Wednesday, July 23, 2008

Maxima Culpa

Who is to blame?

This is the current situation as I see it: Many doctors are unhappy; many patients are unhappy; many hospitals are failing financially. So, who is to blame?

I’m not a doom and gloom guy. I actually love my job. When I go to the hospital, I truly feel like I do something good for humanity and myself. My job is interesting, challenging and certainly makes a huge impact on people’s lives. That said, if I had stayed in clinical medicine, there is a good chance I would have one of my annoying patients in my basement pit with a squeeze-bottle of Jergen’s lotion and an industrial sewing machine ready to prep my next suit.

So why am I in the minority? And again, who is to blame?

If you read the New York Times without periodically retching, then you probably live on the upper west side of Manhattan, make 1.8 million dollars a year as a hedge fund manager and will vote Obama because of your infinite care for the less-fortunate (read: guilt). Unfortunately, the NYT is of the very few newspapers that is well-written and has generally good reporting. You just have to hold your nose for the political articles and the opinion pages. One exception is David Brooks. Ya gotta love anyone whose favorite target is baby-boomer self-importance and hypocrisy.

Brooks’ latest article addresses blame. Specifically, in the mortgage crisis, is the predatory lender; the irresponsible borrower; or the culture that considers irresponsibility acceptable the villain in this play?

Translating to medicine: who or what is to blame: the government’s and administrators’ ill-conceived policy decisions; the doctors who have rolled over and allowed these policies to infest medicine; the irresponsible and unreasonable patients who demand perfect care for free; or the culture that says irresponsibility and unreasonableness is acceptable?

Everyone is going to have a different opinion on where the blame lies, and, as we are well aware, opinions are like assholes: everyone has one, they stink, and they are prominently featured in my favorite films including: Juranal Park, Little Anal Annie and Anus the Menace. Since there “is no right answer” to my question, I want to address the issue of culture: physician culture and patient culture.

Physician culture has always been about the patient. Our culture has always emphasized care, compassion, selflessness and helping people in need. Of course there are exceptions to the rule: some docs are selfish assholes and could give a toss if you live or die. However, that doesn’t change the general culture. People generally go into medicine because they want to do something good for humanity.

Patient culture, traditionally, was about respect for physicians, some degree of personal responsibility, and a recognition that docs do the best we can but, regardless, sometimes people stay sick and die. Maybe this is a ‘rose colored glasses’ view of a halcyon past. It is certainly not the reality of patient culture today: physicians are regularly disrespected, personal responsibility is a joke and if things don’t go perfectly, a lawsuit is waiting right around the corner (again, there are obviously exceptions, but it is a cultural trend). This cultural shift is made possible due to something that Brooks points out in his op-ed piece. We see the obnoxious, jerkoff patient being treated quickly, without complaint and for free by the providers and this gives other patients the signal that this behavior is somehow OK. The behavior of our neighbors, previously not tolerated, is accepted, and it becomes a cultural norm.

The irony here is that physician culture, through the focus on ‘compassion’, has actually enabled this shift. Patients, administrators and the government have noticed that docs actually will sacrifice the self in order to ‘do the right thing’ for the patient. Human nature being what it is, leads patients and administrators to become more aggressive and unreasonable. They see our compassion as weakness and take advantage. Docs have rolled over and been asked to eat feces. We have opened our mouths and said “ahhh”.

Or maybe I’m just overanalyzing the whole thing. Wha’eva, I do what I want.

35 comments:

  1. I am so sorry. It reminds me of how I feel about my kids' school. Different, but sort of the same.

    Quite often my kids come home and tell me that they didn't get to go out for recess because some of the kids did not behave. I have no doubt that my kids have faults, but being disrespectful or misbehaving in school are not among them. They get punished anyway.

    What seems to happen in their classrooms is that everyone knows that someone will ruin it so they all seem to figure it isn't worth it to try to do the right thing because they will get punished anyway.

    This seems to be exactly what happens in real adult life. People notice that some people don't pay or are jerks and decide it is ok to try it themselves. Then our world turns to shit and it is ok because everyone is doing it. No one really even seems to notice it because so many people are doing it. It sucks and makes it really difficult for me to teach my kids to be good people when you seem to do so much better sometimes if you cheat in life.

