More on doctor visits etc

I haven’t visited for a while because I’ve been in a state of limbo, trying to persuade my school that I did in fact leave while also going to a batch of incredibly useless doctor visits. In a nutshell:

“Hey doc, a shark bit my foot off last weekend. See, right there, it’s still wrapped around my leg? Can you help me with this?”

“Gosh, I see here you have a past history of anxiety and depression. Are you sure you don’t think your foot is missing because you’re depressed?”

“Well, uh, I don’t think so. See, that’s clearly a shark. He’s still biting my leg. Shit! This is really painful!”

“All right, I’m going to write you a prescription for Prozac and see you in 6 weeks. If the shark thing is still bothering you, we’ll talk then. Okay, bye! Say hi to your wife for me!”

“But, but, but…”

Bastards.

Counseling, doctor visits, and why it can be so hard to find good help

I came across this post via Brute Reason. The author is a counselor.

The course I hated most in grad school was taught by a professor who said, “If your clients talk about the outside circumstances that keep them down and make their lives horrible, about how they’re so hard done by, they can’t ever take responsibility for their own lives.”  It was supposed to be a course on marriage and family therapy, which is a topic I love a lot on its own; but most of what I learned was about the use of institutional power, from a rich moderate liberal white guy who thought that talking about inequality of any kind was actively harmful to therapy.

and

I had to noticeably hold the door open to conversations about inequality.  There is a lot that subjugated groups know about their experience that they likewise know isn’t safe to talk about with people who have privilege over them, whether the power differential is sex, race, disability, or anything else.  In therapy, clients fear that relationship-shattering moment when their therapist–someone who has so far been a warm and supportive figure–strikes out at them from a place of privilege to enforce social norms.  If I say, “Oh, let’s not make this a race issue, not every white person is racist,” I’m proving that I, at least, am a white woman it’s not safe to talk race with.And often when I opened the door, the immediate and enthusiastic response was the equivalent to, “I’m allowed to talk about racism? OH MY GOD LET ME TELL YOU ABOUT THE RACISM I’VE SEEN.”

Now, the original author was writing about racism, and I’m going to take that ball and run with it a bit. This dynamic exists in medicine, too. Perhaps the easiest example is where the tone of your doctor visit switches, as he/she tells you that you need to quit smoking, or lose weight, or exercise more. If you’ve never had a visit like that, congratulations! Keep doing whatever you’re doing. But for everyone else, this is often an uncomfortable experience. It’s uncomfortable for many doctors, too.

But it’s certainly true that there are elements of privilege here. If you look at AMCAS data for medical student demographics, you’ll notice a lot of medical students have one thing in common: wealthy parents, usually a stable upbringing. And this is in addition to the ability you need to get INTO medical school: reasonable intelligence, a solid work ethic, etc.

Maybe there was a time where medical students were mostly bookish and not super physically active. I’m not sure that’s still the case; at my school, many of our really good students were also generous volunteers who were also in great physical shape who also had good relationships with their family who also had research interests… you get the idea.

I would hazard that the reason these “let me tell you what you need to do” moments is not because what the patient is hearing is uncomfortable or unwanted advice. It’s because there is a ton of privilege being conveyed all at once. You’re a Black woman. Your doctor is an older white guy. He’s about to give you advice on how to live your life better. How awkward is that?

Okay. Now let’s turn things up a notch. Your doctor is a somewhat conservative guy. What does that mean for you?

Keep going. Your doctor is a very conservative dude, who loves talk radio, boats, and by the way he’s an OB/GYN. Shit, is it Ron Paul?

We’re switching gears. Your doctor now loves NPR, organic food, and yoga. And your doctor is now a white woman. Will this affect your doctor visit? Are you sure?

Now, this sort of stuff doesn’t matter in many situations. If you’re diabetic and discussing what medication/diuretics you need, great! If you’re discussing your cancer progression, again, hopefully this won’t matter. Or will it? Wait! What if your cancer is causing you pain? Uh oh.

Racial/ethnic minorities consistently receive less adequate treatment for acute and chronic pain than non-Hispanic whites, even after controlling for age, gender, and pain intensity. Pain intensity underreporting appears to be a major contribution of minority individuals to pain management disparities.

Why is that? I mean, surely we’re dealing with purely medical matters–pain is, after all, considered by some to be “the fifth vital sign”–so surely treatment shouldn’t vary, right?

