich circumstances, we should appreciate that fact: our adequacy is not likely to be the same as that achievable under other circumstances.

Similarly, the Adequate Doctors-and-Patients’ Union recognizes – by charter! – that there is a tension to medicine. On the one hand, much of what ails us gets better with time, and we ought not to interfere with that. But, on the other hand, we want to actively interfere in a great many conditions for which there is no “natural” cure. Adequacy means neither interfering without exception on principle nor refusing to intervene on the basis of some misguided alliance with “nature.” Neither doing too much nor too little, and not looking over one’s shoulder continuously at the latest study. The adequate doctor or patient can be satisfied with her efforts toward health even as she knows she is not perfect.

Adequacy does not mean complacency, but the ability to take stock of our current limitations, appreciating all we are managing to do.

Excellence can be quantified, sure, and we should all aspire to it. Poor performance can be avoided as well with the help of keen analysis. But neither striving for excellence nor avoiding error and harm can get us through a weekday morning, a whiny toddler, a chronic illness, a day full of things-to-do and people with quite legitimate demands whom we need to serve. Sustaining a notion of adequacy is key. The Adequacy League recognizes this. Though it presents no awards, reimburses no one for travel expenses, and has no meetings, it will exist, quietly, wherever you are, as long as you need it.