    You summed it up well, but I am sorry that it seems to be the truth. All the doctors I have ever known have been amazing, kind, caring people, and it makes me really sad/angry that all of you get taken advantage of because of that.

    On a side note, do you really know how to sew? I can't seem to use a sewing machine without breaking it.

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  2. What a great topic....and one my hubby and I have been discussing at length recently. I think the problem comes down to two issues.

    The first being the whole sixties hippy mindset of instant gratification and the even more disturbing mindset that one should be able to go through life without feeling any physical or emotional pain....the "comfortably numb" syndrome I call it....and believe me as the daughter of hippy drug addicts...I know of what I speak. It amazes me the expectations people have when they come in the ED.....to relieve pain (emotional and physical) that they have suffered for years after visiting countless practitioners....and damn it....being the entitled babyboomers they are they will tolerate nothing but total perfection within a record amount of time......if you can't provide....they have a lawyer and another hospital on speed dial...which always makes me want to say, "ohh..after years in your patcholi smelling commune reading Marx and Chomsky.....NOW you threaten me with capitalism when it suits your ends"

    The second I blame on Mr Rogers...yeh that sweater wearing trolly riding dude. I have become amazed recently at my treatment from younger patients (those in their late teens/early twenties) I am in my mid thirties and would never have dreamed of speaking to anyone they way I am spoken too.....I don't even mean cursing and abusive language.....just an attitude of superiority and entitlement....and I blame Mr Rogers for telling everyone how special they are merely for their ability to exist and breathe. He spurned that whole bullshit era of everyone getting a ribbon on field day and every kid feeling like they are king of the fucking world....god I hate that man for what he spawned.....now I'm sure I'm going to hell for cursing Mr. Rogers!

    So why do I stay.....for the 5% of patients that are kind, caring, and appreciative of what I do. My favorites were when I was working in the South at a large well known teaching hospital that just happened to have a surrounding rural population. It was refreshing to walk in room to be greeted by a farmer in his overalls with a big smile and a "hello nurse". They owned guns, read the bible, homeschooled their kids, helped their neighbors, had no problems giving an "ass whooping" if their kids misbehaved, contributed to "climate change" by driving pick up trucks.....and they were the nicest most respective patients I've ever had. They were everything the left sneers at....maybe that's why I liked them so much!

    and oh yes..it might help us if CNN got rid of their "Empowered Patient" section. I swear...you would think healthcare workers are the laziest, most dangerous, negligent, people on the planet. I mean our patients even have to remind us to wash our hands.

    BTW I refused at my work to wear that "Ask me" pin they were making everyone wear about handwashing. Maybe we should make our own "Respect Me" pin!

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  3. Radgirl: I sew like crazy--my Mormon relatives taught me at age five. All doctors sew, don't they?

    The exact same issues of responsibility apply to education: I had a KINDERGARTNER suspended today for choking another child: Who is raising the kids? A tired grandma in this case, as Mom is a crackhead. and BTW, I never punish good kids. I just ignore the bad ones and give Skittles and a daily GOOD behavior note to the good ones. I do have to take notice when someone is being choked, however... I am NEVER teaching summer school again.

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  4. news flash... the world is governed by the aggressive use of force. always has been, always will. if we humans evolve out of this we can expect this to occur sometime in the next one billion years.

    non violent protest works because it is a form of force in and of itself.

    whether the business be communistic or capitalistic there is force as a governing principle. while the force in a communist system comes from people with power (and, dirty little secret, lots of money), the capitalist system has traditionally been governed by those with money who use it wisely. with a real and enforced rule of law this has proved, over and again, to be the most efficient and beneficial system for all.

    color me curious then, why in the good old US of A, we are in the process of embracing the groupthink approach and nanny-state approach which will decrease quality of life for all.

    there are people who do not deserve respect. forcing those of us who have attained respect by actions or education or skill to 'respect' the unrespectable is like sticking a hot poker up our collective asses.

    the backlash, if it comes, will be severe. if it does not come, we can take our place next to east germany, cuba, and the Great Britain of the seventies as once great countries ruined by the cowardice of the public to shoulder their own burden to the best of their ability.

    out.

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  5. e

    you sir are a genious. couldn't have said it better myself.