So to sum up this mess of a post… you’ve got a lot of privilege if you’re a doctor, or counselor, just by virtue of your role. There is an excellent chance you have other privilege–wealthy parents, a more stable upbringing than most, or just the fact that you’re goddamn smart and hardworking.

As a result, when you’re a patient going in to see one of these people, it can be damn uncomfortable. When I first started seeing doctors at my school, they treated me like one of the gang. It would have been great, except this mostly involved quizzing me on trivial bullshit, or asking me what I would do to treat myself (yes, really). I was one of them, just having some temporary setbacks!

And then I kept being sick.

And slowly, things changed. I was depressed and in need of attention, or something. I wasn’t a medical student like my doctors were, no–I was struggling, or clearly uninterested in being a doctor. For shit’s sake, autoimmune diseases run in my family. If someone has the flu you don’t ask them if maybe they just don’t like their job, do you?

And then I was just another patient, one of those weird people who shuffle in a few times a month to get some pain pills or emotional validation or who fucking knows. I was usually a good two decades younger than any of the other patients, so that was unusual, but otherwise I filled a similar role.

Over the course of two years, I basically got to watch my doctors’ level of respect for me slowly drop. When I first switched to my current one, she was excited. A sick medical student! I just needed some proper TLC and then I’d go pass Step One and be a cardiologist or neurosurgeon or who knows. A fixer-upper! A project! Yes!

And then I kept being sick. And I was less exciting. And more of a pain in the ass.

And that’s where I still am today, unfortunately.

While we’re discussing bombings

I think this bombing of a NAACP office deserves some attention too: http://www.vox.com/2015/1/7/7508027/naacp-bombing

I have not seen a damn thing about it yet on major news networks, and now that the Paris shooting occurred I suspect I may not ever. But it reminds me of an event a few years ago, where a man crashed a small plane into an Austin, TX IRS building. This didn’t get a whole ton of attention either.

Look, if we’re going to obsessively focus on terrorist attacks, can we at least be more even-handed? If someone bombs a building, or crashes a plane into it, or whatever, it really shouldn’t matter too much what their skin color, religion, or political beliefs are. If a white Christian guy commits an atrocity, it’s just as bad as if it’s a person of color or a Muslim or whomever.

I mean, if it’s your family member who gets killed, are you really going to feel much better because at least the killer was “saved”?

Mankiw on Piketty

Left unstated, of course, is that much of the Founders’ “capital” was in fact in the form of enslaved human beings.

I assume this is an innocent mistake on Mankiw’s part–surely if he realized the implications of what he wrote, he would never have written it–but the fact that he made it at all is telling.

Sure, you could argue that with historical context the Founders weren’t so bad, and maybe that’s true. But we are explicitly talking about wealth distribution as it pertains to democracy in 2015, not 1776. If your example of how wealth inequality and democracy coexisted historically ignores the existence of slavery, perhaps you need to re-think your hypothesis.

Texas, Democrats, 2014 again

I found this article about Battleground Texas interesting. It’s an attempt to figure out what exactly went so wrong for Texas Democrats in 2014. It wasn’t just Wendy Davis who lost big, see. It was basically every single remotely liberal candidate.

The article confirms some of my suspicions about how campaigns were run. Specifically:

The group’s ethos descends from Organizing for America, the Obama campaign’s organizing engine. OFA was a powerful national organization, attached to a juggernaut presidential campaign and was able to more or less dictate terms to the locals. Some of that attitude made it to Texas, and it went over about as well as you’d expect.

Battleground seemed to disregard institutional knowledge about the state’s political landscape, arguably to the detriment of the Democratic ticket. For example, the combined Battleground/Davis campaign effort tapped BlueLabs, a Washington D.C.-based consulting firm run by yet more Obama whiz kids, to conduct an analysis of the Texas electorate and figure out where to find votes. BlueLabs, the firm’s site says, “specializes in persuasion modeling”—targeting crossover and moderate voters.

This sort of massive centralization is no stranger to Democrats; the Republican Party has been the king of local elections and legislatures for some time. But it’s striking to see just how poorly it went this time around.