    CAT

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  6. No, I think what you have said makes a lot of sense. You know, people mock me because I listen to my doctor. I have to defend myself for doing what appears to be the right thing to me. Then they have to tell me that "doctors treat symptoms, not patients." Which, I think, is a load of crap.

    Of course, some doctors annoying. Like my pediatrician from when I was a kid. He would say half a sentence, not complete the thought and expect me to know what he meant. Then he never explained himself when I asked. But there was no reason for me to disrespect the guy. He did the best he could, he just didn't relate to me very well.

    Yeah, I'm sorry. I do what I can to respect people and be courteous to everyone. I'm only one woman and I don't have a lot of health problems. ;oP

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  7. 911doc - do you really feel that East Germany (which was not really a "nation" until after WWII) and Cuba were "once great countries" of the seventies????

    I find that curious - East Germany is no more, partially because it was corrupt, discriminating - and more importantly - its own people didn't like it.

    As for Cuba - in the seventies, it was far more restrictive than it is now. As a child, I was terrified of the possibility of being invaded by Cuba - hence living with the concept of underground shelters. Under the current Cuban administration, which is still considered "communism", it is trying to become part of the global community, knowing its sytle of government cannot exist on its own unless its huge - ie, China.

    I really don't think you are old enough to remember the Bay of Pigs or the destruction of the Berlin Wall (other than perhaps by news videos). However, you also are perhaps not aware of the situations either of those countries -which are as different from each other as they are from us.

    Your arrogance in which you state "there are people who do not deserve our respect" - are you referring to the respect which comes from just being a human being? Are you so self-rightous that you feel your education, social status, choice of career (skills????? - often physicians have very few "people" skills....) gives you the ability to pick and choose who deserves respect? It appears you feel you deserve respect just because you are a physician. You don't!!! I am one and I've known many I don't respect myself. Whatever respect I've earned - I've earned - it didn't come without hard work.

    One poster thought some farmer who home-schools his children and helped his neighbors (how she found thought out is a conundrum) is far better as an individual than myself. I don't farm, my kids went to public schools and I don't know one of my neighbors who has lived there 5 years. I am a baby boomer!

    Yes - I am one of the individuals who fought that battle that allowed women (of whom I am one) to enter careers which were not previously allowed to women. I also am one of those women who was part of the battle which was pro-active in not allowing "discriminating" questions to be asked on interviews (ie - are you planning to marry, do you want children, will you move when your husband is transferred?).

    911 - I am also the mother of a 23 yo son. I abhorr your comment that the world is governed by the use of aggressive force. It was governed that way in the 1500s, 1600s - yes even into the 1900s - sadly - I lived thru the Vietnam war & lost many. I was not alive during WWII, but I do know after many, many conversations with my own parents and relatives - the reasons, forces, impacts, which made my relatives take part in that combat were far different from what has occurred since. Indeed - few WWII Vets even want to speak of their involvement (and many of those who do didn't even have much combat experience). My own father, who spent time in the South Pacific in foxholes, understood my antiwar sentiment and supported it wholeheartedly. How sad that in the 21st century there are young people like you who feel aggression should be a choice. Why are we acting the same way those who lived centuries ago act? Haven't we progressed farther???

    But, 911 - I have NOT lived thru any - no NOT any aggressive force which this country has become involved in or instigated in which I would risk losing my son. Yes - that goes all the way from Vietnam to the current debacle. I understand you might feel differently than I - and I RESPECT that, just as those posters who have "hippie" parents like me should respect ours.

    However - those of us who are baby boomers do indeed feel we deserve the respect which is something which should be given to ANYONE. Those of you who feel you can pick and choose those of use who deserve respect are at fault for feeling you have that ability - you don't!!!

    Respect, althought difficult to define is that which society feels for the value of an individual - in its broades definition (and narrowest as well). However, in a personal sense (which all of medicine is actually - even for those of us old-timers of medicine), respect is that which you are willing to give in order to get that same consideration back. When we in medicine see patients - we see them at their worst - sick, scared, addicted, out of work, non-compliant - but, our job is to get them the best care which is possible, without prejudice and RESPECTFULLY.

    You may not receive the respect you feel you deserve from that one patient - but, it will come back to you later - or not......after all you are leaving yet another career (are we counting - is this 2 or 3???).

    Respectfully - you are very, very cynical - sad. I've seen a lot in my 30 years of medicine and am proud of it. You won't stick around long enough to see the success of the final outcome or even be part of the solution. I've seen the very best of medicine in the 70's & the very worst of medicine - which has been in all the decades of my practice. I choose to focus on the best - some of you - you specifically choose to focus on the worst.

    I am of an age at which I will be needing medical care in the "sooner" future rather than the later. Its hard to envision that when you're in your 30s - but age does bring its own problems.

    Fortunately, there are more positive physicians out there than negative. I'm happy you are finding another career - its hard to not have this negative influence impact your approach to patients just like me - a baby boomer, but your equal - only if you ask. Would you even ask??????

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  8. I was bothered that "Weapons of Ass Destruction" didn't make the list.

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  9. dear non douchebag anonymous,

    didn't 'weapons of ass desruction' star phil mccraken and pandora box?

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  10. dear anonymous,

    you misread me.

    east germany was a great country prior to world war one as it was indeed part of 'germany' and though the kaiser and then hitler took them from greatness to great madness and murder, germany produced and continues to produce fantastically engineered products, inventions, and contributes to advances in science, literature, and the arts.

    east germany was a shithole just like every other communist country ever, except north korea, where they have done great things in reducing death-by-starvation in the past week by executing a lot of troublemakers.

    great britain is certainly great again, but in the seventies was in a crisis of confidence and finance that seemed irreversible. enter maggie thatcher who yanked the socialist rug out from under them and turned their 'give me stuff' society into a productive one again. sadly, they are inching back towards nanny-statism, and their national health service is a disgrace.

    cuba was a great country before fidel.

    as to the rest of your tome... let me check here..., yup! you are an idiot. you preach the gospel of non judgmentalism and then rip into me in a kind, well, judgmental way.

    if you are a physician and you are not prepared to make judgments about people, their motivations, their secondary gain issues, their real signs and symptoms and their imagined ones, then you are useless.

    our whole job is to judge every scintilla evidence presented to us. gut and brain and common sense. turns out you already do this as you have labeled and diagnosed me without ever talking to me! you certainly are a super non-judgmental judgmentalist! asswipe.

    if someone comes into my ER after smoking crack and they have chest pain then it takes a huge fucking socialist/communist idiot to stay on the 'non judgemental' bandwagon and turn to the family in the next room (who will pay their bill and who have maintained their insurance coverage) and tell them that they are going to be paying some money to care for the cocaine chest pain guy.

    that's exactly what happens you ignoramus. and you want me not to be mad at these people? who are you, ghandi? you are certainly not Christ because he exhibited righteous anger in turning over the money-changers tables in the temple. there is such a thing as justified anger, and if you don't believe me let's try a little experiment... you stand there and watch me hit your son in the face. don't judge me!! i have a 'disease' of 'impulse control disorder'... in fact, it's the only reason i'm writing this.

    your post is an illogical gem of feelings over logic, of form over substance, and complete selfishness.

    so you don't want the US to do anything that might risk your son's life? okay. what about the rest of us... you know... your countrymen?? what if your son was the only one who could prevent detonation of a nuclear device in NYC but his life would be at risk in doing this. Still no? You are a selfish twit with no sense of duty or courage and don't talk to me like you are my father or mother... you are neither... you would make them sick anyway with your namby-pamby wussitude.

    meanwhile, there are still a lot of us out here who have read history and served in the military and appreciate that the birth of this great country was out of war and that war has been with us since the inception of human history and is most certainly not going to be eliminated by the feel good pacifism you embrace. peace comes with victory. speaking persoanlly, i'd prefer it if we won.

    you can thank me later for putting my life at risk in the service of OUR country to protect your freedom to spout ignorant shit anonymously on an open blog in a free country. you can also thank my wife for serving and my friends flying jets and helicopters through the valleys of afghanistan and over the deserts of iraq killing people there who would slit your throat and your sons, given the opportunity, and all because you don't believe in their religion.

    me? i'll take wahabi islam over your absolutely gutless, pacifist mumbo jumbo.

    go get your own blog and lay off the pot, and wherever there is freedom of speech, wherever there is freedom of expression, wherever their is democracy today in our world, if you will simply open a history book, you will see that in almost all cases you can thank the US Marines, US Navy, US Army, or US Air Force. After all, war has never been the answer... except to slavery, hitler and stuff...