And a theme emerges in this article, repeatedly:

In largely Hispanic Nueces County, home to Corpus Christi, Republicans swept every contested race in an area that should be fertile ground for Democrats. One of the problems, local organizers say, was that the coalition didn’t spend enough time mobilizing Democratic base voters early on.

You can spend an infinite amount of money. If you can’t get people to vote–and in Texas, you need to be registered at least a month before elections–you’re going to get annihilated, and that’s what happened here.

As long as Democrats maintain a myopic focus on Washington DC (and inspirational but distant people like Elizabeth Warren) we’re going to continue to get thrashed in elections. We need a local “bench.” We need local social capital for liberal-leaning citizens. We need a right-wing-church equivalent.

If you go to see “Selma,” keep in mind the powerful role that black churches played in the civil rights movement. I wonder whether they might be able to play a large political role yet…

Here’s to a happier 2015!

I’ve been MIA for a few days. The holidays are a bit of a rough time for me. My spouse is awesome, and my kittens are great, though. I am very lucky in many ways.

I’m officially leaving medical school. I’m not super happy about it, especially since academically I’m doing OK. But it’s been wrecking my health and I need to take care of myself. I have nothing but admiration for the people who are able to handle it, let alone those who thrive in it. It has a ton of laudable aspects–you get to take care of people daily, solve complex problems, and get paid several thousand dollars a week. What’s not to like?

I’m still trying to figure that out myself, as well as figure out what “the next step” is. Guides like this from Vox.com don’t help much:

1) Don’t worry too much about the salary

2) Don’t follow your interests

3) Don’t do an easy job

4) Do work that has wider significance

5) Engage in a variety of different tasks

Just with those first five items, I am apparently supposed to ignore not only salary but also my current interests. It should be difficult, meaningful to me personally, and have a wide variety of tasks fall under its umbrella.

I’m surprised it doesn’t ask the readers to ignore their skills (whether they be medical diagnosis, programming, graphic design, whatever) and just apply to jobs that sound good to them. “Well, I’m here for the Chief Surgeon position because it sounded really varied. I have to hurry, though, I have an interview as a Flight Technician after this.”

Uh huh. I’m just going to say the people I saw doing the best in medical school tended to have a really strong interest in the topic, usually cultivated over many years, and a background that supported it (however–some worked as nurses, some were just Bio majors, etc). I’m sure there are a handful who were poets or actors or something. But in general I didn’t find myself surrounded by theater majors for whatever reason.

Meanwhile, other job guides seem convinced that there is One True Career/Job for everyone in the universe out there. No matter how esoteric your interests. You too can find a job involving string theory, basket-weaving and long social lunches. Just put your damn mind to it. And think positive, jerk.

2015 is certainly going to be interesting. Whatever else it will be.

Conservatives in academia

I found this article recently and I am trying to figure out what to make of it: How academia’s liberal bias is killing social science.

have had the following experience more than once: I am speaking with a professional academic who is a liberal. The subject of the underrepresentation of conservatives in academia comes up. My interlocutor admits that this is indeed a reality, but says the reason why conservatives are underrepresented in academia is because they don’t want to be there, or they’re just not smart enough to cut it. I say: “That’s interesting. For which other underrepresented groups do you think that’s true?” An uncomfortable silence follows.

I sympathize with the author of this article. But I confess I don’t really know what the solution for this problem looks like.

Conservatives are underrepresented in academia, but they’re not underrepresented in American society as a whole. They are not underrepresented in positions of power. They currently control both houses of Congress, 30 state legislatures, and Lord knows how many local political positions and small businesses. There is no shortage of sympathetic churches or communities. You may not find many Republican professors, but you will find no shortage of Republicans with a voice, income, and/or social status.

So while I agree conservative underrepresentation in academia is a problem, I don’t think it’s genuinely the same as why other groups are underrepresented (women, for example). I am tempted to lean towards the “conservatives don’t want to be there” explanation, but I have no problem acknowledging there is heavy discrimination against conservatives. The article itself indicates that “82 percent [of academic social psychologists polled] admitted that they would be at least a little bit prejudiced against a conservative [job] candidate.” That is, admittedly, a huge percentage. But what would the author suggest to fix this? Affirmative action for conservatives in academia? Proliferation of conservative universities to counter the massive number of liberal academics?

I’m curious to see what our conservative luminaries can come up with as a solution. I assume it will involve lots of Randian buzzwords, mind you.