    everything else that is 'good' has been produced by midnight candle vigils, 'take back the night' marches, suspension of the death penalty, imposition of hiring quotas, higher taxes, lowest-common-denominator education, busing, government welfare, social security, the family medical leave act, and tolerance of every conceivalble opinion except the conservative.

    you, anonymous, win the douchebag of the month award on MDOD, congratulations, it comes with a $5 starbucks gift card and a pass to the off-broadway production of 'the vagina monologues' (starring nancy pelosi as herself).

    and as to you making assumptions about how i treat my patients and how well i do it you are a hugely arrogant fuckstick. then again, you may have it all figured out... this doctor thing... how to do it without caring so much.

    THIS BLOG is my vent mechanism. if i took care of you you would never guess i wrote this so go take your pacifist, feminized, cowardly keyboard somewhere where emotions and intent are valued more than result.

    good day.

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  11. You illustrated my point well.......

    unprofessional, disrespectful language, arrogant, angry, rambling rant - sorry - vent........

    Respect - you get what you give. You have none because you give none. I knew you were a vet & I gave the respect due them (you) - I just choose not to go down that path nor do I encourage my son, who is an adult. I don't have to agree with the purpose of your assignment to respect you must do it - just as I don't have to agree with the choices my patients (or my president) make. I must treat them - respectfully.

    I doubt, however, you'll ever find the respect you want - that only will come from inside. Yes - that is judgemental on my part. Anyone who can respond with such anger, foul language and demeanor to a poster on a blog is truly unhappy!

    You're correct - time to stop reading this blog! At the top, you folks "don't know where this will lead, but hope it will at least be enjoyable". It is not enjoyable to be treated to such foul language just because we disagree war - and by a colleague!

    Best of luck in your next career! What a huge waste of money our government spent on your education.

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  12. Not enjoyable??? When is an obscenity-filled thousand word response "not enjoyable?" You guys just keep churnin' out classics.

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  13. Dear Anonymous, as you can see from my post I am not ashamed no give my real name, nor am I ashamed to be a baby boomer female. I am ashamed to be lumped into the same category as you, however. I was unable to serve in the military due to a medical condition, but my husband of 32 years served during Vietnam. He did not have to go in-country, but did re-enlist when the time came. He was not ashamed. He is, to this day, proud of our veterans and would not hesitate to help any one he could. If you want respect, you need to earn it. Your post has not earned it, in my opinion. I have two grown children. When they graduated from high school, with no influence from me in either direction, they both enlisted. My daughter joined the Navy, my son joined the Army. I was proud of them and still am. I did not burn my bra, am not a feminist, and am grateful when a man opens a door for me. Please don't give us all a black eye. I appreciate the sacrifices made by policemen, firemen, doctors and the military. I'm sorry you don't.

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  14. Hey Anonymous, I don't have ESP, but I know you're a Social Worker or Psychologist or Child Abuse Counselor. You probably don't drive an 18 Wheeler or F-15. You want to check out some Unprofessional, Disrespectful, Arrogant, Angriness, check out my blog. And your Mom dresses you funny too!

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  15. great fucking comments!

    anonymous tool: If you did not find 911's response "at least enjoyable", then you unequivocally ARE a complete, humorless twat. You perfectly represent the self-involved, myopic, holier-than-thou, short-sighted, self-indulgent, weak, scared and hypocritical baby-boomer generation. What a pathetic legacy to leave.

    BTW, still digging radgirl's scantily clad photo. All hot women, please follow suit. If not hot, please pretend. No dudes please (unless you are REALLY hot).

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  16. Anon - I would hardly call myself a "colleague" of 911 if I were you. You are everything that is wrong w/this country. You make me physically sick. I wish our government spent more money educating incredible, compassionate physicians like 911 and his wife. The world would be a better place. What we can all do w/out are total idiots like you.

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  17. RadGirl, have you considered High Jumping? Great Cardiovascular Workout without the Joint wear and tear you get from Running. I know a great Jumping Pit...

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  18. frank, eto, pedimom, denise, and ruby ridge,


    *sniff*

    thanks for standing up for me against dr. deb.

    me

    *tear*

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  19. 911, sorry late to the party. Why did this comment section have me rolling with laughter?

    Anon Ideologue mom - Do you have to hold your nose when you swallow your own shit?


    e- you're a genius

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  20. 911-

    http://www.pharmalot.com/wp-content/uploads/2008/07/medical-blogs.pdf

    Thanks to HH, you're officially logged in as a monitored site.

    Funny - notice how some of them skew the tone and manner of medical interactions?

    For all the rest of you - yes - I'm very, very comfortable being an antiwar physician - many of us are. That, however, should not influence how we approach medicine - we treat who comes - thats it. Until it is determined otherwise (oh - by the president who so blithlely sent you and so many thousands of young men to a futile desert to effect no particular aim other than those which are offensive - ie, - the gluttony of oil (do you think Cheney is still alive or is he on life support??) or god-forbid - the quest of democracy in countries who cannot support a democracy! I share your grief in your sacrifice, but I don't share your joy in that sacrifice - there really is another way in the 21st century to solve problems. if the US can't find it - heaven help us!

    For those of you who have served and have children in service - I respect that sacrifice and devotion. I just choose to not make it my own - never have and never will.

    I am, however, a member of Doctors Without Borders - this is how I choose to use my talents - I have the time & I have the money to do so. My son, who has talents different from mine, also serves. Does that give you a different perspective? Odd how what someone knows changes things....

    Frank - you're an idiot - but, you know that!

    For all the rest of you - don't be sheep - they just spend their day in a field baaaahing!

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  21. This is for that smug self riotous bitch....yes.... you know who you are.

    Yes....I DO think that farmer that home schools his kids and helps his neighbor (and why is it a "conundrum" that I found that out....I merely was able to converse with my patient in congenial manner) is better than you. I have no problems or issues making such a statement. Moral relativism is a sure path to hell in my not so humble opinion. You probably even think we shouldn't condemn female genital mutilation because it's "part of their culture"

    Let me guess...you are one of those voters that live on the West or East coast and regard the US as just having a lake in between. I do not begrudge you your opinion or your vote....what I do begrudge is your utter elitist contempt for those that do not fall in line to your military hating, western culture bashing ass. You are probably one of those Code Pink bitches who stand outside recruitment stations calling our troops "terrorists"

    911.....ignore this bee-atch.....I think you rock!

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  22. There are foxholes in the South Pacific?

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  23. Teresa - yes - there were - look in you history books - Saipan, Tarawa, Tinian, the Mariani Islands, Guam......

    Or - perhaps, you might try visiting Hawaii - there is a beautiful mural of the South Pacific Theater of WWII at the Veterans Cemetary on Oahu. The foxholes are no longer there (thankfully), but if you drive to the protected side of the island, you can see where the Army and Marines trained. If you are fortunate, as I was, to have someone with you who was actually there - it all comes to life - very, very sadly.

    However, if you're on the East Coast - you can see the beautiful WWII Memorial which depicts both the European and the Pacific fronts of the war.

    I have been to both. I have tossed leis off the side of a ship in the Pacific Ocean off Pearl Harbor and laid wreaths at the WWII Memorial in DC - I have nothing but respect for those who served and have displayed such. How many of you have gone to give your respect? How many of you have sign your name on the register?

    It is more sad than inspiring - that is a quote from my father - who indeed spent 5 days in a foxhole on Tinian (yep - not getting his head above ground - peeing in his own hole, not changing clothes nor eating other than his rations. Sadly, the guy who was with him got his head shot off when he peeked above ground. My dad spent 3 days with that headless corpse thne had to write a letter to the parents since he was the CO). My own mother was a Navy nurse who served during the entire war - she said it was a hell she'd never want to remember - even in dreams.

    Neither of my parents were cowards - they rose to the challenge which was presented to them at the time - a children of 23 - just as my son is now. Both believed in it, lived on the west coast and were affected deeply by Pearl Harbor - but - 2 generations later - agreed that we had adopted a policy of unnecessary aggression.

    Each of us has a belief system which is valid and of worth. I don't discount any of yours - why is mine to be discounted? My own father and mother served, I have a brother-in-law who retired from the Pentagon and many, many friends who lost their lives in Vietnam.

    I just choose a different path........is that so abhorrent and difficult to understand? My own parents understood, supported and agreed, particularly during the very devastating end of the Vietnam war. I was fortunate to be raised by them, but also to have learned from them - both the glories and the devastation of war.

    Why is there such hate for dissension? We're in the 21st century - shouldn't we have come farther than that?

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  24. dear anonymous troll,

    we are ceasing and desisting all further posting and commentary due to our 'monitored status'. okay, not really.

    you are the worst kind of bureaucratic flunky. drunk with perceived power and making inane, obtuse threats. if you had the ability i have no doubt you would shut us down or throw us in jail.

    YOU, in fact, are the one who can't stand dissent. why the fuck else would you keep coming back here? YOU are the one exhibiting barely stifled rage and fear, and it comes out like it does with most uber liberals... couched in comforting and measured words, just like nurse ratched's in 'one flew over the cuckoos nest'.

    you can't wait to throw the switch on folks like me and my colleagues here and anyone who dare question your religion... because that's exactly what it is. you defend your 'position' with the zeal of a jihadist, only the jihadists have the decency to do their dirty work in broad daylight and not couched behind some computer screen under an anonymous screen name.

    if you lived in germany in 1930 you would be wearing the swastika armband proudly and would turn in your parents to the gestapo for hiding jews. if you lived in the ussr in the 1920s you would assist in the dekulakization of the ukraine. if you lived in north korea right now you would be doing important work for the party, eating like a king and sleeping soundly.

    you think you are taking a courageous stand, but you are merely following the path of least resistance. you live and work amongst people who think exactly like you do and you live in a blue city and have no regular interaction with 'common folk'. you watch pbs and listen to npr and give money to the democrat party and think obama has the answers when he is merely a conveniently colored empty suit.

    the people who work for you hate you but are scared shitless of you. nothing you talk about is hard. nothing you talk about requires sacrifice. i know you think it was a huge deal and all that you didn't get into yale and went to duke as a second, but that doesn't count. all you talk about is emotion and fear and 'fighting the power'. but you really tip your hand with the cheney rant... that's what passes for enlightened conversation at the academy these days is it? putz.

    one thing you will get here and from most conservatives is a reasoned opinion, but all you offer is fluff. you skirt the issues and try not to offend anyone but you yourself are always offended. if you don't like what you read here then get the fuck out already.

    if you are truly a physician, something which you have given us no reason to believe, then you are obviously far removed from the tiger pit of the ER, where the pointy end of mindless entitlement policies gets thrust down the throat of the physicians and nurses and techs and paramedics who ARE ACTUALLY CARING FOR AND SAVING THE LIVES OF PEOPLE YOU WOULD NOT ALLOW IN YOUR HOME OR NEAR YOUR SON.

    pointing out the irony and hypocrisy your posts represent is pointless for you, but i'll do it simply to show whoever reads us and likes us that they don't have to be bullied by the backasswards groupthink you represent.

    all the folks who have pointed out the logical fallacies in your arguments have been met with mindless emotional drivel, but mindless emotional drivel is where it's at today, so please, do us a favor... we are all just a bunch of private school, trust fund, war mongering idiots here... you have proved that, much to our shame.

    none of us here worked hard to get where we are... we are all here because daddy got us into med school and paid to get us out of that embarrassing thing with that girl from across the tracks... let's not even bring it up okay? and the secret kkk suits need to remain secret okay? so does our collective closet homosexuality which is obviously producing the neuroses we suffer from.

    rather than shame us further (because shame is unhealthy like cigarette smoking and war and meat), we would all feel a whole lot better, and you would too, if you went over to the daily kos or NPR or your own blog (which may or may not be dr deborah peel's blog), and further enlighten smart, courageous vegan-pacifists like yourself with your witty banter and insight.

    in the meantime i give you this, and, if you deign to grace us with your presence again, please do it gently, with small words, and simple sentence structure, as we kinda sorta don't know what the fuck you are talking about.

    and as an added bonus to our 'douchebag of the month award' i now present you with the 'single greatest argument against the 19th amendment award'. congratulations.

    through this and more i remain,
    your humble servant,
    911doc

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  25. dear anonymous medicine sans frontiers avec plus d'argent,

    the citation you link has mistakenly attributed a quotation to MDOD. in fact the only thing from our blog on that glorious study is our web address. guess we are off the 'watch list'. try again.

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  26. Sheep, eh? How could 911 be our shepherd when Obama himself is risen again in Germania?!? The coverage of that whole event is so amazingly over the top that it borders on hyperbole. He gets my vote when we see the wounds on his palm.

    911, this is epic, and the main reason that we can't have nice things. The MDOD comments sections lately remind me of a zombie flick. Keep 'em in the 10 ring and keep reloading; for every handfull you drop, hundreds more are bitten, and then it's just a matter of time. How ironic that all they want are BRAINS!

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  27. Teresa - yes - there were - look in you history books - Saipan, Tarawa, Tinian, the Mariani Islands, Guam......

    Or - perhaps, you might try visiting Hawaii - there is a beautiful mural of the South Pacific Theater of WWII at the Veterans Cemetary on Oahu. The foxholes are no longer there (thankfully),


    Saipan is in the South Pacific? Tarawa is in the South Pacific? Tinian is in the South Pacific? The Mariani Islands are in the South Pacific? Guam is in the South Pacific? Hawaii is in the South Pacific??

    Perhaps we need to look in a geography book instead of a history book. Heh.

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  28. 911 eloquent as ever.

    I think Anon is the real Debbie Peel come to school us all and cure us of our ignorance. Wait, not cure us, just add us to the flock of sheep. Seriously, I don't know how these people swallow their own crap.

    Anon: Keep drinking the koolaid.

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  29. i now present you with the 'single greatest argument against the 19th amendment award'. congratulations.

    So does that mean I'm not getting it this month? I am so disappointed. I shall just have to labor more ignorantly, I guess.

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  30. Thanks, Amy. I love you, too.

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  31. Anonymous Rat,

    Have you heard of the expresssion: to vent one's spleen? I think you need to have that checked, possibly by any of the physicians on this blog, "bad vapors" are always unhealthy.

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  32. Oh 911, wow. I just read the article. I can't even describe the anticipation and suspense and stress while reading it. Thank God the military has their own reporters. You'll never get a real view like that from regular media outlets. They're too busy praising the new messiah.

    I cannot comprehend what our military service men and women do for us. I cannot imagine what it is like to put ones life on the line. And even more I can't imagine how those elititst anti-war douchebags sit in their ivory towers, with their trite little lectures, priding themselves on their mental masturbation, attacking our military, while our brave men and women fight so they can do just that.

    Once again thank you from the bottom of my heart, to all those who have served.

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  33. Being a baby boomer myself, I remember East Germany. People dying and being shot BY THE GOVERNMENT for the crime of trying to jump over a wall. Cuba? People dying and being shot BY THE GOVERNMENT for trying to board a makeshift raft to leave the country. The common thread? A "peaceful" USSR that enslaved its citizens (re-read The Gulag Archipelago). A "non-threatening" USSR military complex that set up nuclear missiles 90 miles from the US and expected the US to roll over.

    I also remember the soldiers returning from Viet Nam. Shouts of "Baby Killers" and being spat upon on arriving home. They had to run and hide ... from the protesting mobs.

    Yes, anonymous, we sure respected them, didn't we?

    I have never been so ashamed of my generation as to read your post, anonymous.

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  34. I totally agree.
    These days if you are not money minded, you are viewed as a push over by the administrators and get fleeced.The greedy docs get paid higher and higher and if you as a doc,continue to care for just doing your job and doing it right, you never get paid as much as the doc who gets away without working hard.The moral of the story is be a talentless shark like moneyminded guy and you shall get away with getting paid more and more.Be like a responsible compassionate doc who loves her job, get fleeced and exploited more and more.NOt fair at all.
    yeah, true about how compassion is viewed as a weakness.
    As far as patients are concerned, some of them think that by reading a few things online about the disease,it makes them as good as a doctor.Seriously, infact, when i was complaining the other day to my trainer about how tired i was from work, he told me," come on , you are a doctor, you just get to sit around all day, talk to people and write some prescriptions.That can't be hard work" I am not sure, if we need to jump up and down and do somersaults to make our job look hard enough.hmmmm.Seriously, whoever reads internet medical websites and starts thinking that making a diagnosis would require only that much expertise as reading a website, they sure can then go ahead and treat themselves.Why come in for a consultation?Seriously, this just makes me angry and feel so much less validated.

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